LSUHSC’s
Martin says syphilis comeback could wipe out control gains, gonorrhea more
treatment resistant
New Orleans, LA – Dr. David H. Martin, Professor and Chief of the
Section of Infectious Diseases at LSU Health Sciences Center New Orleans
School of Medicine, updated reporters and the National Foundation for
Infectious Diseases on sexually transmitted diseases in the United States on July 22, 2009 at the National Press
Club in Washington , DC. Dr.
Martin, whose presentation was called, Sexually Transmitted Diseases: Neither
Gone nor Forgotten, revealed significant information about STDs including
Chlamydia trachomatis, gonorrhea, syphilis, and a
relatively new STD, Mycoplasma genitalium.
Highlights include
– the number of cases of the asymptomatic Chlamydia trachomatis,
the most common reportable infectious disease in the US, is growing;
gonorrhea, the second most common reportable infectious disease in the US, is
growing more resistant to treatment; syphilis is making a comeback which
could wipe out the gains made in syphilis control following the epidemic of
the late 1980s; and M. Genitalium has the potential
to become a public health target as recent work has now linked it to pelvic
inflammatory disease in women along with being a known cause of nongonococcal urethritis in
men. Dr. Martin’s complete presentation follows.
The most common
bacterial STD: Chlamydia trachomatis is the most
common reportable infectious disease in the United States and the number of
cases is growing every year thanks in part to increasing screening efforts.
It is particularly of concern in adolescents and young adults, and also in
African-American populations, among who reported case rates are 8-fold higher
than in whites. The major adverse events associated with chlamydial
infections are borne by women and include pelvic inflammatory disease,
chronic pelvic pain, ectopic pregnancy and infertility. The organism also can
infect infants at birth and causing conjunctivitis and, more importantly,
pneumonia. In men C. trachomatis causes urethritis and occasionally a testicular inflammatory
condition known as epididymitis. However, most chlamydial infections are asymptomatic. These silent
infections form a large reservoir of infection in the population resulting in
potential for continuous transmission of the organism among those who are
sexually active outside of long term monogamous relationships. Excellent C. trachomatis diagnostic tests are now available and can be
performed on urine specimens. Treatment is inexpensive and safe. Therefore,
theoretically, this common STD could be dramatically curtailed in the U.S.
population if broad based screening efforts were undertaken. In 1989 the U.S.
Preventive Services Task Force recommended C. trachomatis
screening of all sexually active young women. However there are significant
barriers to achieving this goal. These include lack of access to health care,
health care provider reticence to address sexual health issues with their
patients, limited budgets to support screening programs, insufficient
treatment of exposed sex partners, and lack of knowledge on the part of young
sexually active individuals about the true risk of unprotected sexual
intercourse with multiple partners. An example of the limited effect of the
screening recommendation can be found in the data reported by the Healthcare
Effectiveness Data and Information Set (HEDIS) during 2000 2007 and collected
by the CDC. Nationally, the annual screening rate increased from 25.3% in
2000 to 43.6% in 2006, and then decreased slightly to 41.6% in 2007. We
should be doing better. Approaches that are being employed by some public
health agencies around the country include screening high risk populations in
high schools, juvenile retention facilities, adolescent clinics, and drug
treatment centers. Self collection of specimens (vaginal swabs in women and
urine specimens in both sexes) which can be mailed to testing facilities is
now possible and some public health agencies across the country are experimenting
with novel ways of encouraging the at risk population to do so. Increased
Chlamydia testing and treatment should be a goal of evolving plans for health
care reform in the U.S.
Decreasing
treatment options for gonorrhea: Gonorrhea is a potentially dangerous
disease, causing complications similar to those from Chlamydia as well as
potential for disseminated infection. While effective treatment options and
aggressive screening for the causative agent, Neiserria
gonorrhoeae, has made it much less common over the
last four decades, it remains the second most common reportable infectious
disease in the U.S. Racial disparities are more pronounced for gonorrhea than
any other infectious disease, with 19 times higher case rates in African
Americans than whites. An emerging challenge for gonorrhea control is
increasing resistance to currently available antibiotics. In the 1970’s
penicillin resistant N. gonorrhoeae was introduced
into the U.S. by soldiers
returning from the Viet
Nam war. More recently travelers to and
from the Far East brought quinolone antibiotic
resistant strains into the U.S.
These initially were identified in Hawaii
and the West Coast but subsequently spread throughout the country. CDC
recommended against using these well tolerated and inexpensive drugs for the
treatment of gonorrhea in 2008. The cephalosporin class of drugs is now the
mainstay of gonorrhea treatment in the U.S. Unfortunately, there is early
evidence that resistance to this class of drugs may be appearing in N. gonorrhoeae strains isolated from patients in the Far East. Should this problem become wide spread there
would few options available for treating this highly infectious disease. The
N. gonorrhoeae story is a paradigm of how
injudicious use of antibiotics combined with decreased new antibiotic
discovery research may result in a future where untreatable bacterial
infections are common.
The "great
imitator" makes a comeback: By the year 2000 syphilis incidence rates in
the U.S.
had dropped to the lowest levels ever recorded. There was hope that syphilis
could be eliminated in this country and in 1999 CDC launched a national
syphilis elimination program. The plan focused on the South, specifically
counties with persistent relatively high rates of disease. Unfortunately,
beginning in 2001 rates began to rise among men in the West and the Northeast
and have continued to do so since. The majority of these cases have been in
men who have sex with men (MSM) many of whom are HIV infected as well,
creating the potential for enhanced HIV transmission as well as complications
from syphilis, such as neurologic disease. Rates among women continued to
decrease until 2004 when they too began to increase. Soon thereafter in 2006
the feared consequence of increasing numbers of syphilis cases among women,
congenital syphilis, also began to rise. These issues are of great concern as
the gains made in syphilis control following the epidemic of the late 1980s
could be wiped out. As heterosexual syphilis transmission is concentrated in
communities with limited health care resources syphilis control will be
another measure of the success of health care reform in the U.S.
Advances in
molecular microbiology lead to the discovery of a new STD: Mycoplasma genitalium was first
identified in the early 1980s through the serendipitous isolation and
propagation of a single strain isolated from a man with urethritis.
Inability to identify subsequent isolates using the methods of classical
microbiology foiled research efforts for a decade. In the early 1990’s application
of newly developed polymerase chain reaction technology to diagnosis of
infections caused by this organism greatly advanced the work. We now know
that M. genitalium is an important cause of nongonococcal urethritis in
men. Very recent work has shown that there is an association with pelvic
inflammatory disease in women. If it is established that this organism is
associated with serious adverse health outcomes in women such as infertility
and/or that it has consequences for infants born to infected mothers M. genitalium will join C. trachomatis
and N. gonorrhoeae as public heath targets.
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The Associated
Press
(AP) — NEW ORLEANS - Two major medical conventions have signed
contracts to hold meetings in New
Orleans.
The New Orleans
Convention and Visitors Bureau said Wednesday that the Healthcare Information
and Management Systems Society and the American Academy
of Ophthalmology will bring major conventions to the city in 2013 and 2017.
In 2007, the
Healthcare Information and Management Systems Society brought about 24,600
members to New Orleans.
They are to return in 2013.
The American Academy
of Ophthalmology last visited New Orleans
in 2007, with more than 22,000 people. They are to return in 2013 and 2017.
The 2013 meetings
will coincide with New Orleans hosting other
high-profile conventions including the American Society of Neurological
Surgeons and the American
College of
Obstetricians and Gynecologists.
New Orleans also will host the NCAA Women's Final Four
and the Super Bowl in 2013.
http://www.nola.com/newsflash/index.ssf?/base/national-39/1248342529134090.xml&storylist=louisiana
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Jindal
Pans Obama's "Marketing" of Health Plan
Posted by Daniel
Carty
Louisiana Gov.
Bobby Jindal said President Obama's push for health
care reform is more about rhetoric than reality.
"His
marketing is the best part of this," the Republican governor said
Thursday on CBS' "The Early Show", the morning after Mr. Obama
addressed the nation in a prime time news conference aimed at jumpstarting
support for his health initiative.
