Project Prevention has come to town, offering Tucson’s addicts and alcoholics $300 if they agree to long-term birth control.

The project, which says it has paid more than 2,800 men and women in the United States to stop making babies, seeks to end what it says is an epidemic of births of sick babies to substance-abusing parents who don’t or can’t care for them.

We’ve got to feel that the hearts of two proponents – North Carolina’s Barbara Harris, Project Prevention’s founder, and Californian Stephanie Cruz, who evangelized for the project this week at the Ronstadt Transit Center – are in the right place.

Between them, the two have adopted a dozen babies born to addicts or alcoholics. They’re walking the walk.

But their talk is ultimately wrongheaded, and its implications are unsettling.

After the project verifies a person is an addict who has received a long-term form of birth control (an intrauterine device or a hormone shot effective for three months), the addict is paid.

That’s OK. Those contraceptive procedures are reversible.

But we have a problem with offering an incentive for tubal ligation – having one’s Fallopian tubes tied. That’s a permanent form of birth control, according to the Mayo Clinic. So are vasectomies – technically, they are reversible, but in reality, they’re very difficult to undo.

Those forms of “birth control” should be called by their proper name: sterilization.

To dangle money in front of desperate substance abusers in exchange for undergoing a permanent, life-altering procedure is wrong. (Project Prevention pays whether or not the addict has kicked the habit.)

It implies that the addict will never get clean. Often that is not the case. Addiction isn’t forever. But sterilization is and could be a decision that spawns lifelong regret among former addicts.

The project also relies on a questionable perception born at the height of the crack epidemic in the 1980s. It was thought that “crack babies” – those exposed to cocaine or other drugs while in the womb – are lost causes, doomed to stunted lives because of the narcotics that wrecked their bodies and brains.

But as early as the 1990s, studies began to show that prenatal exposure to cocaine does not necessarily wreak destruction on the developing fetal brain.

The IQs of crack babies and nonaddicted newborns were compared at age 7; the research found no appreciable differences. The study concluded that other factors – poverty, or being shuffled through the foster-care system – had a far greater impact on a child’s development.

Would it not be better to create programs for expectant, addicted women that combine prenatal care with treatment to kick their habits? Studies have found that pregnancy can be a powerful motivator for women to get and stay sober.

At the heart of Project Prevention’s argument is the premise that it’s better if some children were never born.

It’s true that drug-addicted women are at risk for giving birth to babies who face a range of problems. But that’s also the case of women who smoke during pregnancy. Or of women older than 40. Yet an organized attempt to induce those groups to undergo sterilization would be met with universal outrage.

Project Prevention should be lauded for encouraging access to contraception in Tucson. But it is embarking on a very slippery slope that we find deeply troubling.

Alternative medicine, from acupuncture to echinacea, can be very effective, which is why more than 1 in 3 adults use some form of nontraditional medicine.

Now 1 in 9 children also is turning to alternative medicine, says a study by the U.S. Centers for Disease Control and Prevention.

But while popular supplements such as fish oil and glucosamine most likely are harmless, parents should be careful about letting kids mix herbal medications with pharmaceutical drugs, pediatricians warn.

The U.S. Food and Drug Administration hasn’t studied how herbal and pharmaceutical substances interact, so parents should err on the side of caution.

Try one kind or the other, but don’t mix the two – especially for children – without consulting an expert.

Parents should follow the doctors’ rule: First, do no harm.

Nielsen

Ever since my severely religious grandfather struck me for talking back, “authority” has had a problem with me.

I’ve been beaten up and put down, and the people who have tried to “teach me a lesson” have taught me only one thing. Freedom of speech is not free.

Because women spoke out against authority in the 1960s, the women of the U.S. no longer need to risk their lives to terminate an unwanted pregnancy. Abortion is legal and safe.

While political activists and progressive clergy of our myriad religions work tirelessly to end suffering – war, poverty, ignorance, brutality in all its forms – the nation’s Catholic bishops met in Baltimore in November to declare abortion “the most important issue in setting policy and in deciding which candidate to vote for.”

The bishops are opposed to abortion, contraception and gay marriage. Sex education is “abstinence” only.

Although 54 percent of Catholics chose to vote for Barack Obama, Archbishop Joseph Naumann asked Kansas Gov. Kathleen Sebelius, to stop taking Holy Communion until she changes her stance on abortion.

Sebelius, I suppose, is among those whom some of the most outrageous members of the clergy, probably empowered by eight years of right-wing government, have warned “to repent or risk their immortal souls” for having voted for candidates who support abortion rights.

“You cannot free a slave who has never known freedom” is an adage our grandmothers’ mothers proved to be false by securing our right to vote, which we have preserved.

The women of the 1960s fought for our right to a legal and safe abortion without apology, and it is our responsibility to continue to prove not only that you can free a slave who has never know freedom, but also that you cannot enslave 21st-century women who have known freedom.

