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Goldman To Private Insurers: No Health Care Reform At All Is Best
by Sam Stein
Huffington Post, November 12, 2009

A Goldman Sachs analysis of health care legislation has concluded that, as far as the bottom line for insurance companies is concerned, the best thing to do is nothing. A close second would be passing a watered-down version of the Senate Finance Committee's bill.

A study put together by Goldman in mid-October looks at the estimated stock performance of the private insurance industry under four variations of reform legislation. The study focused on the five biggest insurers whose shares are traded on Wall Street: Aetna, UnitedHealth, WellPoint, CIGNA and Humana.

The Senate Finance Committee bill, which Goldman's analysts conclude is the version most likely to survive the legislative process, is described as the "base" scenario. Under that legislation (which did not include a public plan) the earnings per share for the top five insurers would grow an estimated five percent from 2010 through 2019. And yet, the "variance with current valuation" -- essentially, what the value of the stock is on the market -- is projected to drop four percent.

Things are much worse, Goldman estimates, for legislation that resembles what was considered and (to a certain extent) passed by the House of Representatives. This is, the firm deems, the "bear case" scenario -- in which earnings per share for the top five insurers would decline an estimated one percent from 2010 through 2019 and the variance with current valuation is projected to be negative 36 percent.

What the firm sees as the best path forward for the private insurance industry's bottom line is, to be blunt, inaction.

The study's authors advise that if no reform is passed, earnings per share would grow an estimated ten percent from 2010 through 2019, and the value of the stock would rise an estimated 59 percent during that time period.

The next best thing for the insurance industry would be if the legislation passed by the Senate Finance Committee is watered down significantly. Described as a "bull case" scenario -- in which there is "moderation of provisions in the current SFC plan" or "changes prior to the major implementation in 2013" -- earnings per share for the five biggest insurers would grow an estimated ten percent and the variance with current valuation would rise an estimated 47 percent.

The report, a Goldman official stressed, was analytic not advocacy-based. Their job was to provide a sober assessment of the market realities facing private insurers under various versions of health care reform.

"If no reform at all happens you would see the largest rise in EPS," a Goldman official acknowledged. "But what we are doing is just analyzing what the stocks would do under different scenarios."

The study does note on the front page that the firm "does and seeks to do business with companies covered in its research reports." Those companies include Aetna, Wells Point and United Health.

In the context of the current health care debate, the findings provide a small window into the concerns that have driven the private insurance industry's opposition to reform legislation. Simply put: health care reform is going to hurt their bottom line. No less a prestigious voice than Goldman Sachs is telling them so.

Some insurers, in the end, will be hit harder than others. CIGNA is the lowest of the big five, for instance, because it does little business providing insurance plans to Medicare patients, individuals and families buying health plans directly, or small employers that offer health plans to their workers.

In addition, some reforms are going to hurt the industry more than others. Regulatory changes -- such as prohibiting the prejudice against consumers with pre-existing conditions -- will have an impact across the board, as will the funding cuts to Medicare Advantage.

Overall, Goldman calculates the probability of reform passing Congress at 75 percent. Though the limitations of Goldman's political prognostications were on full display earlier in the document:

By mid-late October, we expect a cloture vote (60 votes) to bypass a potential filibuster followed by several weeks of debate over proposed amendments on the Senate floor (with a similar process under way in the House). If both the Senate and House are able to pass legislation (perhaps before the Thanksgiving recess), a House-Senate conference negotiation should produce combined legislation for final approval (perhaps by mid-December).

Source: http://www.huffingtonpost.com/2009/11/1 ... 55998.html (includes full text of Goldman memo)

RNC to opt out of abortion coverage
by Jonathan Allen, Meredith Shiner
Politico, Thu Nov 12, 5:12 pm ET

The Republican National Committee will no longer offer employees an insurance plan that covers abortion after POLITICO reported Thursday that the anti-abortion RNC's policy has covered the procedure since 1991.

"Money from our loyal donors should not be used for this purpose," Chairman Michael Steele said in a statement. "I don't know why this policy existed in the past, but it will not exist under my administration. Consider this issue settled."

Steele has told the committee's director of administration to opt out of coverage for elective abortion in the policy it uses from Cigna.

Federal Election Commission Records show the RNC purchases its insurance from Cigna, and two sales agents for the company said that the RNC’s policy covers elective abortion.

As of Thursday, the RNC’s plan covers elective abortion – a procedure the party’s own platform calls “a fundamental assault on innocent human life.”

Informed of the coverage, RNC spokeswoman Gail Gitcho told POLITICO earlier Thursday that the policy pre-dates the tenure of current RNC Chairman Michael Steele.

“The current policy has been in effect since 1991, and we are taking steps to address the issue,” Gitcho said.

The RNC moved quickly Thursday to assuage any concerns its members might have.

In a letter obtained by POLITICO, RNC Chief of Staff Ken McKay writes to the 168 committeemen and committeewomen across the country that Steele "takes this issue very seriously."

He writes that the RNC has been evaluating its health insurance policy and will continue to do so.

Leading up to passage of the House health care reform bill last week, 176 House Republicans joined 64 Democrats in voting for the so-called Stupak amendment, a measure that prohibits federal funds from being used to buy health insurance that covers elective abortions.

A spokeswoman for the National Republican Congressional Committee – the campaign arm for the House Republicans – said it does not include coverage for elective abortions in its employee insurance policy.

“The policy does not cover abortions unless the life of the mother is in danger,” the NRCC spokeswoman said.

According to several Cigna employees, the insurer offers its customers the opportunity to opt out of abortion coverage – and the RNC did not choose to opt out.

But rank-and-file Republicans said Thursday before the change was announced that the policy should – and would – be changed.

“We were not aware of this, obviously, and this will, of course, be fixed,” said James Bopp Jr., a Republican National Committeeman from Indiana. “I think Chairman Steele will see to it that that’s the case.”
Rep. Jack Kingston, a Georgia conservative, said “they need to drop that clause” from the policy or find a new one.

“From a philosophical standpoint, it’s inconsistent,” Kingston said. “It makes me think someone isn’t scrutinizing the purchases.”

Cigna spokesman Chris Curran declined to discuss the specifics of the RNC’s plan, saying it’s against company policy to reveal even the identities of its insured. But he said that Cigna’s products “are designed to meet the requirements of our individual employer clients. Employer clients are informed of the services covered and it is their choice to decide which benefits meet their needs.”

There is no indication that any RNC employee used the abortion coverage, but Planned Parenthood President Cecile Richards said it’s “no surprise” that the RNC had been offering it.

“It’s an employer that wants to provide standard health benefits for its employees,” she said. “That’s why the Stupak amendment goes too far in taking away benefits that women have today, and that’s why women won’t allow the Stupak amendment to become law.”

The Stupak amendment, named for sponsor Bart Stupak (D-Mich.), was adopted by the House before it passed the health care bill on Saturday night. It prohibits a government-backed health care plan from offering abortion services and bans the use of federal subsidies for individuals to buy into health care plans that provide abortion coverage.

Rep. John Shadegg of Arizona was the only House Republican who did not vote in favor of the amendment. He voted “present.”

While 64 Democrats voted for the amendment, the majority did not – and the Democratic Party’s 2008 platform says the party “unequivocally supports Roe v. Wade and a woman’s right to choose a safe and legal abortion, regardless of ability to pay.” The Democratic National Committee provides abortion coverage to its employees, the committee said.

Source: http://news.yahoo.com/s/politico/29456

The Stupak amendment mandates that no federal funds can be used to pay for an abortion or "cover any part of any health plan" that includes coverage of an abortion, except in cases where the mother’s life is in danger or the pregnancy was the result of rape or incest.