"[Obama]
said, he does not want to increase the deficit, does not want government
control of health care. He wants people to keep their insurance. He wants to
crack down on the abuse, the over utilization. All that's great. The problem
is that's not what's in the House Democrat bill. The House Democratic bill
increases the deficit by $250 billion [and] increases the burden on
employers. Why would we want to do that during one of the worst recessions in
decades?"
In his news
conference, Mr. Obama emphasized the importance of reform, but pledged that
he would not support any plan that increased the federal deficit or placed an
economic burden on middle-class families.
Mr. Obama has
insisted that a public plan option will increase competition and drive costs
down in the private sector. Jindal agreed that the
"status quo is not acceptable" but said a government-run plan is
not the solution.
"Nobody is
defending the status quo," said Jindal, who
has been mentioned as a possible GOP presidential candidate in 2012. "We
don't want a bureaucrat telling us which treatments we can receive, which
providers to go to, how much they'll be paid. We don't want government
competition in TV stations, in factories, in stores, in groceries. Why do we
think we need government competition in healthcare? Why do we need the
government to run a plan to make healthcare work?"
"This is the
fundamental issue here. How do you have the government, which is paying for
health care, regulating health care, now competing with the private
sector?"
Jindal also said the tax penalties for not
participating in the plan would place an undue burden on individuals and
business owners.
"Look, in the
House plan they're talking about an 8 percent tax on employers who don't want
to participate [and a] 2.5 percent tax on individuals who don't want to
participate. Our top tax rates in many states are going to be higher than
what you see in Europe. We don't need to be
increasing taxes during these economic times."
White House
adviser David Axelrod, appearing on the "Early Show" after Jindal countered the governor's argument, saying the plan
would give consumers greater control of their own health care.
"The bottom
line here is right now healthcare premiums have doubled over the last decade.
Out of pocket costs up by a third. Health care costs are growing three times
the rate of wages. It's an unsustainable path, and the government is being
crunch the by it, businesses are being crushed by it," he said.
"We have to
respond. Mr. Jindal says, 'Well, the government
shouldn't interfere in the market.' The bottom line right now is everyone is
at the mercy of the insurance industry, and this would reform the system and
put consumers in control. That's what we need."
http://www.cbsnews.com/blogs/2009/07/23/politics/politicalhotsheet/entry5181955.shtml
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Linda Prentice
Re:
"Government control could be a hazard to your health," Other
Opinions, July 11.
Arguments against
proposed health care reform, such as this column by Cal Thomas, tend to focus
on a theoretical lack of freedom in health-care choices and theoretical long
delays for those requiring care. When you have adequate health insurance and
a decent income, these arguments may seem reasonable. What is ignored is how
perilous the current situation is for an average middle-income worker.
I started out with
a well-paying job and what would be considered decent health benefits. I have
now lost my job due to illness, and in the next few months it is likely I
will not be able to pay my COBRA premiums any longer. Unfortunately, my
illness won't just go away because I have lost my health benefits. I will
just be unable to afford necessary medication, and since almost every private
doctor in New Orleans
now requires uninsured patients to pay up front, it is unlikely I will be
able to obtain necessary maintenance treatment.
When my health
situation becomes critical enough, I will probably have to be admitted to a
hospital on an emergency basis since I can't be refused treatment at that
point, and there will be no health insurer to pay the bill. As I am
unemployed, it is unlikely that I will have the funds to pay the full bill,
which means the cost will be passed on to insured patients.
I did not realize
this prior to my illness, but it is almost impossible to qualify for
emergency health assistance programs until you have lost all assets,
including your home.
I personally would
be more than willing to risk any hypothetical future problems rather than
continuing with things they way they are.
Linda Prentice
New Orleans
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/1248327327226930.xml&coll=1
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C. Ray Halliburton
I have followed
the current debate regarding national health-care funding reform with great
interest. Both national statistics and my personal experience indicate that
paying for health care is becoming increasingly problematic for an increasing
number of people. I find it difficult to formulate a brief opinion, so I will
compose a short (and incomplete) wish list of things that I would like to see
happen in this arena.
First of all, I
would like to see universal health-care coverage. It seems apparent to me
that 99 percent of us already think health care should be a right, at least
to those who are gravely injured or ill. We have made laws that prohibit
health-care facilities from refusing emergency care because of the person’s
inability to pay. We just can’t agree on how to cover that expense. So
health-care facilities shift the cost of the nonpaying patients to the paying
patients when able.
Therefore, my
second wish is to require every citizen (excepting only the truly poor) to
pay into health-care coverage to minimize or eliminate the need for cost
shifting.
Thirdly, I would
like to see more consistency among the payers of health-care services about
what they will and will not pay for. Speaking from personal experience,
trying to determine what a particular patient’s health-care plan will cover
is often like being in a Franz Kafka short story. Though private payers
generally compensate better for services compared with Medicare, they are
more opaque in terms of knowing if they will pay at all for a specific
service for a specific patient.
Fourthly, I think
we have to move away from linking payment for health care to employ-menet status. I believe this is both an impediment to
hiring and a problem for the worker who changes employer. Currently, the U.S.
government has taxpayer-funded programs to provide care to the people who are
not employed (the retired, the disabled, the nonworking poor and some working
poor) but assumes that the employed citizens will all be taken care of by
their employers or by themselves. This was a good assumption in 1969 but much
less so today. There are many other important items that I will not touch on
in the interest of brevity.
Let us consider
what is important in our own lives and what we are willing or not willing to
pay for (through either premiums or taxes). With the growing national
deficit, it seems that whatever is done should be at least budget
neutral.
I hope that many
of us will share our thoughts with our senators and congressmen. I think they
need our honest input more than clever, partisan catchphrases.
C. Ray Halliburton
physician,
internal medicine
Baton Rouge
http://www.2theadvocate.com/opinion/51444537.html
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NEW ORLEANS (AP) - As the fourth anniversary of
Hurricane Katrina nears, four new reports by Congress' investigative arm have
found a wide range of problems with the federal government's handling of the
storm's aftermath.
The Government
Accountability Office reports were a reminder that the federal government's
response to the costliest disaster in U.S. history has been flawed, and
that the nation may be unprepared for the worst disasters.
In particular, the
batch of reports, which were released Monday, looked at the inadequate mental
health services for children in the New Orleans
region and the state's disaster-struck health care system, at how workers
helping disaster victims had overwhelming caseloads and at how Louisiana and Mississippi
used their federal rebuilding money differently.
"Four years
after Hurricane Katrina struck, many of its survivors continue to struggle,
which means that we must continue to fight for more effective programs to
help those in need," Sen. Joe Lieberman, I-Conn. and chairman of the
Senate Homeland Security and Governmental Affairs Committee, said on Tuesday
about the GAO reports.
Lieberman said Congress,
the Federal Emergency Management Agency and the White House "must learn
our lessons" to ensure citizens "receive the support they need to
rebuild their lives, and taxpayers receive their money's worth."
In one report, the
GAO said case management agencies for disaster victims had high turnover and
that "some case managers had caseloads of more than 100 clients, making
it difficult to meet client needs."
The report said
the federal government had spent more than $209 million for "disaster
case management services," which helped about 116,000 families affected
by Katrina and Rita. The GAO said FEMA was trying to develop better
guidelines for disaster case management.
Another GAO report
found serious problems with the way children were treated for mental health
issues. Child psychiatrists and psychologists were scarce after the storms,
funding was unreliable, and families were often unwilling or unable to get
their children treated, the report said.
"Children in
the greater New Orleans
area may be at particular risk for needing mental health services," the
GAO said.
According to
semiannual screenings of children, the LSU Health
Sciences Center
found about 30 percent of 12,000 children as of January 2008 "met the
threshold for a possible mental health referral," the report said.
An LSU researcher
said the 2008 data "showed that 16 to 21 percent of children screened
had a family member who had been injured in Hurricane Katrina, and 13 to 18
percent of children screened had a family member who had been killed in the
hurricane," the GAO said.