In this overpopulated world, do a handful of right-wing politicians appealing to a minority of voters, and the right-wing religious rulers of impoverished nations, think the women of the U.S. will be intimidated by their self-righteous nonsense?

The young women I know – Catholics, Protestants, Muslims and Jews – will never let it happen here!

In the name of the “immortal souls” of the women slaughtered through illegal abortion, women who refused to allow the dictates of presumptuous, pompous men of whatever religion come between them and their right to terminate an unwanted pregnancy, I say to our nation’s Roman Catholic bishops: Keep your religion out of politics. Adhere to the U.S. Constitution, the separation of church and state. Give up your pride, face reality and repent.

Gretchen Nielsen is a Tucson peace activist and poet.

Unfortunately, not all cases of SIDS can be prevented. To do so requires a greater understanding of sudden infant death syndrome, which will be achieved only with a commitment from those who value babies and with a considerably expanded research effort. Still, expectant parents can reduce the risk:

1. Get medical care early in pregnancy, preferably within the first three months, followed by regular checkups. Make every effort to assure good nutrition.

2. Do not smoke, use cocaine or use heroin. Use during pregnancy increases the infant’s risk for SIDS.

3. Prevent becoming pregnant during the teen years. The SIDS rate is highest for babies born to teen mothers. The more babies a teen mother has, the greater the risk.

4. Wait at least one year between the birth of a child and the next pregnancy. The shorter the interval between pregnancies, the higher the SIDS rate.

Source: American SIDS Institute:

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On the Web

For more parenting information, go to the Tucson nonprofit New Parents Network’s Web site, www.npn.org.

American SIDS Institute: www.sids.org

‘Heart Disease: An Essential Guide to the Newly Diagnosed’

By Lawrence D. Chilnick (Da Capo/Life Long, $16.95)

With the untimely death of Tim Russert still in the national headlines, the health of our hearts has truly become topic No. 1.

Lawrence Chilnick, a health writer and editor, was stunned and terrified when he suffered a heart attack at age 48. His new book offers strategies for accomplishing necessary lifestyle changes after being diagnosed with heart problems, tips for modifying your diet, choosing the right medical team, recovering from a heart attack or coronary surgery and finding the most effective medications and therapies.

Chilnick is a patient-expert who walks readers through everything you need to learn and do during the first year following diagnosis.

‘Fifty Ways to Leave Your 40s: Living It Up in Life’s Second Half’

By Sheila Key & Peggy Spencer, M.D. (New World Library, $14.95)

Since more than 5 million Americans turn 50 each year, it should be no surprise that increasing numbers of individuals are claiming 50 as the new 30.

Put another way, being over the hill doesn’t have to be underground. This tonic for the midlife blues is divided into four main sections: Body, Mind, Soul and Health. Bursting with anecdotes, advice and inspiration, this zesty guide is just what is needed to survive that dreaded 50th birthday and make the very best of the years that are left.

The authors build a convincing case that the second half can be even more fun and joyful than the first. The secret, they say, is living more mindfully in the ever-present now.

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Editor’s note: Books featured are not necessarily recommended.

Question: What are some important tips for safe medicine use?

Answer: Medicines are important therapeutic tools for living well in later life, but there are also risks, especially among older adults, who take more medicines than any other age group.

It is important to encourage older adults and their caregivers to learn about, understand and follow medication use safety to promote safe and appropriate medicine use among all older adults.

Studies reveal that older adults who live with at least one chronic condition, including arthritis, heat disease and diabetes, take multiple medicines, consult several health care providers and use more than one pharmacy.

The convergence of these factors, in addition to age-related changes that affect the way certain drugs work in the body, as well as important communication gaps about medicines between patients and their providers, sets the stage for potentially serious drug-related problems, including additional illness, hospitalization and even death.

A study in the Sept. 10, 2007, issue of the Archives of Internal Medicine finds the number of serious injuries and deaths reported to the U.S. Food and Drug Administration from medicines more than doubled from 1998 to 2005, further underscoring the need for public education about safe medicine use.

Quick facts: older adults and medicine use

• Older adults comprise 13 percent of the population in the U.S. but account for 34 percent of all prescription medicine use and 30 percent of all over-the- counter drug use.

• Many take multiple medicines at the same time. A recent survey of 17,000 Medicare beneficiaries found that 2 out of 5 patients reported taking five or more prescription medicines.

• Drug-related complications have been attributed to the use of multiple medicines and associated drug interactions, age-related changes, human error and poor medical management, including incorrect medicines prescribed, inappropriate doses, lack of communication and monitoring.

The National Council on Patient Information and Education (NCPIE) this month has launched a public education campaign designed to give older adults and caregivers the tools and information to avoid medication misuse, recognize and manage common side effects and improve medicine use, knowledge, attitudes and skills to avoid medication errors.

