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Opinion: Out-of-pocket drug costs for Medicare beneficiaries need to be reined in

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This year, 56 million U.S. seniors will pay more for Medicare prescription drug coverage, partly due to a single drug most will not take — Aduhelm, a newly approved, expensive, and controversial Alzheimer’s drug.

In late 2021, the Centers for Medicare and Medicaid Services announced one of the largest increases ever — nearly 15% — to monthly premiums for Medicare Part B, which provides coverage for injected or infused medications administered by clinicians, among other outpatient services. CMS’s rationale? The premium price hike was needed in anticipation of potential future coverage of Aduhelm, initially priced at $56,000 per year.

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synapsecracklepop
18 days ago
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Remember: whither Medicare goes, so goes private insurance. When Medicare is allowed to negotiate more favorable drug prices, etc, then large insurers will want the same or better privileges. EVERYBODY WINS.
Frankfurt
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The Very Real Correlation Between Bilingualism and Advanced Executive Function

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Having come of age in the San Francisco Bay Area and in New York, both with dense immigrant populations and tourists, I’ve always taken it for granted that at any given moment, in any given bakery or bus, I might hear foreign speech. To be sure, I’m still the language minority in a crowd of people named Katie and Josh. But I’m far from alone. Not too far there is a Korean supermarket across from a building with a large solemn sign: Russian School of Mathematics. At our local parks, there are women in hijabs telling their toddlers in Arabic to slow down on their tricycles, and men shouting “Gooool!” as they kick a soccer ball with the kids.

Still, as soon as I venture outside my bubble to different neighborhoods and parts of the country, my assumptions about the way people in America talk go out the window.

Being a nonnative English speaker can feel like an anomaly, especially when you’re constantly asked to repeat yourself and spell your name, until you’ve had enough and almost want to say, Screw it, just call me JC.

Then there’s the question of which language to use with the kids in public. Will the others understand? Should they understand? Is that shopper at the supermarket staring because our cart is blocking the dairy aisle, or is he wondering if I’d hacked the presidential election or got hitched for a visa? Does speaking a strange language in public drive a wedge of mistrust between people?

Actually, more than half of the world is bilingual. There are more than seven thousand languages spoken today, with the most common ones being English and Mandarin Chinese, followed by Hindi, Spanish, French, Arabic, Bengali, and Russian, according to Ethnologue, a catalogue of living world languages. Globally, bilingualism is the norm rather than the exception.

What makes someone bilingual, though? Is it the ability to read the menu? To understand the grandparents? To ace a standardized school test? What if the language has no writing system? And who gets the authority to define what bilingualism means, anyway?

In colonial times and into the early 20th century, schools in America were frequently bilingual, from Dutch and German to Spanish and Polish. Linguistic diversity was often the norm.

As soon as I start to pay attention to the way people around me talk to their kids—and to notice how I talk—I realize that attitudes about bilingualism can be strangely complicated.

For much of the 20th century, a person’s language ability used to be judged by their fluency. American linguist Leonard Bloomfield, for example, defined it in 1933 as native-like control of two languages. Several decades later, a diplomatic interpreter, Christophe Thiery, proposed a similarly arduous definition. To him, a “true bilingual” was someone who is accepted by each language community as one of their own, has learned the languages before the age of 14, has no accent in either, and doesn’t let one get in the way of the other when interacting with monolingual people.

Even reading this description might make some people flinch, because honestly, how many of us can speak all of our languages without an accent, write without an error, and “pass” in either culture as one of its sons or daughters? After returning to visit St. Petersburg as an adult, cabbies and museum ticket sellers charged me up to fourfold compared to the locals whenever they heard me speak.

In recent decades, researchers have steered away from defining bilinguals as those with impeccable fluency and grammar and began looking at how they communicate with others. A perfectly balanced bilingual, or two monolinguals rolled into one, is a myth. “The majority of bilinguals simply do not resemble these rare individuals,” writes influential contemporary psycholinguist François Grosjean in his book Bilingual: Life and Reality.

