Health Care on The Huffington Post

Alec Baldwin: The Republican Way: Keeping Everything The Way It Is

2009-11-24T12:10:50Z

Didn't you know, all along, that the goal of U.S. policy in Iraq was about accessing oil?

Not oil as in those production levels at the onset of the Bush era incursion in March, 2003. But newer, stronger, American-style production levels. American oil companies had been forbidden from exploring and developing new oil fields since the nationalization of Iraq's reserves in 1972 and those American oil companies have long contended that Iraqi estimates of their potential reserves are grossly underestimated, by perhaps as much as a couple of hundred billion barrels.

Likewise, didn't you know all along that Republican opposition to current health care reform is about maintaining the unconscionable monopoly that insurance companies have in the American economy. Why? For the same reason Bush went to war in Iraq, spent money we didn't have, pushed the country into financial ruin and did more to threaten our long term national security than any modern president. The GOP needs contributions. I would never contend that the GOP is alone in this practice. When an administration awards contracts to some supporter, they anticipate more support. But no group, in the history of this country, has ever done this to such an extent. Remember, I am always careful to separate the leadership of any party from its rank and file. So when I level such a charge against "Republicans", I am referring to their leadership on Capitol Hill. But, I think it's safe to say now that the war in Iraq was started to provide U.S. oil companies with the opportunity to develop new oil fields there in return for the massive campaign contributions those oil companies will make to the Republicans in 2010 and, especially, 2012 in their effort to unseat President Obama.

The same is true for the health care industry, and insurance companies in particular. They don't want reform. The current system works quite well for them. If an excess of Americans die due to insufficient health care, so what. Republican leaders argue that health care reform will lead to a big, fat, incompetent bureaucracy that will gobble up billions of U.S. taxpayer dollars and provide little accountability. But wait. Isn't the Pentagon a big, fat, incompetent bureaucracy that gobbles up...? Well, you get it.

The Pentagon wastes more money on more crap that you and I don't need and gets it wrong, on a policy level, more often than not since 1960 (I'll give them a pass on Korea, due to all the Cold War anxiety at the time). Republicans never flinch. Spending on the military, and subsequent sales of those weapons systems around the world, help the U.S. economy, in their mind. Those companies, in turn, contribute to the campaigns of men like George W. Bush. This is especially so now that the Pentagon, in the ultimate sign of their stupidity, abdication of their responsibilities and tacit compliance with GOP fundraising goals, have privatized the U.S. military to the tune of one million dollars per soldier in Afghanistan.

Think about that. Recruitment is down. This Pentagon has a shortage of willing and competent soldiers who can run our military machinery. So what do they do? Do they improve recruitment, training and pay for soldiers? No. They privatize as much of these duties as they can (with no bid contracts for staggering sums of money) and create new businesses that, in turn, will contribute to those that helped them

The health care industry wastes untold billions, then passes those costs on to insurance companies who then exploit your fear and pass them on to you. Fear of Al Qaeda. Fear of getting sick without insurance and, therefore, access to effective medical care. Keep everything the way it is, out of fear. Fear that it could get worse. That's the Republican way. These guys have this country coming and going.

Health care reform means less money for insurance companies. Thus less money for the GOP. We should pass this bill for that reason alone.

Switch To Electronic Records Getting Mixed Reviews At Hospitals, Clinics

2009-11-24T11:01:32Z

More than five years ago, one of California's leading hospitals decided to leap into the future of medical care by digitizing its patients' health records. Despite a $50 million investment and countless hours trying to overcome persistent technical headaches, the system is still not fully up and running.

This summer, the University of California San Francisco Medical Center quietly wrote off more than a third of the money it has spent, terminated its contractor and prepared to start part of the project from scratch.

"We're disappointed. A lot of people put in a lot of hard work," said Ken Jones, the medical center's interim chief operating officer.

The costly setback pointedly illustrates the challenges health professionals face trying to meet a government mandate to bring American medicine into the computer age.

Federal officials expect to spend as much as $45 billion in economic stimulus funds over the next ten years to encourage doctors and hospitals to buy electronic records systems. The aim is to improve health care, tame spending and minimize medical mistakes.

Though it enjoys wide-reaching political support in Washington, the drive has generated less enthusiasm in the medical trenches. Many doctors and technology analysts warn that electronic records systems now on the market may constitute a risky investment for taxpayers. Early reports from some American and European hospitals, they say, suggest that some technology may prove unreliable and could even pose safety problems for patients.

"Our basic position is that the current products cannot meet our quality, safety or efficiency needs," said Kendall Rogers, an internist at the University of New Mexico. He chairs an information technology task force for the Society of Hospital Medicine, a doctors' group whose members work primarily in hospitals.

No government agency regulates digital health systems or tracks how well they work. There is no central repository for reporting problems, though a relatively small number of voluntary reports to the Food and Drug Administration hint at the range of breakdowns faced by some hospitals and doctors.

