What to Know About Westminster's Reserve Best in Show, Swagger

People Pets

By Kiran Hefa

02/13/2013 at 05:15 PM EST

Swagger

Mike Segar/Reuters/Landov

Banana Joe may have been named best in show at the Westminster Kennel Club Dog Show – and landed a Broadway gig – but there's another furry face who's emerged as the competition's breakout star: Swagger.

The Old English sheepdog was named reserve best in show (essentially runner-up) on Tuesday and remained a fan favorite throughout the final rounds of judging, drawing cheers from the crowd as he made his laps around the ring at Madison Square Garden.

Much like viewers at home and in the audience, we can't get enough of the energetic furball. So here's what you need to know about Swagger:

Colton Johnson and Swagger

Mike Segar / Reuters / Landov

Swagger isn't his real name.
Like most show dogs, Swagger has a formal name used in competitions: Bugaboo's Perfect Picture.

He's only competed three times before.
Due to a rules change at Westminster, Swagger was allowed to compete despite minimal experience, pitting him against dogs with far more ribbons to their names. "For him to win the group is unbelievable," owner Colton Johnson said. "This is a hard show for dogs that are seasoned, let alone dogs that have showed just four times."

He still has his puppy fur.
At only 20 months old, Swagger is a young entrant into competition, and as a result, has not even shed all of his white and gray baby fur yet. But, "he's a natural," said Johnson.

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Clues to why most survived China melamine scandal

WASHINGTON (AP) — Scientists wondering why some children and not others survived one of China's worst food safety scandals have uncovered a suspect: germs that live in the gut.

In 2008, at least six babies died and 300,000 became sick after being fed infant formula that had been deliberately and illegally tainted with the industrial chemical melamine. There were some lingering puzzles: How did it cause kidney failure, and why wasn't everyone equally at risk?

A team of researchers from the U.S. and China re-examined those questions in a series of studies in rats. In findings released Wednesday, they reported that certain intestinal bacteria play a crucial role in how the body handles melamine.

The intestines of all mammals teem with different species of bacteria that perform different jobs. To see if one of those activities involves processing melamine, researchers from the University of North Carolina at Greensboro and Shanghai Jiao Tong University gave lab rats antibiotics to kill off some of the germs — and then fed them melamine.

The antibiotic-treated rats excreted twice as much of the melamine as rats that didn't get antibiotics, and they experienced fewer kidney stones and other damage.

A closer look identified why: A particular intestinal germ — named Klebsiella terrigena — was metabolizing melamine to create a more toxic byproduct, the team reported in the journal Science Translational Medicine.

Previous studies have estimated that fewer than 1 percent of healthy people harbor that bacteria species. A similar fraction of melamine-exposed children in China got sick, the researchers wrote. But proving that link would require studying stool samples preserved from affected children, they cautioned.

Still, the research is pretty strong, said microbiologist Jack Gilbert of the University of Chicago and Argonne National Laboratory, who wasn't involved in the new study.

More importantly, "this paper adds to a growing body of evidence which suggests that microbes in the body play a significant role in our response to toxicity and in our health in general," Gilbert said.

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Wall Street pauses after rally to five-year high

NEW YORK (Reuters) - Stocks drifted in light volume on Wednesday, ending little changed, as investors remained cautious after the S&P 500 index briefly hit its highest intraday level since November 2007.

The S&P 500 was buoyed by General Electric after cable company Comcast Corp said it will buy from GE the the part of NBCUniversal it didn't already own for $16.7 billion.

Comcast's stock hit the highest since 1999 before closing up 3 percent at $40.13 and GE gained 3.6 percent to $23.39.

The S&P 500 is up 6.6 percent so far this year, partly due to stronger-than-expected corporate earnings and a better economic outlook. The Dow industrials is about 1 percent away from an all-time intraday high, reached in October 2007.

Volume has been weak in recent days with the S&P moving sideways around 1,520. The index is about 3 percent away from closing at a record high.

A scarcity of sellers after a consistent string of gains is a positive sign and shows the uptrend is intact, King Lip, chief investment officer at Baker Avenue Asset Management in San Francisco, said.

"Last year we had double-digit returns in the first quarter. It's fairly possible we can move higher from here," he said.

