The Stupak amendment ... prohibits the use of any funds authorized or
appropriated under the Act “to cover any part of the costs of any health
plan that includes coverage for abortion,” except in cases of rape, incest, or physical life endangerment, even if the abortion coverage is paid for
with a separate premium. Private plans can only offer abortion coverage
to persons receiving federal affordability subsidies if the coverage is
offered as separate supplemental coverage, paid for with premiums that
are not subsidized under the Act and that fully cover the administrative
costs of the abortion coverage. The public plan may not offer abortion
coverage at all. Private plans that participate in the exchange and
include abortion coverage (i.e. plans that are sold without
affordability credits) must also offer plans through the exchange that
are identical in every respect except for not covering abortion.
Exchanges are not required to offer plans that cover abortion.

The amendment covers all funds authorized and appropriated under the
Act. It is not, therefore, limited to the affordability credits, but
also to credits paid to small employers to encourage them to insure
their employees and presumably to other programs like school-based
health clinics, nurse managed health centers, or health services for
Native Americans that are also funded under the Act. (The Act already
contained separate abortion coverage prohibitions for school-based and
Native American Health Services.

In other words, any plan, public or private, that wants any Federal
money, cannot offer abortion services.

As a foster parent who has taken the impoverished,
unwanted and neglected children of drug abusers into my home, I can
honestly say that in some cases, abortion would have been preferable to
the abuse they suffered as babies and children, often homeless, beaten,
and unfed. It’s not easy to raise a child: it takes love, training, and a
fair amount of money. Children having children helps no one. And the
dream of adopting all these kids is far-fetched: most foster children
NEVER get adopted.

I’m not talking here about abstract issues of women’s rights, although of course I (a
woman) believe in them. I’m talking about grim reality. I took my foster
daughter to get an abortion at Planned Parenthood when she got pregnant
at 16 by a ne’er-do-well, and now she is a happy mother of 25. She
thanks me every day. And by the way, I paid for that out of my own
pocket.

Trying
to duck the trick-or-treaters on my block on Saturday night (Halloween induces a
bark-a-thon at my house), I escaped into the closest movie, Michael
Jackson's This is It.  I
expected nothing. Like everyone else, after Jackson died I watched
every person who ever met him once parade through Larry King Live
saying what a good person he was, and listened to Liz Taylor moan about
how she couldn't go on. While I never thought Michael Jackson was a
child molester, I wasn't a true fan, either. And I probably believed he
couldn't make it through fifty shows on the drugs he was on.

I
now question my own judgment. The very first show would have
electrified the world and given Jackson the adrenalin to go on. The man
was a genius. Coming into rehearsals, he clearly knew every song, every
move, every note. It was as if the music poured out from inside his DNA
, where it always lived and now was being given the chance to express.
Having never been anything but a performer, Michael Jackson was still a
performer at 50, capable of astounding dance moves and exquisite
timing. Not only that, but at 50 he was happy to be in the role of
mentor to the younger dancers and musicians, rather than a competitor
with them. He clearly wanted to give them an opportunity to shine. The
audience would have loved him. Did he do every acrobatic move that the
younger dancers did? Of course not.  But he reminded me of a great
tennis player who can win a match through superior strategy even though
athletically past his prime.

At the rehearsals, he seemed
comfortable with the show. Never irritable on camera, he appeared
gracious and loving. By the time they were set to go to London, he had
accepted the cast and crew as family, and they gave him the adulation
he deserved. Many of them had traveled around the world to audition for
the show. It's sad they never got the chance to hear the applause. And
it's sad Michael never got a chance to do even one show, because the
sets, costumes, lighting, and graphics would have been out of the
ballpark.  Go see this movie to see what they were working on; this
production would have been worth the ticket price even if the
understudy went on for Michael Jackson.

The footage was shot
with two cameras, fortunately in high definition, but nothing like a
finished movie. It was meant to be for Jackson's personal archive, and
it is truly a documentary -- it documents the rehearsals without window
dressing. In it you can see the mutual respect between Kenny Ortega,
who directed the movie and co-directed the show with Michael, and
Michael Jackson. Clearly they are used to working together, and they
help each other out. I especially liked it when Ortega told Jackson to
"hold on" to the bars on the cherry picker the first time Jackson took
a ride on it. Jackson seemed fearless, wanting to take it higher and
sing while doing it, but Ortega only wanted him to take the ride and
test the safety.