Some technology analysts also have criticized provisions in some sales contracts that may prohibit buyers of digital records software from publicly disclosing any flaws.

Are you a patient who has begun tracking your medical records online? Are you a health care provider who has converted to digital records management? Do you sell or develop these technologies? We'll be following the nation's adoption of new digital medical records, and we want to hear from you. Send us your Health IT stories and we may publish the results.

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U.S. Sen. Charles E. Grassley (R-Iowa), ranking member of the Senate Finance Committee, is looking into complaints from patients, doctors and engineers "regarding difficulties they have encountered" with the systems. In a letter sent last month, Grassley directed 10 manufacturers to report service problems since January 2007 to the committee.

Through a spokeswoman, the health information technology industry's trade association said it would have no comment on Grassley's probe or other quality issues. However, a spokeswoman for Cerner Corporation, an industry leader, said the company welcomed the senator's review and was cooperating with it.

"We are pulling the data and nearly ready to submit it," said Cerner spokeswoman Kelli Christman. "I think it's a great idea they are looking at it, particularly when (taxpayers) are investing billions of dollars."

In the case of the University of California San Francisco, the hospital ended its contract with General Electric "based on overall delay in getting an integrated system in place and fully functional," a spokeswoman said.

Despite the problems, many at the hospital remain committed to the idea of electronic records. Glitches are worrisome but the products are "getting better as more people use them," said Robert M. Wachter, a professor of medicine and an expert on patient safety issues.

"We have to jump in," Wachter said, "and accept the fact that there will be a learning curve and work our way through it."

'Huge Challenges'

Many health policy experts agree that phasing out paper medical charts could revolutionize health care. They often note that digital record-keeping will help foil medical mistakes stemming from sloppy doctor handwriting on prescription pads and save money from tests and X-rays that must be repeated when paper records can't be located.

Beyond simply storing written medical findings, the software is expected to link doctors with hospitals and federal health data banks. Doctors would be able to send and receive medical test results online and automatically remind patients when it's time for a check-up. Most systems have built-in alerts and alarms to warn doctors of dangerous drug interactions and boast other safety features to assist them in caring for patients.

And proponents predict that the ability to mine electronic data from millions of patients will yield clues about which medical treatments work the best, spot adverse drug reactions more quickly and speed up detection of infectious disease outbreaks.

David Blumenthal, a physician and the federal government's top health information technology official, said that as part of the stimulus program his office plans to spend $693 million to, among other things, "provide technical assistance, guidance and information on best practices" to doctors and hospitals.

As part of the stimulus bill, Congress directed Blumenthal's Office of National Coordinator within the Department of Health and Human Services to set standards for handing out the federal subsidies. Doctors who meet the standards can receive up to $44,000 in stimulus payments, starting in the fall of 2010. Hospitals are eligible for millions of these dollars.

The Obama administration wants to store every American's medical data online within the next five years, a goal first set by President George W. Bush. Even with the incentives, the magnitude of the task is enormous - downloading millions of existing records from some 600,000 doctors and about 5,000 hospitals and engineering dozens of software products to interact.

Blumenthal conceded in an April New England Journal of Medicine article that "huge challenges" lie ahead and that many systems weren't "user-friendly" or designed to improve quality and efficiency.

In a written response to questions this month, Blumenthal said his unit is learning from past problems with electronic health records, often referred to as EHRs. He said that in many cases the systems "have a tremendous record of success." Blumenthal wrote: "The overwhelming majority of physicians who use EHRs are satisfied and believe the new technology makes them better doctors. Of course, no one is perfect."

Critics say federal officials should pay more attention to the troubles that emerged in countries that were early adopters. For instance, Great Britain's electronic records system has been "beset by poor product quality, delays and repeated changes to delivery schedules," according to a British government evaluation in October 2005. Bugs still plague some parts of the system.

British officials have singled out Cerner, a major subcontractor on parts of the National Health Service project, for criticism. A House of Commons report in January of this year found that the project was four years behind schedule and that progress to fix things had been "very disappointing." The report cited "considerable problems with the Cerner product."

Trustees of a 327-bed hospital in the seaside resort community of Weston-super-Mare in southwest England found "continuing problems" with Cerner's digital system in a September 2008 audit, calling it "difficult and overly complicated to use." The audit added that "training needs to be improved and users have little confidence in the information generated."

Cerner officials declined to comment about the British project for this article.

In Sweden, a country widely hailed for its progress in computerizing health records, a government panel last May issued a report linking computer malfunctions to "severe incidents" and even deaths. The panel favored stricter regulation of digital health systems.

Prescription Mixups

Manufacturers in the United States have staved off formal regulation, telling the Food and Drug Administration in May 2008 that their products should be excluded from review partly as a means to speed up their adoption.

The industry went on to say that no deaths or injuries could be attributed to a software failure. But there is no way to know for sure, because unlike makers of medical devices, companies manufacturing health information technology systems are under no obligation to report injuries resulting from software malfunctions to the government--and only Cerner Corporation appears to be doing so voluntarily.