The Dow Jones industrial average <.dji> fell 35.79 points or 0.26 percent, to 13,982.91, the S&P 500 <.spx> gained 0.9 point or 0.06 percent, to 1,520.33 and the Nasdaq Composite <.ixic> added 10.38 points or 0.33 percent, to 3,196.88.

The S&P gained 12 percent in the first three months of 2012.

Deere & Co , the world's largest farm equipment maker, forecast a modest increase in sales this year despite the prospect of the biggest corn crop in U.S. history. The forecast fell short of analysts' expectations, sending shares of Deere down 3.5 percent to $90.68.

In extended trading, shares of technology bellwether Cisco Systems fell 2 percent after it posted results.

Dr Pepper Snapple fell 5.8 percent to $42.69 after it forecast profit for the current year below analysts' estimates.

Cliffs Natural Resources lost a fifth of its market value a day after the miner reported a quarterly loss and slashed its dividend by 76 percent. Its shares fell 20 percent to 429.29.

According to the latest Thomson Reuters data, of the 364 companies in the S&P 500 that have reported results, 70.3 percent have exceeded analysts' expectations, above a 62 percent average since 1994 and 65 percent over the past four quarters.

About 5.9 billion shares changed hands on the New York Stock Exchange, the Nasdaq and NYSE MKT, below the daily average in February last year of 6.94 billion.

On the NYSE, roughly seven issues rose for every five that fell and on Nasdaq more than six rose for every five decliners.

(Editing by Kenneth Barry and Bernadette Baum)

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News Analysis: As North Korea’s Nuclear Ability Grows, China Faces Dilemma

BEIJING — In the aftermath of Tuesday’s nuclear test by North Korea, China will almost certainly join the United States in supporting tougher sanctions at the United Nations, accompanied by sterner reprimands from Beijing against its recalcitrant ally in Pyongyang.

But as impatient as China might be with North Korea, there is little chance that the new Chinese leader, Xi Jinping, will move quickly to change the nation’s long-held policy of propping up the walled-off government that has long served as a buffer against closer intrusion by the United States on the Korean Peninsula.

The Chinese military, and to a lesser extent the International Liaison Department of the Chinese Communist Party, assert strong influence on China’s Korean policy, and both these powerful entities prefer to keep North Korea close at hand, Chinese and American analysts say.

While the People’s Liberation Army does not even conduct military exercises with the North Koreans — the government in the North forbids such contact with outsiders — Chinese military strategists adhere to the doctrine that they cannot afford to abandon their ally, no matter how bad its behavior, analysts here say.

At the same time, the Chinese Communist Party looks upon the North Korean Communist Party — led by Kim Jong-un, the grandson of the nation’s founder — as a fraternal brotherhood. Indeed, relations between the two countries are conducted largely between the two parties rather than through the more normal diplomatic channels between the two foreign ministries.

But within this basic contour there could be some adjustments by Mr. Xi, according to Zhu Feng, a professor of international relations at Peking University, an advocate of a tougher policy by China against North Korea.

“One nuclear test will not make China’s new administration decide to ‘abandon North Korea’ but it will definitely worsen China-North Korea relations,” Professor Zhu wrote in a recent article in the Straits Times of Singapore. “North Korea’s nuclear test will make the new Xi Jinping administration angry, and give China a headache.”

Mr. Xi, who became head of the Communist Party and military council in November, will ascend to the presidency of the country next month. Already he has shown himself to be more nationalistic than his predecessor, Hu Jintao, displaying China’s determination to prevail in the East China Sea crisis in which China is seeking to wrest control of islands administered by Japan. He has also displayed considerably more interest in China’s military, visiting bases and troops in the last two months with blandishments to soldiers to be combat ready.

To improve China’s strained relationship with the United States, Mr. Xi could start with getting tougher on North Korea, harnessing China’s clout with the outlier government to help slow down its nuclear program. If Mr. Xi does not help in curbing the North Koreans, perhaps by privately threatening to pull the plug on infusions of Chinese oil and investments that keep North Korea afloat, he will almost certainly face an accelerated American ballistic missile defense program in Northeast Asia on behalf of Japan and other allies in the region. That would be an unpalatable situation for China.

