New Orleans CityBusiness |
07.20.09
by Jim McNamara
All of us who are
committed to improved health care and the emergence of bioscience economic
development in New Orleans
are concerned about the impasse in the negotiations for a new downtown
medical center.
However, this
breakdown is not stopping the development of the bioscience industry. Over
the past four years, more than 50 New
Orleans area leaders from industry, education, and
state and local economic development organizations have worked to organize an
independent body to ensure growth and future competitiveness.
The Greater New
Orleans Biosciences Economic Development District was created in 2005 and is
committed to continued development of health care institutions, medical
education through the participation of its teaching and research universities,
and expansion of economic opportunities of businesses and industries that
support improved health care, including innovative technologies.
Soon, the district
will be master-planned as the hub of world-class academic training, research
and development of medical technology and devices, and top-notch health care
delivery for everyone, regardless of social or economic status. Its goal is
to help re-establish New Orleans
as a medical center of excellence second to none.
Here are some of
the actions and priorities established by the biosciences industry that are
addressing the community’s health care needs and, at the same time,
developing one of its most vibrant industries:
• Construction of
the cornerstone facilities such as the New Orleans BioInnovation Center
and the Louisiana Cancer Research Consortium to serve as catalysts and
resources for spurring growth. This priority focuses on creating the
infrastructure necessary to encourage the industry growth.
• Recruiting a
bioscience and health care work force to New Orleans, ensuring the region has the
talent necessary to support a growing bioscience industry.
• Support the
creation, attraction, retention and growth of innovative bioscience companies
by ensuring access to capital and infrastructure support. There is some
momentum in this area but it has to remain a priority to address the
access-to-capital problem that so many bioscience companies face. Efforts to
merge the innovation and entrepreneurial cultures are also under way and
showing signs of improvement.
• Position New Orleans for global
leadership in the cutting-edge areas of bioscience research and emerging
growth markets. The focus of this priority is to get technologies out of the
research institutions and into the private market for commercialization.
• Developing the
“place.” The district is poised to complement these two hospitals and the
academic mission of these universities by creating the master-planned
district. It will be a beacon for New Orleanians
who desire a smarter, healthier, happier and sustainable community.
One could debate
about individual action items and the best use of precious funds, but no one
can argue it is not needed.
New Orleans will never recover until the
self-destructive bickering ceases, but to say that the current impasse has
thwarted all progress in the biosciences is a mischaracterization of the true
progress that is under way.
http://www.neworleanscitybusiness.com/viewStory.cfm?recID=33726
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The Advocate
Capital News Bureau
The LSU System’s
health chief, Fred Cerise, said last week that the ball is back in Tulane University’s
court in a dispute over management of a proposed $1.2 billion medical center
in New Orleans.
Tulane signed off,
but LSU refused to approve a “memorandum of understanding” outlining the
governance structure. LSU wants to change the makeup of the board that would
oversee the LSU-aligned hospital training physicians for both universities.
Not seeing a
reason to proceed without agreement on basic management, Commissioner of
Administration Angèle Davis put a halt to efforts
to purchase property.
The halt to
property acquisition has not caused LSU’s Board to reconsider its position,
he said. “That hasn’t changed anything,” Cerise said.
http://www.2theadvocate.com/news/51109117.html?showAll=y&c=y
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The Advocate
Capital News Bureau
Louisiana’s health-care chief, Alan Levine, said
he’s been fielding calls from Washington,
D.C., on comments retired U.S.
Army Gen. Russel Honoré
made last week to The Associated Press.
Honore said that soon after arriving in New Orleans at the head of a convoy of soldiers — an action widely
celebrated as returning the city to order following Hurricane Katrina — he
was led to believe by state officials that Louisiana
hoped to use storm damage as a way to get the federal government to pay for
replacing Charity
Hospital. It’s a
position that some federal authorities use to pay less than the $492 million
state officials want for storm damage repairs.
Levine, who was in
Florida at the time, said he relies on the representations of state officials
who were there, including the denials of Kathleen Blanco, who was governor at
the time, and Fred Cerise, who then held the post Levine does now.
Still, the barrage
of questioning from D.C. has put his office on the defensive, Levine said.
“They say ‘Are you
suggesting that Gen. Honoré, the well-decorated
general who saved New Orleans
is lying?’ No, I’m not saying he’s lying, I’m saying there may be more to the
story,” Cerise said.
http://www.2theadvocate.com/news/51109117.html?showAll=y&c=y
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by The
Times-Picayune
RESERVE -- Four of
President Obama's cabinet members are coming to south Louisiana today.
The four are
scheduled to be in St. John
the Baptist Parish to host a forum about rural health as part of a national
tour.
At the meeting
will be: Agriculture Secretary Tom Vilsack;
Veterans Affairs Secretary Eric Shinseki; Labor Secretary Hilda Solis; and
Kathleen Sebelius, head of the Department of Health
and Human Services.
The meeting is
scheduled for 11:30 a.m. at the Army National Guard Readiness Center at 4120 Airline Hwy.
in Reserve.
The forum comes as
the Obama administration continues to push an overhaul of the nation's health
care delivery system. Obama last week tapped Dr. Regina Benjamin, an Alabama physician and Xavier
University graduate who has devoted
her career to rural health, to serve as U.S. surgeon general.
The federal
government, meanwhile, is still holding a request from Gov. Bobby Jindal's administration that would make many changes to Louisiana's health
care system, including putting a greater emphasis on primary and preventive
services, rather than hospital-based care, in rural areas.
Shinseki's agency
has an expensive stake in the New
Orleans region as it plans to build a 200-bed
medical complex in Mid-City to replace the downtown Veterans Affairs hospital
that was damaged by Hurricane Katrina. The $600 million-plus hospital is
slated to open in 2012, ahead of the adjacent state teaching hospital that
would replace Charity and University
Hospitals.
http://www.nola.com/news/index.ssf/2009/07/four_obama_cabinet_members_to.html
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Lenore Hoffman
The medical
profession is not a war between universities. We have a serious need in New Orleans for good
doctors.
As for the
reference to taxpayers' money ("Hospital is LSU's domain," Your
Opinions, July 6) everybody pays taxes -- even those associated with Tulane.
Lenore Hoffman
New Orleans
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/1248067266280670.xml&coll=1
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The Advocate
Capital News Bureau
The LSU School of
Medicine’s chief of hand surgery, Dr. Harold Stokes, joined the ranks of the
state’s highest-paid employees last week.
Stokes, who also
is a member of the state’s top higher education oversight board, had his
total pay doubled from $240,000 to $480,269 by the LSU Board of Supervisors.
While Stokes’
$110,000 base salary stays the same, his annual supplement was increased from
$130,000 to $370,269.
In an e-mail
response to questions, Larry Hollier, chancellor of
the LSU Health Care Science Center in New Orleans, said the pay hike is
justified because Stokes brought in more than $900,000 in income this year
through his clinical work — the most among all faculty members.
Hollier also noted that many young orthopedic hand
surgeons were making $100,000 a year more than Stokes prior to the pay hike. Hollier said the supplements are frequently changed and
that Stokes’ new pay is not guaranteed in future years.