Among about four dozen voluntary filings about software malfunctions involving Cerner products is one sketchy report of a death said to be linked to the company's digital prescription software. Such reports are logged by the FDA's online reporting system and can be entered anonymously and with no identifying information. The record indicates that the report came in January from an unnamed physician. Cerner said the FDA has taken no action as a result.

The other reports, agency records show, range from mixing up patients or posting data to the wrong chart to confusing medication doses. The FDA reports indicate that a few of the malfunctions resulted in injuries, while the company said others that posed a significant risk were discovered before anyone was hurt.

Among them:

• In December 2008, Cerner reported to the FDA that two patients had received too much medicine from pharmacies because the system failed to update changes in doses doctors had ordered. In one case, an elderly patient received too much of a blood thinner for six weeks. No injury resulted, according to the report.

• In June 2008, a pharmacist reported that three children's hospitals had identified similar problems with medication orders that rounded off small numbers, causing an error in dosage. The pharmacist said the hospital nearly gave a patient ten times the correct dose of insulin because of the defect.

• In June 2007, Cerner reported that messages stored to a patient's file would wipe out earlier ones. "Patient care could be adversely affected as clinical decisions could be based on incorrect information," the company stated. Cerner said it was working on a software update to correct the problem.

• In August 2007, Cerner reported its radiology system was mixing up patients, which the company stated "could potentially cause the radiologist to interpret images from one pt. and generate dictation on a different pt." The company said three reports were mixed up, but doctors caught the errors and no injury resulted.

• April 2006: A three-week-old lab system dropped the word "no" from herpes simplex virus test results. As a result two of five patients were told they had the virus when they did not. At least one person started taking antiviral crème treatment because of the error.

Cerner regulatory affairs director Shelley Looby said reports of injuries or defects are "extremely rare." She said the company voluntarily files about six or seven reports with the FDA each year.

"I think that our software is safe and effective. When we do find an issue we are upfront about it," Looby said, adding: "We want to make sure we do the right thing."

Sharona Hoffman, a Case Western Reserve University law professor and expert on legal risks posed by digital record storage, said rigorous pre-market testing and inspections are needed to wipe out many software bugs. In her view, manufacturers should be required to report any flaws to the government.

Computerizing health records "is a very significant development that could lead to a new era in medicine, if we do it right," Hoffman said.

University of Pennsylvania sociologist Koppel, a prominent researcher on the topic, agrees. He is critical of "non-disclosure" clauses inserted in sales contracts by some health technology firms, which oblige buyers to keep quiet about any problems that crop up. The companies also benefit from "hold harmless" clauses that may shift liability for errors caused by their systems to the doctors and hospitals that use them.

"That's critical," said Koppel. "It takes the onus away from the vendor. Even if there are thousands of complaints, the vendor is not responsible for repairing it."

Trying to Adapt

For the government, the hardest group to persuade may well be the doctors themselves. Their early experience with digitizing records has drawn mixed reviews. In late May, a health care analyst reported that one in five physicians in the Phoenix area who went digital ditched their systems after they turned out to cost more than expected, slowed them down, or were too tough to master and keep running.

The "simple act of writing a prescription can take five times as long on a computer as it does with pen and paper," wrote Chris Clancy, an analyst with the consulting firm HealthLeaders InterStudy.

Others argue that most doctors who have taken the plunge would never go back to pen and paper and that those who are reluctant will come around. Brad Tritle, who directs a group in Arizona that promotes electronic records, expects the tech industry to adapt smartly and quickly by upgrading its offerings. "There are some fantastic systems," Tritle said.

Yet the existing concerns are echoed in dozens of mostly negative postings to a blog recently set up by federal health officials to solicit comments about the digital records plan. Blumenthal said in his written response to questions that officials are "glad the blog is generating good feedback, that's what it was supposed to do." He also wrote: "We want to hear from doctors, hospital leaders, patients and anyone who has thoughts about this important program."

For his part, Koppel, the University of Pennsylvania sociologist, said he believes the stimulus spending is misplaced if it helps subsidize the purchase of systems that rely on years-old technology.

"I think that the money the administration has allocated should be used to figure out how to make more usable and more responsive software," he said.

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What President Obama Is Reading On Health Care

2009-11-24T10:11:26Z

In Tuesday's "Playbook," Mike Allen reports, "Sources say President Obama declared that a Saturday blog post by Ronald Brownstein on The Atlantic's 'Politics' channel -- on how health reform would control costs -- was mandatory reading for all senior staff and that everyone involved in, or covering, the health care debate should see the piece."

You can read Brownstein's full piece, titled "A Milestone In the Health Care Journey," here. It makes the case, through statements from economists and Obama's budget director Peter Orszag, that the Senate health care bill does about as much as possible to "bend the cost curve" -- i.e., lower health care spending -- while also significantly expanding health care coverage.