For more information about medication safety, download NCPIE’s fact sheet “Medicine Use and Older Adults,” available at the MUST for Seniors Web site online at www.mustforseniors.org.

Today’s question is answered by Adina Wingate, Pima Council on Aging’s public relations director, using information provided by the National Council on Patient Information and Education that appears online at www.mustforseniors.org. Send questions for PCOA to generations@ tucsoncitizen.com

Mostly, though, what Sen. Tom Coburn, R-Okla., objects to is the $75 million he says it would cost, though he also opposes the bill without any funding.

The obituary page of the Des Moines Register on a recent day had two prominent tributes to people who died within 24 hours of each other.

Velma Miklus was a 75-year-old grandmother. Roger DeGroot was a 49-year-old father. Linking them was the cause of death: ALS.

Amyotrophic lateral sclerosis attacks fast, usually killing within two to five years, first stripping the ability to walk, talk, swallow or breathe on one’s own.

Although 20,000 Americans are living with ALS, until recently, few others even knew about the illness. Consumed with the intense demands of daily care, it’s hard for patients or their loved ones to be out raising awareness or lobbying for a cure.

Still it’s baffling that 67 years after the death of Yankees legend Lou Gehrig, we have no idea what causes ALS, or the failure of motor neurons (nerve cells) that defines it.

In about 95 percent of cases, it seems to strike at random. Researchers don’t even know what environmental, occupational, family history or other factors may link people with ALS.

With so little to go on, the 5,600 people diagnosed every year know only that it is a death sentence. There are clinical trials but, so far, nothing promising. There’s the prospect of embryonic stem-cell surgery – once the ban on federal research on it is lifted.

At the very least, there should be a national database of patients so researchers can find patterns. But a bipartisan bill in the U.S. Senate to create one is being blocked by one senator, Republican Tom Coburn of Oklahoma.

The bill would create a national ALS registry at the Centers for Disease Control and Prevention. The House passed it 411-3. In the Senate, 77 members are co-sponsors.

In response to Coburn’s unilateral roadblock of that and other legislation, Senate Democratic leaders last month included the ALS Registry in an omnibus bill called Advancing America’s Priorities. But Republicans filibustered that, too.

Coburn objects to any disease-specific legislation, says his spokesman John Hart; he also put a hold on a breast-cancer research act.

He thinks the CDC and the National Institutes of Health should make their own decisions: “It’s really about members of Congress wanting to reap the political benefits of an emotionally sensitive target,” said Hart.

Mostly, though, what Coburn objects to is the $75 million he says it would cost, though he also opposes the bill without any funding.

Coburn, by the way, is a doctor.

A CDC spokeswoman, however, acknowledged what advocates in the ALS community say the bill would provide congressional authority to do: coordinate with other agencies such as the NIH and the Department of Veterans Affairs.

There are 250 Iowans living with ALS. Jason Lee, who heads the Iowa chapter of the national ALS Association, sees a database as essential. “A lot of doctors are locked because we don’t have good patient information,” he says. Lee says there are registries for other illnesses, such as lupus.

Theories abound linking ALS to printing presses, metals, farm chemicals, wars. It seems to strike veterans with greater frequency, and Gulf War veterans 50 percent more than the general population. Maybe if we knew what else sufferers have in common, we could learn why.

There’s a move afoot to try to bring the act (Senate file 3297) to a floor vote when the Senate reconvenes next month. Lee urges proponents in every state to lobby their senators.

Even with a registry, a cure is probably a long way off. But without one, there’s almost nothing to go on.

Once you’ve seen this insidious illness up close, as I did watching my late husband suffer from it, you can’t turn your back. Nor can you fathom how a politician can deliver such a hard slap to any hope on the horizon.

Rekha Basu is an editorial columnist for the Des Moines Register. E-mail: rbasu@dmreg.com.

Tribe has highest rate of type 2 diabetes in world

Johnson

Fifty years ago, diabetes was unheard of among the Tohono O’odham people.

Today, more than half of all Tohono O’odham adults suffer from type 2, or adult-onset diabetes, the highest rate in the world. The type 2 incidence among the O’odham is eight times that of the general population in the United States. And children barely old enough to enter kindergarten are developing the disease.

Among those living with type 2 diabetes is Terrol Dew Johnson, a 35-year-old O’odham community activist and artist, who recently embarked on what he’s calling “the walk home” or “a 3,000-mile journey to Native American wellness.”

On June 16, Johnson and four of his young relatives began a walk across the United States – from Maine to Arizona – to get fit and to promote native foods and culture. The group will visit native and non-native communities during their travels.

Johnson is co-founder and co-director of Tohono O’odham Community Action, a nonprofit group in Sells that advocates a return to a traditional Tohono O’odham diet as a solution to the epidemic of type 2 diabetes.

TOCA operates a 100-acre farm on which it grows tepary beans, squash, corn and melons. Such crops, along with cholla buds and saguaro fruit, were once staples of the Tohono O’odham diet.