Many people still fall into the trap of perfection, though. When it comes to assessing our own language skills and those of our children, we can get a little bit judgey.

“Bilinguals themselves rarely evaluate their language competencies as adequate,” Grosjean writes. “They complain that they don’t speak one of their languages well, that they have an accent, that they mix their languages. Some even hide their knowledge of their weaker language. All this is unfortunate,” he concludes. Instead, Grosjean defines bilingual people as “those who use two or more languages (or dialects) in their everyday lives.”

It’s hard to talk about bilingualism without also briefly looking at its history in the United States, which I’ll get to in a moment. That’s because language does not exist in a vacuum. It is a living thing, influenced by culture, politics, and attitudes.

“Language is political!” declares one linguist that I speak to as I start my research. I am beginning to see why.

*

The United States, many people are surprised to find out, does not have an official language. But it isn’t for lack of lawmakers trying to establish it, even though the majority of Americans speak only English. In colonial times and into the early 20th century, schools were frequently bilingual, from Dutch and German to Spanish and Polish. Linguistic diversity was often the norm, with a range of newspapers and religious services in different languages serving the multilingual population. There were stark exceptions, of course. Native American children were forced to speak English at boarding schools and punished for using their indigenous languages; enslaved African people, too, were forced to give up their languages and speak only English.

Then, during World War I, anti-German sentiment swept across America, shaking up attitudes about bilingualism. As many as 23 states banned foreign language education in American schools. Iowa governor William L. Harding took it a step farther and outlawed all public use of all foreign languages in Iowa, in what’s known as the Babel Proclamation. Only English would now be legal in schools, in public conversations, on trains, on the phone, and during religious services, he decreed in 1918. German language instructors were fired and textbooks burned; German newspapers disappeared.

Former president Theodore Roosevelt supported this sentiment. “We have room for but one language here, and that is the English language; for we intend to see that the crucible turns our people out as Americans, and not as dwellers in a polyglot boarding-house,” Roosevelt wrote. To him, dual language meant divided loyalties. “There is no place here for the hyphenated American,” he remarked in a speech in 1915, “and the sooner he returns to the country of his allegiance, the better.”

With World War I raging, anti-German bias snuck into fermented foods too. Sauerkraut consumption in America plunged by 75 percent, and vegetable dealers suggested renaming it “liberty cabbage” (not unlike french fries turning into “freedom fries” in the United States when France refused to support the 2003 Iraq invasion).

This was, understandably, a rough time for bilingualism. Some called it a “social plague.” An influential educational researcher even suggested in 1926 that speaking a foreign language at home caused “mental retardation as measured by intelligence tests.” These attitudes went hand in hand with the anti-immigrant sentiment touched on in the beginning of this book.

Researchers kept conjecturing that bilingual children had a language handicap. Their study methodologies, however, were a mess.

Finally, in 1962, Canadian researchers published a groundbreaking study of French- and English-speaking children, showing their superior mental flexibility and verbal intelligence on tests. “Bilingual education would not create a social or cognitive Frankenstein,” is how linguists would later describe this discovery.

Other researchers began to see these benefits too.

Does this mean bilingualism is finally considered normal? Nope, not really.

Knowing a foreign language is widely accepted as a symbol of worldliness and erudition. “My father spoke five languages!” some people reminisce. Or “I’m sending my child to a Mandarin immersion preschool to give her a leg up in the global economy.” Or “It’s wonderful that you are teaching your children a foreign tongue. I wish I could read Don Quixote the way it was meant to be read.”

At the end of the day, though, these views depend on which language someone knows and how that person came about learning it. Many foreign language speakers often find themselves marginalized, particularly if they are immigrants or nonwhite or both.

In the United States, monolingualism is usually seen as the norm and bilingualism as an unstable condition, even a problem, unlike in many Asian and African countries and smaller European nations with multiple official languages.

That stigma can come from politicians and from everyday folk too. Three in ten Americans say it bugs them to hear foreign languages in public, a 2019 Pew Research Center survey found. (I’m fairly certain, though, that some of those beleaguered respondents were also foreign born; they just had a bone to pick with other immigrant groups.)