Here's a taste:

In their November 17 letter to Obama, the group of economists led by Dr. Alan Garber of Stanford University, identified four pillars of fiscally-responsible health care reform. They maintained that the bill needed to include a tax on high-end "Cadillac" insurance plans; to pursue "aggressive" tests of payment reforms that will "provide incentives for physicians and hospitals to focus on quality" and provide "care that is better coordinated"; and establish an independent Medicare commission that can continuously develop and implement "new efforts to improve quality and contain costs." Finally, they said the Congressional Budget Office "must project the bill to be at least deficit neutral over the 10-year budget window and deficit reducing thereafter."

As OMB Director Peter Orszag noted in an interview, the Reid bill met all those tests. The CBO projected that the bill would reduce the federal deficit by $130 billion over its first decade and by as much as $650 billion in its second. (Conservatives, of course, consider those projections unrealistic, but CBO is the only umpire in the game, and Republicans have been happy to trumpet its analyses critical of the Democratic plans.) "Let's use the metric of that letter," said Orszag, who helped shape the health reform debate for years from his earlier posts at CBO and the Brookings Institution. "Deficit neutral; got that. Deficit-reducing second decade, got that. Excise tax: That was retained. Third is the Medicare commission: has that. Fourth is delivery system reforms, bundling payments, hospital acquired infections, readmission rates. It has that. If you go down the checklist of what they said was necessary for a fiscally responsible bill that will move us towards the health care system of the future, this passes the bar."

Larry McNeely: Will Health Reform Opponents Face the Facts

2009-11-24T09:58:02Z

Over the weekend, the Senate commenced its historic debate on health reform legislation. So what are they talking about in what many call the world's greatest deliberative body?

Throughout this year's debate, rather than making reasoned policy arguments, reform opponents have parroted the latest partisan political talking points: death panels, abortion, "You Lie," immigration scaremongering, making any argument that came to mind in an attempt to slow reform's momentum. And in the past few weeks, Republican opponents and skeptical Democrats have parroted the insurance industry's claim that the bill will raise, not lower health care costs.

It's time these Senators put aside politicking and faced the facts about health care. This year, the cost of the average employer-provided family plan was upwards of $13,000. Health spending amounted to 16.2% of entire economy. If you think that's all right, know that the New America Foundation projects these costs will climb to $24,291 by 2016 - if it's tough to afford coverage now, try paying for it when costs have doubled.

While it's perfectly reasonable to argue about the best way to reduce costs, it is the height of irresponsibility to do nothing about a national crisis and hope the sloganeering and inaction redounds to your political advantage.

The truth is that the Senate bill does more than many thought possible to lay the groundwork for real reductions in the trajectory of rising health care costs in the coming years. It includes:

• An Independent Medicare Commission with the authority to make the hard decisions on provider payment policy, needed to secure Medicare's future. This is a vast improvement over the present system where Congress must okay each adjustment in reimbursement rates amidst pressure from special interest lobbyists.

• Patient-Centered Outcomes Research determining which treatments work best, so that consumers and their providers can be armed with the latest science when making decisions about care.

• Unprecedented investments in primary care and prevention, keeping people out of the hospital and away from expensive ER visits. The bill includes payment increases for primary care providers to spend more face-to-face time with patients, funding for scholarships and loan-forgiveness for primary care providers, and a permanent, secure funding stream for prevention activities.

• A new Center for Innovation, housed in the Centers for Medicare & Medicaid Services (CMS), to rapidly develop and test innovative payment models that will transform our health care system to one that rewards quality not quantity.

• Administrative simplification provisions, insurance premium rate review, and new insurer efficiency standards (based on medical loss ratios) will ensure that customers' premiums go to care and not unnecessary administrative costs, excessive profits, or outrageous executive compensation packages.

An honest reading must acknowledge that these unprecedented steps do more to reduce the growth in health costs than any legislation in decades. For those still skeptical of the cost-saving heft of this bill, the non-partisan Congressional Budget Office has estimated $127 billion in federal savings over the next ten years, and nearly $650 billion over the following ten years.

Is there more that could be done? Are there other cost-containment ideas? Sure. That's the debate the Senate should be having.

But amidst opponents' hyperbolic rhetoric and the inevitable filibuster, I'm just not sure America will ever get to see it.

Clinic With Two Doors, A Symbol Of Two-Tier Care

2009-11-24T09:44:07Z

NEW YORK - In America, you get what you pay for. Those who pay more get better service. That's the way it is in restaurants, and in health care, too.

But imagine a restaurant with one kitchen, one chef, but two doors and two price lists. That's the model of health care that some doctors are practicing.

AP: GOP Spinning Hard On Health Care Reform Bill

2009-11-24T08:34:44Z

WASHINGTON — Republicans love to get their hands on the Democrats' health care legislation. They show it to the cameras at every opportunity, even piling one version on top of another to make a big pile look even bigger.