“Every village on the reservation had their own farms, worked the land and grew their own foods,” Johnson said. “There there wasn’t much obesity.”

During World War II, Tohono O’odham men left their farms to serve in the military, where they were introduced to processed foods, Johnson said. At the same time, he said, the government encouraged women and children to work in the commercial cotton fields.

By the 1950s, the Tohono O’odham farming tradition was dying out. Lard, sugar and flour, courtesy of the government commodities program, became the new staples of the Tohono O’odham diet.

Since founding TOCA in 1996 with Tristan Reader, Johnson has been working to revitalize the tribe, to reconnect the people to their culture, their language, the environment and the native foods.

It’s not easy. Poverty on the reservation makes it hard for people to make healthful eating decisions, Johnson said. If you’re poor, are you going to spend $1 for a head of lettuce or use that same dollar to buy 10 packages of Top Ramen? he asked. Are you going to spend $1 for two loaves of white bread or $3 for one loaf of whole wheat bread?

Even as an advocate for healthful living, Johnson has found it hard to follow his own counsel, which is the reason for the 3,000-mile walk.

“I wasn’t living the talk,” he said. “I wasn’t doing the stuff that I was talking about to the community.”

“I live in Tucson and I’m single, chronically single, and I don’t cook . . . On each corner of my neighborhood, there is a fast-food place,” Johnson said.

Those places offer fast, cheap and tasty choices. But about four years ago, Johnson began cooking more frequently at home, mostly soups or stews that he could freeze in portion-sized containers. And he started moving around more, getting some exercise.

“It was a lifestyle change and it is still a lifestyle change.”

Joining Johnson on his journey are Desaray Reino, 16, Maray Johnson, 14, Shane Johnson, 16, and Trudy Silas, 12. For those wondering about their schooling during this walk, the youths will be home-schooled and complete lessons on laptop computers.

They didn’t do any advance training, so they are building up their daily mileage. For now, the group is walking 12 to 15 miles a day and camping out at night, Johnson said. A support staff of one sets up the camp and prepares the meals.

To date, the group has traveled 260 miles through Maine, New Hampshire and Massachusetts and hopes to soon cross into Connecticut.

“We’re getting to see a lot of beautiful countryside,” Johnson said. “It’s amazing what all these kids haven’t seen before All we were used to growing up were cactus and rocks.”

Johnson has taken an 18-month sabbatical from TOCA and is dedicated to completing the walk, no matter how long it takes.

“I am a really slow walker,” he said.

To learn more about “The Walk Home,” or to help the group with its expenses, go to thewalkhome.org.

Anne T. Denogean can be reached at 573-4582 and adenogean@tucsoncitizen.com. Address letters to P.O. Box 26767, Tucson, AZ 85726-6767. Her columns run Tuesdays and Fridays.

The Navajo Nation recently came close to doing the right thing and beginning a smoking ban in all public areas, including its future casinos.

It was close, but no cigar, as concern for casino profits took precedence over tribal health, as has been true with nearly every tribe that enters into the gaming business.

Apparently, they’ve learned too well the ways of the white man, who also refuses to let customer or worker health concerns stand in the way of maximizing profits in his smoke-filled casinos.

All four Tucson-area casinos – two run by the Pascua Yaqui and two by the Tohono O’odham – allow smoking, with some designated nonsmoking areas. Representatives from both tribes declined to comment for this column.

On July 25, the Navajo Nation Council voted to ban use of commercial tobacco in public buildings and in shared public air space at outdoor venues. On Aug. 8, tribal President Joe Shirley Jr. rejected the measure, in large part, because he feared it would hurt business at the planned Navajo casinos.

The Navajo will open their first casino this fall in Church Rock, N.M., and eventually hope to open as many as six casinos in Arizona and New Mexico. Banning smoking would put the Nation at a “competitive disadvantage,” Shirley said in his veto message.

Council delegate Thomas Walker Jr., who represents the southwestern portion of the Nation in Arizona, sponsored the anti-tobacco legislation.

Though he described the measure during a phone interview as a health law, not a casino law, he said he is concerned that some 200 employees in each casino would be exposed to secondhand smoke for eight to 10 hours each working day.

And he questioned whether a no-smoking policy really would hurt the planned casinos.

“How do we know we would be the least attractive casino if we banned smoking?” asked Walker, who’s hoping the council will override the veto.

In fact, going smoke-free could have the opposite effect.

The gaming industry has long claimed that 70 percent of its customer are smokers, but recent research out of the University of Nevada, Reno, debunked the myth, finding that 4 of 5 casino customers are nonsmokers. And a survey of 1,700 California gamblers released by J.D. Powers and Associates last month found that 85 percent would prefer a smoke-free environment.

Casino operators across the country are adding nonsmoking areas and improving their air ventilation systems. But only a few have taken the courageous and ethical step of going completely smoke-free.