Stokes is the
founder of Hand Surgical Associates in Metairie and a former chief of staff
at East Jefferson General
Hospital.
http://www.2theadvocate.com/news/51109117.html?showAll=y&c=y
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New Orleans CityBusiness |
07.18.09
by The Associated
Press
NEW ORLEANS — Dr.
Fred H. Rodriguez, a professor of pathology at the School of Medicine in the
LSU Health Sciences Center at New Orleans, is being honored by the American
Society for Clinical Pathology.
In October,
Rodriguez is to receive the organization's 2009 Israel Davidsohn
Award for Distinguished Service. The award was established in 1989 and is
presented annually to an exemplary American Society for Clinical Pathology
member for significant contributions to the Society's continuing medical
education activities.
In addition to his
duties at the LSU
Health Sciences
Center, Rodriguez is
chief of the Pathology and Laboratory Medicine Service for the Southeast
Louisiana Veterans Health Care System.
http://www.neworleanscitybusiness.com/uptotheminute.cfm?recid=25817
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By MARK BALLARD
Here’s something
that’ll keep you awake at night: Just like this fiscal year, state government
next fiscal year won’t collect enough taxes, royalties and other revenues to
pay the government’s bills.
But unlike this
year, state taxpayers in 2010 also could face a health-care bill of about $1
billion that they have no choice but to pay.
“I wake up every
day, and I feel like I’m staring down the barrel of a shotgun,” said Alan
Levine, secretary of the state Department of Health and Hospitals.
“Every person who
cares about higher education needs to sit up and take notice,” Levine said
last week about the bulk of that bill, which is caused by a fight over
fine-print jargon and would require Louisiana
taxpayers to pick up a tab next year that federal taxpayers
paid this year.
Unless the problem
is fixed, the money to pay the increased health-care costs will come from
higher education, roads and bridges and other government services.
The reason is a
federal funding formula that Levine calls “flawed.”
Basically, here’s
the problem: If a state provides
health care for its poor and uninsured — all states do — the federal
government pitches in, through a program called Medicaid.
Just how much
federal taxpayers help each state is adjusted each year using a complex
formula — the Federal Medical Assistance Percentage — that determines what a
state can afford. For Louisiana,
the federal share historically hovers around 70 percent, which in 2009 is
higher than all but three states. That means the federal government pays
about 70 cents and state taxpayers kick in 30 cents of every dollar spent on
providing health care.
Louisiana has the nation’s second-highest percentage
of people living in poverty — one of every four residents uses Medicaid — and
the state’s taxpayers have among the nation’s lower average salaries.
Levine rummages
through a warren of charts and statistics stacked around his office as he
talks about how the billions of dollars spent in Louisiana to recover from
hurricanes Katrina and Rita artificially pumped up a key component of the
formula: per capita personal income — which bureaucrats call PCPI.
Finding the line
in the Bureau of Economic Analysis report, Levine shows how Louisiana’s PCPI
plugged along through the decade at an average 6 percent annual growth, then
jumped to 42 percent between 2005 and 2007 because of extra hurricane
recovery dollars.
Florida, Alabama,
Mississippi, Texas
and even Iowa have experienced a similar
anomaly after catastrophic disasters, though not to the extent Louisiana has, Levine
says. He admits to a tough task ahead but hopes to amend bills in the U.S.
Congress that would suspend using the formula when PCPI jumps by 5 percent or
more after the president declares a disaster.
Meanwhile, federal
Medicaid assistance to Louisiana
drops from 72.3 percent to 67.6 percent in October, then down to 63.2 percent
in October 2010. State taxpayers — me and you, whose annual incomes have not
actually risen — will have to pay almost a dime more on every dollar spent
for health care.
Levine calculates
that losing the PCPI fight would add $700 million or so to the burden on Louisiana taxpayers.
In addition, he points out that $368 million in federal stimulus money used
to prop up part of the health-care budget drops off. Changes in audit rules
also increase the state’s cost by another $48 million.
Louisiana can balance its state budget by further
cutting spending for roads, for public safety, for subsidizing private
businesses, for colleges and for universities.
Or Louisiana could go
with the genocide approach by doing away with Medicaid altogether and
essentially denying basic health care to more than 1 million people.
Or state
government could opt to slash parts of the program that are not mandatory by
denying medical care to a lot of children or by refusing to help pay for
prescription medicine. But, as Levine points out, those approaches
essentially push more people to put off health care until they have no choice
but to visit the emergency room — at a far-higher cost, which state taxpayers
will then have to pay.
“It’s cataclysmic
and there are no good options. You can’t cut around the margins to fix this.
You have to go to the heart of the program,” Levine said. “I don’t think any
of us want to be the guy to do that. That would be my worst moment in public
service.”
http://www.2theadvocate.com/opinion/51106567.html
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DAVID ESPO
The Associated
Press
(AP) — WASHINGTON - The
chairman of the opposition Republican party is accusing President Barack
Obama of conducting "risky experimentation" with his health care
proposals, saying they will hurt the economy and force millions to drop their
current coverage.
Michael Steele, in
remarks prepared for delivery at the National Press Club, also said the
president, Speaker Nancy Pelosi and key congressional committee chairmen are
part of a "cabal" that wants to implement government-run health
care.
"Obama-Pelosi
want to start building a colossal, closed health
care system where Washington
decides. Republicans want and support an open health care system where
patients and doctors make the decisions," Steele said in excerpts of his
speech made available in advance.
The Republican chairman is making his speech
at a time when Obama is struggling to advance his trademark health care
proposal after a period of evident progress. Two of three House committees
have approved their portions of the bill, while one of two Senate panels have acted.
But conservative
Democrats have raised objections to some elements of the legislation, and
efforts in the Senate to reach a bipartisan agreement have yet to bear fruit.
Obama's attempt to impose an early August deadline on both the House and
Senate for passage of legislation is in jeopardy.
Obama has
repeatedly said he does not favor a government-run health care system.
Legislation taking shape in the House envisions private insurance companies
selling coverage in competition with the government.
Even so, numerous
Republicans in Congress continue to level the accusation at Obama and
congressional Democrats, and Steele did so in sharply critical terms.
"Many
Democrats outside of the Obama-Pelosi-Reid-Waxman cabal know that voters
won't stand for these kinds of foolish prescriptions for our health care. We
do too. That's why Republicans will stop at nothing to remind voters about
the risky experimentation going on in Washington,"
the party chairman said in advance excerpts. Harry Reid is Senate majority
leader; Rep. Henry Waxman is chairman of the House Energy and Commerce
Committee. Both are Democrats.
The United States
is the only developed nation that does not have a comprehensive national
health care plan for all its citizens, and Obama campaigned on a promise of
offering affordable health care to all Americans.
About 50 million
of America's
300 million people are without health insurance. The government provides
coverage for the poor and elderly, but most Americans rely on private
insurance, usually received through their employers.
Republican
officials said they were supplementing Steele's speech with a round of
television advertising designed to oppose government-run health care. No
details were immediately available on the areas where the commercials would
run or their cost.
In his speech,
Steele broadened his attack beyond health care to question Obama's
truthfulness.