Although they complain they don't have time to read all of it, they found the time to tape it together, page by page, so they could roll it up the steps of the Capitol like super-sized toilet paper and show how very long it is.

Huff TV: Arianna Discusses Senate Health Care Reform On Countdown With Keith Olbermann

2009-11-23T21:42:38Z

Arianna stopped by Countdown with Keith Olbermann Monday night to talk about the politics behind the Senate's approach to health care reform, including recent comments by Senator Blanche Lincoln (D-Ark.) and whether Democrats can afford to settle. Her view: "Without a public option, there's no real cost containment. There's no real competition for the health care industry. Why go for something that will not be real reform?"

They also discussed comments made by former DNC Chair Howard Dean in the Huffington Post, arguing that Democrats face only two options: a bad bill, or losses in 2010.

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Chris Weigant: Democrats Now "All In" on Health Care Reform

2009-11-23T18:58:47Z

President Barack Obama and the Democratic Party are now, to use a poker term, "all in" on healthcare reform. Some may immediately respond to hearing this by saying: "Hey, Chris, you're just on an endless quest for fresh, new metaphors to describe the healthcare reform effort, after writing about it for months." I won't quibble the point. Having pretty much exhausted our sports metaphors for now (at least until the Winter Olympics and all that ultra-hip snowboarding lingo comes barrelling down the hill), we turn to the world of card games for today's installment. Which brings us to the poker hand we've been dealt on healthcare reform. But rather than focusing on the cards themselves, let's instead take a look at the betting action. Because Democrats have now officially gone from "pot committed" to "all in." The stakes, to be blunt, have been raised until they are as high as they can go. And losing this particular hand could have some major consequences for the party as a whole.

For those of you not conversant in the language of gambling, allow me to explain. When you have a good poker hand you start raising the betting until, at some point, you are said to be "pot committed." This means you've invested such a major portion of your available chips in that hand's kitty (or "pot") that folding is no longer an option for you -- because it would leave you too weak to effectively continue playing. But if another player is equally as confident about their hand, a bidding war will ensue. And, at some point, you just decide the heck with it and push all your chips into the pot. You know that if you lose this hand, you'll effectively be sidelined in the game anyway, so you might as well win as much as you can in the current pot... if the cards turn up in your favor. That's a big "if," though -- because if you lose, you're out of the game. It's a bold and risky move, but one that can pay off in a big way.

The "chips" in this metaphor can be equated to that favorite inside-the-Beltway term: "political capital." The Democrats came into office with lots of it, riding a wave of change. And while they scored some early wins at the table, they've been battered around for months now, and their political capital has ebbed lower as a result. After the spring congressional season of passing some good laws faded into the public's distant memory, the Democrats have essentially been playing a single hand ever since -- healthcare reform. It's a big hand, and a big gamble. If Democrats do score a win on healthcare reform, it could pay off enormous dividends for them politically. They could trumpet that they were only the third Congress and president in 70 years to move America forward in such a sweeping fashion.

But now, with the entry of the bill to the floor of the Senate, Democrats are effectively "all in" on this particular hand. The implications are pretty close to binary: if they get healthcare reform passed, they've got a chance in the upcoming 2010 midterm elections; if the entire exercise falls apart at the last minute, then the Democratic Party will enter the midterm season politically bankrupt, and will pay a heavy price at the polls.

Former Vermont governor and former presidential candidate Dr. Howard Dean seems to somewhat agree with this read of the cards, in a Huffington Post article today:

"I think if you passed the Senate bill tomorrow it would be OK. But then the problem is [Democrats] don't have any defense for their members in 2010," Dean said, noting that the public option would not become operational until 2014. "On the other hand, if they drop the public option, I think they lose seats."

"So this is really tough. I didn't anticipate being in this position. I thought it would pass. Maybe Harry [Reid] has some magic up his sleeve. But I don't see how he gets those four votes [Senators Joe Lieberman, Mary Landrieu, Blanche Lincoln, and Ben Nelson] without compromising the bill," Dean concluded.

The former Vermont governor warned that if the party allowed the four moderates to further water down the bill (or defeat it altogether) it could lead to primary challenges or a drop in fundraising from the party's base.

"If you have members refusing to vote for Reid on procedural issues you will have a revolt in the party," Dean said. "What is the point of having a 60-vote margin? This is going to be death for the [Democratic Congressional Campaign Committee] and the [Democratic Senatorial Campaign Committee]. Why would anyone donate to them if they're supporting candidates who defeat the Democratic agenda?"

Democrats could go, in two short years, from winning once-in-a-generation majorities in both houses of Congress to something very like the 1994 fiasco which swept them from power. Now, many on the Left discount such dire warnings, thinking complacently: "Democrats are moving slow, true, but there's just no way the public will vote the Republicans back in power, since they're the ones who got us into all these messes." Such thinking ignores two very important constants in American politics: the public has a very short attention span, and likewise a very short memory; and secondly, the public has very little tolerance for politicians not being able to get anything done. If the Democrats have crushing losses next year, we pundits will waste a lot of ink and electrons debating whether it was an anti-Democratic, pro-Republican, or just anti-incumbent "wave" among the populace, but none of it will change the outcome one whit after the fact. Given the duality of our two-party system, if people are annoyed with Democrats for whatever reason, then Republicans are the ones who will benefit. That's the way the game's played in America.