The way we talk is one of the most obvious markers of identity. It’s easy to pathologize. Bilingual education keeps stirring up controversy, and our news feeds are abuzz with stories like the one about a New York lawyer threatening to report restaurant workers to ICE for speaking Spanish.

In the United States, monolingualism is usually seen as the norm and bilingualism as an unstable condition, even a problem.

But foreign languages are intimately tied to the identity of this country. Today, one in four children in America has at least one foreign-born parent, a 50 percent increase from just a couple of decades earlier. One out of five people in America now speaks a language other than English at home.

So yes, multilingual families are on the rise, and so are our living, breathing languages.

*

As I chat with other families, scroll through social media and, heck, talk to the people inside my own home, one thing is clear: passing down a heritage language takes work. Like an Olympic sport type of work, but with no formal competition or gold at the end; just moody little athletes slogging through the mud, and whining, “Ugh, do we have to?”

Amandine, who moved from France to the United States with two small children and an English-speaking husband, also fought the good fight.

She spoke French with her children when they were little. But then her daughter headed to an American daycare. “She quickly realized everybody around her was speaking English just like Daddy, and Mommy is speaking English with Daddy, so why should she be speaking French?” Amandine reflects. “She started to ask my husband to read to her in the evening rather than me, because she didn’t want to hear it in French.”

For a while, her daughter did study French as an elective. But only until middle school. Then she switched to Spanish, “just because she was contradictory,” explains Amandine, and because she was self-conscious about her American accent.

So why, I occasionally ask myself, do we even bother?

There’s an extraordinary number of reasons. Knowing another language helps us see the world beyond the immediate field of vision.

It can be a perk in the job market.

Bilingualism makes people better communicators. Even mere exposure to a multilingual environment can boost social communication skills and teach children to see things from a different perspective. In one study from the University of Chicago, children were asked to move objects like toy cars to different locations, taking into account the point of view of the adult in the room. The bilingual kids and kids from multilingual environments moved the correct cars more than 75 percent of the time, while monolingual ones got it right only half the time.

Bilinguals constantly monitor for clues in social situations to figure out what language to use with others. This makes them more socially aware, research suggests.

Speakers of two or more languages are said to be more creative thinkers. Studies have also shown that bilingual children have better-developed metalinguistic awareness (the ability to think about words and language as abstract things). This may help them learn to read earlier. Plus, being bilingual in childhood makes picking up another language easier.

And let’s admit it, it is also a nifty invisibility cloak in public once in a while. “Sometimes we speak the other language intentionally, so that they don’t know what we’re saying!” jokes Christine from Utah about speaking Spanish with her husband, Miguel.

Yet a huge advantage of bilingualism is cognitive. It’s a workout for the brain, helping with focusing and multitasking.

I decide to speak to Professor Ellen Bialystok, a renowned cognitive neuroscientist at York University in Toronto.

Bialystok has spent over 40 years researching bilingualism, earning the title of the Officer of the Order of Canada, one of the nation’s highest honors, for her discoveries. She first got involved in the field in late 1970s, at a time when the cognitive benefits of bilingualism were already known but the specifics weren’t clear. It was an exciting new area of research. Psychologists and parents were wondering what it meant for children and whether those benefits persisted into adult- hood. Bialystok arrived at a few groundbreaking conclusions.

A huge advantage of bilingualism is cognitive. It’s a workout for the brain, helping with focusing and multitasking.

One is that bilingualism can delay the symptoms and diagnosis of dementia, such as Alzheimer’s disease, in older bilingual adults by four to five years. Switching between languages stimulates the brain and builds up cognitive reserve. Although bilingualism doesn’t stop Alzheimer’s in its tracks, it empowers the brain with better coping skills and gives the attention networks more resiliency, protecting against neurodegeneration.