The president
"tells us he doesn't want to spend more than we have, he doesn't want
the deficit to go up, he doesn't want to live off
borrowed money. But he also told us he didn't want to run an auto company.
President Obama justifies this spending by saying the devil made him do it.
He doesn't want to spend trillions we can't afford, but he says he just can't
help it," Steele said in the prepared excerpts.
http://www.nola.com/newsflash/index.ssf?/base/national-6/1248079226238780.xml&storylist=health
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The New York Times | 07.20.09
By ANDREW POLLACK
A medicine to
treat lupus has proved effective in a large clinical trial, which could pave
the way for approval of the first new treatment for the disease in more than
40 years. In recent years, many other companies have tried but failed to
bring a lupus treatment to market
The success of the
trial could lead to a rise in the shares of the drug’s developer, Human
Genome Sciences, which will announce the results Monday morning. Almost all
Wall Street analysts have been predicting the drug, known as Benlysta, would fail in the trial.
“For the one
million people with lupus in the United States,
this is nothing short of revolutionary,” said Dr. Daniel J. Wallace, a
clinical professor of medicine at the University
of California, Los Angeles, who was a consultant to Human
Genome Sciences on the structure of the trial.
In the Human
Genome Sciences study, a Phase 3 trial, 57.6 percent of patients on the
higher dose of Benlysta and 51.7 percent of those
on a lower dose had a meaningful improvement in their symptoms after one
year. That compared with 43.6 percent of those taking a placebo.
There are caveats.
The results have not yet been published or subjected to scrutiny by
independent experts. The data suggests that the drug would help only 8 to 14
of every 100 patients treated. And the drug is likely to be far more
expensive than the old generic immune suppressants and steroids now used to
treat lupus.
Human Genome
Sciences, based in Rockville,
Md., is sharing development and
marketing rights to the drug with GlaxoSmithKline. Results from a second
Phase 3 trial are due in November. If that succeeds, the companies will apply
for regulatory approval in the first half of next year.
Lupus is an
autoimmune disease, in which the defense system against pathogens attacks the
body’s own tissues. The disease, which primarily affects women of
child-bearing age, can cause rashes, arthritis, mouth sores, kidney damage
and other problems.
One recent study
estimated that 322,000 Americans definitely or probably have systemic lupus erythematosus, the most common form of the disease and
the one against which Benlysta was tested. The
Lupus Foundation of America estimates that 1.5 million Americans have some
form of lupus.
Because the
disease’s symptoms wax and wane on their own and vary considerably from one
patient to another, it has been hard to demonstrate the efficacy of drugs in
clinical trials.
Among the
companies that have had setbacks or outright failures in clinical trials are
Roche and Biogen Idec with their drug Rituxan; La Jolla Pharmaceutical with Riquent;
Bristol-Myers Squibb with Orencia; ZymoGenetics and Merck Serono
with atacicept; Genelabs
Technologies with Prestara; Teva
Pharmaceutical Industries with edratide; and Aspreva Pharmaceuticals and Roche with CellCept.
Benlysta, which was previously called Lymphostat-B and is known generically as belimumab, also failed in its Phase 2, or midstage, trial.
But Human Genome
Sciences, in consultation with the Food and Drug Administration, restricted
the Phase 3 trials to a subset of patients who seemed to respond better to
the drug in the earlier trial. It also changed the measurement of success and
lengthened the trial to give the drug more time to work.
“We knew the drug
was safe and biologically active,” H. Thomas Watkins, chief executive of the company,
said in an interview. “The question was, ‘Can you prove in a very large trial
what we’ve proven here?’ ”
The 865 patients
in the trial, who were mainly in Asia, South America and Eastern
Europe, received either Benlysta or a
placebo in addition to the drugs they were already taking.
More patients on
the drug had the required improvement in symptom severity. In addition, about
20 percent of patients taking Benlysta were able to
reduce their use of the steroid prednisone by at least 25 percent, compared
with about 12 percent of those on placebo.
Although the
difference between the treated patients and those given the placebo in the
trial might appear modest, Dr. Joan T. Merrill, a lupus expert at the
Oklahoma Medical Research Foundation, said Benlysta’s
safety and its ability to reduce steroid use would make it attractive to
doctors. Steroids can cause severe weight gain, acne and the weakening of
bones, among other side effects.
“I think it looks
good,” Dr. Merrill said. “And we are in a field where we haven’t even had
anything fair.”
Benlysta, which is given by infusion once every
four weeks, inhibits the action of a protein in the body called B-lymphocyte
stimulator, which helps B cells in the blood respond to infections. The
company said high levels of the protein might spur the immune system to
attach the body’s own tissues.
Human Genome, a
pioneer in studying human genes, discovered the gene for the stimulator
protein. If Benlysta gets to market, it will be the
first drug from the company, and one of the first in the industry, to result
from genomics.
In 2000, the
company’s share price soared to over $100 on anticipation that understanding
the human DNA blueprint — the human genome — would
lead to a cornucopia of drugs. On Friday, it closed at $3.32 a share.
http://www.nytimes.com/2009/07/20/business/20lupus.html?ref=health
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By CHARLES
BABINGTON
WASHINGTON — President Barack Obama is using a
touch-all-bases approach to try push through his health care overhaul, a
struggle that might demand deep concessions.
He's summoned
Republicans and Democrats to the White House. He's used public forums to
bypass Congress and make a direct pitch to the people. He's turned to his
political operation to air campaign-like TV ads.
But it hasn't
squelched congressional concerns about the high cost of extending insurance
coverage to millions of Americans.
So the president
soon must decide how hard to press contentious cost-saving plans such as
limiting Medicare reimbursements. Obama also must choose, at some point,
whether to make concessions on his top domestic priority that could attract a
few Senate Republican votes — and anger liberal supporters. The alternative
is a bare-knuckled parliamentary tactic that would inflame partisan tensions
and probably kill some of the items he wants in the legislation.
In a week that
presented plenty of good and bad news for Obama, the White House took a
stay-the-course approach. The president promoted his proposals daily. There
was a last-minute White House statement Friday and a health-focused radio and
Internet address Saturday.
In public at
least, Obama has embraced a general message and left the specifics to
Congress. He hasn't backed away from major parts of the plan or the
fast-approaching deadline he has sought for weeks, despite requests from
various Democrats to do so.
That was true even
when the nonpartisan Congressional Budget Office stunned Obama's supporters
by saying the bills moving through Congress would add to the nation's
long-term health care costs rather than reduce them.
Critics reveled in
the news.
Several Democrats
said they could not support the bills without significant changes. Their
threats could doom the legislation because GOP lawmakers are nearly unanimous
in their opposition.
For the most part,
Obama exuded optimism and emphasized the week's positive developments.
"Those who are betting against this happening this year are badly
mistaken," he said Friday.
Two House
committees and one Senate committee endorsed bills containing many of Obama's
priorities: subsidizing insurance for the poor, limiting insurers' ability to
deny coverage, providing a government-run option for insurance. Major groups
representing doctors and nurses became the latest to endorse the efforts.
Still, some of
Obama's tactics left people scratching their heads.
On Wednesday he
invited four Republican senators to the White House to discuss health care.