To be fair, other factors will be in play next year as well. The economy getting better, or worse, will be either a headwind or tailwind for Democrats on the campaign trail. There will be other battles in Congress which will briefly catch the attention of the media and the public, and there will be some divisive issues served up by the Hot Button Issue Squad over in Republican headquarters. Soldiers may be coming home in droves from Iraq, only to be sent out in droves to Afghanistan (that one will be an interesting balancing act, no matter how it plays out). President Obama's jobs summit may produce some very popular legislation early next year, which could indeed raise people's esteem for Congress at a crucial moment, especially if the unemployment rate gets better later in the year.

But all of those may be minor influences at most. The major deciding factor is going to be whether Congress can pass healthcare reform or not, and whether some immediate benefits are seen by the general public (like an immediate ban on insurance companies denying people with pre-existing conditions, for instance) -- since the major parts of any bill won't take effect until after the 2012 presidential election. But if some of the benefits are front-loaded so people notice the change in their own lives immediately, it could counteract this to a big extent.

President Obama himself is also "all in" on healthcare reform. His approval ratings are falling below the 50 percent line for the first time -- which is dangerous territory for any politician's numbers to be in. He needs a big win. After passing some easy, "low-hanging fruit" legislation early in his first year in office, Congress has mostly been consumed by one issue ever since -- healthcare reform. Whether deserved or not, the perception the public has right now is that Congress has spent the last six months or so on one issue -- while everything else was pushed aside (the media certainly played a part in this perception, but that's water under the bridge right now).

This is when Democrats got "pot committed" on this particular hand -- where, after months and months of town hall protests and obstructionist tactics, bills actually moved out of all the committees and were consolidated into single pieces of legislation in each house. Expectations grew. Now, with the bill moving to the Senate floor after the House approved their bill, the end is actually in sight. Major obstacles remain -- any one of which could stop the entire process -- but the sheer number of such obstacles is dwindling. The nearer we get to actual passage, the more intense the pressure on Congress will be. Ironically, if the bill had fallen apart in August and Democrats had just given up the effort for this year, they may have been stronger politically next year as a result (due to lower expectations at the time). Even early failure would likely have been better politically than ultimate failure, after getting mere inches from the finish line. Democrats have upped the ante by their successes so far in advancing the bill -- farther than any other such bill has ever gotten. When people started looking at healthcare reform as being a definite possibility (rather than just a perennial issue to talk about endlessly, while never going anywhere), expectations for actual passage started growing. And getting let down after a big buildup is always worse than just not expecting much to begin with.

These expectations are now so high that to fail would destroy the political capital of both Democrats and President Obama for the foreseeable future. If Obama does not have this big victory to talk about during his upcoming State Of The Union address, then his first year in office will be marked as a (legislative, at least) failure. He could eventually recover from such a blow, but it would be a tough road to travel for him. "Change we can believe in" has pretty much come down to "get healthcare reform passed" -- whether that's fair or not -- and Obama will be graded on whether he signs a bill or not. Now, no matter what happens on healthcare reform, Obama still has three more years of his first term to go, and many things can happen in three years (good and/or bad). Without healthcare reform, Obama could still have a successful presidency and get re-elected... but it will be a lot harder for him to climb that hill. Even with healthcare reform, Obama could yet be an unsuccessful president on many other fronts, and may wind up losing in 2012 anyway. Three years is a long time in politics, and there are no guarantees.

But most Democrats in Congress are indeed going to have to face the voters next year. They don't (with the exception of some of the senators) have the luxury of this three-year window. And the conventional wisdom in Washington is that not much of anything gets done in Congress in an election year -- or at least not much of anything controversial or bold. Congressional Democrats' fortunes are going to be closely wrapped up with the president's. Democrats were given huge majorities in both houses by the voters in 2008, and they were put there for a reason -- to enable President Obama to pass his agenda, and change this country for the better. Going back to the voters empty-handed is just not going to work. The voters -- quite rightly -- will say: "How big a majority do you guys need before you actually get something done?!?"

Electing Democrats just to have more Democrats in Washington is not going to work this time around. Because there's really no point to it, if they can't manage to act like a majority party and score some legislative victories once they get there. Just having lots of folks in office with a "D" next to their name is not sufficient any more.

Which is why Democrats are no longer just "pot committed" in this poker game. They are truly "all in" on healthcare reform. If they win and manage to get a bill signed, they can proudly campaign on this success. But if they lose this hand -- are forced to "fold," in one way or another -- then they will simply have no chips left to play with, and next November they will likely be ejected from the table by the voters.