Was Michael Jackson a sick drug addict? No way.
Did we, the public and the media, hasten the death of a man who felt
for the planet and wanted to deliver a message of love to the world?
Probably. We have a grim way of eating our public figures alive these
days. I'm sure Michael Jackson wasn't perfect, but neither are we.

Now the site has a new feature, "Health Events," that contains 1.6 million health education and screening events, most of them free, all over the country. For people who want to make life changes, and people without health insurance, these events can be the difference between life and death.

EmpowHer began as a specifically women's online health resource started by Michelle Robson, who when sick herself, despite all her resources and access, learned from personal experience that women are under served. She also learned about the incredible forces arrayed on the side of the status quo.

Out of her own illness and her search for alternatives, she became a powerful advocate for women, and started EmpowHer to scale her daily outreach further than just answering her phone and her Blackberry to connect women with resources she had discovered herself. Her goal is still to make women more knowledgeable, healthier and happier. You should see her offices: EmpowHer staff is down the hall from a personal trainer, and the company pays for its people to work out under the trainer's supervision. For a startup, that's not only rare, but it's walking the talk.

When she started the company, Michelle knew nothing about technology, social networks, or online communities, but she knew the web could help information spread and could be a powerful resource. Most web developers are male, and it took Michelle a while to settle on the team (both men and women) that "got it" about what she was trying to accomplish and why. Two years later, EmpowHer is one of the leading patient communities on the web, and has a male CEO, a tech veteran who understands the power of high quality health information not biased by vested interests.

With its powerful "ASK" and "SHARE" messages, EmpowHer invites women to contribute their stories and ask for help from experts. A team of "Her Writers," most of whom are women with chronic conditions, are paid to write about their expertise, which ranges from post-partum depression to heart disease. While anyone can contribute their own experience under the "Share" tab, the "Her" writers are charged with assuring the quality of content on the site. It's not advertorial; it's helpful. And the cool part is that these women who can't go out and work ordinary jobs, receive income for sharing their learning.

And then their are the physicians. They are anxious to allow themselves to be taped in short segments so they can offer women information they often don't have time to give in their own offices. EmpowHer sends teams around the country to locate the leading experts in each of their fields and interview them, posting the interviews on the site. Want to know what the latest nutritional advances are in osteoporosis - Dr. Maoshing Ni, a 38th generation doctor of Chinese medicine can tell you, or you can read the latest allopathic research results under "Her News" and can click through to the National Osteoporosis Foundation.

We've all but lost the idea of reforming health care in our efforts to reform health insurance. But wise policymakers know that the best way to bend the cost curve is to give people tools to practice prevention and wellness. Cynics think people won't easily give up their bad health habits, but EmpowHer has millions of visitors who expose that as false.

Disclosure: Michelle Robson is a personal friend. And I share my own health stories on EmpowHer.

Because I own my own business, Aurora Loan Services
asked me for three years of tax returns, three months of bank
statements, a year-to-date P&L, a hardship letter, and a personal
financial statement. I sent them all, at a cost of about $100 by the
time I printed everything at Kinko's and FedExed it to them. And then I
had to turn around and do the same thing for Citibank which holds my
home equity line, because the "mortgage" I was given is actually a
melange of a mortgage and a HELOC (common in California avoid the very high rates for jumbo loans).

After about 60 days Aurora told me 1) I was not eligible for Obama's
program because I didn't have an FHA loan, and 2) they couldn't do
anything for me.

After I heard the government had put more pressure on the lenders to
restructure mortgages, I reapplied. Once again, I had to send all those
documents, and once again I was told they couldn't help me. Their
"investors" had said no.

In April, I learned that if I could break even on paper I could
refinance, so I sent everything again.  This time Aurora asked for my
2008 return, and I sent it. They told me they were now very busy trying
to restructure loans, and to wait 90 days.

I heard nothing, so I called: they said they were missing my tax
returns, proof of the contracts responsible for my income for the rest
of the year, and three months of current bank statements. I sent those
in July. I called in August, and they asked me whether I remembered
that I had to wait 90 days.