Source: http://www.alternet.org/story/143849/ho ... ion_rights

"So you still did not tell me how Stupak is not just plugging a loophole in the Hyde amendment. It even allows people who get government subsidies to get abortion coverage, they just have to do it with their own money, not the taxpayers. Once again all Stupak does is make it where federal money will not fund abortions as has been the law for over a generation. You have to agree that without the Stupak amendment then government dollars would pay for abortions, this fixes that. I agree with the President that this is not an abortion bill and should not be used to change the law, it is Stupak who is ensuring the status quo not changing it."

"Do you have any proof to back this claim up? No, because it is a scare tactic used by fear mongers trying to make this law into something it isn’t. If 100 insurance companies cover abortion now, and want to be on the exchange they will just drop abortion coverage in the exchange. Even on the exchange you are allowed to buy a rider that allows abortion coverage as long as you do it all with your own money. Have you even bothered to read the law? Also Supply and demand will dictate that out side of the exchange, where no government dollars are paying for healthcare, if people want abortion coverage there will be abortion coverage. As a practical matter, without the Stupak amendment government money would pay for abortions. You have to admit this, it would. The fact is the removal of the Stupak would be a fundamental change to our current policy on abortion. Stupak is not the radical."

False Hope and the Stupak Amendment
by Matt Yglesias

One reason private health insurance tends to cover abortions is that having an abortion is a lot cheaper than having a baby. Consequently, it kinda sorta seems like the Stupak Amendment might have a limited practical impact. Thus I’ve had thoughts along the lines of this from Mark Kleiman:

But what happens when some of the women you insure get pregnant and wants to terminate? Since perinatal care plus delivery would probably cost you $2500, while a first-trimester abortion costs about $200, you’d be happy to provide the abortion coverage gratis if you thought that otherwise even as many as one in twelve of those women would choose to carry to term. You can’t provide it gratis; that’s what Stupak provides. But you could provide it cheap, even to someone who’s already pregnant. Charge $50 for the abortion-coverage rider, effective immediately.

There seem to me to be logistical questions about this. But I don’t think the profit profit motives quite add up. After all, an abortion is not a hugely expensive medical procedure, and whether or not to carry a pregnancy to term is a major life choice. Consequently, I think we should anticipate the price-elasticity of abortions to be relatively low. In other words, in a Stupaked universe most women who find themselves with an unwanted pregnancy are just going to take the financial hit, not have the baby. Under the circumstances it doesn’t really make sense for insurance companies to provide the coverage at an actuarial loss.

The big losers here, however, will be the set of poor women who really may not be able to get together the few hundred dollars that would be needed. This is, of course, entirely typical of relatively “soft” abortion restrictions. Very few people are sufficiently hardcore to push for legislative measures that would really and truly make abortions generally unavailable. Instead the tendency is to create situations that leave loopholes for the affluent while making poor women bear the burdens of middle America’s somewhat incoherent moral stance on the issue.

My proof is that in Oklahoma and North Dakota you can not get abortion coverage and guess what, abortion coverage is still available in other states. The insurance companies are going to do whatever makes them the biggest profit. With the vast amount of people on private or company funded plans if there is a demand the insurance companies will supply abortion coverage outside of the exchange, where no government money would pay for it and thus not changing the current status quo. As far as it meaning President Obama would be wrong, well he is not infallible.

And in response to the Yglesias article, he added ...

The Stupak amendment is not supposed to stop abortion, just make sure government money is not used for them. It does that.

Please answer this question: Without the Stupak amendment would taxpayer dollars be used to pay for abortion?

Buy whatever coverage you like, but I have the right to not pay for it with my tax dollars.

Wow you just described the Stupak amendment

Here is the text, please show me the part that is wrong:

Stupak-Pitts Amendment to H.R. 3962

(a) IN GENERAL -

No funds authorized or appropriated by the Act (or amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of an act of rape or incest.

(b) OPTION TO PURCHASE SUPPLEMENTAL COVERAGE OR PLAN -

Nothing in this section shall be construed as prohibiting any nonfederal entity (including an individual or a State or local government) from purchasing separate or supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as-

(1) Such coverage or plan is paid for entirely using funds not authorized or appropriated by this Act; and
(2) Such coverage or plan is not purchased using-
(a) individual premium payments required for an Exchange-participating health benefits pan towards which an affordability credit is applied; or
(b) other nonfederal funds required to receive a federal payment, including State's or locality's contribution of Medicaid matching funds.

(c) OPTION TO OFFER SUPPLEMENTAL COVERAGE OR PLAN -

Notwithstanding section 303(b), nothing in this section shall restrict any nonfederal QHBP offering entity from offering separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as-
(1) premiums for such separate supplemental coverage or plan are paid for entirely with funds not authorized or appropriated by this Act;

(2) administrative costs and all services offered through such supplemental coverage or plan are paid for using only premiums collected for such coverage or plan; and

(3) any nonfederal QHBP offering entity that offers an Exchange-participating health benefits plan that includes coverage for abortions for which funding is prohibited under this section also offers an Exchange-participating health benefits plan that is identical in every respect except that it does not cover abortions for which funding is prohibited under this section.

-----

Capps is not acceptable because it does not fulfill the guarantee that no public funds are used to pay for abortions, as the nonpartisan fact check.org put it:

http://www.factcheck.org/2009/08/aborti ... bricating/

The Capps amendment does contain a statement – as we noted in an earlier article – that prohibits the use of public money to pay for abortions, except in cases of rape, incest and to save the life of the mother. That would still allow the public plan to cover all abortions, so long as the plans took in enough private money in the form of premiums paid by individuals or their employers. The Capps language also would allow private plans purchased with federal subsidies ("affordability credits" for low-income families and workers) to cover abortion.

As for the House bill as it stands now, it’s a matter of fact that it would allow both a "public plan" and newly subsidized private plans to cover all abortions.

Newly subsidized private plans means private plans paid for with help from the government in the form of capital (tax credits, money, etc...) That is why Stupak was needed to fill this loophole. As well as the public plan covering abortions.

Obama's chief of staff is annoyed at all the critics who like to imagine a better health-care reform bill but have no idea how to pass such a thing:

“Let’s be honest,” Rahm Emanuel said in a recent interview. “The goal isn’t to see whether I can pass this through the executive board of the Brookings Institution. I’m passing it through the United States Congress with people who represent constituents.”

He went on: “I’m sure there are a lot of people sitting in the shade at the Aspen Institute — my brother being one of them — who will tell you what the ideal plan is. Great, fascinating. You have the art of the possible measured against the ideal.”

Source/full story: http://voices.washingtonpost.com/ezra-k ... nt_to.html

For Some Uninsured, Health Bill Benefits Would Kick In Right Away
by Arthur Delaney
Huffington Post, November 17, 2009

A common complaint about the health insurance reform legislation moving through Congress is that the uninsured won't see any help until 2013.

While it's true that major provisions of the bills don't take effect until 2013, some important reforms would be immediate.

Sandra Ingram, 63, of Iowa, is one of the people eagerly awaiting the legislation's passage.

After a battle with breast cancer, Ingram's doctors declared her cancer-free in January. Then she lost her job and in September, her cancer returned -- this time in her bones and liver.

Ingram still has insurance, because she kept her employer's health benefits through COBRA Continuation Coverage. But that coverage is set to expire in July.

If reform derails in the Senate, Ingram will be out of luck come Independence Day, as her pre-existing condition would make her pretty much uninsurable.

If legislation like what passed the House is signed into law, Ingram will see her COBRA insurance extended until 2013, when an "exchange" is in place where she could choose an affordable insurance policy from a variety of options.

Or she might be eligible for a temporary government-run program for uninsured people with pre-existing conditions -- via an "interim high-risk pool" -- until the exchange is available. The $5 billion high-risk pool would be established on Jan. 1, 2010. The COBRA extension would go in effect as soon as the bill is signed.