Passing healthcare reform has always been a risky gamble. But the stakes are now so high that the chips are down not just for the betterment of the American people, but also for the job security of Democrats in Congress. And they'd better realize it soon (and start acting like it), or the party is going to be in a very rough spot next year -- bereft of political capital, and begging the voters to give them another chance. By going all in, they have put the future of the Democratic Party into the kitty as well. It could pay off big, and then again it could lead to political bankruptcy. That is what is now riding on this hand.

Chris Weigant blogs at: ChrisWeigant.com

NEW! Follow Chris on Twitter: @ChrisWeigant

Susan Bevan: Reform...at What Cost?

2009-11-23T17:55:30Z

The recent debate on health care reform has brought new focus to the important issue of reproductive choice -- and a clear understanding that it cannot be taken for granted.

As the Senate prepares now to take up its version of a massive health care overhaul, pro-choice Americans are watching closely to see if the Senate will sell out the reproductive rights of women, just as the Democratic leadership did in the U.S. House. The potential ramifications of any legislation that would eliminate women's reproductive health choices -- effectively discriminating against American women -- will undoubtedly reverberate to the 2010 elections, and beyond.

The renewed focus on reproductive choice was triggered by the House's actions. In the frenzy to pass a health care bill -- any bill -- Nancy Pelosi and House majority leadership allowed a vote on the now-infamous Stupak Amendment. Sponsors of the amendment misrepresented their efforts as a move to stop federal funding for reproductive choice. In fact, there is already a ban on federal funding for abortion. What Stupak did was effectively ban insurance coverage for most abortions from all public and private health plans in the new health exchange. Translation: it would make it nearly impossible for any American woman to obtain insurance coverage for abortion.

This travesty took place on the Democrats' watch. They cannot explain it away, and they cannot deny that they had complete control over this amendment's viability. This was an outrageous "compromise" that constituted no compromise at all. House Democrats, determined to push a health care reform bill this year, decided it was acceptable to sacrifice women's current reproductive health rights in the process.

The most unfortunate fall-out from this vote is that Congress is now legislating policy that is discriminatory against women, particularly low-income women. Abortion can be an expensive procedure, and many women, who use protection and practice responsible sex, still find themselves faced with an unwanted pregnancy for a multitude of reasons. The price tag attached to an abortion often means that, while every woman has the right to an abortion, only wealthier women have access to it.

Like it or not, abortion is a legal medical procedure and a decision that has to be left to doctors and families. Why are women being singled out and denied coverage, even through private plans? The claim that abortion is preventable or elective only underlines the discriminatory aspect of the Stupak Amendment. The truth is, countless treatments for preventable conditions, such as smoking cessation or the effects of obesity, are covered by private and public insurance plans. Would Congress ever offer amendments to unduly punish people who act 'irresponsibly' and make poor lifestyle choices by smoking, failing to wear seat belts or eating unhealthy foods? Of course not.

We do not, as a society, say, "I don't want my tax dollars to care for someone who has been in a car crash and didn't have a seat belt on." It sounds ludicrous. We all pay for people's regrettable decisions, and the financial impact of these 'preventable' medical needs is staggering. According to the Campaign for Tobacco-Free Kids, $96.7 billion is spent on public and private health care combined annually due to smoking. Each year, each household spends $630 in federal and state taxes for expenses related to smoking. A new report released this week projects that in 10 years, 21% of all medical costs will go to treat diseases linked to obesity up from 9% we spend now.

Congress, the Senate and the President need to understand that women's reproductive health deserves the same equitable treatment that these other preventable medical procedures enjoy. It certainly must not be used as a bargaining chip in the rush to pass one of the largest legislative initiatives of our time. In fact, if the controlling Democrats cannot get their own majorities to agree on a health care compromise, that should make it clear that there are major problems that need to be addressed before dumping another expensive, government-run program on the American people.

As difficult as it is for real Republicans like us to admit, we've seen misguided efforts like the Stupak Amendment from extremists in our own party far too often. We have sadly watched as more and more women and 'moderate' voters have left our party because they believed the Democratic Party would do anything and everything to protect our individual freedom of reproductive choice. In one vote, that assumption was erased and pro-choice Americans are outraged.

Marisa Acocella Marchetto: The Cancer Vixen Mission: No Breast Left Behind

2009-11-23T16:50:12Z

Ever since I kicked that bitch cancer's bony ass, I've been pretty fearless. And feistier than ever.

So when The United States Preventive Services Task Force said Monday that women should start regular breast cancer screening at age 50, not 40, and that doctors should stop teaching women to examine their breasts on a regular basis, you can imagine that it raised my ire. I got more than a little irked.

Why? For starters, I was 43 when I was diagnosed with breast cancer, and I fall in that weird age-range. Luckily I caught it in its early stage. But what if I was discouraged to get tested if the new guidelines were actually implemented? And will others my age (my friends!) be as lucky as I was if they're not getting screened? The later breast cancer is caught, the less chance there is for survival.