Three — Sens. Saxby Chambliss of Georgia, Bob Corker of Tennessee and Lisa
Murkowski of Alaska — are seen by colleagues as highly unlikely to vote for
an Obama-backed plan.
The fourth, Sen.
Susan Collins of Maine,
is a moderate Republican viewed as a possible supporter, even though she has
demanded changes in the Democratic-drafted bills.
Even those who
accepted White House invitations said it's hard to imagine that Obama thinks
such chats with conservatives will win him any votes.
"I think he's
just trying to get a sense as to what the prognosis might be in the
Senate," Murkowski said in an interview.
As for Obama's
push to get the House and Senate to pass separate bills by August, she said,
"I just don't see how it comes together."
Murkowski said the
White House is sending a "mixed message" by coupling its GOP
outreach with thinly veiled threats to use strong-arm tactics to ram home a
health care bill if Republicans insist on too many changes.
Obama adviser
David Axelrod is walking that line.
"We want to
work with everyone who will work with us, and we want to do it in the spirit
of bipartisanship," he said in an interview Thursday. But, he added,
"We can't defer reform and we want to move forward. Those who don't,
they need to address those Americans struggling with higher premiums and
losing their insurance."
Senate Democrats
could resort to a parliamentary procedure, known as
"reconciliation," that essentially would bar Republicans from using
stalling tactics to block a health care bill. But Senate rules would allow
opponents to knock some nonbudgetary items from the
bill. Those might include the "public option" for insurance, which
is dear to many liberals.
"It's obviously
better to have it bipartisan," said John Podesta,
who headed Obama's transition team and advises on health care. "But
there is a considerable amount that could be done, and will be done, with
reconciliation" if Republicans don't come on board, he said.
With high cost
projections posing the greatest political threat to Obama's plans, the White
House gently promoted two ideas last week that would give the executive
branch greater control over medical costs.
One would allow a
panel of medical experts to endorse certain treatments that would be eligible
for federal payments under Medicare and Medicaid. The second would empower a
different board to set Medicare reimbursement rates, which now vary
considerably from state to state. Congress could vote to reject the rates,
but the plan would substantially reduce lawmakers' direct role in the
politically tinged process of running Medicare.
Outside Washington, people are
seeing dueling TV ads from groups favoring and opposing Obama's health care
proposals.
Families USA
and a major pharmaceutical group are airing ads supporting the president's
agenda on three major national cable networks.
Organizing for America,
the Democratic Party organization that is closely tied to Obama,
is running a nationwide campaign that includes thousands of house parties and
other grass-roots activities. It is airing ads in Arkansas,
Indiana, Florida,
Louisiana, Maine,
North Dakota, Nebraska
and Ohio to
get senators to back the health care effort.
On the other side,
a coalition of health insurance groups is readying TV ads opposing a public
option for insurance. Other groups are airing ads suggesting that Obama would
push the United States
into a Canada-like system that would require long waits for important medical
treatments.
http://www.google.com/hostednews/ap/article/ALeqM5iI5gr8qyydj9C9c3jXnPk9j7wNigD99GTK880
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The New York Times | 07.19.09
By KEVIN SACK and
ROBERT PEAR
BILOXI, Miss. —
The nation’s governors, Democrats as well as Republicans, voiced deep concern
Sunday about the shape of the health care plan emerging from Congress,
fearing that Washington was about to hand them expensive new Medicaid
obligations without money to pay for them.
The role of the states
in a restructured health care system dominated the summer meeting of the
National Governors Association here this weekend — with bipartisan animosity
voiced against the plan during a closed-door luncheon on Saturday and in a
private meeting on Sunday with the health and human services secretary,
Kathleen Sebelius.
“I think the
governors would all agree that what we don’t want from the federal government
is unfunded mandates,” said Gov. Jim Douglas of Vermont, a Republican, the
group’s incoming chairman. “We can’t have the Congress impose requirements
that we are forced to absorb beyond our capacity to do so.”
The governors’
backlash creates yet another health care headache for the Obama
administration, which has tried to recruit state leaders to pressure members
of Congress to wrap up their fitful negotiations. Both Ms. Sebelius, who was Kansas’ governor before she joined the
cabinet in April, and the federal Medicaid chief, Cindy Mann, made
appearances at the meeting on Sunday. Meanwhile, other administration
officials spent the day pushing President Obama’s proposal on television talk
shows.
Mr. Obama also plans
to address questions about his health plan at a news conference on Wednesday
evening.
Ms. Sebelius emerged from her hour-long meeting with the
governors saying that “there’s a recognition that
states don’t have cash right now” and that “it’s difficult to send states the
bill if they don’t have the money.”
Although many
governors said significant change in how the nation handles health care was
needed, they said their deep-seated fiscal troubles made it a terrible time
to shift costs to the states. With the recession draining states of tax
revenues even as their Medicaid rolls are surging, the National Governors
Association projects that states will face aggregate deficits of $200 billion
over the next three years.
Each of several
health care bills coursing through Congress relies on a large increase in
eligibility for Medicaid, the state and federal insurance program for the
poor, as one means of moving toward universal coverage.
Because the states
and the federal government share the cost, any increase in eligibility
levels, benefits or payments to doctors would impose new burdens on the
states unless Washington
absorbs them. In at least one of several bills circulating in Congress, the
states would eventually pick up a share of the new costs, and the governors
fear they cannot count on provisions in other bills that they will not bear
costs.
It was unclear
whether the governors would draft a statement expressing their dismay, at
least partly because half of them did not attend. Many, including the group’s
chairman, Gov. Edward G. Rendell of Pennsylvania,
a Democrat, stayed home to deal with budget crises.
Some of the
group’s most notable names — Arnold Schwarzenegger of California, Sarah Palin of Alaska, Tim Pawlenty of Minnesota
and Bobby Jindal of Louisiana — were not here.
But the sentiment
among those who were could not have been more consistent, regardless of
political party. The governors said in interviews and public sessions that
the bills being drafted in Congress would not do enough to curb the growth in
health spending. And they said they were convinced that a major expansion of
Medicaid would leave them with heavy costs.
They are already
anticipating large gaps in Medicaid financing after 2010, when stimulus money
dries up. And they pointed out that Medicaid already suffered from low
payment rates to health care providers, discouraging some doctors and
hospitals from accepting beneficiaries. If Medicaid is expanded, states will
almost surely have to increase payments to doctors to encourage more of them
to participate.
Gov. Phil Bredesen of Tennessee,
a Democrat, said he feared Congress was about to bestow “the mother of all
unfunded mandates.”
“Medicaid is a
poor vehicle for expanding coverage,” added Mr. Bredesen,
a former health care executive. “It’s a 45-year-old system originally
designed for poor women and their children. It’s not health care reform to
dump more money into Medicaid.”
Mr. Bredesen was far from alone in his concern. “As a
governor, my concern is that if we try to cost-shift to the states we’re not
going to be in a position to pick up the tab,” said Gov. Christine Gregoire of Washington,
also a Democrat.
“I’m personally
very concerned about the cost issue, particularly the $1 trillion figures
being batted around,” said Gov. Bill Richardson, the New Mexico Democrat who
served in the Clinton
cabinet and ran for president against Mr. Obama.