That rate was
better than the 2005-2006 school year screening, but "the rate of
decline was slower than experts had expected," the GAO report said.
"The effects of a traumatic event can persist for years," the GAO said.
The GAO report on
children did not offer recommendations. Two other GAO reports dealt with the
federal government's handling of Community Disaster Block Grant funds and the
Department of Health and Human Services' $100 million in health care grants to
Louisiana
to restore primary care services for the poor.
The GAO said the
Department of Housing and Urban Development should develop guidelines for
future disasters to spell out how the community block funds can be used,
after Louisiana and Mississippi went different ways with their
money.
In Louisiana, the state adopted a plan "that linked
federal funds to home reconstruction and controlled the flow of funds to
homeowners, while Mississippi
paid homeowners for their losses regardless of their intentions to
rebuild," the GAO said.
"This helped Mississippi avoid challenges that Louisiana would encounter, but with fewer
assurances that people would actually rebuild," the report said.
"Federal
guidance was insufficient to address Louisiana's
program and funding designs," the GAO said.
Since 2005,
Congress has appropriated about $26.2 billion in CDBG funds to help the Gulf Coast
recover from four major storms - Katrina, Rita, Ike and Gustav.
As for health care
funds spent in New Orleans,
the GAO said that despite the HHS' grant money, primary care providers still
found it hard to find and retain staff and refer patients "outside of
their organizations." "And these challenges have grown since
Hurricane Katrina," the GAO said.
"From
strengthening case management, to untangling housing funds from bureaucratic
red tape, to increasing access to mental health and other primary health care
services, these GAO reports shed light on several concrete steps our
government must take to improve response and recovery," said Sen. Mary
Landrieu, D-La., who chairs the Senate's subcommittee on disaster response.
http://www.wlox.com/Global/story.asp?S=10772636&nav=6DJI
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Jackson Sun | 07.23.09
There are more
than 47 million Americans who lack any form of health insurance, so they
mostly do without. Some of them have even lost their lives due to an
inability to get treatment for certain treatable conditions.
According to a University
of Maine study, our country has the most costly health care system in the
industrialized world, being twice as expensive as average. But the CIA World Factbook says the U.S. ranks 45th in length of
lifespan at birth. Private enterprise has proven itself unable to run the
health care industry. That leaves only the government to save what is left.
The ignorant blame
physicians for living too high on the hog and overcharging their patients.
That is simply because doctors are more visible than other health care
players. It is true that education is usually their justification for their
high fees, but that is a shallow argument until doctors of music make as much
as doctors of medicine. But as members of the local economy, it makes little
difference, because they contribute heavily to taxes and the general welfare
of the community.
Even if doctors
practiced for free, the cost of medical care would still be astronomical. But
one should point out that it makes sense to educate more doctors. But this is
where the American Medical Association controls supply and demand by limiting
seats in medical schools. In this regard, they are an un-American institution
by indirectly, but effectively, restraining free trade. And publishing
national cost averages for medical procedures also is distasteful when almost
every other businessman gets prison time for even discussing the subject of
price fixing.
Our local public
hospital is probably typical of others and is a prime culprit when it comes
to the cost of health care. A bill from the hospital makes the doctor's
charges seem like a bargain, which they are by comparison. Physicians are at
least doing something while hospitals are just following orders and
warehousing. In a normal year our hospital doubles its money on every patient
that rolls out of there, and considering that their base price is ridiculous
to start with, doubling it is especially reprehensible, even if common. The
giveaway that they are riding a good horse to death is that they made as much
money from investments as they did from medicine in past years.
The pharmaceutical
companies' management ought to wear black ski masks. Probably the most
lucrative segment of the health care pie is wolfed down by them. Their excuse
is that research is expensive and they deserve consideration for undertaking
what others call "business investment." It is just another
"cost of sale" according to accountancy. But if new drugs are
profoundly risky and rarely as useful as they would have us believe, give
them some legislative relief from frivolous lawsuits while requiring that
they sell their product for the same price here as they do in other
countries.
And then there are
the insurance companies. Their story is that they facilitate their
policyholders for averages up to 15 percent of the billing. Of course, that
presumes that they allow the billing or the procedure to be performed in the
first place. We probably all know at least one friend who went to the
graveyard because he or she lacked the legal fees to fight an insurance
company when a procedure was arbitrarily disallowed by some clerk.
Conversely, they try to practice medicine by dictating what the doctor may or
may not do. But their worst disservice to the industry is by inserting
themselves between the buyer and the seller, the patient and the system.
Nothing encourages gouging or soaring charges like two people deciding how
much a third person should pay for something.
The bottom is
"out of the tub," and only the government is big enough to fix it.
It will be a tremendous job, but even a blind man can see that now is the
time.
http://www.jacksonsun.com/article/20090723/COLUMNISTS20/907230303
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By CHARLES
BABINGTON
WASHINGTON — After
weeks of urging lawmakers to embrace his health care agenda, President Barack
Obama is taking his case back to the road Thursday as the public's qualms
about the plan seem to be growing.
In his comments
Wednesday and at scheduled events Thursday in Cleveland, the president is
speaking directly to families about their pocketbook and medical concerns,
urging them to ignore political opportunists and naysayers in order to
achieve sweeping changes, which previous administrations could not attain.
"If we do not
reform health care, your premiums and out-of-pocket costs will continue to
skyrocket," Obama said Wednesday night, looking past the dozens of
reporters assembled for his White House news conference and peering straight
into the TV cameras. "If we do not act, 14,000 Americans will continue
to lose their health insurance every single day."
On Thursday in Ohio, the president will undertake two more events
focused on health care, the issue dominating his administration even as the
economy still suffers and wars continue in Iraq
and Afghanistan.
For his supporters, Obama's stepped-up pace is coming not a second too soon.
For all his
efforts, which have included public statements each weekday for the past few
weeks, Republican lawmakers and other critics sense
momentum building against Obama's plan. They particularly cite nonpartisan
cost projections that have not predicted the savings the White House
promises.
"What I heard
last night was a president that seems somewhat frustrated that people do not
understand what this government health care plan is all about," Rep.
Eric Cantor of Virginia, the House Republican whip, said Thursday on NBC's
"Today" show. "I think people still have a lot of questions
about what a (new) health care plan means for them and their families."
Louisiana Gov.
Bobby Jindal, another leading Republican, said on
CBS's "The Early Show" that he "liked a lot of what he (Obama)
had to say last night."
"I think he's
actually ... his marketing is the best part of this," Jindal added. "You listen to what the president
said. He said he does not want to increase the deficit, does not want
government control of healthcare. He wants people to keep their insurance. He
wants to crack down on the abuse, the over-utilization. All that's great. The
problem is, that's not what's in the House Democrat
bill."
The number of
Americans who disapprove of the president's health care plan has jumped to 43
percent, compared with 28 percent in April, according to the latest
Associated Press-GfK poll. Obama still holds a
strong hand, with most Americans favorable to him in general, and half
supporting his health care agenda.
But it's the
negative trend that worries his supporters, and some want the president to be
even more forceful and visible in pushing his top domestic priority.
"He's the
great communicator," said Rep. Jim Cooper of Tennessee, a moderate Democrat who wants
lower costs but supports the overall thrust of Obama's efforts. "If
anybody can explain this, he can."
"The White
House needs to assert more authority," said Cooper, who has focused on
health care for years. "I'll be relieved when they take over the
marketing of this, because Congress has done a terrible job."
It's hard for
Obama, or anyone, to succinctly advocate health care changes just now because
multiple versions are slowly moving through the Democratic-controlled House
and Senate.
"The case has
not been made" for a particular version because the eventual legislation
is unclear, said Rep. Artur Davis, D-Ala. With
critics seizing on the confusion to attack the Democratic proposals' costs,
enhanced government role and uncertain benefits, Davis said Wednesday, the
administration soon must decide whether to accept a partial victory that
might leave room for a later push for the rest.
For now, Obama
keeps insisting on all the major elements of his far-reaching proposal and
warning of dire consequences if they are not enacted.