In another famous study, Bialystok and her colleagues showed that bilingual children are better at focusing, multitasking, and weeding out unnecessary information, skills collectively known as executive function (although some have debated these findings). These cognitive processes “are the most energy-expensive processes we have,” says Bialystok. In this study, children were asked to say whether certain sentences were grammatically correct or not. But there was a twist. Those sentences were illogical, like “Apples grow on noses.”

“We said, just tell us if this sentence is said the right way or the wrong way. That’s all we want to know,” says Bialystok. “We don’t care if the sentence is silly—it’s fun to be silly.”

All kids thought the sentences were hilarious. Their answers differed, though. The monolingual youngsters stated that the sentence was said the wrong way. But the bilingual ones said the sentence was said the right way. They all understood grammar equally, but their ability to focus on the task and tune out the irrelevant information wasn’t the same.

“What we realized is that the bilingual kids could do that, and the monolingual kids could not,” Bialystok tells me. “That’s now been demonstrated many times. But we introduced distraction that they had to ignore. You have to ignore this silly meaning. And in order to ignore something that salient and really hitting you in the face, you need executive functioning.”

In the bilingual brain, both languages are active at the same time, forcing the speaker to constantly control which one to use and which one to suppress.

“That’s a crazy way to build a brain. A smart thing would be to put in a switch, so you flip it. But that’s not how the bilingual brain is organized,” Bialystok explains. “Bilinguals are always having to solve a problem of attending to the language they need to be using right now and not getting distracted by that other language, which is, unfortunately, also active,” she says.

Bialystok’s team went on to test children on other tasks and kept concluding that bilinguals had better executive function.

Her more recent study, conducted with colleagues and published in 2019, revealed benefits even among tiny participants: babies as young as six months of age. Infants were shown pictures in different parts of the screen above their cribs and their eye movements were tracked. If the babies could learn to predict where the image would appear next, they’d be “rewarded.”

“A silly dancing star is going to appear on the left side—they like it a lot, so they want to see this silly dancing star,” Bialystok tells me.

Turns out the infants who heard two languages at home were better at learning these rules. They had better attentional control than babies from monolingual households.

“What bilingualism is really doing is it’s shaping up the attention system to be more selective, more responsive, and to be better at picking up important information in the first year of life,” Bialystok explains.

These executive function skills predict long-term academic success and well-being, she adds. “There’s just nothing more important in terms of how this person is going to do in life.”

Bialystok does caution that bilingualism is not a magic bullet. “The kinds of outrageous claims I’ve read, you know, bilinguals are taller, prettier, nicer, kinder—come on, it’s all rubbish,” Bialystok says. “They’re none of those things. They just have better executive functioning.”

Besides, people don’t study languages to be smarter.

“You learn a foreign language because it’s going to make you more knowledgeable, it’s going to give you a better perspective,” she says. “People who speak more than one language can see things in more than one way. It’s going to make you a more sympathetic person, because if you learn a language, you learn about other people who speak that language.”

*

Those are all excellent reasons to teach a child a foreign language. But for immigrants, they don’t tell the whole story. Sometimes, those reasons are immeasurable.

“It melts my heart when my son speaks my language with me,” a friend says.

For Paula, a Colombian-born writer and a mother of an eight-year-old girl, Spanish is a link to family. “I just couldn’t imagine my child going [to Colombia] and not being able to communicate with my relatives,” says Paula, who lives in Houston. “I never thought of cognitive advantages or, you know, advantages in the workforce.”

Paula and her friend Monika, born in Puerto Rico, even cofounded a popular podcast about raising bilingual kids, called Entre Dos, which they host together. Both women have proudly kept the Spanish pronunciation of their names, not anglicizing them. Monika pronounces hers as MOH-nee-kah and Paula is PAH-oo-lah, with rounded vowels.

To Monika, Spanish is like a warm croqueta. (Aptly, this is also the title of one of their first podcast episodes.)

“I feel very emotional when I think about the possibility that I might not be successful in passing on my language,” Monika tells me. She doesn’t want her young daughter to sense this worry, “because, oh my God, what a burden! You wonder if that’s right or wrong, but immediately, you feel protective, like you want to build a little bubble where you can keep them there.”