Asked about the
concerns, Peter R. Orszag, director of the White
House Office of Management and Budget, made two points. First, he said, one
of Mr. Obama’s overriding goals was to reduce the rate of growth of health
costs, and that would benefit states by relieving pressure on their budgets.
In addition, he said, some versions of the legislation, including the House
bill, could slightly reduce state spending on Medicaid and the Children’s
Health Insurance Program over the next 10 years.
Many governors
expressed frustration that the prolonged negotiations in Washington had made it difficult to gauge
the potential impact on their budgets.
“There’s a concern
about whether they have fully figured out a revenue stream that would cover
the costs, and that if they don’t have all the dollars accounted for it will
fall on the states,” said Gov. Bill Ritter Jr. of Colorado, a Democrat.
Under the health
care proposals before Congress, Medicaid eligibility would be based solely on
income, without regard to factors that have historically been used to decide
who qualifies.
In the House bill,
Medicaid would be expanded to cover all nonelderly people with incomes at or
below 133 percent of the poverty level, or $29,300 for a family of four. The
federal government would pay all the costs for those who were newly eligible.
Medicaid would also cover newborns, for up to 60 days after birth, if they
did not have insurance from other sources.
The Congressional
Budget Office projects that 11 million more people would receive coverage
through Medicaid under the House bill, and that it would increase federal
Medicaid spending by $438 billion over 10 years. Medicaid thus accounts for
about 40 percent of the cost and 30 percent of those who gain coverage.
In a draft of the
bill in the Senate Finance Committee, the federal government would pick up
the extra costs for perhaps five years, but states would eventually have to
pay their normal share. On average, the federal government pays 57 percent.
One of the
proposals being considered by the Finance Committee would encourage states to
issue bonds to cover the costs of expanding Medicaid. Governors in both
parties revolted, trumpeting their opposition in a conference call last week
with Senator Max Baucus, the Montana Democrat who leads the committee.
“There is strong
bipartisan opposition to the idea of the states’ issuing bonds to pay for
operational expenses,” said Gov. Haley Barbour of Mississippi, chairman of the Republican
Governors Association. “One governor said it would be like taking out a
mortgage to pay the grocery bill.”
http://www.nytimes.com/2009/07/20/health/policy/20health.html?_r=1&ref=health
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South Africa Is Seen to Lag in H.I.V. Fight
The New York Times | 07.19.09
By CELIA W. DUGGER
ORANGE FARM, South Africa — Young men have flocked by the
thousands to this clinic for circumcisions, the only one of its kind in South Africa.
Each of them lies down on one of seven closely spaced surgical tables, his
privacy shielded only by a green curtain.
“I’ve done 53 in a
seven-hour day, me, myself, personally,” said Dr. Dino Rech,
who helped design the highly efficient surgical assembly line at this
French-financed clinic for cutting off foreskins.
Circumcision has
been proven to reduce a man’s risk of contracting H.I.V. by more than half.
Yet two years after the World Health Organization recommended the surgery,
the government here still does not provide it to help fight the disease or
educate the public about its benefits.
Some other African
nations are championing the procedure and bringing it to thousands. But in South Africa,
the powerhouse country at the heart of the epidemic, the government has been
notably silent, despite the withering international criticism the country has
endured for its previous foot-dragging in fighting and treating AIDS.
“Countries around
us with fewer resources, both human and financial, are able to achieve more,”
said Dr. Quarraisha Abdool
Karim, the first director of South Africa’s national AIDS
program in the mid-1990s under President Nelson Mandela. “I wish I understood
why South Africa, which
has an enviable amount of resources, is not able to respond to the epidemic
the way Botswana and Kenya
have.”
Even without
government involvement, demand for the surgery, performed free under local
anesthetic, has surged over the last year here at the Orange Farm clinic. The
men are counseled to continue using condoms since circumcision provides
partial, though substantial protection.
Men waited
nervously one recent chilly morning for their turn. Most were hoping the
procedure would help them stay healthy here in the nation with more
H.I.V.-positive people than any other.
But some said they
were also drawn by a surprising, if powerful, motivation: They had heard from
recently circumcised friends that it makes for better sex. You last longer,
they said. Your lovers think you’re cleaner and more exciting in bed.
“My girlfriend was
nagging me about this,” said Shane Koapeng, 24. “So
I was like, ‘O.K., let me do it.’ ”
As new H.I.V.
infections have continued to outpace efforts to treat the sick in Africa, there is growing concern about the ballooning
costs of treatment for an ever-expanding number of patients who need
medicines for the rest of their lives. Almost two million people were newly
infected in 2007 in sub-Saharan Africa,
bringing the total of those living with H.I.V. in the region to 22 million,
according to United Nations estimates.
The major
international donors to AIDS programs, including the United States and the
Global Fund to Fight AIDS, Tuberculosis and Malaria, are ready to pour money
into male circumcision, but the countries have to be ready to accept the
help.
“You can’t impose
it from the outside, particularly such a sensitive intervention,” said the
Global Fund’s executive director, Dr. Michel Kazatchkine.
Public health
doctors agree that circumcising millions of men will be no simple task. Africa has a severe shortage of doctors and nurses, and
circumcision is potentially a political and cultural minefield in countries
where some ethnic groups practice it but others do not.
Still, some
countries are showing it can be done. In Botswana, circumcision was
largely stopped in the late 19th and early 20th centuries by British
colonial-era administrators and Christian missionaries.
But Festus Mogae, who was president from 1998 to 2008, provided a
critical endorsement of male circumcision just before he stepped down.
Over the past
year, the government has trained medical teams to do circumcisions in all its
public hospitals and aims by 2016 to have circumcised 470,000 males from infancy
to age 49, which is 80 percent of the total number in that group.
Public awareness
is being raised through advertisements on radio and television. Billboards
have sprouted across the country featuring a star of the national youth
soccer team.
“Men have started
to flock to the hospitals,” said Dr. Khumo Seipone, director of H.I.V./AIDS prevention and care in Botswana’s
Ministry of Health.
In Kenya,
where the Luo do not generally practice
circumcision, Prime Minister Raila Odinga, himself a Luo, encouraged
the procedure and lobbied elders. The H.I.V. infection rate among Luo men is more than triple that of Kenyan men generally
— 17.5 percent versus 5.6 percent.
“Anything that
could help save lives needs to be tried,” Mr. Odinga
said, adding that he had been circumcised.
So far, more than
20,000 men in Kenya
have been circumcised in hospitals, dispensaries, village schools, social
halls and tents. Teams of doctors, nurses and counselors have even taken
boats to islands in Lake Victoria to
circumcise Luo fishermen.
“If the Luo Council of Elders and local politicians had been
against it, the government would not have dared endorse circumcision,” said
Robert Bailey, the principal investigator on the Kenya male circumcision clinical
trial.
In sharp contrast,
male circumcision has no political champion here in South Africa, where the largest ethnic group,
the Zulus, have generally not practiced it since the early 19th century, when
it was abandoned due to protracted warfare, according to Daniel Halperin, an epidemiologist and medical anthropologist at
Harvard University.