He cited a Colorado woman with
cancer that her insurance company would not cover. He referred to a
"middle-class college graduate from Maryland whose health insurance expired
when he changed jobs." He used the word "families" 22 times in
55 minutes.
http://www.google.com/hostednews/ap/article/ALeqM5juui7didNwh_vzBmJyrbjxkeF-IgD99K4VJ02
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by Sharon Theimer, The Associated Press
WASHINGTON -- President Barack Obama's administration
began holding private meetings with health industry executives at the White
House a few weeks after he took office, a visitor list released Wednesday
night by the White House shows. Lobbyists were among those there to talk
health care.
Lobbyist Billy
Tauzin, a former Louisiana
congressman, is on the White House visitor list five times this year.
Richard Umbdenstock, president of the American Hospital
Association, was at the White House on Feb. 4 and has been back at least a
half-dozen times since then, most recently May 22. Other industry executives
making February visits included health insurance company chief executives
Angela Braly of WellPoint Inc. and Jay Gellert of Health Net Inc.
Gellert, a $500 donor to Obama's presidential
campaign, was there Feb. 10, twice in March and May 11, while Braly visited on Feb. 13.
Obama released a
list of White House visits by health care executives after a government
watchdog group, Citizens for Responsibility and Ethics in Washington, announced it planned to sue to
try to get White House visitor logs. Only names and dates were released, not
the visitors' titles or employers.
So far, the Obama
administration is following a Bush administration policy of refusing to
release the logs, which are maintained by the Secret Service.
In recent weeks,
the White House has announced agreements under which hospitals and the
pharmaceutical industry promised cost savings in return for an expanded base
of insured patients. The deals were struck in private meetings, drawing
comparisons to Vice President Dick Cheney's secret talks with the energy
industry as he helped President George W. Bush draft a national energy
policy. Cheney's 2001 meetings drew criticism from Democrats throughout the
Bush years.
"The
president has decided to exercise his discretion and release the following
information, which is reflected in the relevant visitor logs," Gregory
Craig, White House counsel, wrote to CREW. "We are continuing to review
your specific FOIA request, as well as the White House's general policy
governing the discretionary release of visitor records."
During his
presidential campaign, Obama promised to hold lobbyists at arm's length and
make his administration the most transparent in history.
Obama was asked at
a news conference Wednesday night about his administration's refusal to say
who has been to the White House to discuss a national health care overhaul.
"On the list
of health care executives who visited us, most of time you guys have been in
there taking pictures, so it hasn't been a secret," he said in response.
"And my understanding is we just sent a letter out providing a full list
of all the executives. But, frankly, these have mostly been at least photo
sprays where you could see who was participating."
CREW said it was
pleased the White House had provided the list but that it didn't consider it
a sufficient response to its Freedom of Information Act request for the
visitor logs themselves. It plans to continue pressing for them.
"The actual
visitor records likely would indicate with whom each official met, the
administration official who requested clearance for the visitor, the time of
the meeting, the duration of the meeting and, in some cases, the purpose of
the meeting. In addition, no information was provided regarding any visits to
the vice president's residence," CREW said in a written statement.
"Finally,
transparency is not situational. It is not sufficient for the White House to
release certain visitor records shortly before a press conference to avoid
distraction," the group said.
Other health care
industry representatives named in the list released by the White House and
the dates they visited are:
--Registered
lobbyist Billy Tauzin, a former Louisiana
congressman who heads the drug industry lobby, the Pharmaceutical Research
and Manufacturers of America. He went to the White House on March 5, the day
of a summit on health care, and again on May 11, 19, June 2 and June 24.
--Registered lobbyist
Karen Ignagni, president and CEO of America's
Health Insurance Plans, an industry trade association; March 5, 6 and 11, May
11 and June 30.
--Dr. J. James Rohack, who became president of the American Medical
Association in June; March 25, May 11, and June 22 and 24.
--William Weldon,
CEO of Johnson & Johnson health care product and pharmaceutical company;
May 12.
--Jeffrey Kindler,
CEO of drugmaker Pfizer Inc.; March 5, May 6 and
June 2.
--UnitedHealth
Group Inc. chief executive Stephen Hemsley; May 15
and 22.
--George
Halvorson, head of Kaiser Foundation Health Plan, Inc.; March 27, May 11 and
June 5.
--Thomas Priselac, chief executive of the Cedars-Sinai Health
System; April 3 and May 11.
--Richard Clark,
CEO of the Merck & Co. pharmaceutical company; March 24 and May 11.
--Wayne Smith,
chief executive of Community Health Systems; June 4.
--Registered
lobbyist Rick Smith, a senior vice president of PhRMA;
May 11 and 19 and June 2.
--David Nexon, senior executive vice president with trade association
AdvaMed; May 11.
http://www.nola.com/health/index.ssf/2009/07/health_care_industry_executive.html
[BACK TO TOP]
Mass. has lessons for health care debate
USA TODAY | 07.23.09
By Richard Wolf, USA
TODAY
BOSTON — The state that pioneered health care for
all is about to take another leap into the unknown: paying for it.
Three years after
mandating that residents get health insurance and requiring employers,
insurers and taxpayers to chip in, Massachusetts
has yet to control soaring costs that are eating up half its budget. So it's
considering an equally radical idea: changing the way doctors and hospitals
are paid to reward results.
As Washington wrestles with the idea of overhauling the
nation's health care system, the Bay
State offers an object
lesson in how to do it in stages. It's an approach favored by state officials
but rejected by the Obama administration, which is intent on addressing
coverage, cost and quality all at once.
Massachusetts dealt with coverage first: just 2.6% of
state residents remain uninsured, compared with more than 15% nationally.
That's due in part to the 2006 law, which said most residents must get
insurance, most employers must help provide it, and most taxpayers must help
pay for it.
Dealing with cost
and quality has proved trickier. Higher health care costsfueled
a combined $9 billion gap in the state's 2009 and 2010 budgets that had to be
closed last month, leaving less for education, public safety, the environment
and other services.
"There are a
few other things people want us to pay for," quips Leslie Kirwan, state secretary of administration and finance.
Quality has been
an issue, too. Because more people have insurance, some doctors and
safety-net hospitals are overwhelmed. A study by the non-partisan Urban
Institute found one in five adults in the state have been turned away by a
doctor's office or clinic.
Using Massachusetts as a
partial model, President Obama is trying to tackle even more difficult
coverage, cost and quality problems all at once. The president seeks to extend
insurance to up to 46 million people without it. At the same time, he wants
to slow the growth of Medicare and Medicaid, now projected to rise from 5% of
the nation's economy to more than 17% by 2080.
Still,
Massachusetts offers lessons for national policymakers as they debate the
biggest change in health care delivery since Medicare and Medicaid were
created nearly a half century ago:
• Peddle the plan
to the public. A Republican governor at the time, Mitt Romney, and a
Democratic Legislature sold it to state residents as both a moral imperative
and a common-sense addition to the requirement that residents have automobile
insurance.
• Don't alienate
powerful interest groups. Insurers and businesses, rebelling in Washington, signed on
here. The state did not create a public plan to compete with private
companies; it has only a state-subsidized plan for low-income earners who
don't get Medicaid or employer insurance. It required only a $295-per-worker
annual fee from companies with 11 or more employees that do not offer health
insurance. Plans percolating in Congress include much bigger fees.
• Prepare for
years of trial and error. Government officials, providers and consumers here
say they expected a lengthy, often troublesome implementation.
"This is
never over," says John McDonough, who ran the statewide advocacy group
Health Care for All when the law passed and is now a senior adviser to Sen.
Edward Kennedy, D-Mass. "It is always messy."
The demand for
insurance didn't take long to materialize.
No sooner did Massachusetts require
health insurance in 2006 than hundreds of thousands of residents signed up.
The number of insured soared by more than 200,000 in the first two years, at
least 40,000 more than forecast, according to Commonwealth Connector, the
state agency created to oversee the health plan.