For the Taos Pueblo tribe of northern New Mexico, which operates the Taos Mountain Casino, the decision to go “100 percent smoke-free” has set it apart, in a good way, from the rest of state’s casinos.

The Taos Pueblo entered gaming with a tobacco-free, 10-machine slot room in 1994. It was a success from Day One when people waited outside in a snowstorm to get in, said Marc Kaplan, marketing director for the casino.

Even smokers liked the non-smoking policy because “they were happy that they didn’t have to get other people’s smoke in their hair and clothing,” Kaplan said.

When the Taos Pueblo expanded the slot room into a casino in 1997, there was no doubt it would remain smoke-free, he said.

Kaplan said if other casinos went the same route, they’d be surprised at how many more nonsmoking gamblers would come in and at how much longer those customers would stay.

Taos Mountain has exceeded the tribe’s financial expectations, Kaplan said. Customers come from many miles away to play in a smoke-free environment. And the smoking ban helps the casino keep its expenses down.

In comments made in April at a meeting of the Southwest Navajo Tobacco Education Prevention Project, Kaplan estimated that Taos Mountain saves 20 percent on its property, casualty and risk management insurance results because of the policy.

Casino employees call in sick less frequently because they aren’t exposed to second-hand smoke, he said. And less illness has meant better HMO rates.

The casino has no cigarette burns on the bar stools, the chairs or the carpeting, all of which are expensive to replace, repair or clean.

The doors, walls and slot machines require less cleaning. And the casino never has to buy ashtrays or matches.

As someone who has enjoyed concerts, dining, dancing and gambling at all four Tucson-area casinos, I’ve always thought the tribes were doing a disservice to their customers and their employees, many of whom are Native Americans, by allowing smoking.

What’s sad about it is they don’t have to sacrifice people for profit. The Taos Mountain experience proves that a smoke-free casino can have both healthy profits and healthy people.

Anne T. Denogean can be reached at 573-4582 and adenogean@tucsoncitizen.com. Address letters to P.O. Box 26767, Tucson, AZ 85726-6767. Her columns run Tuesdays and Fridays.

Jonathan Vogel, 11, gets his blood sugar checked by his father, Ben, Monday afternoon during a break in a basketball practice at St. Gregory College Preparatory School, 3231 N. Craycroft Road. Jonathan and his brother Daniel, 8, have juvenile diabetes.

Most people struck with juvenile diabetes dream of a cure. Jonathan Vogel, 11, works toward one.

The Orange Grove Middle School student with a gift for gab has raised close to $43,000 for the University of Arizona Steele Children’s Research Center in the past two years. He has given speeches on behalf of the Juvenile Diabetes Research Foundation. And he traveled to Washington, D.C., with the rest of his family in March 2007 to meet with senators and representatives and urge them to approve funding for National Institutes of Health diabetes research.

“You either just sit back and wait for the cure or you do something to get to it,” he said in an interview at his family’s North Side home this week.

Jonathan’s 8-year-old brother, Daniel, received a diagnosis of juvenile or type 1 diabetes in 2002 at age 2. Jonathan remembers how his little brother used to hide from their mother when it was time for insulin injections.

One spring morning three years ago, Jonathan told his mother he had gotten up to urinate five times the night before. He recognized it as a symptom of diabetes. A finger stick to test his blood sugar confirmed a glucose level three to five times normal. Jonathan shed no tears, but simply asked for an insulin shot (approved by a doctor) so he could play baseball.

It was, after all, “the first day of baseball season, opening day for the whole league,” and Jonathan had no intention of missing it. Medical testing confirmed the diagnosis the next week.

“If I was the first person in the family, I guess I would be more affected, but I’m just used to it,” Jonathan said.

His matter-of-fact acceptance of the disease made it easier for his parents, Rosi and Ben Vogel, to accept, but it’s a constant challenge.

“It’s one of those diseases that burns you out, the day to day to day,” Rosi Vogel said.

Juvenile diabetes is an autoimmune disorder in which the immune system attacks the insulin-producing beta cells in the pancreas.

Without the hormone insulin, glucose stays in the blood and can damage all the organ systems in the body.

Jonathan and Daniel must pay constant attention to how much and what they eat and to their exercise level.

They prick their fingers nine to 12 times a day for glucose checks. They are now able to avoid multiple daily insulin injections by having insulin delivered through an insulin pump, but the site of the pump needs to be changed regularly to avoid scarring.

“Particularly for kids, it’s not an easy disease to have,” said Dr. Mark Wheeler, chief of pediatric endocrinology at the Steele Center.

But Jonathan stays on top of his diabetes, Wheeler said.

In 2006, Jonathan was asked to speak briefly at the local Fathers of the Year awards dinner and gala. His father is a member of the Father’s Day Council executive board.

It went so well that he was asked to give a longer presentation in 2007. Those attending the 2007 dinner were so moved by his speech that they donated $13,000 for the Steele Center’s Angel Wing for Children with Diabetes.