Thabo Masebe, a spokesman for President Jacob Zuma, said the Health Ministry must first set a policy on
circumcision before Mr. Zuma, who took office in
April, can take a position. Mr. Zuma is Zulu. The province of KwaZulu-Natal, the Zulu heartland, has
the highest adult H.I.V. prevalence rate in the country, 39 percent,
according to Unaids.
“The president
gets involved when decisions are made,” Mr. Masebe
said. “If the president spoke now, and when the time comes to make a policy,
a different decision is taken, it wouldn’t sound good.”
The new health
minister, Aaron Motsoaledi, spoke at length about
AIDS in a recent speech to Parliament but made no mention of male
circumcision. Dr. Yogan Pillay,
a senior official at the National Department of Health, said a policy was
being drafted and would be put forward for discussion by the end of the
month.
In March 2007, the
World Health Organization concluded from rigorous clinical trials in Kenya, Uganda and here in Orange Farm
township that male circumcision reduced female-to-male H.I.V. transmission by
about 60 percent.
“This is an
important landmark in the history of H.I.V. prevention,” the W.H.O. said at
the time.
That same year, a
committee of scientists, advocates and others advising the South African
government recommended offering circumcisions as quickly as possible, perhaps
by contracting with private doctors while public health workers were trained.
Instead, the government set up a task force to study the issue, said Dr. Abdool Karim, a committee
member.
The surgical
methods developed in Orange Farm are now being copied in the region.
Population Services International, which provides counseling at the Orange Farm
clinic, is putting them into practice in Zimbabwe in collaboration with
the Health Ministry there. It also received $50 million from the Bill and
Melinda Gates Foundation to work with the governments of Zambia and Swaziland in the hope of
circumcising some 650,000 men in those two countries.
South Africa has made strides in recent years, and now
provides antiretroviral therapy to more people with AIDS than any other
developing country.
But this is not
the first time its policies have lagged behind. The country delayed for years
providing antiretroviral medicines to treat AIDS under its former president,
Thabo Mbeki, who denied the scientific consensus about the viral cause of the
disease. Harvard researchers estimated that the government would have prevented
the premature deaths of 330,000 South Africans earlier in the decade if it
had provided the drugs.
“South Africa has no shortage of scientists,”
said Olive Shisana, chief executive officer of South Africa’s
government-financed Human Sciences Research Council. “We have a shortage of
people willing to take the evidence that exists and use it for public
health.”
http://www.nytimes.com/2009/07/20/world/africa/20circumcision.html?ref=health
[BACK TO TOP]
The New York Times | 07.18.09
By GARDINER HARRIS
Federal officials
may soon require improvements for the glucose monitors used by more than 11
million diabetics in the United
States.
The rise in the
use of home glucose monitors, even by hospitals, is pushing the action by the
Food and Drug Administration, which for decades has followed international standards
that allow the devices to be wrong by as much as 20 percent. Such a wide
error rate can leave patients vulnerable to severe problems, including
seizures, unconsciousness and coma.
In June, the
agency pressed the international group that sets the standards to tighten
them. If the group refuses to act, the agency “may instead recognize other
(higher) performance standards” on its own, according to a June letter from
Dr. Margaret A. Hamburg, the agency commissioner.
A change in the
international standards is the easiest and best option, officials said. The
International Organization for Standardization, which sets the standards, can
act quickly and broadly. But the F.D.A. can change the rules itself through a
more time-consuming and cumbersome process.
Officials said
they would keep pushing until monitor accuracy improves, a promise that
diabetes doctors cheered. In a May letter, the American Association of
Clinical Endocrinologists formally asked that the agency
act on the issue.
“Because of the
highly variable quality of the meters and the glucose testing strips in
widespread use, the safety of our patients who depend upon those meters is
threatened,” the letter said.
Khatereh Calleja, a
spokeswoman for the Advanced Medical Technology Association, which represents
monitor manufacturers, responded, “We think the present standard is working.”
Diabetes has been
diagnosed in 18 million people in the United States, and another 6
million are estimated to have the disease without knowing it. It is the
seventh leading cause of death and costs the United States an estimated $174
billion a year, with the federal Medicare program spending $1 billion on
diabetes test strips alone.
Of particular
concern to federal officials is the increasing use of home glucose monitors
in hospitals. A landmark 2001 study published in The New England Journal of
Medicine found that using insulin to maintain low blood sugar levels in
critically ill patients, even those without diabetes, reduced hospital deaths
by 34 percent — a result so astonishing that hospitals around the world soon
adopted the practice.
But instead of
buying the highly accurate and expensive glucose monitors used in the study,
many hospitals bought cheaper home models never approved for hospital use.
More recent studies have shown that critically ill hospital patients whose
glucose levels were kept low suffered more problems — the opposite result
from 2001.
The difference,
F.D.A. officials said, may have resulted because many patients in the second
study were checked with home monitors.
“We think this
technology is not up to par for some of the protocols we see out there” like
hospital treatment of critically ill patients, said Dr. Alberto Gutierrez,
deputy director of the agency’s in vitro diagnostics office. “We feel
passionately that this is an important issue.”
Besides having a
wide error rate, many home monitors give the wrong result if patients are
taking certain drugs like Tylenol or even vitamin C. The Accu-Chek
monitors made by Roche can be confounded by drugs commonly used in dialysis.
Julie A. Vincent, a Roche spokeswoman, said, “Every blood glucose monitor on
the market has some limitation or interferences.”
The F.D.A. issued
warnings about the drug-related problems, but doctors complain that they have
a hard time keeping straight which drugs conflict with which monitors.
“In the hospital
setting, you really don’t know how many deaths are due to things that may be
related to meter accuracy,” said Dr. Richard Hellman, a former president of
the endocrinology group. “I don’t know how common it is, but I don’t think
it’s rare.”
A study by
government researchers found that when comparing tests from five different
popular monitors, results varied by as much as 32 percent. For a class science
project recently, Morgan DiSanto-Ranney, 16, of Bishop O’Connell
High School in Arlington, Va.,
bought seven different glucose monitors and had her father, a diabetic, use
all of them.
“What I found was
that almost all of the meters were off from one another by 60 to 75 points,”
Morgan said in an interview. Two of the meters — Ascensia
Breeze and Ascensia Breeze II, both made by Bayer —
differed by an average of 62 points, she said.
Staci Gouveia, a Bayer spokeswoman, said her company’s monitors
meet federal requirements. “If the F.D.A. standards change, Bayer will work
with the F.D.A. to meet their requirements and assure the accuracy and
effectiveness of our meter,” Ms. Gouveia said.
Morgan’s mother is
Emilia DiSanto, a staff investigator for Senator
Charles E. Grassley, Republican of Iowa. Briefed on Morgan’s test and other
studies, Mr. Grassley sent a letter to the F.D.A. in June asking officials to
review the problem.
As a result of her
project, Morgan’s father lost faith in glucose monitors. “He doesn’t use them
as much anymore,” she said.
That reaction is
exactly what federal officials are hoping to avoid by quietly pressing
manufacturers to improve accuracy. Multiple studies make clear that diabetics
who routinely use monitors are healthier and suffer fewer serious
complications than those who do not.