So Ingram has been emailing and calling one of her senators, Chuck Grassley (R) -- who cooperated with Democrats at first but changed his position over the summer -- to encourage him to support the bill. And she's been reaching out to local media so people know her story. "I think the way things are with insurance companies -- people need to understand what kind of a grip they have on our throats."

When asked if she took insurance reform personally, she said, "My dear, it could happen to you!"

Another person with a personal stake in reform is Mary Duffy, 60, whose COBRA benefits will expire at the end of next month. Like Ingram, Duffy is a cancer survivor who would benefit from the same two provisions -- either the COBRA extension or the insurance policy for people in a high-risk pool. She's been speaking out, too, talking to reporters and telling her story at town halls.

Duffy, who lives in California, has been trying to get a job since her layoff earlier this year, and she's been trying to get insurance, too. When she calls insurance companies to ask about a policy and tells them she's a three-time breast cancer survivor, "you can almost hear the laughter," she said. She said the best offer she's gotten has been for an $898-a-month policy from Blue Cross/Blue Shield.

As much as a health bill would help her, Duffy opposes it in the form it passed the House, because of its restrictive abortion provision, which she hopes won't survive in the Senate. "I don't understand why the price of insurance is to set women's rights back 50 years," she said.

Source: http://www.huffingtonpost.com/2009/11/1 ... 60595.html

McConnell: GOP Will Delay Health Care At Least Six More Weeks
by Sam Stein
Huffington Post, November 15, 2009

If there was any doubt that Senate Republicans are eager to drag their heels when it comes to health care reform, Minority Leader Mitch McConnell (R-Ky.) removed it on Sunday.

The Kentucky Republican, during an appearance on "Fox News Sunday," demanded that the Senate take, at the very least, six weeks to deliberate legislation once it is sent to the floor for amendments.

"There will be a lot of amendments over a lot of weeks. The Senate is not the House, you saw in the House there was three votes and it was over in one day," McConnell warned. "This will be on the floor for quite a long time."

Warning that health care reform "cuts Medicare rates, raises taxes and raises insurance premiums," McConnell also insisted that Majority Leader Harry Reid had kept the legislation secret from his colleagues.

"We know it's been in Harry Reid's office for six weeks and the other 99 senators haven't seen it," he said. "I think we ought to at least have as much time for other 99 senators and all of the American people to take a look at this bill as Majority Leader Reid has had."

The strategy for Republicans, McConnell outlined, would be to "delay the process so we fully understand what's in the bill." That means a reform debate that's gone on for roughly nine months could extend to a tenth; if Republicans throw up enough parliamentary hurdles, reform could be delayed into 2010.

"I think it ought to be on the floor as least as long as it was in Harry Reid's office," said McConnell.

Source: http://www.huffingtonpost.com/2009/11/1 ... 58305.html

AP POLL: Tax The Rich To Pay For Health Bill
by Erica Werner/AP
Huffington Post, November 17, 2009

WASHINGTON — Americans don't want to shoulder the cost of President Barack Obama's health care overhaul themselves. They think the rich should pay for it.

That's the finding from a new Associated Press poll, and it could be a boost for House Democrats, who have proposed taxing upper-income people to fund their sweeping remake of the U.S. medical system. Their plan, which the House approved this month, would extend coverage to millions of uninsured Americans.

The poll, conducted by Stanford University with the nonpartisan Robert Wood Johnson Foundation, found survey participants sour on other ways of paying for the health overhaul that is being considered in Congress.

The options they don't like include taxing insurers on the high-value coverage packages derided by Obama and Democrats as "Cadillac plans." That tax approach, being weighed in the Senate, is one of the few proposals in any congressional legislation that analysts say would help reduce the nation's health expenditures. It has come under fire from organized labor and has little support in the House.

Lawmakers also are looking at levying new taxes on insurance companies, drug companies and medical device makers. But the only approach that got majority support in the AP poll was a tax on upper-income Americans.

The House bill would impose a 5.4 percent income tax surcharge on individuals making more than $500,000 a year and households making more than $1 million.

The poll tested views on an even more punitive taxation scheme that was under consideration earlier, when the tax would have hit people making more than $250,000 a year. Even at that level the poll showed majority support, with 57 percent in favor and 36 percent opposed.

"You know, I mean, why not? If they have that much money, it should be taxed," said Mary Pat Rondthaler, 60, of Menlo Park, Calif. "It isn't the same way that the guy making $21,000 is."

Not everyone agreed.

"They earn their money. And they shouldn't have to pay for somebody else. It doesn't seem fair," said Emerson Wilkins, 62, of Powder Springs, Ga.

An income tax increase on all Americans to pay for a health care remake – an approach Congress never considered – was overwhelmingly rejected in the poll. Seventy-five percent opposed that idea, and only nineteen percent were in favor.

Overall, the poll found the public split on Congress' health care plans. In response to some questions, participants said the current system needed to be changed, but they also voiced concerns about the impact on their own pocketbooks, preferring to push any new costs onto wealthier Americans.

For example, 77 percent said the cost of health care in the United States was higher than it should be, and 74 percent favored the broad goal of reducing the amount of money paid by patients and their insurers. But 49 percent said any changes made by the government probably would cause them to pay more for health care. Thirty-two percent said it wouldn't change what they pay, and just 12 percent said they would end up paying less.

With lawmakers searching for new revenue sources to pay for the overhaul legislation, upper-income taxes may be increasingly gaining favor.

Legislation passed by Senate committees did not go that route, but now Majority Leader Harry Reid, who has a free hand in merging two committee-passed bills, is considering raising the payroll tax that goes to Medicare on income above $250,000 a year, officials told The Associated Press last week. Current law sets the tax at 1.45 percent of income, an amount matched by employers.

The Senate Finance Committee bill would tax health insurance plans costing more than $8,000 annually for individuals and $21,000 for families, although those numbers are expected to end up higher in Reid's bill. Union members are lined up against that approach because they fear their benefits could be hurt, and the public doesn't like it either, the AP poll found. Fifty-six percent were opposed and only 29 percent were in favor.

Other payment methods being contemplated on Capitol Hill also met with disapproval. Participants in the poll didn't support new taxes on medical device makers, drug companies or even insurers – even though they said in response to different questions that drug companies and insurance companies made too much money.

Forty-eight percent in the poll were opposed to new taxes on insurance companies, and 42 percent were in support. Fifty-one percent opposed raising taxes on drug and device makers, while 41 percent supported that approach.

But 72 percent of people polled said insurance companies made too much profit, compared with 23 percent who said they made about the right amount. And 74 percent said drug companies made too much profit, versus 21 percent who said they made about the right amount.

People who told pollsters they generally supported Congress' health care overhaul plan were also more receptive to new taxes to pay for it. Taxing health care companies, drug companies and equipment manufacturers eked out majority support from that group.

The payment approach that met with least approval by far in the poll was borrowing the money and increasing the federal debt, something Obama has repeatedly vowed not to do. Just 6 percent of people polled said they could support that approach, while 88 percent opposed it.

The poll was based on landline and cell phone interviews with 1,502 adults from Oct. 29 to Nov. 8. It has a margin of error of plus or minus 2.5 percentage points. The interviews were conducted by GfK Roper Public Affairs and Media. Stanford University's participation was made possible by a grant from the Robert Wood Johnson Foundation, which conducts research on all facets of the health care system.

Source: http://www.huffingtonpost.com/2009/11/1 ... 60357.html

Uninsured Patients Twice As Likely To Die In The ER: Study
by Carla K. Johnson/AP
Huffington Post, November 16, 2009

CHICAGO — Uninsured patients with traumatic injuries, such as car crashes, falls and gunshot wounds, were almost twice as likely to die in the hospital as similarly injured patients with health insurance, according to a troubling new study.