Last week I emailed them. And guess what? They told me they needed
copies of my 2008 tax return, a year-to-date P&L, those contracts
again, and proof of which  bank deposits came from those contracts. You
have no idea how hard it is to keep generating and updating these
documents, even for me a person whose information is mostly in the
cloud as mine is (not the contracts, which are sent to me by
municipalities for signing as hard copies that I have to mail back).

It has been 9 months since I began trying for relief. So it's only fitting that this afternoon I went to see Michael Moore's Capitalism: A Love Story.

I urge you to see this film.

I am the first to agree that Michael Moore exaggerates. But in this movie,
not so much. It is 100% true that Congress is owned by the financial
institutions lock, stock and barrel.  I don't care which party you
belong to -- I'm an independent -- you should be outraged by this movie if
you are young, or have children, or work, or build businesses.  Because
America has been, and continues to be, ruined for the rest of us by
about a hundred people on "Wall Street" who have all the money and
therefore run the government and your life. It's everything from credit
card fees to subprime mortgages, to Ponzi schemes, to health insurance
reform.

In Phoenix, the real estate market has bottomed and the "investors"
are coming in and beating first-time home buyers to foreclosed houses
with all cash deals. The banks don't care who they sell to; the people
who want to take advantage of the tax credit can't get in on the deals.

Because Moore shows a lot of archival footage in the movie, I got to
think about how much American life has deteriorated for the middle
class during the past 25 years. When I started my business in 1980, I
made a great deal more money doing essentially the same thing, and I
had a pretty good life. Twenty-five years later, my standard of living
has totally deteriorated. I personify the vanishing middle class, and
so do most of you. I wouldn't ignore it if I were you. As my friend
Fred says to me every Saturday night, "It's a good thing we're not
going to be here to see what's coming."

This is the conclusion I draw from iGuard.org’s publication of a white paper on prescription drug trends in the US. iGuard
is a service that helps patients monitor drug safety, publishes alerts,
and clearly collects data. Some of the data in the white paper is their
own, and the rest comes from respected sources.

Nearly half of all Americans take at least one prescription drug and one in six Americans takes three or more medications. (Source: Institute of Medicine (IOM) 2007. The Future of Drug Safety: Promoting and Protecting the Health of the Public, Washington DC: National Academies Press)


• 32 million Americans are taking three or more medications daily. (Source: American Heart Association)


• Prescription drug use is rising among people of all ages, and use
increases with age with five out of six persons 65 and older taking at
least one medication and almost half the elderly taking three or more. Source: CDC National Center for Health Statistics: Health, United States 2004 – 12/2(S/04

The top classes of drugs for all patients in July 2008 included:

1. Codeine, alone and in combination (typically with acetaminophen)

2. Statins (cholesterol-lowering, simvastatin, atorvastatin)

3. Beta Blockers (heart drugs)

4. SSRI antidepressants (e.g., Lexipro, Celexa, Prozac, Zoloft, Paxil)

5. ACE Inhibitors (hypertension, Lisinopril)

6. Seizure disorders (used for epilepsy as well as migraines (Topamax),
bipolar disorder (Lamictal), and pain (Lyrica, neurontin)

7. Thyroid medications

8. PPIs for ulcers, GERD (e.g., Nexium, Aciphex, Prevacid)

9. Benzodiazepines (anxiety – Xanax, Valium)

10. Calcium channel blockers (hypertension)

The top classes of drugs that children from ages 0-17 are taking include:

1. Analeptics (medications for ADHD)

2. Aminopenicillins (antibiotics)

3. Cephalosporn (antibiotics)

4. Leukotriene agents (Singulair, allergy & asthma)

5. Corticoids, dermatological (topical steroids)

6. Macrolides (antibiotics)

7. Beta Agonist Aerosol (e.g., albuterol)

8. Codeine and combination

9. Oral corticoids (oral steroids)

10. Antibiotic drops for the ear

You can see that kids get a lot of antibiotics and asthma meds.
Adults get a lot of pain-killers (physical and emotional). This costs
the health care system big bucks.