*

Teaching the family language to my kids is a link to something bigger than words. It isn’t a sweater one can just peel off on a warm day.

Its cadence is in our DNA and the conversations waiting to happen, the words of affection and the untranslatable humor. It’s in my grandmother’s wrinkled fingers, mincing onions to the tune of a folk song like they have a thousand times before. It’s the muscle memory forming the familiar vowels, like in that dream where you soar above a city and recognize every brick, every clothesline, so vivid you can swoop down and almost touch them. Almost.

__________________________________

Parenting with an Accent, Masha Rumer

Excerpted from Parenting With An Accent: How Immigrants Honor Their Heritage, Navigate Setbacks, and Chart New Paths for Their Children, by Masha Rumer (Beacon Press, 2021). Reprinted with permission from Beacon Press.

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synapsecracklepop
70 days ago
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A nice look at a topic near and dear to my heart, as my kids were two of the "1 in 4 kids in America with a foreign-born parent" and we chose to rear them bilingual (and so met many others doing the same). I then had the flip-it-and-reverse-it experience of becoming the minority-language parent when we took the show on the road a couple years ago.
Frankfurt
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AAN Blasts 'Runaway' Neurology Drug Costs

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A statement by the American Academy of Neurology, American Neurological Association, and Child Neurology Society details ethical concerns about high drug prices -- and what neurologists can do.
Medscape Medical News
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synapsecracklepop
103 days ago
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"The AAN paper identifies a number of policy reforms to address drug pricing at a national level, including giving Medicare officials the power to negotiate drug prices, allowing the safe importation of drugs from other countries, and speeding the FDA approval process for generic drugs."

The past 2 years, my Ocrevus cost 6,000€ a dose (for 2 doses a year) vs $60,000 a dose because Germany is allowed -- nay, obligated -- to negotiate drug prices, while the US gov't is prohibited (by...the US gov't?) from doing so.

Before I lived the difference, it seemed mad that we would subsist with such self-imposed barriers to affordable care.

Now I've just moved back to the US, and it took a full week and at least 17 phone calls to change my name and address with Social Security.
Frankfurt
sarcozona
100 days ago
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COVID-19 Vax in MS: Lower Response on Certain Medications

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New data on COVID vaccination in MS patients has shown a reduced humoral response in patients treated with certain medications -- including ocrelizumab, rituximab, and fingolimod -- but not others.
Medscape Medical News
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synapsecracklepop
103 days ago
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The results we've been (expecting and) waiting for: "We showed that patients on ocrelizumab or rituximab had a very low or no antibody response to COVID vaccination," she added. "However, some previous studies have shown some T cell response to vaccination in these patients, and we are looking at that now."
Frankfurt
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Parents Are Not Okay - The Atlantic

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It was two weeks, originally. Who couldn’t do two weeks with the kids at home? Two weeks to bend the curve. It was simple.

Then it was two months—because nothing bent—and, well, we did two weeks and that went okay, so two months would be doable, right? Right?

And then it was summer, and kids are always home in the summer, so how was that different? Sure, we can’t go anywhere, but we’ll just do a little more TV, a little more iPad, a little more of everything we’re already doing. Besides, school is just around the corner and finally they’ll go back.

Except they didn’t. Instead it was a year in limbo: school on stuttering Zoom, school in person and then back home again for quarantine, school all the time and none of the time. No part of it was good, for kids or parents, but most parts of it were safe, and somehow, impossibly, we made it through a full year. It was hell, but we did it. We did it.

Read: Parents are losing their minds over masks in schools

Time collapsed and it was summer again, and, briefly, things looked better. We began to dream of normalcy, of trips and jobs and school. But 2021’s hot vax summer only truly delivered on the hot part, as vaccination rates slowed and the Delta variant cut through some states with the brutal efficiency of the wildfires that decimated others. It happened in a flash: It was good, then it was bad, then we were right back in the same nightmare we’d been living in for 18 months.

And suddenly now it’s back to school while cases are rising, back to school while masks are a battleground, back to school while everyone under 12 is still unvaccinated. Parents are living a repeat of the worst year of their lives—except this time, no matter what, kids are going back.