The findings by Harvard University researchers surprised doctors and health experts who have believed emergency room care was equitable.

"This is another drop in a sea of evidence that the uninsured fare much worse in their health in the United States," said senior author Dr. Atul Gawande, a Harvard surgeon and medical journalist.

The study, appearing in the November issue of Archives of Surgery, comes as Congress is debating the expansion of health insurance coverage to millions more Americans. It could add fodder to that debate.

The researchers couldn't pin down the reasons behind the differences they found. The uninsured might experience more delays being transferred from hospital to hospital. Or they might get different care. Or they could have more trouble communicating with doctors.

The hospitals that treat them also could have fewer resources.

"Those hospitals tend to be financially strapped, not have the same level of staffing, not have the same level of surgeons and testing and equipment," Gawande said. "That also is likely a major contributor."

Gawande favors health care reform and has frequently written about the inequities of the current system.

Story continues below

The researchers took into account the severity of the injuries and the patients' race, gender and age. After those adjustments, they still found the uninsured were 80 percent more likely to die than those with insurance – even low-income patients insured by the government's Medicaid program.

"I'm really surprised," said Dr. Eric Lavonas of the American College of Emergency Physicians and a doctor at Denver Health Medical Center. "It's well known that people without health insurance don't get the same quality of health care in this country, but I would have thought that this group of patients would be the least vulnerable."

Some private hospitals are more likely to transfer an uninsured patient than an insured patient, said Lavonas, who wasn't involved in the new research.

"Sometimes we get patients transferred and we suspect they're being transferred because of payment issues," he said. "The transferring physician says, 'We're not able to handle this.'"

Federal law requires hospital ERs to treat all patients who are medically unstable. But hospitals can transfer patients, or send them away, once they're stabilized. A transfer could worsen a patient's condition by delaying treatment.

The researchers analyzed data on nearly 690,000 U.S. patients from 2002 through 2006. Burn patients were not included, nor were people who were treated and released, or dead on arrival.

In the study, the overall death rate was 4.7 percent, so most emergency room patients survived their injuries. The commercially insured patients had a death rate of 3.3 percent. The uninsured patients' death rate was 5.7 percent. Those rates were before the adjustments for other risk factors.

The findings are based on an analysis of data from the National Trauma Data Bank, which includes more than 900 U.S. hospitals.

"We have to take the findings very seriously," said lead author Dr. Heather Rosen, a surgery resident at Los Angeles County Hospital, who found similar results when she analyzed children's trauma data for an earlier study. "This affects every person, of every age, of every race."

Source: http://www.huffingtonpost.com/2009/11/1 ... 59718.html

Drug Makers Raise Prices in Face of Health Care Reform
by Duff Wilson
New York Times, November 15, 2009

Even as drug makers promise to support Washington’s health care overhaul by shaving $8 billion a year off the nation’s drug costs after the legislation takes effect, the industry has been raising its prices at the fastest rate in years.

In the last year, the industry has raised the wholesale prices of brand-name prescription drugs by about 9 percent, according to industry analysts. That will add more than $10 billion to the nation’s drug bill, which is on track to exceed $300 billion this year. By at least one analysis, it is the highest annual rate of inflation for drug prices since 1992.

The drug trend is distinctly at odds with the direction of the Consumer Price Index, which has fallen by 1.3 percent in the last year.

Drug makers say they have valid business reasons for the price increases. Critics say the industry is trying to establish a higher price base before Congress passes legislation that tries to curb drug spending in coming years.

“When we have major legislation anticipated, we see a run-up in price increases,” says Stephen W. Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota. He has analyzed drug pricing for AARP, the advocacy group for seniors that supports the House health care legislation that the drug industry opposes.

A Harvard health economist, Joseph P. Newhouse, said he found a similar pattern of unusual price increases after Congress added drug benefits to Medicare a few years ago, giving tens of millions of older Americans federally subsidized drug insurance. Just as the program was taking effect in 2006, the drug industry raised prices by the widest margin in a half-dozen years.

“They try to maximize their profits,” Mr. Newhouse said.

But drug companies say they are having to raise prices to maintain the profits necessary to invest in research and development of new drugs as the patents on many of their most popular drugs are set to expire over the next few years.

“Price adjustments for our products have no connection to health care reform,” said Ron Rogers, a spokesman for Merck, which raised its prices about 8.9 percent in the last year, according to a stock analyst’s report.

This year’s increases mean the average annual cost for a brand-name prescription drug that is taken daily would be more than $2,000 — $200 higher than last year, Professor Schondelmeyer said.

And this means that the cost of many popular drugs has risen even faster. Merck, for example, now sells daily 10-milligram pills of Singulair, the blockbuster asthma drug, at a wholesale price of $1,330 a year — $147 more than last year. Singulair is now selling at retail, on drugstore.com, for nearly $1,478 a year.

The drug companies “can charge what they want — it’s not fair,” Eric White, the 42-year-old owner of a small jewelry store in Queens, said as he left a pharmacy recently.

Despite having drug insurance, Mr. White says he now pays $110 a month out of pocket for two brand-name allergy medicines, even as he has cut prices in his jewelry store by at least 40 percent to keep customers coming through the door.

He shook his head. “What can I do?” he said. “I need my medicines.”

The drug industry has actively opposed some of the cost-cutting provisions in the House legislation, which passed Nov. 7 and aims to cut drug spending by about $14 billion a year over a decade.

But the drug makers have been proudly citing the agreement they reached with the White House and the Senate Finance Committee chairman to trim $8 billion a year — $80 billion over 10 years — from the nation’s drug bill by giving rebates to older Americans and the government. That provision is likely to be part of the legislation that will reach the Senate floor in coming weeks.

But this year’s price increases would effectively cancel out the savings from at least the first year of the Senate Finance agreement. And some critics say the surge in drug prices could change the dynamics of the entire 10-year deal.

“It makes it much easier for the drug companies to pony up the $80 billion because they’ll be making more money,” said Steven D. Findlay, senior health care analyst with the advocacy group Consumers Union.

Name-brand prices have risen even as prices of widely used generic drugs have fallen by about 9 percent in the last year, Professor Schondelmeyer said. But name brands account for 78 percent of total prescription drug spending in this country. And as long as a name-brand drug still has patent protection it faces no price competition from generics.

Ken Johnson, senior vice president of the industry association — the Pharmaceutical Research and Manufacturers of America — criticized the analysis Professor Schondelmeyer had conducted for AARP, saying it was politically motivated.

“In AARP’s skewed view of the world, medicines are always looked at as a cost and never seen as a savings — even though medicines often reduce unnecessary hospitalization, help avoid costly medical procedures and increase productivity through better prevention and management of chronic diseases,” he said.

But Professor Schondelmeyer’s analysis — which found prices for the name-brand drugs most widely used by the Medicare population rising by 9.3 percent in the last year, the fastest rate since 1992 — is in line with the findings of a leading Wall Street analyst, too. The report was released on Monday.

Catherine J. Arnold, a drug industry analyst at Credit Suisse, said her latest study of the nation’s eight biggest pharmaceutical companies showed markedly similar results: list prices rising an average of 8.7 percent in the 12 months ending Sept. 30 — the highest rate of growth since at least 2004.

As does Professor Schondelmeyer, Ms. Arnold based her price calculations on reported wholesale prices and a formula that puts more emphasis on each company’s best-selling drugs.

Ms. Arnold said the prospect of cost containment under health care reform, as well as the tougher business environment, entered into the decisions of manufacturers to raise prices this year.

The industry stands to gain about 30 million customers with drug insurance from the legislation pending in Congress. But the industry also faces the prospect of tougher negotiations from both public and private buyers as the government tries to squeeze savings out of the health system.

“If you’re going to take price increases,” Ms. Arnold said, “here and now might be the place to do that, because the next year and the year after that might be tough.”