The Obama administration excoriated Mr. Hu after North Korea’s second nuclear test in 2009, accusing him of “willful blindness” to that country’s actions.

“With Hu out of the picture, the administration is intent on determining whether Xi Jinping will prove more attentive to U.S. security concerns,” said Jonathan D. Pollack, director of the John L. Thornton China Center at the Brookings Institution.

“How Xi chooses to respond will be an important early signal of his foreign policy priorities and whether he is ready to cooperate much more openly and fully with Washington and Seoul than his predecessor,” he said, referring to South Korea.

A more heightened debate about North Korea is now swirling around China’s foreign policy circles. On one side are those like Professor Zhu who favor some kind of co-operation with the United States in curbing North Korea’s nuclear program. On the other side are the traditionalists in powerful positions in the army and the party who adhere to the buffer zone theory.

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Biggest Loser's Alison Sweeney Blogs About Valentine's Day Temptation

TV Watch

The Biggest Loser

By Alison Sweeney

02/12/2013 at 05:30 PM EST

Alison Sweeney hosts NBC's The Biggest Loser and is the award-winning star of Days of Our Lives, in addition to being an author, director, producer, wife and mom. Like she has for the past two seasons, Alison will blog each week about the latest episode of The Biggest Loser. Follow her on Twitter @Ali_Sweeney.

It's time for singles on The Biggest Loser – and that changes everything! Once I'd given each remaining contestant their new color, I loved the celebration in the house, particularly for Danni who had been competing as a single for the last couple of weeks.

However, the celebration was short-lived when they were introduced to their Valentine's Day temptation. It's incredible that a holiday celebrating love comes with so many calories that hurt those you love the most. So as the challenge began, I put on my night vision goggles and it killed me to watch Francelina and Alex stuffing calories into their mouths. Meanwhile, I was so proud of Danni for using the time for a workout.

In the gym, it was fun to watch the trainers working with different contestants. Jillian – never one to shy away from a challenge – took Francelina and Alex as punishment for their eating during the temptation. She also took Jeff because they'd butted heads in the past. Despite his tough exterior, I think Jeff finally figured out that Jillian can break through any wall and get to the heart of what caused contestants to become overweight. And she's then able to work with them on transforming their entire lives.

After this week's challenge, Danni really impressed me (again!) by giving her reward to Gina and Michael so they could spend 24 hours with their loved ones. We were all so moved by Gina and Michael's reaction to the prize – to knowing they would see loved ones. Not a dry eye. For Gina to see her husband and put her wedding ring back on because it finally fit again was heartwarming. Then to watch Michael with his wife and his baby was just awesome. How cute is Little Mike?

During this week's weigh-in, it was great to see Alex reach "One-derland" (being in the 100s) despite the calories she consumed during the temptation. It was also great to see Jackson's elation at having such a great weight loss for the week.

In the end, for the first yellow line, the choice came down to whether to eliminate Francelina or Michael. When the decisions were made, it was Michael who was sent home. But, just like others before him this season, Michael showed that what he learned on the Ranch could be applied at home and I know he's going to make sure his entire family gets healthy and stays healthy.

With the kids this week, it was great to watch them step further outside of their comfort zones and to have fun while working out. For them, it's not about clocking hours in the gym but more about finding ways to have fun being active and to gain self-confidence through successes.

My favorite moment of the week: Michael's reaction when his wife and baby walked in the room and surprised him.

Happy Valentine's Day to everyone, especially to Dave, my incredible husband of almost 13 years, and to my kids, Ben and Megan. (Check out Ben's awesome jump over the sofa and Megan's adorable reaction in my Good Housekeeping cover story, which is on stands now!)

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Pope shows lifetime jobs aren't always for life

The world seems surprised that an 85-year-old globe-trotting pope who just started tweeting wants to resign, but should it be? Maybe what should be surprising is that more leaders his age do not, considering the toll aging takes on bodies and minds amid a culture of constant communication and change.

There may be more behind the story of why Pope Benedict XVI decided to leave a job normally held for life. But the pontiff made it about age. He said the job called for "both strength of mind and body" and said his was deteriorating. He spoke of "today's world, subject to so many rapid changes," implying a difficulty keeping up despite his recent debut on Twitter.