The money went to purchase a variety of equipment, including a machine that does a number of blood tests from a finger stick, which the children are used to, instead of requiring a trip to the laboratory and a needle blood draw for the kids, Wheeler said.

Also, the machine produces test results in five to 10 minutes, he said.

In June, Jonathan gave another speech at the Father’s Day event about living with diabetes and raised $30,000.

The funds will be used to purchase continuous glucose monitoring devices for the patients of the Angel Wing. These devices give glucose readings every five minutes and show trends, which allow doctors to fine-tune their insulin dosages.

Maintaining normal glucose levels is key to preventing or reducing the complications of diabetes over time, Wheeler said.

The Vogel family has participated in the Walk to Cure Diabetes each year since Daniel’s disease was diagnosed and has raised $20,000 to $25,000 for the Juvenile Diabetes Research Foundation through the event, said Rosi Vogel, who is a board member of the Tucson chapter of the JDRF.

Aside from helping to raise funds for diabetes research and treatment, Jonathan is a normal kid who does well in school and likes math, basketball and playing guitar and piano.

He’s proof that one can live – in the fullest sense of the word – and even give with a chronic disease.

Anne T. Denogean can be reached at adenogean@tucsoncitizen.com and 573-4582. Address letters to P.O. Box 26767, Tucson, AZ 85726-6767. Her columns run Tuesdays and Fridays.

Medicare’s fiscal woes are well known, and the fiscal demise of the program’s Hospital Insurance component is looming ever closer.

The so-called Trust Fund for “Part A” – consisting of government IOUs – will begin the slide toward bankruptcy in just three years and reach total insolvency in 2019.

A lesser known fact, however, is that Congress can take several cost-controlling measures to alleviate coming budget disruptions that won’t require tax hikes, price controls or government bailouts.

Although solutions to preventing Medicare’s collapse vary, the first step toward reform may begin with something as simple as dialysis – starting at the door of Fresenius Medical Care, which has 51 clinics in Arizona.

Fresenius has more than 3,000 dialysis patients in Arizona – about half the state’s total dialysis patients in 2005, according to U.S. Renal Disease System statistics.

Medicare currently serves as the secondary payer for a patient undergoing dialysis for end stage renal disease for the first 30 months of treatment, during which the beneficiary’s own private insurance plan provides primary payment.

However, patients are forced to switch to Medicare as their primary payer after 30 months of treatment – regardless of their age or preferences.

Extending private coverage from 30 to 42 months, as proposed in the otherwise ill-advised Children’s Health and Medicare Protection Act of 2007, would save $1.2 billion over 10 years, according to a Congressional Budget Office estimate.

Given its tax and spending hikes, the CHAMP Act deserved to be buried by presidential veto, but the bill’s Patient Coverage Extension is worth salvaging.

PCE opponents claim it will severely burden private employers’ insurance plans, but only 5 percent of firms in Arizona would be affected by the extension, according to USRDS. Taxpayers would see direct and substantial savings, while health insurance costs would be minimally affected, if at all.

In addition to common-sense changes such as PCE, Congress could save tens of billions of dollars annually lost to waste, fraud and abuse in federal health programs by expanding the use of private-sector Recovery Audit Contractors.

RACs corrected nearly $443 million in improper Medicare payments – more than 90 percent of which were overpayments – in fiscal years 2006 and 2007, according to the Department of Health and Human Services.

Every dollar paid to RACs has resulted in $15 of identified improper payments.

Among the dubious cases RACs uncovered: triple-billing for a single session of speech therapy and seven appendectomies in one day for the same patient.

Lawmakers also should preserve another important accountability measure for Medicare: an “alarm bell” requiring medicare trustees to issue a warning (and Congress to respond) if overall funding from general federal revenues exceeds a 45 percent share in two consecutive annual reports.

When Medicare habitually depends on nearly half its funding from the Treasury at large instead of payroll taxes, politicians should pay attention, not play dumb.

Another way to rein in Medicare spending is means-testing, which would reduce cash and in-kind benefits on a sliding scale as income rises.

A National Taxpayers Union Foundation study determined that modest limits for wealthier individuals could yield annual savings of more than $75 billion.

Sen. (and presidential candidate) John McCain recently proposed a slightly higher premium for those with incomes above $160,000 who get Medicare’s Part D prescription benefit. This step alone has the potential to save the program several billion dollars.

Finally, Congress should enact health care reforms outside Medicare that could take pressure off the program in the future.

The Health Care Choice Act, which would allow patients to purchase health insurance across state lines, is one proposal that would expand consumer choices, reduce onerous state regulations and lower prices.

Health Savings Accounts, which empower Americans to save tax-free for medical expenses and insurance, should be expanded.

Containing Medicare’s spiraling costs likely won’t be accomplished by a single bill, but rather by a multipart approach.