The state plan is
set up so that those who receive government subsidies pay no premium if their
income is below 150% of the federal poverty level — $16,620 for individuals
and $33,084 for a family of four. Others pay premiums based on a sliding
scale and choose from an array of plans chosen by the state.
Nearly everyone is
required to get insurance, unless the state deems all the available premiums
too expensive. Those who don't comply face penalties up to $1,068 per year if
they are at least 27 years old and earn three times the poverty level.
Exemptions can be
sought by individuals earning up to $54,600 if they can't find monthly
premiums below $342, and by families earning up to $114,400 if they can't
find premiums below $820.
Overall, nearly
430,000 residents out of about 600,000 who were uninsured now have coverage.
Virtually every type of insurance has increased: Medicaid, the new
Commonwealth Care subsidy program, unsubsidized plans and those provided by
employers, state data show. About 163,000 residents have taken advantage of
government subsidies. Another 150,000 have chosen employer plans.
Most of those who
got insurance under the Massachusetts
program are grateful. Francisco Diaz of South Boston, 54 and unemployed, pays
nothing for his care at the South
Boston Community
Health Center
and is scheduled for a hip replacement next month. Lizete
Rosa of Fall River,
56, laid off from her factory job in September, pays no premium and a low $10
copayment. Sandra McInerney of Chicopee, 50, a private school teacher who
was unemployed for a year, pays $194 a month and $15 a visit. "I guess
it's fair," she says.
Cost is
'somebody's income'
The major task
facing Massachusetts
now is the same one confronting the nation: controlling costs that were
spiraling long before the 2006 law.
Expanding access
to insurance has made that problem tougher by adding more than $700 million
in annual costs, split evenly with the federal government, according to the
Massachusetts Taxpayers Foundation. The annual cost to care for those who
were uninsured in 2006 has risen from $1 billion to $1.7 billion.
The state saved
money by reducing payments to hospitals for uncompensated care and increasing
the cigarette tax by $1 per pack to help pay for the expansion. Then came the
recession, forcing thousands of laid-off residents to sign up for subsidies.
Phone counselors
at Health Care for All are fielding 1,100 calls a week — a demand not seen
since the program's inception.
"The only
thing that went wrong is we ramped up faster than we anticipated," says
Jonathan Gruber, a health economist at the Massachusetts Institute of
Technology and a board member of the agency that runs the state's new health
insurance program.
Jon Kingsdale, that agency's executive director, says putting
access before cost was intentional. It made covering the uninsured a moral
imperative without forfeiting the support of providers, insurers and
employers — many of whom could lose money when costs are cut. "It's a
lot harder to do cost and access together," he says. "Everybody's
cost is somebody's income."
The problem was
punted to the payment commission, which last week recommended a system in
which health care providers would be paid a set amount for each patient, with
adjustments for health status and other factors. Doctors, nurses and
hospitals would work as a team to manage the patient's care.
If you offer it,
they will come
Once people had
insurance, the state reasoned, they would flee emergency rooms for
neighborhood doctors and drug stores. As a result, state funds intended to
pay safety-net hospitals and community health centers for serving the
uninsured have been reduced by $660 million.
But if anything,
demand has increased as the newly insured seek more medical attention.
"The funding levels are not keeping pace with the volume that we're
seeing," says William Halpin, CEO of South
Boston Community Health Center. "There's been a little bit of robbing
Peter to pay Paul."
Boston Medical
Center, the state's largest provider to the poor,
filed a lawsuit against the state last week charging that it's getting only
64 cents on the dollar to care for low-income patients.
"We kept the
patients, but we didn't keep the money," says Thomas Traylor, vice
president for federal, state and local programs.
The situation is
even worse at Cambridge Health Alliance, the second largest such provider.
Six health centers have closed, mental health and substance abuse services
cut, and Somerville
Hospital no longer
admits inpatients.
As the state faced
a budget crisis this spring, other health care services were threatened,
including dental care for 92,000 residents and all care for 28,000 legal
immigrants with fewer than five years in the country. The cuts were put on
hold last month, but funding still must be found.
"The message
is wrong," says Eva Millona, executive
director of the Massachusetts Immigrant & Refugee Advocacy Coalition.
"We have been a model in the country. We should sustain that."
http://www.usatoday.com/news/health/2009-07-22-masshealth_N.htm
[BACK TO TOP]
Infant Inhalation Of Ultrafine Air Pollution Linked To Adult Lung Disease
ScienceDaily (July 23, 2009) — Stephania
Cormier, PhD, Associate Professor of Pharmacology at LSU Health Sciences
Center New Orleans, has shown for the first time that early exposure to
environmentally persistent free radicals (present in airborne ultrafine
particulate matter) affects long-term lung function. She recently presented
her latest research data at the 11th International Congress on Combustion
By-Products and Their Health Effects at the Environmental
Protection Agency
Conference Center
in Research Triangle Park,
N.C.
Dr. Cormier, a
2006 National Institute of Environmental Health Sciences Outstanding New
Environmental Scientist awardee, is conducting
research to determine how inhalation exposure to environmental factors such
as allergens, pollutants, and respiratory viruses during infancy leads to
pulmonary inflammatory diseases, such as chronic obstructive pulmonary
disease (COPD) and asthma later in life.
Using protein
profiling techniques, Dr. Cormier’s lab was able to determine that early
exposure to these ultrafine pollutants caused genes to produce a number of
proteins, including one associated with COPD and steroid-resistant asthma,
and also caused proteins to misfold, rendering them
dysfunctional. These genetic defects
are linked to structural changes in the lung, airflow limitations, and
permanent changes in immune responses.
“It is no surprise
that elevations in airborne particulate matter (PM) are associated with
increased hospital admissions for respiratory symptoms including asthma
exacerbations,” notes Dr. Cormier. “What has come as a surprise is that early
exposure to elevated levels of PM elicits long-term effects on lung function
and lung development in children.”
These results
could be especially important because the US Environmental Protection Agency
does not currently regulate ultrafine PM emissions.
According to the
National Institutes of Health, more than 12 million Americans are currently
diagnosed with COPD and another 12 million probably have it and don’t know
it. Asthma is now the most common chronic disorder of childhood, affecting an
estimated 6.2 million US
children under the age of 18.
“Glucocorticoid (steroid) treatment is the foundation of
asthma treatment; however, while the majority of patients with asthma respond
to glucocorticoid treatment there are a number of
patients who do not,” says Dr. Cormier. “In cells, a protein called cofilin-1
appears to inhibit glucocorticoid function. We are
currently testing whether cofilin-1 also does this in the body. If it does,
then it is possible to envision the development of therapeutics aimed at inhibiting cofilin-1
for use in steroid-resistant asthmatics.”
http://www.sciencedaily.com/releases/2009/07/090722123751.htm
[BACK TO TOP]
Maya Rodriguez /
Eyewitness News
NEW ORLEANS – It's a death raising questions about the
health of the New Orleans Police Department's K-9 unit. So far, this year,
three of the unit's dogs have died.
Video: Watch the
Story
The latest
happened in May, when the K-9 Primo died of heat-related stress after it was
left unattended in a police vehicle.
Flowers and dog
biscuits mark the site of a memorial for Primo in front of NOPD Headquarters.
"I've been on
a number of scenes where K-9 Primo was very successful in making
apprehensions, detecting narcotics, so it will be a great loss, he will be a
great loss," said New Orleans Police Asst. Superintendent Marlon Defillo.
A necropsy report
shows Primo died of shock, brought on by heat. Pictures from inside the
vehicle show ripped up seat cushions – the damage the dog inflicted, shortly
before he died.
Riley: We don't
neglect our animals
Officer in anguish
over death of NOPD dog; investigation ongoing
"At no time,
would we neglect any of our animals," said NOPD Superintendent Warren
Riley.
At a news
conference on Wednesday, Riley said all K-9 vehicles are outfitted with a
special ventilation system, meant to prevent dogs from overheating. It is
designed to kick in when, the temperature reaches 87 degrees.
"We want
everyone to know, let our citizens know, that we take great care and concern
for our animals," he said.