"This seemed to me a very brave, courageous decision," especially because older people often don't recognize their own decline, said Dr. Seth Landefeld, an expert on aging and chairman of medicine at the University of Alabama at Birmingham.

Age has driven many leaders from jobs that used to be for life — Supreme Court justices, monarchs and other heads of state. As lifetimes expand, the woes of old age are catching up with more in seats of power. Some are choosing to step down rather than suffer long declines and disabilities as the pope's last predecessor did.

Since 1955, only one U.S. Supreme Court justice — Chief Justice William Rehnquist — has died in office. Twenty-one others chose to retire, the most recent being John Paul Stevens, who stepped down in 2010 at age 90.

When Thurgood Marshall stepped down in 1991 at the age of 82, citing health reasons, the Supreme Court justice's answer was blunt: "What's wrong with me? I'm old. I'm getting old and falling apart."

One in 5 U.S. senators is 70 or older, and some have retired rather than seek new terms, such as Hawaii's Daniel Akaka, who left office in January at age 88.

The Netherlands' Queen Beatrix, who just turned 75, recently said she will pass the crown to a son and put the country "in the hands of a new generation."

In Germany, where the pope was born, Chancellor Angela Merkel, who is 58, said the pope's decision that he was no longer fit for the job "earns my very highest respect."

"In our time of ever-lengthening life, many people will be able to understand how the pope as well has to deal with the burdens of aging," she told reporters in Berlin.

Experts on aging agreed.

"People's mental capacities in their 80s and 90s aren't what they were in their 40s and 50s. Their short-term memory is often not as good, their ability to think quickly on their feet, to execute decisions is often not as good," Landefeld said. Change is tougher to handle with age, and leaders like popes and presidents face "extraordinary demands that would tax anybody's physical and mental stamina."

Dr. Barbara Messinger-Rapport, geriatrics chief at the Cleveland Clinic, noted that half of people 85 and older in developed countries have some dementia, usually Alzheimer's. Even without such a disease, "it takes longer to make decisions, it takes longer to learn new things," she said.

But that's far from universal, said Dr. Thomas Perls, an expert on aging at Boston University and director of the New England Centenarians Study.

"Usually a man who is entirely healthy in his early 80s has demonstrated his survival prowess" and can live much longer, he said. People of privilege have better odds because they have access to good food and health care, and tend to lead clean lives.

"Even in the 1500s and 1600s there were popes in their 80s. It's remarkable. That would be today's centenarians," Perls said.

Arizona Sen. John McCain turned 71 while running for president in 2007. Had he won, he would have been the oldest person elected to a first term as president. Ronald Reagan was days away from turning 70 when he started his first term as president in 1981; he won re-election in 1984. Vice President Joe Biden just turned 70.

In the U.S. Senate, where seniority is rewarded and revered, South Carolina's Strom Thurmond didn't retire until age 100 in 2002. Sen. Robert Byrd of West Virginia was the longest-serving senator when he died in office at 92 in 2010.

Now the oldest U.S. senator is 89-year-old Frank Lautenberg of New Jersey. The oldest congressman is Ralph Hall of Texas who turns 90 in May.

The legendary Alan Greenspan was about to turn 80 when he retired as chairman of the Federal Reserve in 2006; he still works as a consultant.

Elsewhere around the world, Cuba's Fidel Castro — one of the world's longest serving heads of state — stepped down in 2006 at age 79 due to an intestinal illness that nearly killed him, handing power to his younger brother Raul. But the island is an example of aged leaders pushing on well into their dotage. Raul Castro now is 81 and his two top lieutenants are also octogenarians. Later this month, he is expected to be named to a new, five-year term as president.

Other leaders who are still working:

—England's Queen Elizabeth, 86.

—Abdullah bin Abd al-Aziz al-Saud, king of Saudi Arabia, 88.

—Sabah al-Ahmad al-Jaber al-Sabah, emir of Kuwait, 83.

—Ruth Bader Ginsburg, U.S. Supreme Court associate justice, 79.