I am a father. I have a 6-year-old and a 16-year-old. And what I can tell you is that I am furious and I am afraid. I can also tell you that the only real difference between this year and last is that the most effective tool for keeping our kids safe—remote school—seems to be off the table. When cases were plummeting this spring, most every district and state board of education made the quick decision to stick a knife in remote school. It was awful last year, don’t get me wrong, and I understand what motivated that decision. But now we’re stuck with full-on, 30-kids-in-a-room, wide-open school as the Delta variant rages.

It’s a real monkey’s-paw situation, because, as a parent, all I’ve wanted for a year and a half is for my kids to go back to school—for their sake and for mine—but not like this. Now I’m stuck wishing that the thing that barely worked last year was still an option, because what’s looming is way worse.

School is only just starting and already kids are being quarantined in mind-boggling numbers: 20,000 across the state of Mississippi, 10,000 in a single district in Tampa, Florida. They’re getting sick too, with hospitalizations of kids under 17 across the country up at least 22 percent in the past month, by the CDC’s count, and each new week sets pediatric hospitalization records for the entire pandemic. The rapid increase of COVID-19 cases among kids has shattered last year’s oft-repeated falsehood that kids don’t get COVID-19, and if they do, it’s not that bad. It was a convenient lie that was easy to believe in part because we kept most of our kids home. With remote learning not an option now, this year we’ll find out how dangerous this virus is for children in the worst way possible.

Of course, things can be done to reduce the risk to kids, but those very things are fueling pitched battles across the country. Masking, the easiest solution to reducing the spread of COVID-19, is at the center of the fight. Fourteen states require masks in schools, eight have banned local districts’ ability to make them mandatory, and every other state has kicked the can down to the local level so that parents can brawl at school-board meetings. Florida has gone so far as to threaten administrators with fines and firings if they defy the mask ban, making it seem like some governors, legislators, and run-of-the-mill assholes just won’t quit until kids are stacked like cordwood. And all of this assumes that the fight should be over masks, and not reinstating the ability to hold school online until every child can be vaccinated.

Katie Moylan and David Schepard: The 1 thing teachers can do to protect students

It’s enough to bring a parent to tears, except that every parent I know ran out a long time ago—I know I did. Ran out of tears, ran out of energy, ran out of patience. Through these grinding 18 months, we’ve managed our kids’ lives as best we could while abandoning our own. It was unsustainable then, it’s unsustainable now, and no matter what fresh hell this school year brings, it’ll still be unsustainable.

All this and parents are somehow expected to be okay. We are expected to send our kids off into God knows what, to work our jobs and live our lives like nothing’s wrong, and to hold it all together for months and maybe now for years without ever seeing a way out. This is not okay. Nothing is okay. No parent is okay, and I’m not sure how we come back from this.

Parents aren’t even at a breaking point anymore. We’re broken. And yet we’ll go on because that’s what we do: We sweep up all our pieces and put them back together as best we can. We carry on chipped and leaking and broken because we have no other choice. And we pray that if we can just keep going, our kids will survive too.

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synapsecracklepop
150 days ago
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LOL. Moved abroad for spouse's job and 6yo twins' education, 3 months before COVID. They were in school for nearly 6 weeks before the first lockdown (private $chool, because no public spots in the middle of the year, in this country where homeschooling is illegal). By August I asked for a divorce. In January, spouse's company closed the office we'd sold everything to move here for. A few weeks ago, I bought a plane ticket to move home, alone, come October. "Broken" doesn't begin to describe it.
Frankfurt
acdha
155 days ago
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Washington, DC
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christophersw
153 days ago
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Yup.
Baltimore, MD

All watched over by machines of loving grace

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All watched over by machines of loving grace

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synapsecracklepop
391 days ago
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Frankfurt
MaryEllenCG
150 days ago
My mom works for a doctor, and used to bring home tons and tons of drug-branded stuff. Her whole house is still full of it! I kind of want the Lexapro mouse...
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