• More than half (53%) of all consumers go online to look for prescription drug information, vs. 41% in 2007 (Source:
11th annual national survey, “Consumer Reaction to DTC Advertising of
Prescription Medicines,” conducted by Prevention, Men’s Health and
Women’s Health magazines, with technical assistance from the FDA. The
study is one of the primary consumer studies informing the FDA’s stance
on Direct-to-Consumer (DTC) issues. 6/10/08)


• The same Prevention study reported that of those taking prescription
medicines, 55% saw an advertisement for the medicine they were taking.
“Consumers are firmly rooted in the era of online health management as
more and more patients embrace tools and trackers such as Google, Yahoo
and Revolution Health,” said Cary Silvers, Director of Consumer
Insights at Rodale, who spearheaded the 2008 study. “Along with the
doctor and pharmacist, the online component has become the third leg of
the stool as consumers learn about drugs. The more consumers know, the
more likely they are to take action.”

But then the information gets ugly. The number one problem doctors
report about treating patients is failure to take prescription
medications correctly, regardless of patient age. Most Americans
receive the prescriptions they need, but either don’t fill them, don’t
finish them, or don’t take them correctly. More than half of Americans
with chronic diseases don’t follow their physicians’ advice. People go
so far as to fill their prescriptions and then fail to take ANY of the
medicines.

These are big public health problems. We are throwing money spent on
pharmaceuticals — and it’s something over $100 billion a year — down
the toilet. The wrong people are taking the drugs — the sick don’t take
them, and the lifestyle experimenters and addicts do.

Many people don’t take their drugs because of adverse events. They
are beginning to report those online in patient forums and to the FDA,
but not nearly in the numbers they should for the information to be
effective. However, in 2006, consumers replaced physicians as the
largest source of adverse event reporting to the FDA.

Consumers need to be encouraged to report adverse events that aren’t
serious enough to hospitalize them but are enough to make them stop
taking a medication, or the FDA can’t do its aftermarket surveillance
properly. iGuard’s own member data reports that 25% of its diabetic
members are taking medications with a risk rating of 4 out of a
possible 5.

As consumers, we can fix this system if we each contribute our own
experience. It’s called crowd-sourcing, and it’s very valuable.

(crossposted to http://azhealthworks.org/americans-on-drugs)

So
I have given this post a somewhat hyperbolic title. But not as much as
you would think. The Senate Finance Committee voted down the public
plan today, and because I was driving around Maricopa County Arizona (all 9200 square miles of it) for a good
part of the morning, I heard the good, the bad, and the ugly about the
debate. Snippets that I caught included:

"There is no competition among insurance plans in 95% of the states. Two insurers rule the market."
"The doctors, at least the ones I've talked to, don't want to  be paid Medicare rates."
"Medicare has a $37 trillion unfunded liability. Does anyone even know how much money that is?"
""A public option won't mean government run health care this year, or maybe even next, but just wait until 2013 or 2014."

A few hardy Democrats tried to say the people wanted a public plan, but they were beaten back by one Senator saying
"I don't even think these people shopping for a public plan or a private plan even know what they're buying."

And someone else said, "the person whose doctor says get an MRI is in
no position to judge whether he needs iit or not. He has to trust the
doctor."

These snippets tell me we are nowhere near a consensus
on what health care should be like in America, much less how to get
there.

Eons ago, Steve Gillmor told me that if we got nothing
out of reform but an end fo rejecting people for pre-existing
conditions, we would have achieved a lot. At the time, I thought that
was nothing. I now totally agree with him, and believe that in the
current climate, the Democrats are lucky to escape with their shirts.

The lack of a coherent plan that people could rally around has left
Obama in the dubious position of violating his own dictum: "Strategy
first, then resources." If that's good enough for Afghanistan, it
should be good enough for health care. If we pass reform this year, we
will be throwing resources at a non-strategy.

You can tell I'm a
registered Independent, or as that is translated in Arizona, "no
political party." Having a choice of Republican, Democrat, Green or
Libertarian, I opt out.

 I agree that there is no competition
among health plans. I remember when there was, and no one could get
enough traction to justify the expenses of operating, so different
plans gradually withdrew from certain states, other companies merged
and acquired and consolidated, and now we have what we have.

I
also agree that Americans cannot have everything and pay nothing, and
that rationing is a part of every health care system and should be
brought out into the open and discussed.  It's not the province of the
public plan; in fact, one reason that Medicare has so much financial
trouble is that Medicare rations much less viciously than private plans.

