Boston hospital performs double hand transplant (AP)

BOSTON � A quadruple amputee who received new hands through a transplant operation says he is looking forward to doing ordinary things again: getting dressed, taking a shower, making coffee and, sweetest of all, touching the faces of his two grandsons.

Richard Mangino, 65, of Revere, lost his arms below the elbows and his legs below the knees after he had a kidney stone in 2002 and contracted a severe bloodstream infection.

Last week, a team of more than 40 surgeons, nurses and support staff at Boston's Brigham and Women's Hospital worked for more than 12 hours performing a hand transplant.

Mangino said at a news conference Friday that he had adjusted to his life as a quadruple amputee. The former director of the ground crew for United Airlines at Boston's Logan airport, Mangino taught himself to do daily activities with his prostheses, mowing the lawn, shoveling snow and painting. He said people kept telling him what a "miracle" he was.

"But the one miracle I have prayed for, since my oldest grandson Trevor was born, was to be able to feel the sense of touch again ... to touch his and Nicky's little faces, and stroke their hair, and to teach them to throw a ball," he said. "To me, that would be a miracle. And today, my miracle has come true."

Doctors said it will take six to nine months for Mangino to regain sensory function in his hands, but days after surgery he began independently moving his fingers.

The donor's name was not made public.

In a statement, the wife of the donor said her husband, in talking about donation, always said, "It's just a body."

"I didn't have to struggle with the decision," she said of donating her husband's hands. "After I digested what it entailed, I thought, if it can help someone else out � I felt strongly that my husband would feel the same way," she said in her statement.

Dr. Bohdan Pomahac, director of plastic surgery transplantation at Brigham and Women's, said there have been approximately 50 hands transplanted worldwide, about a dozen of them in the United States. He said Mangino's surgery was only the fourth bilateral hand transplant in the U.S.

Mangino's procedure was the second bilateral hand transplant by surgeons at Brigham and Women's, which has performed four face transplants.

In May, a Connecticut woman who was mauled by a chimpanzee received a new face and two hands at the hospital, but the hand transplant failed after Charla Nash developed pneumonia and other complications after surgery.

Mangino's surgery involved multiple tissues, including skin, tendons, muscles, ligaments, bones and blood vessels on his forearms and hands.

He said he is looking forward to being able to do everyday things without having to struggle.

"I won't have to perform a miracle anymore to just get up in the morning," he said.

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Obama pulls plug on part of health overhaul law (AP)

WASHINGTON � The Obama administration Friday pulled the plug on a major program in the president's signature health overhaul law � a long-term care insurance plan dogged from the beginning by doubts over its financial solvency.

Targeted by congressional Republicans for repeal, the program became the first casualty in the political and policy wars over the health care law. It had been expected to launch in 2013.

"This is a victory for the American taxpayer and future generations," said Sen. John Thune, R-S.D., spearheading opposition in the Senate. "The administration is finally admitting (the long-term care plan) is unsustainable and cannot be implemented."

Proponents, including many groups that fought to pass the health care law, have vowed a vigorous effort to rescue the program, insisting that Congress gave the administration broad authority to make changes. Long-term care includes not only nursing homes, but such services as home health aides for disabled people.

Known as CLASS, the Community Living Assistance Services and Supports program was a longstanding priority of the late Massachusetts Democratic Sen. Edward M. Kennedy.

Although sponsored by the government, it was supposed to function as a self-sustaining voluntary insurance plan, open to working adults regardless of age or health. Workers would pay an affordable monthly premium during their careers, and could collect a modest daily cash benefit of at least $50 if they became disabled later in life. The money could go for services at home, or to help with nursing home bills.

But a central design flaw dogged CLASS. Unless large numbers of healthy people willingly sign up during their working years, soaring premiums driven by the needs of disabled beneficiaries would destabilize it, eventually requiring a taxpayer bailout.

After months insisting that could be fixed, Health and Human Services Secretary Kathleen Sebelius, finally admitted Friday she doesn't see how.

"Despite our best analytical efforts, I do not see a viable path forward for CLASS implementation at this time," Sebelius said in a letter to congressional leaders.

The law required the administration to certify that CLASS would remain financially solvent for 75 years before it could be put into place.

But officials said they discovered they could not make CLASS both affordable and financially solvent while keeping it a voluntary program open to virtually all workers, as the law also required.

Monthly premiums would have ranged from $235 to $391, even as high as $3,000 under some scenarios, the administration said. At those prices, healthy people were unlikely to sign up. Suggested changes aimed at discouraging enrollment by people in poor health could have opened the program to court challenges, officials said.

"If healthy purchasers are not attracted ... then premiums will increase, which will make it even more unattractive to purchasers who could also obtain policies in the private market," Kathy Greenlee, the lead official on CLASS, said in a memo to Sebelius. That "would cause the program to quickly collapse."

That's the same conclusion a top government expert reached in 2009. Nearly a year before the health care law passed, Richard Foster, head of long-range economic forecasts for Medicare warned administration and congressional officials that CLASS would be unworkable. His warnings were disregarded, as Obama declared his support for adding the long-term care plan to his health care bill.

The demise of CLASS immediately touched off speculation about its impact on the federal budget. Although no premiums are likely to be collected, the program still counts as reducing the federal deficit by about $80 billion over the next ten years. That's because of a rule that would have required workers to pay in for at least five years before they could collect any benefits.

"The CLASS Act was a budget gimmick that might enhance the numbers on a Washington bureaucrat's spreadsheet but was destined to fail in the real world," said Senate Republican Leader Mitch McConnell of Kentucky.

Administration officials said Obama's next budget would reflect the decision not to go forward. Even without CLASS premiums, they said the health care law will still reduce the deficit by more than $120 billion over 10 years.

Kennedy's original idea was to give families some financial breathing room. Most families cannot afford to hire a home health aide for a frail elder, let alone pay nursing home bills. Care is usually provided by family members, often a spouse who may also have health problems.

"We're disappointed that (Sebelius) has prematurely stated she does not see a path forward," AARP, the seniors' lobby, said in a statement. "The need for long-term care will only continue to grow."

Sebelius said the administration wants to work with Congress and supporters of the program to find a solution. But in a polarized political climate, it appears unlikely that CLASS can be salvaged. Congressional Republicans remain committed to its repeal.

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