A veterinarian
said it is possible for dogs to overheat and die, even in moderate
temperatures.
"We've had
dogs in 75 degree weather come in with all the same symptom of heat stroke,"
said Dr. Gary Levy, with Lakeview
Veterinary Hospital.
Primo is the third
member of the NOPD's K-9 unit to die within the
last few months. A 14-year-old K-9, known as Carlos, died of what Riley
called "natural causes," but it was also discovered that he had
heartworms.
Another dog, Phantom, died during a
training exercise at the shuttered Charity
Hospital. When the
floor collapsed under him, the dog plummeted more than a dozen floors to his
death. The incidents have prompted the Metropolitan Crime Commission to send
a letter to the district attorney, asking for an investigation of the K-9
unit.
"So, a third
of their K-9 unit dying in a little over a month's period of time, under
facts and circumstances that, at least on their face, could've been
prevented, we believe cries out for a thorough investigation, not just into
Primo, but into the policies and procedures that are in play right now, in
the K-9 division, to make sure they represent best practices," said
Rafael Goyeneche of the Metropolitan Crime
Commission.
The NOPD is still
investigating the deaths of both Primo and Phantom. Each K-9 dog costs the
department between $11,000 and $15,000. Riley said the department will
acquire more K-9's. Two new ones are undergoing training right now.
http://www.wwltv.com/topstories/stories/wwl072209cbk9deaths.67ddb074.html
[BACK TO TOP]
Ben Feller /
Associated Press
WASHINGTON -- Six
months in office, President Barack Obama sought Wednesday night to rally
support for sweeping health care legislation he's struggling to push through
Congress, expressing support for a surtax on families making more than $1
million a year to help pay for it.
President Barack
Obama responds to questions during a news conference in the East Room of the
White House in Washington
Wednesday, July
22, 2009.
Under pressure
from Democrats to weigh in personally on the details of legislation, Obama
also vowed at a prime-time news conference to reject any measure
"primarily funded through taxing middle-class families."
While the session
was dominated by health care, Obama said in response to one question that Cambridge, Mass.,
police "acted stupidly" last week in arresting Henry Louis Gates
Jr., a black scholar at Harvard, in his house. Police were called to the
house to investigate a possible break-in. Gates produced identification but
was arrested on a charge of disorderly conduct after protesting the police
conduct.
"Now I don't
know, not having been there, what role race played in that," the
president said. But he added that blacks and Latinos often are stopped by
authorities in disproportionate numbers. Police have dropped charges
initially lodged against Gates.
Obama stepped to
the microphone looking grayer than the man who ran for president and took
office in January and immediately began confronting the worst economic
recession in decades.
He defended his
decision to set a midsummer deadline for the House and Senate to act on
health care, even if it isn't met. "I'm rushed because I get letters
every day from families that are being clobbered by health care costs, and
they ask me can you help," he said.
If the
consequences are high for nearly 50 million Americans who lack insurance, the
political impact is huge for Obama, who is putting much of his credibility on
the line to gain congressional passage. His stepped-up public role comes as
he faces rising criticism from Republicans, sliding public approval ratings
and divisions within his party. Obama acknowledged that many people are
uneasy about growing federal budget deficits and the fast-rising government
debt.
He said that
without a deadline for action, a recent proposal to curtail the growth in
Medicare costs would not have materialized "until who knows when."
He said in the past few days, leaders in both houses had agreed to
incorporate it into legislation taking shape.
Asked if it was
his job to produce a deal on legislation, the president said:
"Absolutely it's my job. I'm the president. And I think this has to get
done."
He said that since
he moved into the White House, "we have been able to pull our economy
back from the brink."
Yet, he said,
"of course we still have a long way to go." Obama didn't say so,
but unemployment, currently 9.5 percent, is expected to remain stubbornly
high for many months to come.
He was eager to
talk about health care -- an issue that now towers above all others -- and
has led at least one Republican to say that it could prove to be the
president's Waterloo
if the drive collapses.
"This isn't
about me. I have great health insurance and so does every member of
Congress," he said.
The president said
that in addition to helping millions who lack coverage, the health care
legislation is central to the goal of eventually rebuilding the economy
stronger than it was before the recession that began more than a year ago.
He said Medicare
and Medicaid, government health care programs for the elderly and the poor,
are the "biggest driving force behind our federal deficit."
Unless they are
tamed, he said to a national TV audience, "we will not be able to
control our deficit. If we do not reform health care, your premiums and
out-of-pocket costs will continue to skyrocket."
The president said
he believed it was possible to fund more than two-thirds of the cost of
health care legislation by eliminating waste and redirecting federal funds
already being spent. The rest must come from higher taxes, he said.
The administration
proposed last winter a plan to raise taxes on upper-income wage earners by
limiting their ability to claim deductions.
Congress looked
unfavorably on the proposal, and Obama said he was open to alternatives --
with one notable exception.
"If I see a
proposal primarily funded through taxing middle-class families, I'm going to
be opposed to it," he said.
It was not
immediately clear whether the president was signaling he would accept at
least some higher taxes on middle-class families as the price for winning
passage.
As a candidate he
vowed repeatedly that no one earning under $250,000 would face higher taxes
if he won the White House.
Obama's remarks
about a proposed tax on million-dollar families aligned him with Speaker
Nancy Pelosi. Draft legislation in the House calls for the surtax on
individuals making $280,000 and families with $350,000 income or more, but
she suggested earlier in the week those levels should be increased.
The president
stepped to the microphone as Congress labored over his call for legislation
to expand health care to millions who lack it, as well as control the costs
of medical care generally.
In his opening
statement, he stressed the second of those two goals.
"In the past
eight year, we saw the enactment of two tax cuts, primarily for the
wealthiest Americans, and a Medicare prescription program, none of which were
paid for."
He vowed anew that
he wouldn't sign health care legislation that wasn't paid for, although his
administration has exempted from that pledge an estimated $245 billion to
raise Medicare fees for doctors.
"This debate
is not a game for these Americans, and they cannot afford to wait for reform
any longer," Obama said. "They are looking to us for leadership.
And we must not let them down."
The president said
he was pleased banks are returning to profitability. But he added, "What
we haven't seen I think is the kind of change in behavior and practices on
Wall Street that would ensure that we don't find ourselves in the fix where
we've got to bail out these folks again." He said legislation he has
proposed to Congress includes new regulations to control executive
compensation and limit excessive risk taking.
http://www.wwltv.com/topstories/stories/wwl072209cbobama.689baa98.html
[BACK TO TOP]
The New York Times | 07.22.09
By SHERYL GAY STOLBERG and JEFF ZELENY
Stephen Crowley/The New York
Times
President Obama held a prime-time news conference on
health care reform.
WASHINGTON —
President Obama tried on Wednesday to rally public support for overhauling the
nation’s health care system and said for the first time that he would be
willing to help pay for the plan by raising income taxes on families earning
more than $1 million a year.
“If I see a
proposal that is primarily funded through taxing middle-class families, I’m
going to be opposed to that,” Mr. Obama said in a prime-time news conference
in the East Room of the White House. A surcharge on the highest-income
Americans, under consideration in the House, “meets my principle,” he said.
On a day when the
leader of fiscally conservative Democrats said a deal was a long way off and
House Speaker Nancy Pelosi insisted that she had the votes to push a bill
through, Mr. Obama used the news conference to take his message over the
heads of lawmakers and straight to the public. Conceding that “folks are
skeptical,” he sought to convince Americans that overhauling the nation’s
health care system would benefit them and strengthen the economy.
“If somebody told
you that there is a plan out there that is guaranteed to double your
health-care costs over the next 10 years,” he said, “that’s guaranteed to
result in more Americans losing their health care, and that is by far the
biggest contributor to our federal deficit, I think most people would be
opposed to that,”
“That’s what we
have right now,” he said. “So if we don’t change, we can’t expect a different
result.”
While Mr. Obama
declared, “it’s my job, I’m the president,” he did not use the appearance at
the White House to make any fresh demands on Congress, which is struggling to
meet his timetable for both chambers to pass legislation before members break
for August recess. Mr. Obama did not repeat that demand Wednesday night.