We've had almost a year of debate based on half truths,
circumlocutions, slogans, and bull-oney. Now we're here. No matter what
happens henceforth, the Democrats will lose in 2010, probably Obama
will lose in 2012, and health care costs will continue to rise.  We
have wasted an entire year of lobbyist time, company money, and
consumer trepidation for nothing. All we've done is show that on the
health care side our government is as broken as it is on the banking
side.

Is your credit card interest rate 29.99%  Is your house
under water? Can you get in to see a doctor? Is your doctor happy with
his or her occupation?

Money wins.  Doctors and patients lose. And I am disappointed because I really thought Obama was talking change.

I'm pretty much a disciple of Ghandi, so I understand why Obama
would address the United Nations, trying to "be the change" he wants to
see. But I also wonder if when the US media calls out these guys as
"crackpots," we are seeing things through our own eyes and those of our
allies, or through the eyes of their constituents. How do I know how
much credence to give these unfamiliar-behaving world leaders?

I'm troubled by the fact that, even in the Internet era, I
can't get a good fix on whether these guys represent mainstream opinion
in their countries, or are indeed the lunatic fringe. Ghadafi, who
wanted to pitch a tent on Donald Trump's lawn because he doesn't like
elevators, is a little easier to dismiss than Iran's president, but he,
too, seems not to be an accepted leader in his own country. And Karzai?
Another crooked election?

So is the UN outdated, bloated, and over? I suspect so.  By
having these meetings, we are showcasing people who would be
marginalized if we didn't bring them an audience of global media. Or
are we showing different points of view about the world that need to be
aired? How crooked are our own elections?

At times like these, I think I don't get out of my comfort
zone enough, and that perhaps I should go to places like Pakistan,
Afghanistan, Libya and Iran before I accept the judgment of the cable
news networks that I so readily dismiss on issues like health insurance
reform, where I possess enough information to form my own judgment.
Knowledge is power.

1. Make health insurance mandatory, but make coverage compulsory for insurers. The insurers can't survive if they don't have the healthy people on their rolls as well as the sick, and the healthy young people often opt out. (As it is, the rise of DNA testing is going to change the insurance industry as people use their DNA test results to decide whether or not to buy insurance and what kind to buy. In the future, without mandatory health insurance the system will collapse.)



2. Make everyone pay something -- employers, employees, and the unemployed, but make the premiums reflect true costs. Medical care is expensive. Subsidize those who truly can't pay. Become tranparent about the costs of medical care.



3. Regulate insurance companies like utilities, and do it nationally. Allow buyers to buy across state lines.



4. Negotiate with drug companies nationally.



5. Put a limit on jury awards and on legal fees in medical cases.



6. Go back to the days of banning law firm and drug company advertising. We have created an artificial demand for drugs that treat overactive bladder and restless leg syndrome by re-defining annoyances as sicknesses and creating pills for them at great expense.



7. Make computerization of medical records mandatory within a few years, and subsidize (i.e., tax credits) record conversion to get it done. Introduce uniform applications, medical records, and claims forms nationally, preferably open source.



8. Increase the number of doctors and nurses by providing subsidies and tax benefits to both students and medical educational institutions. Provide some form of loan forgiveness for primary care docs , pediatricians and geriatricians. Not every doctor visit should be to a specialist.



9. Put everyone under the same system. No separate deals for Congress, Federal and State employees, high paid executives, or special groups like retired railroad workers.



10. Basic coverage for everyone, with 5 star benefits only for those who can pay. Not everyone can have a Cadillac.

"Obama and many congressional Democrats see Advantage as a wasteful bonanza averaging about $17 billion a year for the companies, which critics say provide few benefits beyond regular Medicare.

The companies and their supporters say they earn the extra payments by providing seniors -- who pay nothing extra -- with significant benefits, including freedom from government red tape.

What lifts the disagreement above other points of contention on healthcare is its potential for spreading fear and outrage among Medicare recipients as a whole, much like the public outcry after Republicans accused Democrats of trying to create death panels to cut off care for severely ill seniors and the disabled.

The allegation, although untrue, fueled outrage among critics of the health care overhaul at town hall meetings across the country."