Manufacturers have
long complained that any requirement to improve accuracy would lead them to
raise prices, which would discourage use.
“If we decrease
the use of meters, you will have some fairly dire consequences to health,”
Dr. Gutierrez said, but requiring stricter accuracy standards “seems a
reasonable and safe practice to do.”
Every year, the
F.D.A. receives reports of several deaths and thousands of injuries related
to glucose monitor failures, but the reports represent only a fraction of the
actual toll. Insulin-dependent diabetics slip into unconsciousness once a
year on average, and 40 percent suffer seizures or
coma in their lifetimes because of low blood sugar levels, according to the
American Diabetes Association, which has long advocated stricter accuracy
standards for monitors.
“Insulin is a
dangerous drug, and if someone makes the wrong decision about its use because
of a bad test, they could die,” said Dr. David Sacks, an associate professor
of pathology at Harvard
Medical School.
http://www.nytimes.com/2009/07/19/health/policy/19monitor.html?ref=health
[BACK TO TOP]
The New York Times | 07.18.09
By ANNE EISENBERG
A TINY glass
telescope, the size of a pea, has been successfully implanted in the eyes of
people with severely damaged retinas, helping them to read, watch television
and better see familiar faces.
The new device is
for people with an irreversible, advanced form of macular degeneration in
which a blind spot develops in the central vision of both eyes.
In a brief,
outpatient procedure, a corneal specialist implants the mini-telescope in one
eye in place of its natural lens. The telescope magnifies images on the
retina, extending them so they fall on healthy cells outside the damaged
macula, said Allen W. Hill, chief executive of VisionCare
Ophthalmic Technologies in Saratoga,
Calif., the implant’s maker.
In March, an
advisory panel to the Food and Drug Administration unanimously recommended
approval of the device. VisionCare says it expects
the F.D.A. to give its O.K. later this year. The device has already been
approved for use in Europe.
The implanted
telescope holds much promise for patients, typically elderly, who suffer from
end-stage, age-related macular degeneration, or A.M.D., said Janet P. Szlyk, a member of the advisory panel. Dr. Szlyk is executive director of the Chicago Lighthouse for
People Who Are Blind or Visually Impaired, a social services agency.
The device does
not cure the disease, but it does improve visual acuity, she said. For
example, a person who might usually see a blur when looking at a friend’s
face might, with the help of the magnified image, see a blur only in the area
of the person’s nose or mouth.
“People can use it
to recognize faces in a social setting,” she said. ‘That’s a huge advance.”
The telescope is
implanted in one eye for jobs like reading and facial recognition. The other
eye, unaltered, is used for peripheral vision during other activities like
walking. After implantation, extensive therapy is crucial, she said, to learn
to deal with the different abilities of the eyes.
Ruth A. Boocks, 86, of Alpharetta,
Ga., who received an implant of
the device in March 2003 during clinical trials, said her brain learned to
adapt quickly. Mrs. Boocks uses her new visual
abilities in various ways — for instance, to read e-mail and the messages
that scroll across the bottom of the screen when she’s watching television.
“My goal was to read to the bottom of the eye charts,” she said. “But I
didn’t quite make it.” (She has gotten to the third line from the bottom.)
“I feel like a
young woman,” she added. “It’s opened a lot of opportunities for me.”
Henry L. Hudson, a
retina specialist in Tucson,
Ariz., and lead author of two
papers on the telescope published in peer-reviewed journals, said the device
was not for everyone with A.M.D. “Maybe only 20 out of every 100 candidates
will get the telescope,” he said. “They may not be eligible because of the
shape of their eyes,” or they may have another problem, like maintaining
balance, that precludes their selection, he added.
After F.D.A.
approval, VisionCare will apply to Medicare to
cover the device, Mr. Hill said. “We anticipate that it will be seen as a
covered benefit for the improvement of visual acuity,” he said.
The price of the
device has not been set. Current tools for ameliorating low-vision problems,
like glasses fitted with telescopes or reading machines,
are typically not covered by insurance.
Dr. Bruce P.
Rosenthal is chief of low-vision programs at Lighthouse International in New York City, where
telescopes mounted on eyeglass frames, for instance, might be prescribed for
people with A.M.D. to help them watch a sports event. He said that patients
might be as well served by these glasses as by the new implants, and that he
hoped long-term studies would compare the benefits of the two approaches.
“Even though
studies on the implants have reported minimal complications, there can be
complications when you are inserting anything in the eye,” he said. “Even
routine cataract surgery can lead to loss of vision.”
Dr. Rosenthal said
the implanted telescope might be beneficial for some patients, “especially if
they don’t want other people to know they are visually impaired.” Telescopes
mounted on eyeglasses bulge outward, often extending an inch or so beyond the
frames.
But he is
concerned that people using implants might have trouble with balance. “There
is a potential for falling when a person has a big image from one eye and a
normal-sized image from the other,” he said.
DURING trials of
the device, there was no increase in the incidence of falls among
participants, Dr. Hudson said. More than 200 patients received implants in
the study, and the effects have been tracked in the group for the past five
years.
“The vast majority
of the patients have been able to adapt to the new state,” using one eye for
ambulating and the other for reading, facial recognition and similar chores,
he said. “The average patient goes from legally blind to being able to read
large-print books.”
http://www.nytimes.com/2009/07/19/business/19novel.html?ref=health
[BACK TO TOP]
The New York Times | 07.17.09
By ROBERT PEAR and
DAVID M. HERSZENHORN
WASHINGTON — Three of the five Congressional
committees working on legislation to reinvent the nation’s health care system
delivered bills this week along the lines proposed by President Obama. But
instead of celebrating their success, many Democrats were apprehensive,
nervous and defensive.
Even as Democratic
leaders and the White House insisted that the nation was closer than ever to
landmark changes in the health care system, they faced basic questions about
whether some of their proposals might do more harm than good.
And while senior
Democrats vowed to press ahead to meet Mr. Obama’s deadline of having both
chambers pass bills before the summer recess, some in their ranks, nervous
about the prospect of raising taxes or proceeding without any Republican
support, were pleading to slow down.
Democrats had
three reasons for concern. The director of the Congressional Budget Office
warned Thursday that the legislative proposals so far would not slow the
growth of health spending, a crucial goal for Mr. Obama as he also tries to
extend insurance to more than 45 million Americans who lack it.
Second, even with
House committees working in marathon sessions this week, it was clear that
Democrats could not meet their goal of passing bills before the summer recess
without barreling over the concerns of Republicans and ending any hope that
such a major issue could be addressed in a bipartisan manner.
Third, a growing
minority of Democrats have begun to express reservations about the size,
scope and cost of the legislation, the expanded role of the federal
government and the need for a raft of new taxes to pay for it all. The
comments suggest that party leaders may not yet have the votes to pass the
legislation.
Mr. Obama tried
Friday to shift the political narrative away from the grim forecasts of the
Congressional Budget Office. He said he and Congress had made “unprecedented
progress” on health care, with even the American Medical Association
endorsing the House bill this week.
He acknowledged a
treacherous path ahead, saying, “The last few miles of any race are the
hardest to run,” but insisted, “Now is not the time to slow down.” And he
vowed: “We are going to get this done. We will reform health care. It will
happen this year. I’m absolutely convinced of that.”