Mr. Johnson did not dispute the Credit Suisse study or deny Ms. Arnold’s finding that American drug makers have raised prices at the fastest rate in five years.

He said both studies were incomplete by failing to include rebates that drug makers give distributors. But Ms. Arnold, Professor Schondelmeyer and a 2007 Congressional study of Medicare said the rebates often accrue to the middlemen, not consumers, and higher manufacturer prices lead to higher retail prices.

And the drug industry’s own major consulting firm, IMS Health, has also reported a significant run-up in prices. Back in April, IMS predicted that United States drug sales might actually decline this year.

Billy Tauzin, president of the industry’s trade association, highlighted the gloomy prediction in a June 1 letter to President Obama shortly before striking the deal to cut drug costs by $80 billion. In negotiating the deal, the drug makers argued that they could not afford to give up more than that.

But in October, IMS made an unusual change in the middle of its forecasting cycle, saying it now believed United States sales would grow at least 4.5 percent in 2009 — or $21 billion more than expected six months earlier.

A major reason, IMS said, was higher-than-expected price increases for drugs in the United States.

Source: http://www.nytimes.com/2009/11/16/busin ... rices.html

An Open Letter to Harry Reid on Controlling Health Care Costs
by Robert Reich
Huffington Post, November 13, 2009

Dear Senator Reid,

I know you're in a tough spot. It would be bad enough if you only had to get Ben Nelson, Evan Bayh, Mary Landrieu, and Blanche Lincoln on board, but anyone who has to kiss Joe Lieberman's derriere deserves a congressional medal of honor.

But Harry, you really need to take on future health-care costs. The House bill fails to do this. The public option in the House bill is open only to people without employer-provided health insurance. That will be too small a number to have bargaining clout to get good deals from drug companies and medical providers. And it will mainly attract people who have more expensive medical needs, which is why the Congressional Budget Office decided it would cost more than it would save.

You also know a public insurance option that's open to everyone would cut future health costs dramatically by imposing real competition on private for-profit insurance plans. That's why the private insurers hate the idea. Even if states were allowed to opt out of this robust public option, the big states would almost certainly opt in, giving it the scale needed to negotiate great deals from drug companies and medical providers. This would put pressure on any state that opted out because their citizens would soon discover they're paying far more.

In addition to the House's weak public option, the deals the White House and Max Baucus made with the drug companies and the AMA will force Americans to pay even more. If, on the other hand, Medicare were allowed to negotiate lower drug prices, biotech drugs weren't granted a twelve-years monopoly, and doctors had to accept Medicare reimbursements in line with legislation enacted years ago, Americans would save billions.

You know all this but you're also trying to get 60 votes in order get any bill to the floor. You have my sympathies, but unless you get these reforms into the final Senate bill you're not really helping most Americans afford future health care.

So what do you do?

First, try for the "reconciliation" process, which requires only 51 votes. Every one of the reforms I mention above would fit under the Byrd rule.

If that doesn't work, wrap these reforms together -- a public option open to everyone (allow states to opt out of this if they dare), Medicare-negotiated drug benefits, no 12-year monopoly for new drugs, and a major squeeze on Medicare reimbursements for doctors -- and have CBO score the savings. I guarantee you, the number will be large. Then you should dare anyone, Democrat or Republican, to vote against saving Americans so much money in years ahead. How is Ben Nelson going to face voters in Nebraska who would have to pay, say, 20 percent more for health care in the future if Nelson refuses to go along?

If neither of these tactics work, then take whatever bill you must to the Senate floor. But then introduce this reform package as the very first amendment to the bill. Call it the "Ted Kennedy Amendment for Helping Middle Class Families Afford Health Care," and whip the hell out of the Democrats. Get the President to help you. Surely Joe Biden will. If you can't get 51 votes out of Dems for this, publish the list of Dems who vote against it, strip them of their committee chairs or sub-chairs, and make sure the Democratic Senate Campaign Committee gives them zilch when they're up for re-election.

Nobody promised you this would be easy, Harry. But, hell, why are you there, anyway? Your responsibility isn't just to pass whatever will muster 60 votes and that the President and Dems can later call "health care reform." It's to do the right thing by the American people and bring down future health-care costs. Don't cave in to Lieberman or Nelson or the drug companies or the private insurers or the AMA or anyone else. Lead the charge.

All best.

Source: http://www.huffingtonpost.com/robert-re ... 57316.html

Afghan Escalation Would Make One-Year Pentagon Budget Almost As Big as Entire 10-Year Health Bill
by David Sirota
Huffington Post, November 16, 2009

In pitting the 10-year cost of Democrats' health care bill against the 10-year projected cost of the bloated Pentagon budget, my newspaper column last week made a simple comparison rarely ever made in politics today -- a comparison that might provide citizens with much needed context, but a comparison that is ignored.

Is the comparison's omission deliberate? It's hard to say, but when you read this typical New York Times piece, it's hard to argue that it isn't being irresponsibly ignored:

While President Obama's decision about sending more troops to Afghanistan is primarily a military one, it also has substantial budget implications that are adding pressure to limit the commitment, senior administration officials say...

Even if fewer troops are sent, or their mission is modified, the rough formula used by the White House, of about $1 million per soldier a year, appears almost constant.

So even if Mr. Obama opts for a lower troop commitment, Afghanistan's new costs could wash out the projected $26 billion expected to be saved in 2010 from withdrawing troops from Iraq. And the overall military budget could rise to as much as $734 billion, or 10 percent more than the peak of $667 billion under the Bush administration.

Kudos, of course, to the Times for even reporting on the unfathomably large costs of intensifying militarism and adventurism. But as you'll see in the story, there's no attempt to put the costs into any context -- specifically, there's no mention that an escalation in Afghanistan would mean outlays for the one-year Pentagon budget is approaching the total outlays of the entire 10-year health care bill.

Of course, the Times does offer up one fleeting contextual message indicating that increased defense spending from an Afghanistan escalation "would be a politically volatile issue for Mr. Obama at a time when the government budget deficit is soaring, the economy is weak and he is trying to pass a costly health care plan." But even that brief mention is dishonest.

On what basis does the Times call the health care plan "costly?" As I said in my column, while the Congressional Budget Office (ie. the nonpartisan institution that reporters/politicians use to price bills -- the nonpartisan institution that congressional Republicans tout as an authority) says the health legislation would mandate about $890 billion, CBO also makes painfully clear its tax and budget-cutting provisions would recover a net of $109 billion over 10 years, meaning the bill is as "costly" to the public treasury as the purchase of a stock that produces a net 10% return on investment. I mean, seriously -- if you invested $1,000 into a stock and got $1,100 back, would you lament to a friend about how "costly" the investment was to your bank account? No -- because your friend would look at you like you were insane.

Indeed, only in Washington is a big return on taxpayer investment and a $109 billion reduction in the deficit an example of something that's "costly" to taxpayers -- and only in a quickly deteriorating American media would defense spending be reported with almost zero context.

Source: http://www.huffingtonpost.com/david-sir ... 58932.html

Stupak: I'll Kill Bill If Abortion Amendment Goes (VIDEO)
Huffington Post, November 17, 2009

Rep. Bart Stupak (D-Mich.) pledged on Tuesday that he would kill health care reform legislation if his anti-abortion amendment is taken out.

"They're not going to take it out," Stupak said on Fox News. "If they do, health care will not move forward ... We won fair and square."

Asked about a comment from White House senior adviser David Axelrod this weekend suggesting that the language should be adjusted, Stupak was dismissive. "That is why Mr. Axelrod is not a legislator," he said. "He doesn't really know what he is talking about."

Stupak said 10 to 20 Democrats would join him in voting against the bill if his language was stripped out. The amendment would bar any insurance plan that is purchased with government subsidies from covering abortions.