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Associated Press writers Paul Haven in Havana, Cuba; David Rising in Berlin; Seth Borenstein, Mark Sherman and Matt Yancey in Washington, and researcher Judy Ausuebel in New York contributed to this report.

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Wall Street ends slightly higher, Dow near a record

NEW YORK (Reuters) - Stocks closed modestly higher on Tuesday, putting the Dow within striking distance of an all-time high, as investors looked ahead to President Barack Obama's State of the Union address.

Investors will be listening to Obama's speech for any clues on a deal with Republicans to avert automatic spending cuts due to take effect March 1. The tone of the speech will also be scrutinized, with any sign of compromise likely to be warmly received.

The S&P 500 has risen for the past six weeks, putting it up 6.5 percent so far this year, while the Dow is about 1 percent away from its all-time closing record of 14,164.53, reached in October 2007.

But gains have been harder to come by since the S&P hit a five-year high on February 1. Daily moves have been small and trading volume light as investors search for new reasons to drive stocks higher.

About 5.73 billion shares changed hands on the New York Stock Exchange, the Nasdaq and NYSE MKT on Tuesday, below the daily average so far this year of about 6.48 billion shares.

"We're likely to settle in for a period and digest the gains we've had, though there's still a bias towards positive momentum," said Eric Teal, chief investment officer at First Citizens Bancshares in Raleigh, North Carolina.

"Questions over government spending are the big overhang, and we're looking for Obama to inspire some confidence over that tonight."

The White House has signaled Obama will urge investment in infrastructure and clean energy, suggesting companies in those sectors may be volatile in Wednesday's session.

"Gun makers could also see a reaction if Obama talks about anything with respect to gun control," said Teal, who helps oversee $5 billion. Shares of Smith & Wesson fell 2 cents to $9.11 while Sturm Ruger was up 0.4 percent at $53.91.

The Dow Jones industrial average <.dji> was up 47.46 points, or 0.34 percent, at 14,018.70. The Standard & Poor's 500 Index <.spx> was up 2.42 points, or 0.16 percent, at 1,519.43. The Nasdaq Composite Index <.ixic> was down 5.51 points, or 0.17 percent, at 3,186.49.

Housing shares were among the strongest of the day, led by a 12.5 percent jump in Masco Corp to $20.02 after the home improvement product maker said it expects new home construction to show strong growth in 2013. The PHLX housing sector index <.hgx> rose 3.7 percent.

Avon Products Inc surged 20 percent to $20.79 as the S&P 500's top percentage gainer after the cosmetics company reversed sales declines and cut costs.

On the downside, Coca-Cola Co fell 2.7 percent to $37.56 and was the biggest drag on the Dow after reporting revenue below estimates, hurt by a weaker-than-expected performance in Europe.

Michael Kors Holdings shares jumped 8.8 percent to $62.04 after the fashion company handily beat Wall Street's estimates and raised its full-year outlook.

With earnings season starting to wind down, Thomson Reuters data through Tuesday morning shows of the 353 companies in the S&P 500 that have reported results, 70.3 percent have exceeded analysts' expectations, above a 62 percent average since 1994 and 65 percent over the past four quarters.

Fourth-quarter earnings for S&P 500 companies are estimated to have risen 5.3 percent, according to the data, above a 1.9 percent forecast at the start of the earnings season.

About 62 percent of stocks traded on the New York Stock Exchange closed higher while 59 percent of Nasdaq-listed shares closed in positive territory.

(Editing by Nick Zieminski)

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Ruling Adds Another Chapter to Unsolved Italian Jet Crash

ROME — Itavia Flight 870 was entering the final leg of a routine domestic trip from Bologna to Palermo, Sicily, one clear summer evening when it suddenly plunged into the Tyrrhenian Sea near the small island of Ustica, killing all 81 people aboard.

Mechanical failure was ruled out early on, and almost 33 years later, the causes that led to the crash on June 27, 1980, are still a topic of passionate debate in Italy, fueled by three decades of inquiry boards, parliamentary commissions, countless expert reports and one of the longest judicial inquiries in recent Italian history. But despite all that, no formal charges have ever been filed in connection with the crash.