On Capitol Hill,
the picture is more complex. Representative Jared Polis, a freshman Democrat
from Colorado
who voted against the bill approved Friday in the Education and Labor
Committee, said he worried that the new taxes “could cost jobs in a
recession.”
To help finance
coverage of the uninsured, the House bill would impose a
surtax on high-income people and a payroll tax — as much as 8 percent
of wages — on employers who do not provide health insurance to workers.
Mr. Polis said
these taxes, combined with the scheduled increase in tax rates resulting from
the expiration of Bush-era tax cuts, would have a perverse effect. “Some
successful family-owned businesses would be taxed at higher rates than
multinational corporations,” he said.
In a letter to the
House speaker, Nancy Pelosi, Mr. Polis and 20 other freshman Democrats said
they were “extremely concerned that the proposed method of paying for health
care reform will negatively impact small businesses, the backbone of the
American economy.”
And in the latest
sign of lawmakers’ chafing at Mr. Obama’s ambitious timetable, a bipartisan
group of six senators, including two members of the Finance Committee, sent a
letter to Senate leaders pleading with them to allow more time.
“While we are
committed to providing relief for American families as quickly as possible,”
they wrote, “we believe taking additional time to achieve a bipartisan result
is critical for legislation that affects 17 percent of our economy and every
individual in the United
States.”
The group included
three senators, Ben Nelson, Democrat of Nebraska; and Olympia J. Snowe and Susan Collins, Republicans of Maine, who met
with Mr. Obama at the White House this week and urged him not to rush the
bill.
“The legislative
process right now is going in the wrong direction,” said Senator Joseph I.
Lieberman, the Connecticut
independent, who also signed the letter. “I think it’s extremely doable to
get this done before the end of the year. But just to try to get it passed in
the Senate before we leave for the August recess seems just about impossible.
It’s just too big a bill.”
The House
education committee approved the bill, 26 to 22, on Friday morning, after an
all-night session. Three Democrats crossed party lines and voted no.
The vote came
eight hours after the House Ways
and Means Committee approved a nearly identical bill, 23 to 18, with 3
Democrats voting no. On Wednesday, the Senate health committee approved a
generally similar bill on a party-line vote, 13 to 10.
The House and
Senate bills would require insurers to take all applicants and vastly expand
coverage, with federal subsidies for millions of people.
But the director
of the Congressional Budget Office, Douglas W. Elmendorf, testified on
Thursday that doing so would come at a steep cost and that the proposals
would not curb the rise in health spending by the federal government, which
he called “unsustainable.”
A budget office
analysis released Friday said the House bill would “result in a net increase
in the federal budget deficit of $239 billion” over 10 years, partly because
of an increase in Medicare spending to avert sharp cuts in payments to
doctors.
House Democrats
who voted no cited various concerns.
“We are not doing
enough to reform the health care delivery system, to change the incentives so
reimbursement will be based on the value, rather than the volume, of
services,” Representative Ron Kind of Wisconsin said.
Others worry that
a government-run health plan, to be created under the House bill, would underpay
doctors and hospitals by using Medicare reimbursement rates. “I have a
serious problem with the public plan in this bill because it’s based on
Medicare rates,” Representative Earl Pomeroy of North Dakota said. “North Dakota is underpaid by Medicare.”
Mr. Obama said he
was confident that Congress and the White House would reach a deal on how to
pay for the bill, and lower health care spending over the long term — an
optimistic view that not all lawmakers share. But on one of Mr. Obama’s
points, there was no dispute: “We’re going to be putting in a lot more
hours,” the president said. “There are going to be a lot more sleepless
nights.”
http://www.nytimes.com/2009/07/18/health/policy/18health.html?ref=health
[BACK TO TOP]
By Steven Reinberg
THURSDAY, July 16
(HealthDay News) -- The obesity epidemic in the United States is hitting minorities the
hardest, U.S.
health officials report.
Here are the hard
numbers: Blacks have a 51 percent greater prevalence of obesity than whites,
and Hispanics have 21 percent greater obesity prevalence than whites,
according to researchers from the U.S. Centers for Disease Control and
Prevention.
Obesity rates also
vary geographically. Among blacks and whites, the highest rates of obesity
are in the South and Midwest. Among
Hispanics, obesity rates were highest in the South, Midwest
and West, according to the July 17 issue of the Morbidity and Mortality
Weekly Report, a CDC publication.
"There are at
least three reasons for these findings," said study author Dr. Liping Pan, a CDC epidemiologist. "The first is
individual behavior."
For example,
blacks and Hispanics are less likely to engage in physical activity compared
with whites, she said.
There are also
differences in attitudes and cultural norms, Pan said. "For example,
black and Hispanic women are more accepting of their own body size than white
women," she said. "They are happy with their weight and less likely
to try to lose weight."
The third factor
is the limited access to healthy affordable food and safe places to engage in
physical activity, Pan said.
Pan noted that all
ethnic and racial groups in the United States have a high
prevalence of obesity. Programs to fight obesity need to be directed at
everyone, not just specific groups, she said.
For the report,
Pan's team uses data from the CDC's Behavioral Risk Factor Surveillance
System for 2006 through 2008.
The researchers
found that, in 40 states, the prevalence of obesity was 30 percent or more
among blacks. In Alabama, Maine,
Mississippi, Ohio
and Oregon,
the obesity rate among blacks was 40 percent or more.
Among blacks,
obesity rates ranged from 23 percent to 45.1 percent throughout the United States.
For Hispanics the obesity rate ranged from 21 percent to 36.7 percent. In 11
states, the prevalence of obesity was 30 percent or higher among Hispanics,
Pan's group found.
Among whites, the
prevalence of obesity ranged from 9 percent to 30.2 percent around the
country. West Virginia
was the only state where the prevalence of obesity among whites was 30
percent or more.
The CDC is
currently focusing its efforts on getting people to eat more fruits and
vegetables and stay away from high-calorie, high-sugar foods. In addition,
the agency is encouraging new mothers to breast-feed their infants, Pan said.
Dr. David L. Katz,
director of the Prevention
Research Center
at Yale University School of Medicine, said that while there are reasons for
the toll obesity is taking on blacks, whites are
also dealing with the same obesity problem.
"We should
not be surprised to see major disparities in obesity, since the factors that
cause it -- eating the wrong kinds of food and too much, and doing too little
activity -- are themselves highly disparate in our society," Katz said.
Relative poverty,
lower levels of education, neighborhoods that provide limited opportunity for
outdoor recreation or to find and choose healthful foods are
the underlying problems, Katz said. "There are ethnic disparities in
obesity because there are ethnic disparities in the basic standard of
living," he said.
"We should,
of course, direct resources at this problem where it is most acute,
developing community-based interventions to control and prevent obesity where
it is most rampant. But we should also recognize that we are all in the same
boat," Katz said.
Recently published
projections indicate that all adults in the United States will be overweight
or obese by 2048, should current trends persist, he noted. "Dedicated
efforts to combat obesity-related disparities should take place within a
society-wide effort to curtail this threat that is stalking us all," he
said.
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