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On "The Rachel Maddow Show" Monday night, Sen. Sherrod Brown (D-Ohio) said that the language restricting abortion would not be in the Senate health care bill.

"I don't think that it's a threat at all," Brown said on MSNBC. "There aren't more than four or five Democratic senators that I would say are anti-choice. There are at least, I think, two Republican senators who are pro-choice."

Source: http://www.huffingtonpost.com/2009/11/1 ... 61309.html

Orrin Hatch Will Introduce Abortion Funding Restrictions In Senate Health Bill
by Patricia Murphey
Politics Daily, November 17, 2009

Sen. Orrin Hatch (R-Utah) told Politics Daily Tuesday that he plans to introduce an amendment to the Senate health care reform bill similar to the amendment by Rep. Bart Stupak (D-Mich.) that was attached to the House health care reform bill. When asked if his amendment would mirror the Stupak language, he said. "I think so, I think that's a fair appraisal."

Stupak's measure says people who buy insurance through the new government exchange, and use subsidies to help them do it, would not be allowed to buy a policy that covered abortion.

Few specifics are known about the full bill that Senate Majority Leader Harry Reid will bring to the Senate floor for consideration, but one thing is assured. With Hatch's amendment, the issue that threatened to derail House passage of the bill -- restricting direct and indirect federal funding for abortion -- will be a part of the Senate debate.

"It will be much more difficult in the Senate," Hatch predicted. He said he has already reached out to Democrats to get support for the measure, but said, "There are so few you can really turn to."

The conservative senator has led the effort to restrict federal funding for abortion throughout the health care reform debate this year. He offered two amendments -- one in the Senate Finance Committee and one in the Health, Education and Labor and Pensions Committee -- to permanently restrict federal funding for abortion services. The existing Hyde amendment language already restricts direct federal funding for abortion, but must be approved annually.

Both of Hatch's amendments were defeated at the committee level, but did garner some Democratic support. Sen. Kent Conrad (D-N.D.) voted with Hatch in the Finance Committee, which defeated the amendment 13 to 10. Sen. Bob Casey (D-Pa.) supported the Hatch amendment on the 11-12 vote in the HELP committee. During the Finance committee's consideration of the Hatch amendment, Sen. Maria Cantwell (D-Wash.) warned the measure would be "a poison pill" for health care reform.

After suffering a stinging defeat with the House's approval of the Stupak amendment, pro-choice activists have mobilized to prevent Senate passage of a similar measure. NARAL Pro-Choice America delivered petitions with more than 90,000 signatures opposing the Stupak amendment to Reid's Senate office Monday, but the fate of the measure will come down to a handful of moderate senators who oppose either abortion or federal funding for it.

Today, Sen. Ben Nelson (D-Neb.) told Politics Daily he wants to see stronger language restricting federal funding for abortion services than exists in the committee-passed bills. Because Reid has not revealed specific language of his bill, it is not known how abortion is treated in the legislation. It would be difficult to remove language during the conference committee if it has already been passed by both the House and Senate.

Source: http://www.politicsdaily.com/2009/11/17 ... -in-senat/

Brown: Senate GOP can't get even a majority for abortion provision
By Michael O'Brien
The Hill's Blog Briefing Room, 11/17/09 09:10 AM ET

Republicans won't even have a majority in the Senate to add abortion provisions to the health bill, Sen. Sherrod Brown (D-Ohio) suggested Monday night.

Brown said that the Senate bill faces no threat from Republicans and pro-life Democrats looking to add language to the bill that would impose new rules on federal subsidies for abortion, mirroring an amendment attached by Rep. Bart Stupak (D-Mich.) to the House bill.

"I don't think that it's a threat at all," Brown said Monday night during an appearance on MSNBC. "There aren't more than four or five Democratic senators that I would say are anti-choice. There are at least, I think, two Republican senators who are pro-choice."

"Again, on an up or down vote -- Harry Reid's not going to put the Stupak language in the bill, I'd be certain," Brown added. "Then the Republicans will try to amend it into the bill, and they will be unsuccessful; they won't even get close to 50 votes."

Liberal Democrats have decried the Stupak amendment as clamping down on existing abortion rights, and 41 House Democrats, led by Rep. Diana DeGette (D-Colo.), have pledged to vote against a final health bill that includes any such provisions.

Some senators had signaled that abortion language would be necessary in the Senate bill, including on-the-fence Sen. Ben Nelson (D-Neb.). However, CNN reported Monday night that Nelson had relented on that issue, and had concluded that abortion language in the Senate Finance Committee was adequate.

Brown said that DeGette had told him that the House bill could not pass with Stupak's language. If the Senate were to include such language, it would prove a significant hurdle to clear in conference for Democrats hoping to get rid of the language.

Source: http://thehill.com/blogs/blog-briefing- ... -provision

10 Reasons Why the Stupak-Pitts Amendment Has to Go
by Nancy L. Cohen
Huffington Post, November 13, 2009

Once upon a time in America, men lorded over women, screwed any woman they could, and women and children paid the price. That quaint world lives on in the Family's C Street house, home to Sen. John Ensign, former home to Gov. Mark Sanford, and home to the new celebrities, Reps. Bart Stupak and Joseph Pitts. They'd like to revive that old-time religion throughout the land. Thanks to the Democratic Party they are one big giant step closer to their retro dream.

Lest you're also feeling nostalgic for a simpler time, here are some features of that lost world you might want to consider. Not too long ago children born to unmarried women had their birth certificates stamped "illegitimate." Why? You might suppose this was to enforce universal chastity on all. Nope. Just women. Nine out of ten men had sex before marriage. Four out of ten women weren't virgins at marriage, but most of that premarital sex was with their fiances shortly before the wedding. Almost 40 percent of men reported extramarital affairs at the time; among women just over 10 percent fooled around. Who knew Don Draper was Everyman? The real purpose of the state's stamp of disapproval? To deny children and their mothers any legal claim on the father's income and property. Not until 1968 did the Supreme Court rule that 'illegitimate' children had the same legal rights as legitimate ones.

I bring up this tale of the real-life consequences of the double standard because we need to be clear what is at stake in the Stupak-Pitts antiabortion amendment in the House Health Care Reform bill. Even if some Democrats who voted for the amendment did so because of deep convictions or from fear of the wrath of the Catholic Church, the main thrust of the measure is to condemn women for being sexually active. (If this seems a stretch to you, take a look at the comments section across the blogosphere. Women have to 'take responsibility' for their sex. Who knew humans had figured out asexual reproduction?)

Jumping into bed with the extreme anti-abortion Christian Right is a criminally stupid strategy for the Democratic party. We know the Democrats have become terrified by exaggerated warnings of doom in 2010 from Beltway insiders. Here are 10 numbers they might want to contemplate instead:

1. 10 million more women than men voted in 2008.*

2. 6 out of every 10 votes for Obama were from women.

3. 1,040. A very conservative estimate of the minimum number of times an average American woman who wants two children will have sexual intercourse not for procreation during her fertile years.

4. 1 out of 4 middle-class and low income women have, since the recession began, put off a gynecological visit or are having a hard time affording birth control.

5. 8.7% of women using oral contraceptives get pregnant in the first year of use; 17% using condoms do.

6. 1 out of 2 pregnancies in the United States are unintended.

7. 19% of American children under 18 years of age live in poverty.

8. 35% of American women will have had an abortion by age 45.

9. 61% of American women obtaining an abortion have at least one child already.

10. 80% of Americans think abortion should be legal in some circumstances. 41% think it should always be legal. 10% think it should never be legal.

"I'm angry, I'm still angry. I thought we would get a break." This from a woman, who campaigned hard for Obama, about the Stupak-Pitts amendment. Democrats beware. (Particularly those of you who voted for this amendment. Names here.) Similar outrage is boiling among women, your most reliable and most neglected supporters.