Whichever party wins this fall’s election will witness firsthand the beginning of the end for Medicare’s finances. The outcome of this drama depends on whether politicians enact modest reforms sooner to avoid catastrophe later.

Pete Sepp is vice president for policy and communications for the Alexandria, Va.-based National Taxpayers Union (www.ntu.org), a 362,000-member, nonprofit, nonpartisan citizen group founded in 1969 to work for lower taxes, limited government and economic freedom at all levels.

Question: I recently went to a high school basketball game and as I was leaving, a player’s dad caught up with me and asked: “What do I do? My son doesn’t like basketball anymore. As a matter of fact, he doesn’t like much of anything anymore.

“He doesn’t do things with friends. I don’t even know if he has any friends anymore. He isn’t happy and it looks like he is sad and disappointed all the time.

“He used to love basketball. He was so good. He was always the best on his team, and it didn’t matter who his team was playing against, he dominated.

We often talked about college scholarships and even playing pro ball.

“Now he’s going into his senior year, and isn’t getting much playing time.

What happened? What do I do?”

Answer: Unfortunately, I have heard and seen this story before.

The cause is hard to face, but there is still the possibility that his future can be brighter.

Let’s look at how too many young kids fall into this funk. There are several things that contribute:

• Too much parental pressure. Look out, be careful. Parents need to stop emphasizing and becoming consumed with college scholarships and playing pro ball. Our kids can feel the pressure, and they learn how to protect themselves. They try to guard themselves against disappointment and failure. Many times the desire to give all they’ve got diminishes as soon as they realize there are other players out there that are just as good or better. They figure if they didn’t try their hardest, they won’t look so foolish when they come up short. To fail going half speed is easier to take than failing going all out.

• When they realize that other kids are catching up, or even passing them up, they often retreat. The momentum has changed hands, and they see the writing on the wall. The challengers spend more time practicing and trying to improve, while early achievers are threatened by the realization that they are being passed up; so again, their “fall” can be explained away because they didn’t try that hard.

• They put all their eggs in one basket. Early on, the focus can become too isolated on one sport. Other sport skills and long lasting relationships are compromised for the sake of focusing on one sport.

So, when they aren’t the best on the team anymore, or in some cases don’t even make the team, they have very little to fall back on.

Is there hope?

Of course there is, but the ball is in your court. They need two things from you now:

First, they need affirmation. They will melt into your arms if they feel your unconditional acceptance. They need to be released from the bondage of thinking they have disappointed you. They need your unconditional love and approval rather than your dreams and plans.

Second, they need your encouragement. They need to find their own dreams and challenges. They need your guidance and maturity to go out and find new things to do. It’s never too late for fun and friendship. They need their mom and dad back, not the “coach, trainer and agent.”

Even at 17 years old, they need to feel like a kid again.

If you have questions or comments for Tom Kuyper, e-mail him at tomkuyper@athletesintraining.com.

What is acceptable behavior for kids when they win or lose a game? What is good sportsmanship?

After a hard-fought game, can we expect the losing team to jump up and down and cheer, celebrating their opponent’s victory? Come on, that is way too far out there. It’s unrealistic and abnormal to expect that kind of reaction from our kids in defeat.

Youth sports are all about teaching our kids life skills. The old phrase is still true: It’s not about winning or losing; it’s how you play the game.

It’s all about having fun, and losing shouldn’t spoil that goal. Isn’t the most important thing that they gave it their all and tried their hardest?

So then, what do we do about those feelings? Do we just force our kids to be fake and put on a mask? Should we teach our kids to learn how to bury their feelings? This is not good teaching of life skills.

Kids need to learn that they don’t have to like to lose, but they do have to learn how to accept it.

They have to learn that how they express themselves is important.

My two basic rules of thumb are:

• You never have permission to violate someone else’s heart or spirit.

• You should not draw attention to yourself by inappropriate behavior.

Let’s look at these rules. What does it mean to violate the heart or the spirit of someone else? You see this when you yell at the other team, coach or the officials. They can yell words that are hurtful or degrading. Many things are said in frustration that are manipulative, abusive and penetrating. Most of the time, when people yell at officials, parents, kids or coaches, they are looking for someone to blame or find an excuse for why things aren’t going the way they want.

This rule also holds true for winning. You never are allowed to make fun of or “rub it in” to the losing team.

Second, drawing attention to yourself (either on the winning or losing side of the game) is unacceptable behavior. Stomping your feet, throwing things and yelling are examples of ways to draw the focus to yourself.

Remember, you can’t dictate or force the way each person feels after a loss, but you can help them to release those emotions in a healthier way.

So, is crying OK? Sure it is, if it is not done to gain attention and is a heartfelt reaction to the disappointment every kid experiences in some way or another.

If you have questions or comments for Tom Kuyper, e-mail him at tomkuyper@athletesintraining.com.