The crash, known as the Ustica affair, has produced legions of conspiracy theories here, the way the Kennedy assassination — or, on a lesser scale, the crash of TWA Flight 800 off Long Island in 1996 — have in the United States. But in the Ustica affair, the case for a cover-up is far stronger.

Last week, when Italy’s highest court ruled that the country’s Defense and Transportation Ministries had to compensate the families of some of the victims, the court implicitly acknowledged the most widely accepted theory behind the crash: That a missile fired by a warplane had hit the twin-engine McDonnell Douglas DC-9 of Itavia, a now-defunct domestic Italian airline. But the court did not say where that missile came from.

To conspiracy buffs, it was vindication — to a point.

“It’s like the O.J. Simpson affair, where he got off in criminal court but was found guilty in a civil procedure and had to pay damages,” said Andrea Purgatori, an investigative reporter whose exhaustive book on the disaster and the presumed cover-up was made into a 1992 film.

Over the years, several Italian Air Force officials have been investigated for withholding evidence — wiping clean flight tracks and radar scans — and four generals were tried on charges of treason and obstructing investigations. But no one has been convicted.

In this atmosphere, it is not surprising that conspiracy theories have proliferated over the years. The crash has been blamed on U.F.O.’s (several Web sites subscribe to this reconstruction) or domestic terrorism (the Bologna train station was bombed not five weeks later, killing 85 and wounding dozens more). In this scenario, the plane went down after a bomb exploded onboard, most likely in the toilet.

The missile theory gained a new impetus in 2008 when Francesco Cossiga, the prime minister at the time of the Ustica affair, said in an interview that the flight had been shot down by French military planes. Mr. Cossiga did not provide further details, nor can he. He died in 2010, at age 82.

At the time, proponents say, Italy was covertly allowing Libyan aircraft to fly through its airspace undisturbed. They did so by gliding in the slipstream of Italian domestic aircraft, where they could not be detected by radar. On the night of June 27, 1980, there were unsubstantiated reports that Col. Muammar el-Qaddafi was on one of those planes, the theory goes, and French forces tried to shoot it down to kill the Libyan leader, but hit the DC-9 by mistake. Don’t ask why. It has to do with rebels in North Africa and jockeying for oil concessions between Italy and France.

But Colonel Qaddafi had been warned of the plan and never boarded his plane, according to this reconstruction, which also says the pilot made a successful emergency landing at sea. There, a British submarine reached it and deployed scuba divers to plant explosives to sink the plane and to silence potential witnesses to the assassination attempt.

One hypothesis, detailed by an investigative journalist, Claudio Gatti, holds that the plane was shot down by Israeli forces that mistook it for a plane carrying enriched uranium earmarked for Iraq. “No country would attack in the Mediterranean for anything but extraordinary reasons,” and Israel “had that reason,” Mr. Gatti said. “It’s the only scenario that makes sense.”

The Western warplane scenario has gathered weight through the years, as Italian prosecutors disclosed that several NATO planes were flying in the same airspace that night.

Prosecutors in Rome are still pursuing the Ustica affair. Several international rogatorie — legal requests for information — have since been sent to Belgium, France, Germany and the United States, but responses have been slow in coming, leading the victims’ families to accuse those countries of dragging their feet.

Prosecutors say there are no time limits to such requests, which “depend solely on the collaboration that countries see fit to give,” said Erminio Amelio, one of the prosecutors currently leading the criminal investigation, which has passed through various hands over three decades.

Even though much has changed since that night in the Mediterranean almost 33 years ago, official sensitivities are still high, and no one expects any of the governments thought to be involved to come clean anytime soon.

“This is an incredible story, where a series of colossal lies have been told,” Mr. Purgatori said.

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Are You Loving LeAnn Rimes's New Bangs?

Stylewatch
Style News Now

02/11/2013 at 04:48 PM ET

Courtesy of Leann Rimes

First, Duchess Catherine cut hers. Then, Michelle Obama made the cut. And now we think we can officially declare bangs to be the hairstyle to have, because LeAnn Rimes has debuted her blunt new fringe on Twitter.

“Love my Andy LeCompte! I got banged,” she joked on Twitter of the new cut, along with a photo of her smiling next to the renowned celeb stylist. “Love em! Was time for a fun change.”