* Additional statistics for this article come from the U.S. Census and the General Social Survey.

Source: http://www.huffingtonpost.com/nancy-coh ... 56887.html

Economists Tout Health Care Reform In Letter To Obama
by Sam Stein
Huffington Post, November 17, 2009

In a boost to the Obama administration's efforts to frame health care reform as an economic boon, a group of 20 health economists sent a letter to the White House on Tuesday touting the fiscal results of passing reform legislation.

The group lists four specific elements of reform as crucial to controlling costs and righting the fiscal trajectory of the health care system's overhaul. They include making legislation deficit neutral (which describes both the House and Senate version of reform), including an excise tax on high-cost insurance plans (which is part of the Senate's version of reform, but not the House's version), creating an independent Medicare commission (also in the Senate bill), and general changes to the delivery system.

There is, notably, no mention of a public option for insurance coverage, which is estimated by other analysts as a major price savor in the health care system. But the note from the group of economist could give a needed boost to those conservative Democrats who are already skittish about the costs and size of congressional reform efforts.

As the economists write: "we believe that it is important to enact health reform, and it is essential that health reform include these four features that will lower health care costs and help reduce deficits over the long term. Reform legislation that embodies these four elements can go a long way toward delivering better health care, and better value, to Americans."

**SEE ORIGINAL ARTICLE FOR COPY OF ACTUAL LETTER BY ECONOMISTS

The list of signatories is below:

Dr. Henry Aaron, The Brookings Institution Dr. Kenneth Arrow, Stanford University, Nobel Laureate in Economics Dr. Alan Auerbach, University of California, Berkeley Dr. Katherine Baicker, Harvard University Dr. Alan Blinder, Princeton University Dr. David Cutler, Harvard University Dr. Angus Deaton, Princeton University Dr. J. Bradford DeLong, University of California, Berkeley Dr. Peter Diamond, Massachusetts Institute of Technology Dr. Victor Fuchs, Stanford University Dr. Alan Garber, Stanford University Dr. Jonathan Gruber, Massachusetts Institute of Technology Dr. Mark McClellan, The Brookings Institution Dr. Daniel McFadden, University of California, Berkeley, Nobel Laureate in Economics Dr. David Meltzer, University of Chicago Dr. Joseph Newhouse, Harvard University Dr. Uwe Reinhardt, Princeton University Dr. Robert Reischauer, The Urban Institute Dr. Alice Rivlin, The Brookings Institution Dr. Meredith Rosenthal, Harvard University Dr. John Shoven, Stanford University Dr. Jonathan Skinner, Dartmouth College Dr. Laura D'Andrea Tyson, University of California, Berkeley

**Source: http://www.huffingtonpost.com/2009/11/1 ... 61469.html

Real Health Care Reform: What's Next?
by Mehmet Oz, M.D.,
Huffington Post, November 12, 2009

On a recent episode of my show, I met a woman named Sandi. Her eyes streamed with tears as she told me about how she binged on food every night after her children were asleep. She was at her wit's end. She was suffering with complications from obesity -- borderline diabetes, hypertension, fatigue and most importantly, depression and anxiety. To modern medicine, she was a simple math equation -- her BMI needed to be under 30, her blood sugar around 100 and blood pressure around 120/70. There are any number of useful drugs that could help. But they would by no means deal with the cause of her problems or bring her to wellness.

Sandi isn't just a math equation that I can fix with drugs or surgery. She is a person, plain and simple. To treat her properly I need to understand every aspect of her life -- her food cravings that she likens to getting a crack hit, her feelings of defeat as she gives in night after night, her feelings of powerlessness and isolation. I need to look at her family; her life circumstances; her mental and spiritual health; her relationships; her daily routine; where she lives and how she gets to work each day. I need to provide to her with a comprehensive list of additional resources -- therapists, counselors, nutritionists, exercise trainers, spiritual counselors, her personal "go to" team to buttress every corner of her personhood.

Sandi will go to a long-term rehabilitative facility that treats patients with chronic eating disorders by addressing the physical and emotional components that make up the distress I witnessed at her intervention. The list of factors is lengthy, but each of them is deeply embedded in every tear that rolls down her cheek as she shares her story. And Sandi's tears are a call to action.

As I write this, the news is that the House passed the health care reform bill which will now move to the Senate. As government does its part to grapple with the economics of coverage, we the care providers and we the people have an enormous part to play. All of us must work together to create the change we need so that all Americans can experience a culture of health and well-being. Health care reform is not just about who pays. It must also address what we are paying for. And we have to start paying for health rather than treating sickness.

Recently at an event held by the Bravewell Collaborative, this community of philanthropists and thought leaders delivered a report on integrated medicine to the Insitute of Medicine. This event and the report signified the perspective on health we need to adopt going forward. We need to create a culture of health and wellness that fosters a nationwide understanding that personal behaviors are a major factor in health and well-being. And at the same time, we need to make the necessary societal changes so that all individuals are supported in making the correct choices. We need to make it easier to do the right thing.

We need to create a culture of health and well-being in our country that teaches a new vision -- that true health involves being well in body, mind, and spirit in the context of one's community. We need to change the idea that health is simply the absence of disease. It isn't. It is much more than that. Health provides for a vital state of engagement with life.

Americans pay far more for health care than the citizens of any other nation, and these costs are escalating every year. In fact, spending on health care related expenses now consumes more than one out of every six dollars we earn. Yet we experience greater incidence of disease and the World Health Organization's analysis of healthy nation indicators puts our life expectancy near the very bottom of the top 40 nations.

How can this be?

The problem sits at the very core of how we approach health care.

American health care does not help people become or stay healthy and does not make it easy for people who are seeking prevention. We have a disease management system based on the episodic care of illness or trauma, which means we treat symptoms instead of causes. In essence, we can operate on Sandi, but we can't give her a comprehensive pathway to wellness after her surgery. True healing can only begin when we correctly diagnose the problem and treat the root cause.

When we treat body parts without caring for the whole patient, it means that we are leaving out one of the strongest healing forces available -- YOU, the person with the ailment.

We know from research that the digestive system is controlled by the mind and anxiety, depression, and fear affect its functioning. Social and psychological stress can aggravate a wide variety of diseases, such as diabetes mellitus, high blood pressure, and migraine headaches. Emotions affect heart rate, blood pressure, sleep patterns, stomach acid secretion, and elimination processes. Treating Sandi isn't about the biology of what caused her weight problem -- it's about understanding and addressing those dark hours at night where she finds herself in that vortex of anxiety, defeat and feelings of helplessness. That's a complex understanding that has taken me a lifetime to learn. We can't afford to ignore these connections when we treat people. We can't leave the person out of the equation.

Currently, the majority of our health care dollars are spent after a person is in crisis -- like when I have to bring in an interventionist and watch them go through an emotional catharsis. It costs the most to intervene when the possibilities for full recovery are the slimmest. Think about it. Last year, $2.1 trillion dollars were spent in this country on medical care, or roughly $12,000 per family, and 95 cents of every dollar were spent to treat diseases after they had already occurred.

The fact is -- it is much easier to prevent a disease from developing than it is to cure it once the problem has reached a critical stage.

Let's look at chronic disease as an example. More than half of Americans suffer from one or more chronic diseases and we know that conditions such as heart disease, cancer, and diabetes are not only the leading causes of death and disability in the United States, they drive more than half of the health care expenditures of the nation.

But we also know that seven of the most common chronic diseases -- cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental disorders -- have been linked to behavioral and environmental risk factors that can be addressed. They might even be prevented altogether if people were helped and encouraged to make better choices. By this I mean eating nutritionally sound food, adopting healthy habits such as not-smoking, building healthy relationships, living and working in non-toxic environments, being purposefully engaged in life, practicing stress reduction activities, and staying fit through exercise.