Instead, he
sounded cerebral as he delved into policy specifics for nearly an hour and
tried to link them to the concerns of ordinary Americans.
As he sought to
reassure the public that a new health care system would be an improvement, he
also acknowledged that there would be changes that could be unsettling, a
point that is often raised by critics of overhauling the health care system.
“Can I guarantee
that there are going to be no changes in the health-care delivery system?
No,” Mr. Obama said. “The whole point of this is to try to encourage changes
that work for the American people and make them healthier.”
Health legislation
is Mr. Obama’s highest legislative priority, and his success or failure could
shape the rest of his presidency. But while he is under increasing pressure
from leading Democrats to delve more deeply into the negotiations by taking
positions on specific policy issues, he largely resisted doing so Wednesday
night.
But the president
did weigh in how the government might pay for the plan.
In addition to
saying he would be open to taxing those households earning more than $1
million — a scaled-back version of an earlier proposal that would have
imposed a surcharge on households earning $350,000 or more — he signaled that
he was also receptive to another idea under consideration in the Senate:
taxing employer-provided health benefits, as long as the tax did not fall on
the middle class.
On Capitol Hill,
Ms. Pelosi said Democrats remained on track to reach a deal on major health
care legislation. But she acknowledged that the process had slowed in
response to concerns among conservative Democrats about the cost of the bill,
and that some House Democrats were reluctant to embrace the income surtax on
high-earners without knowing whether the Senate would go along.
Indeed, even as
Ms. Pelosi insisted that Congress was closer than ever to achieving a
comprehensive overhaul of the nation’s health care system, leaders of the
Blue Dogs, a conservative faction of Democrats, said a deal was still a long
way off. Asked if the House Energy and Commerce Committee could resume work on
the bill by late Thursday, as House leaders hoped, Representative Charlie Melancon, a Blue Dog from Louisiana, said: “No way.”
A senior
Democratic aide on Capitol Hill said party leaders now believed it was
essential for Mr. Obama to be more specific about what he wanted in a health
care bill — and not just exhort Congress to pass one.
“The president
needs to step in more forcefully and start making some decisions,” said the
aide, speaking on condition of anonymity because he did not want to be
publicly identified as criticizing Mr. Obama. “Everyone appreciates the fact
that Obama has devoted so much time to health care. The bully pulpit is
powerful. But in view of the deadlines Congress has missed, we would like to
hear more from the president about what he wants in this bill.”
While he faces
pressures from fellow Democrats, Mr. Obama is also fending off attacks from
Republicans who sense an opportunity to knock him off his stride by arguing
that the health care bill, estimated as costing more than $1 trillion over
the next decade, will not slow or reduce the growth of health spending.
The White House
has been in a running debate this week with Senator Jim DeMint, Republican of
South Carolina, who predicted that health legislation would prove to be Mr.
Obama’s “Waterloo
moment” and would break the president. To that, Mr. Obama said: “This isn’t
about me. I have great health insurance, and so does every member of
Congress.”
In his opening
remarks Wednesday night, Mr. Obama said he was aware that many Americans are
asking, “What’s in this for me?” But he also tried to appeal to the nation’s
conscience, casting the issue as a matter of urgency to families who are
losing their life savings trying to pay for medical care and to businesses
burdened by trying to provide coverage to their employees.
Asked what the
rush was to meet his August deadline for passage of House and Senate bills,
Mr. Obama replied: “I’m rushed because I get letters every day from families
that are being clobbered by health care costs. They ask me, ‘Can you help?’ ”
In fact, there is
another reason Mr. Obama is rushed: he knows time is not on his side. The
more Congress delays passage of a health bill, the more time his Republican
opponents will have to marshal their opposition and kill it.
“If you don’t set
deadlines in this town, things don’t happen,” Mr. Obama said. “The default
position is inertia.”
http://www.nytimes.com/2009/07/23/us/politics/23obama.html?_r=1&ref=health
[BACK TO TOP]
By DAVID M.
HERSZENHORN and ROBERT PEAR
WASHINGTON — As
Democratic Congressional leaders try to round up the votes to remake the
health care system, they face a range of concerns about the cost and scope of
the legislation among centrist lawmakers in each party whose support is vital
to a deal.
Representative
Charlie Melancon, Democrat of Louisiana, suspects
that a proposed government-run health insurance plan will be another
unaffordable “entitlement program” that puts a stranglehold on the federal
budget and on future generations.
Senator Ben
Nelson, Democrat of Nebraska, expresses fears that the health care
legislation could inadvertently cause some Americans to lose their existing
coverage. And he wants to be sure that any bill includes new “incentives for
healthy lifestyles.”
Representative
Mike Ross, Democrat of Arkansas, wants to reduce or eliminate the disparities
in what Medicare pays for health services in rural areas versus urban
centers, a gap that he says has forced hospitals to close and doctors to move
away.
Senator Susan
Collins, Republican of Maine, worries about requiring employers to provide
insurance to workers. Without categorically rejecting the idea, she said: “My
inclination is to oppose an employer mandate. Employers want to provide
health insurance and do so if they can afford it.”
Many of the
centrists said they shared the same concerns: that the legislation proposed
so far is too expensive; does not sufficiently reduce health care costs over
the long term; and would raise taxes too much, or in ways they oppose.
If there is one
thing centrists in the House and the Senate agree on, it is that they are
being pushed way too fast to act on a hugely complex bill with an
astronomical price tag of roughly $1 trillion over 10 years, prompting a loud
chorus of demands to slow down.
But aside from
taking more time, and missing President Obama’s deadline of having each
chamber pass a health care bill before the August recess — a goal that seems
impossible to meet — getting to “yes” will require an artful set of
compromises.
In many cases, the
concerns of centrist lawmakers reflect conflicting goals: to expand health
coverage to nearly all Americans while reducing the growth of health
spending, cutting the cost of the bill and minimizing new taxes.
In the House, a
group of seven Democrats who are members of the fiscally conservative Blue
Dog Coalition have stalled the proceedings of the Energy and Commerce
Committee, the last of three House panels needed to approve the bill.
The House speaker,
Nancy Pelosi, said Wednesday that she shared some of the group’s concerns but
also said, “I have no question that we have the votes on the floor of the House
to pass this legislation” — a remark that some took as a threat to barrel
ahead.
“Why are we
rushing it?” asked Mr. Melancon, a Blue Dog on the
Energy and Commerce Committee. “Let’s get it right.”
And he effectively
dared House leaders to press ahead without fully addressing his group’s
concerns, noting that the Blue Dogs potentially had enough votes in Energy
and Commerce to stall the bill and that leaders
would have to resort to pressure tactics.
“We’re going to
need some orthopedists around here to take care of the broken bones and
twisted arms,” he said.
The best hope for
a bipartisan compromise seems to lie with a small group of lawmakers in the
Senate Finance Committee, which continued to meet on Wednesday.
The committee
chairman, Senator Max Baucus, Democrat of Montana and a centrist with a long
history of collaborating with Republicans, has resisted pressure from Senate
leaders and the White House while insisting that a compromise is within
reach.
Republicans on
that committee, including Senator Charles E. Grassley of Iowa, are insisting that any new taxes to
help pay for the legislation come from within the health care arena. They
have expressed no interest in the income surtax, on high-earners, proposed by
the House that would raise $544 billion over 10 years and instead are
exploring a menu of smaller items including fees on private insurers.
Last week, a
bipartisan group of senators, including two on the Finance Committee, sent a
letter to the Senate leadership pleading for more time. A number of other
senators have said they want the panel to continue working carefully toward a
deal.
Ms. Collins, who
joined Democrats in supporting the economic stimulus measure this year, said
she had several big concerns about the House health care bill and a separate
measure approved last week on a party-line vote by the Senate Committee on
Health, Education, Labor and Pensions.
She said that she
was “very skeptical” of the new government health insurance plan that
Democrats want to create, and that she was “not a proponent of an employer
mandate,” which would require employers to provide health benefits to workers
or pay a fee to the government.