The star stepped out the night before her Saturday cut in a glam mini and her signature loose, blonde waves. But she decided not to take her new do for a spin on the Grammys red carpet, tweeting “I like my PJs better!”

We can’t say we blame her, but we hope she doesn’t keep the finished cut under wraps for long. We need more bangs inspiration for our Pinterest board.

Tell us: What do you think of Rimes’s new bangs?

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Need surgery? Good luck getting hospital cost info

CHICAGO (AP) — Want to know how much a hip replacement will cost? Many hospitals won't be able to tell you, at least not right away — if at all. And if you shop around and find centers that can quote a price, the amounts could vary astronomically, a study found.

Routine hip replacement surgery on a healthy patient without insurance may cost as little as $11,000 — or up to nearly $126,000.

That's what researchers found after calling hospitals in every state, 122 in all, asking what a healthy 62-year-old woman would have to pay to get an artificial hip. Hospitals were told the made-up patient was the caller's grandmother, had no insurance but could afford to pay out of pocket — that's why knowing the cost information ahead of time was so important.

About 15 percent of hospitals did not provide any price estimate, even after a researcher called back as many as five times.

The researchers were able to obtain a complete price estimate including physician fees from close to half the hospitals. But in most cases, that took contacting the hospital and doctor separately.

"Our calls to hospitals were often greeted by uncertainty and confusion," the researchers wrote. "We were frequently transferred between departments, asked to leave messages that were rarely returned, and told that prices could not be estimated without an office visit."

Many hospitals "are just completely unprepared" for cost questions, said Jaime Rosenthal, a Washington University student who co-authored the report.

Most hospitals aren't intentionally hiding costs, they're just not used to patients asking. That's particularly true for patients with health insurance who "don't bother to ask because they know insurance will cover it," said co-author Dr. Peter Cram, a researcher at the University of Iowa's medical school.

But he said that's likely to change as employers increasingly force workers to share more health care costs by paying higher co-payments and deductibles, making patients more motivated to ask about costs.

The study was published online Monday in JAMA Internal Medicine. A California study published last year about surgery to remove an appendix found similar cost disparities.

Commenting on the study, American Hospital Association spokeswoman Marie Watteau said hospitals "have a uniform set of charges. Sharing meaningful information, however, is challenging because hospital care is unique and based on each individual patient's needs."

She said states and local hospital associations are the best source for pricing data, and that many states already require or encourage hospitals to report pricing information and make that data available to the public.

U.S. insurance companies typically negotiate to pay less than the billing price. Insured patients' health plans determine what they pay, while uninsured patients may end up paying the full amount.

The study authors noted that Medicare and other large insurers frequently pay between $10,000 and $25,000 for hip replacement surgery.

Sean Toohey, a grains broker at the Chicago Board of Trade, had hip replacement surgery last summer at Loyola University Medical Center in Maywood, Ill. An old sports injury had worn out his left hip, causing "horrendous" pain on the job, where he's on his feet all day filling orders.

Toohey, 54, said his health insurance covered most of the costs, and it didn't occur to him to ask about price beforehand. He was back at work two weeks later and is pain free. That's what matters most to him.

"I never really looked or paid attention" to the cost, he said.

He paid about $7,900, but wasn't sure what the total bill amounted to.

The average charge for hip replacement surgery at Loyola is about $42,000, before the negotiated insurance rates. The most expensive items on a typical hip replacement bill include about $11,000 for the hip implant, said Richard Kudia, Loyola's vice president of patient financial services

Kudia said some patients do ask in advance about costs of surgery and other medical procedures, and those questions require "a little bit of research" to come up with an average estimate. Costs vary from center to center because "there is no standard pricing among hospitals across the country. Each hospital develops its own pricing depending on its market," he said.

An editorial accompanying the hip replacement study said "there is no justification" for the huge cost variation the researchers found.

A few online sites provide price comparisons for common medical procedures, but the editorial said that kind of information "is of almost no value" without information on hospital quality.

A proposed federal measure that would have required states to force hospitals to make their charges public failed to advance in Congress last year but could be revived this year, the editorial says.

"It is time we stopped forcing people to buy health care services blindfolded," the editorial said.

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Online:

Journal: http://www.jamainternalmed.com

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