People often have a hard time believing that something as simple as the choices we make about our daily lives can be as powerful as drugs and surgery. But they are.

The World Health Organization just released a report revealing that global life expectancy could be increased by nearly five years and millions of lives could be saved annually by addressing 24 factors affecting health. The list includes a mixture of environmental, behavioral and physiological factors, such as air pollution, tobacco use and poor nutrition.

In a recent study published in the Archives of Internal Medicine, CDC researchers found that individuals who adhered to four healthy lifestyle habits had a 78 percent lower risk for chronic disease, including diabetes, stroke, heart disease, and cancer. The four factors were never having smoked, having a body mass index (BMI) less than 30, exercising for at least 3.5 hours per week, and eating healthfully.

The Lifestyle Heart Trial published in the Lancet showed that people with severe coronary heart disease were able to stop or reverse it without drugs or surgery by simply making intensive lifestyle changes.

A trial published in the Journal of Urology by my colleague Dean Ornish showed that lifestyle changes can slow, stop, or even reverse the progression of early-stage prostate cancer.

You get the point. Or do you? This isn't theory. These aren't utopian pipe dreams. This isn't idealism. This is evidence-based peer reviewed science that even the most methodical and empirically minded individual can understand.

Said differently, the science suggests that the reason lifestyle change programs work so well is because the combined interventions affect gene expression, turning on genes that prevent disease and turning off genes that promote heart disease, prostate cancer, breast cancer, and other illnesses.

When you look at the big picture, improving the health of all Americans cannot be achieved by addressing the health care system in isolation from the rest of society. We have to change our entire culture. That's not as daunting as it sounds. It's simply a matter of how we look at things. The steps themselves are simple, but they require a social choreography and a new outlook. On a positive note, in all my years in medicine, I have never felt we were at such a critical mass as we are now for these ideas to take root and grow. Regardless of the outcome of the health care reform debate, the national discussion has created a turning point for the way we see and prioritize health.

We have to make the promotion of health part of what we do in our homes and in our places of work. This could range from reducing the amount of toxic chemicals we use for cleaning -- to planning nutritional meals for our families -- to demanding smoke-free work environments -- to making time in our schedules for exercise -- to adopting corporate wellness programs that reward healthy behaviors.

Being health conscious involves monitoring what food we grow and how we manufacture it, which includes anything from supporting local farmers -- to buying organic foods -- to regulating how our food is genetically altered -- to asking major food processing companies to remove trans fats and reduce sugar content in their products.

Our cultural emphasis on health must involve improving the quality of our air and water. This could mean planting more trees, placing stricter demands on automobile emissions, eliminating contamination sources flowing into our lakes and oceans, and creating riparian buffers along our rivers.

City planning and health departments need shared goals. Having health as a priority in community design would mean creating more bicycle and walking paths, establishing a network of green rooftops, creating community gardens and ensuring that all residents have access to fresh food.

Health promotion has to be part of the educational process of our children. This would include teaching nutrition and stress reduction in elementary and middle schools, ensuring that food served in cafeterias is healthy and nutritious, banning the sale of soda and candy on school premises, and demanding that recess and physical education classes are never cut from the school day.

Our focus on health has to be part of the work processes of our corporations, which means helping employees in their pursuit of better health, eliminating toxins from the manufacturing process, and creating products that leave smaller footprints or -- in the case of medicines -- produce less side effects.

And it has to be part of our everyday culture. This can mean anything from having access to calorie counts for restaurant items -- to encouraging our friends to make better choices -- to ensuring that insurance companies reimburse for prevention.

When we do all this, not only will each individual benefit, so will the whole country. An investment in health and wellness is an investment in our future prosperity and the strength of our nation.

We are so close, and I hold great hope. Lets do it.

Source: http://www.huffingtonpost.com/dr-mehmet ... 56123.html

Progressives To Reid: Hold Firm On Public Option (VIDEO)
Huffington Post, November 17, 2009

Senate Majority Leader Harry Reid met on Monday night with a group of Senate Democrats who urged him not to back down from his decision to put a public option in health care legislation.

Sen. Sherrod Brown (D-Ohio) requested the meeting, saying that progressive lawmakers had concluded that they had compromised enough.

"Most of us in the caucus want a strong public option, support the Reid way of doing it," he told the New York Times. "And we're confident that over time, as the debate unfolds and we take amendment after amendment after amendment, that we can get 60 votes."

"We figure on the public option there has been a lot of compromise already," he said. "...A large number of people in this country including many, many doctors wanted Medicare for all. That didn't happen. Then we wanted a strong public option tied to Medicare rates. Then we wanted a public option building the Medicare network. That didn't happen. Now we are saying public option coming out of the HELP Committee. And now we're saying public option with the state opt-out. Where was the compromise coming from their side?"

Sherrod Brown also discussed his position on "The Rachel Maddow Show" Monday night. He backed Sen. Tom Harkin (D-Iowa), who said recently that the Democrats would force Republicans trying to delay the bill to stay in 24-hour sessions. "Whatever it takes," he said.

Asked about Sen. Joe Lieberman's (I-Conn.) threat to filibuster the bill, Brown reiterated that the majority of Democrats backed the public option. "We're not gonna let the tail wag the dog here," he said. He added that he was confident that in the end, reluctant Democrats would let the public option go to an up-or-down vote. He also said he was sure Harry Reid would not put an amendment restricting abortion coverage in the Senate bill.

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Source: http://www.huffingtonpost.com/2009/11/1 ... 60387.html

Harkin says Senate will work weekends this December on health
By Michael O’Brien
The Hill, 11/16/09 11:45 AM ET

The chairman of a key Senate committee overseeing healthcare reform said Monday that the chamber will work every weekend in December to pass the bill by Christmas.

Sen. Tom Harkin (D-Iowa), the chairman of the Health, Education, Labor and Pensions (HELP) Committee, predicted during an interview on the liberal "Bill Press Radio Show" that the Senate will have the 60 votes needed to call up the healthcare bill this week. But Harkin said senators will not begin amending the legislation until after the Thanksgiving break.

Harkin said Democrats expect Republicans will try to stall the debate by asking for the entire bill to be read on the Senate floor. If that happens, Harkin said, the majority party is likely to use a procedural maneuver to keep the Senate in session this weekend.

"If the Republicans want to stay here this Saturday and Sunday to read the bill, then let them stay here," Harkin said, adding that Democrats would hold a "live quorum," where the sergeant at arms requests the presence of all absent senators.

"I'll tell you, we're going to do something like that," Harkin said. "We are planning to do something that would require Republicans to be there 24 hours a day, and if they leave the floor, we'll ask unanimous consent to dispense with the reading, and that'll be the end of it."

The Iowa senator laid out an ambitious schedule for the final weeks before the end of the year. He said Democrats expect to hold the first big test vote by Friday on a motion to proceed to the bill. But no amendments will come up until Nov. 30, at the earliest. He said Majority Leader Harry Reid (D-Nev.) is committed to working through every weekend in December if that’s what it takes to pass the bill before lawmakers break for the Christmas holiday.

"We're going to be going long days — I've already talked to Leader Reid about this — long nights, weekends — constantly, from then until right before Christmas, when I think we'll have the votes, hopefully, to pass the bill," he said.

Harkin said Reid will appoint conferees immediately after the bill passes and would hopefully have Senate staffers begin work on a conference report with their House counterparts during the Christmas break. Conferees would then begin work after the first of the year, with an eye toward sending a final bill to the president by mid-January, shortly before President Barack Obama's State of the Union address.

The HELP chairman signaled that Senate Democrats expect the Congressional Budget Office (CBO) to release its score of the health bill by Tuesday, a figure eagerly anticipated by Democrats and Republicans before the health debate begins.

Source: http://thehill.com/homenews/senate/6790 ... n-december