Instead, she said,
“I would like to encourage more employer coverage by giving generous tax
credits to smaller businesses.”
As for reaching a
deal, Ms. Collins said, “we have a long way to go.”
The Senate Finance
Committee has been working on a compromise idea that would create private
nonprofit health insurance cooperatives instead of a government-run insurance
plan to compete with private insurers in an effort to reduce costs.
Mr. Ross, of Arkansas, said the
House Blue Dogs were open to considering the co-op idea and any number of
other proposals that might reduce the cost of the legislation while still
expanding insurance coverage to most Americans.
At a meeting at
the White House on Tuesday, the Blue Dogs said, they won agreement from the
Energy and Commerce Committee chairman, Representative Henry Waxman of
California, to try to curtail Medicare spending by giving the executive
branch new power to set annual payment rates for doctors, hospitals and other
health care providers, based on recommendations from an independent advisory
council.
Rates are now set
by statutory formulas, and Congress is besieged by lobbyists pleading for
bigger increases each year.
But Mr. Ross said
that addressing long-term costs was just one area of concern for the Blue
Dogs. They also want to reduce or eliminate the disparity in Medicare
payments that result in lower rates for health providers in rural areas.
Mr. Ross said his
hometown, Prescott, now has three doctors —
down from six — and that private insurers in Arkansas pay 30
percent more than Medicare, making doctors reluctant to accept new Medicare
patients.
http://www.nytimes.com/2009/07/23/health/policy/23center.html?ref=health
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Sheila Guilloton - Health Care Examiner
The National
Governors Association meeting in Biloxi, Mississippi expressed uniquely bipartisan concern over
the proposals coming out of both the House and Senate in Washington. Their concern was primarily
focused on expensive new Medicaid obligations without money to pay for them.
While each of the
many Congressional proposals is slightly different, all of them rely on
increasing the eligibility to participate in Medicaid as one of the primary
means to achieve universal health care coverage.
Financing the
Medicaid program is shared jointly by the Federal and State governments. The
Federal share is 50% for administration and a percentage for services based
on a formula that provides higher reimbursement for states with lower per
capita incomes.
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.
Health and Human
Services Secretary, Kathleen Sebelius, met with the
governors and conceded that it would be difficult to send a bill to a state
right now as there is an understanding that the states simply don’t have the
money. Secretary Sebelius was the governor of Kansas before she
joined the cabinet in April.
The governors are
already anticipating large gaps in Medicaid financing after 2010, when
stimulus money dries up. Medicaid is suffering from low payment rates to
health care providers. This has discouraged some doctors and hospitals to
accept Medicaid patients.. If Medicaid is expanded,
states will almost surely have to increase payments to doctors to encourage
more of them to participate.
Gov. Phil Bredesen the Democratic Governor of Tennessee, said he feared Congress was
about to bestow “the
mother of all unfunded mandates.”
Health care reform is not just dumping more participants and more
money into Medicaid.
Mr. Bredesen was not 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.
One idea that had
the governors particularly angry was a proposal from the Senate Finance
Committee that suggested that the State could issue bonds to cover the cost
of expanding Medicaid. Governors in both parties revolted placing a
conference call to Senator Max Baucus, the Montana Democrat who leads the
committee.
It is not good
fiscal policy to issue bonds to pay for operating expenses. One Governor,
Haley Barbour of Mississippi
likened the suggestion to “taking out a mortgage to pay the grocery bill.”
Many of the
Governors faced with
an escalating fiscal crisis
at home did not attend the meeting.
Even Gov. Edward G. Rendell of Pennsylvania,
the group's Chairman was not in attendance. Other governors who could not
attend were Arnold Schwarzenegger of California, Sarah Palin
of Alaska, Tim Pawlenty
of Minnesota and Bobby Jindal
of Louisiana.
http://www.examiner.com/x-11804-Health-Care-Examiner~y2009m7d22-Governors-fear-Medicaid-cost-increases-promised-by-health-reform
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The New York Times | 07.22.09
By LAWRENCE
K. ALTMAN
For the first time, scientists have shown that chimpanzees
in the wild become sick and die from the simian version of AIDS.
The finding upsets a widely held scientific belief that
chimpanzees, the closest relatives to humans, can get the virus that causes
simian AIDS but without harm.
It also suggests that an outbreak of AIDS is contributing
to the declining chimpanzee population in Africa, said the leader of the
research team, Dr. Beatrice Hahn of the University
of Alabama at Birmingham.
She said that comparisons of the viruses that cause AIDS
in chimpanzees and humans could lead to new insights into the responses of
the immune systems in both species.
“Our findings allow us to look at H.I.V. from a new angle,
comparing and contrasting chimpanzee and human infections,” Dr. Hahn said in
an interview. Her team’s study is being reported in the journal Nature on
Thursday.
As researchers conducted autopsies on the bodies of the
dead chimps they could find, they detected evidence of organ and tissue
damage similar to that in late-stage human AIDS. Infected chimpanzees were
also found to have a 10 to 16 times greater risk of
dying than uninfected ones. Infected females were less likely to give birth.
If they did, they could pass the virus to their infants, and they had a
higher infant death rate than that of uninfected females.
The scientists made the discovery by testing hundreds of
samples of chimpanzee waste in a nine-year study of three small communities
of chimpanzees at the Gombe
National Park in Tanzania,
which Jane Goodall made famous. While chimpanzees
nested in trees at night, a field assistant below them caught urine in a
plastic bag held between a forked twig. Researchers
also picked up feces from the forest floor.
The simian virus, known as S.I.V.cpz,
is considered the precursor of H.I.V.-1, which crossed the species barrier
sometime in the past 100 years.
“We cannot date exactly when chimpanzees first got
infected, but we certainly suspect that it was much, much longer than 100
years ago,” Dr. Hahn said. “Our gut feeling is that the chimp virus infection
is not quite as” damaging as H.I.V.-1 is in humans. The difference in the way
the virus damages tissue, she said, “leads us to speculate that chimps may be
one step ahead in adapting to the virus, and identifying that step would be
important.”
More than 40 simian immunodeficiency viruses are known to
infect African primates. African monkeys infected with the virus that causes
simian AIDS have rarely developed AIDS. Only seven chimpanzees naturally infected
with S.I.V.cpz have been studied in captivity, and
five of them died of unknown causes as infants. The only chimpanzee that was
naturally infected with the simian virus and underwent standard virological and immunological tests showed none of the typical
damage of AIDS, like low CD-4 cell counts and damaged lymph nodes. Two other
chimpanzees injected with S.I.V.cpz in captivity
did not show such changes.
Until now, scientists have known little about S.I.V.cpz’s effects on chimpanzees in the wild, because
they lacked the means to identify and monitor chimp behavior there. Using
recently developed molecular and other tests, Dr. Hahn’s team of
primatologists, pathologists, geneticists and virologists studied three
chimpanzee communities in Gombe National
Park.
The chimpanzee communities have distinct ranges. But the
chimpanzees have territorial fights, and females typically leave their native
group before having their first babies.
Starting in 2000, the scientists followed 94 chimpanzees
in the park. Every day, a team of field assistants followed one chimpanzee
from each community from dawn to dusk.
Gene tests of feces identified individual chimpanzees. S.I.V.cpz infection was found in all three chimpanzee
communities, and virological testing indicated that
migrating females helped spread S.I.V.cpz. The
scientists found nearly identical S.I.V.cpz viruses
in four chimpanzees. That suggested that some of them acquired S.I.V.cpz from mating partners soon after they had become
infected, a period when transmission of the virus is greatest.
Two baby chimpanzees were infected. In one, transmission
presumably was through breast-feeding because the animal was uninfected at
birth.
Of 30 uninfected females, 22 gave birth to 30 infants. Of
nine infected females, four gave birth to four infants. The difference was
statistically significant.
Infected chimpanzees died or disappeared at a faster rate
than uninfected chimpanzees.
http://www.nytimes.com/2009/07/23/science/23chimp.html?em
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