Three strikes and you’re out! Isn’t that the most basic rule in baseball?

In the legal world, in some cases you get three strikes against you before you pay the biggest consequence.

Isn’t there an unwritten rule that says if you try out for the high school baseball team and get cut your first three years of school that you hang up the cleats and not try out your senior year? (The ol’ three-cuts-and-you’re-done rule!)

Well, Coulton Sadler forgot that rule. Each of the first three years he tried out for the high school baseball team he was cut.

Three years he went to try out for the high school baseball team and all three years he tried out, he was cut.

Most kids would then donate their bat and glove to the local little league team. Not Coulton. He bought some more glove oil and a new batting glove and went to work.

Even during the summer months, when all the other high school kids were sleeping in, Coulton and I would go to the baseball diamond at 6 a.m. and we practiced together. It was great father-and son-time, said his dad, Bob.

Coulton is the perfect example of not giving up.

Hard work, discipline and commitment were his motto.”I knew I could play at that level,” Coulton told me. “I had the ability, I just needed the opportunity.”

His dad kept asking him, “What do you want to do?” after each time he was cut. Coulton never lost hope.

“Michael Jordan got cut from his high school team,” he answered his dad. “I’m going to make varsity.”

He loved baseball so much that he got a job at Inside Pitch, a batting cage and baseball practice facility.

It was there he got his break. The owner (Fred Speck) was the assistant coach at Pinnacle High School. Speck grew to appreciate Coulton as a hard worker and a person. He invited Coulton to transfer schools and try out for his team.

“Here’s my chance,” Coulton thought.

He tried out and made the team. He played second base and sometimes came off the bench as a pinch hitter. He didn’t care; he was on the team! He finished the year with a .330 batting average.

One of his highlights was going 2 for 3 against the high school that cut him three years in a row.

Pinnacle made it to the state playoffs. It won its first game, then was knocked out of the playoffs in its second game. Coulton’s last at-bat at their come-from-behind rally was a two run triple to left-center.

“I really smacked that one pretty good, didn’t I?” Coulton said to his dad on their drive home.

Getting that varsity letter was a great feeling, but nothing compared to the award he received at the awards banquet.

He was given the Pinnacle Award, given to the player who best exemplifies dedication, commitment and coachability.

Thank you, Coulton Sadler, for your model of determination, hard work and a coachable attitude.

If you continue your life journey in this same spirit, you are destined for great things. Who knows, you may even be president some day. It may take three elections to get there, but I don’t think that will be a problem for Coulton Sadler. Just because you have three strikes against you, doesn’t mean you’re out of the game.

If you have questions or comments for Tom Kuyper, e-mail him at tomkuyper@athletesintraining.com.

What would happen if some youth coaches were forced to say to the kids what they were really thinking? What would that sound like?

• “Well guys, let’s be honest here. Most of you are expecting good playing time. My son will be getting most of it. His playing time was the main reason I signed up to be the coach.”

• “Hey, that paper we all signed about sportsmanship and the priority of youth sports being to teach and learn life skills, well, I didn’t even read it. I just had to sign the bottom line and I was in. This is all about me having a winning season.”

• “The reason I signed up to be your coach again this year is because I recruited some new players. Who cares if we got them fake birth certificates? I am not going to lose to Coach Johnson again. I am going to prove to him and all the parents that I am the better coach. This year, it’s all about me!”

• “You guys are horrible, come on, you’re making me look bad.”

• “The truth is that I just checked the box that said parent helper, but they couldn’t find a coach, so here I am. I’ll never check that box again; it’s a trap.”

• “You guys are playing like a bunch of girls out there.”

• “I wanted to coach because I never got to achieve what I wanted in sports; here’s my chance to live my dream. If you need to cheat, hey, I’m not the one who’ll turn you in.”

• “OK, I have to be honest with you. I don’t know anything about this sport, but I checked it out online, and I’m good to go.”

• “The real reason I yell at the referees is that it’s what the big-time coaches do on TV, and I think it looks pretty impressive.”

• “Let’s get matching shoes and gym bags so everyone will be impressed and wish they were on our team.”

• “You’re kidding me, right? All it takes is a snow cone and you’re happy again? We just lost the game. How can watermelon crushed ice make you feel better? I want you to go over every mistake over and over again in your minds the same way I do.”

• “It’s your choice. Yeah, you can go sing in your school concert, but don’t plan on playing in next week’s game. What are your priorities? I’ve heard you sing; you’re tone deaf. Don’t worry about it. If you’re gone, it will be one less person I have to worry about getting into the game.”

• “Fun? Who said anything about fun?”

Kind of a downer? Just a little something to make us think.

Let’s make sure our motives are right when we make a choice to influence kids.

If we’re faking it at any level, it will eventually seep out and effect our actions. Take the time to reflect on what lies beneath the surface.

If you have questions or comments for Tom Kuyper, e-mail him at tomkuyper@athletesintraining.com.