I know about all this because for the last six years I've had breasts on the brain.

I'm a cartoonist/activist (yes I am) who wrote Cancer Vixen (Pantheon), a graphic memoir, and I've traveled all over the world talking to women who've had breast cancer and survived it because they caught it earlier before it was too late. And I couldn't disagree more with the USPSTF. There has been a consistent reduction in the rates of death from breast cancer in every country--including the United States--that has instituted a regular screening program.

Mammograms, while not perfect, do detect breast cancer. If you catch breast cancer early, you have a 98 percent survival rate. If you don't test yourself until you're 50 - then you risk receiving a later diagnosis, which could lead to death. To be blunt: it could kill you. A higher death rate from breast cancer is unacceptable in the United States of America.

More alarming, 80% of women find breast cancer themselves, yet the USPSTF urges doctors to stop teaching women how to give themselves a self-exam. This is another stark example of how incredibly irresponsible the USPSTF is, and how they are endangering the lives of every woman in America.

Thank you USPSTF, thank you so much.

Dr. Larry Norton, Breast Cancer Research Foundation Scientific Director; Chairman, BCRF Executive Board of Scientific Advisors, had an 11 year-old patient with breast cancer. We're hearing about women and unfortunately, even girls diagnosed at younger ages, and yet now they're raising the age for women to get screened. How could this possibly make sense?

I feel cautious about what the next step is: the government will not pay for your mammogram unless you're 50 and over. This is common in Europe, where medicine is socialized so the government doesn't have to pay for it. If this is the case, it's only a matter of time before each and every woman in this country is under 50 and has insurance will have to pay for a mammogram. We're in a recession. Paying for a mammogram is an additional obstacle for something that no one wants to do in the first place. It's just one more reason not to do the very thing that can save your life.

I started the CANCER VIXEN FUND here in New York City for women who are uninsured so they can get free mammograms. (When I was diagnosed, I was uninsured.) I believe that each and every woman has the right to live. The Cancer Vixen Mission: No Breast Left Behind. We've done over 600 mammograms and have saved at least two lives. I can say with absolute certainty that mammograms do work.

Women of America, we cannot let the USPSTF change the guidelines for mammograms. We must fight for ourselves, our mothers, our sisters, our cousins, our aunts, our friends and even our frenemies. (Yes, even frenemies. You'll get good karma points.)

Each and every woman in this country should have an equal opportunity to kick cancer's bony ass, and the best way for that to happen is when you catch it early.

USPSTF, get out of our way because if you insist on implementing these guidelines, you're next.

I'm putting on my killer 6-inch heels.

Watch out.

Paul DeBell: What Spirituality Has To Do With The Health Care Debate

2009-11-23T16:36:43Z

As a practically minded psychiatrist, I have developed a great tolerance and deep sympathy for human foibles. Even when our choices don't make sense to anyone else but us and cause us great pain, we still don't change them very easily. Yet, despite this level of understanding, I still can't help being at times amazed, enraged and disgusted when I hear the healthcare debate. I am even more amazed about how we, the public, have come to accept such flagrant displays of irrationality with resignation as the normal state of affairs and elect people who choose to carry on like this year after year.

Why do we so value our passions and self-interest in areas where reason should prevail? What gives us the hubris to so openly defend our self-interest above that of the common good? What can be done about this aspect of human nature?

Since taking a more rational approach to spirituality is my great passion, I would like to offer my thoughts as to how it would make us less prone to emotional logic in all areas of life and even raise the bar in the healthcare debates. The reason is that for those of us who strongly believe in another dimension to life -- and the vast majority of Americans do, we have only been taught to approach spiritual life through inspiration, emotion and blind faith. This makes us more positively predisposed to the same kind of logic in other areas of life. A greater reliance on evidence can counter our natural tendency toward self-serving thinking in all its forms. Taking such a radically rational approach to knowing more about what was previously considered unknowable automatically raises the bar in debates of issues like healthcare and the debates with those close to us about who should take out the garbage or clean up a certain mess around the house.

Since greater attention to evidence is so crucial to our coming up with better solutions to conflicts of interest, let me give you an example of the role evidence plays in decision making in healthcare before turning to the role it can play in making spirituality into the medicine of the soul and solidifying the grasp of reason in the very foundations of our thinking. If you look at the controversy over mammograms, you can see a good example of how evidence informs a discussion but can't make the final decision. When new evidence raised the question as to whether or not mammograms are justified in women under 50, it caused an uproar. Other experts rushed forward with other evidence. Consumers were shocked that they or their loved ones might die because of being denied a test. We consumers add up the risks and the benefits far differently from experts. Yet, the new evidence cited raised the level of the debate so that individual women could be aware of the conflicting opinions based on the evidence and make better informed decisions for themselves. It makes us all more aware of what evidence can and cannot do so that we will weigh our healthcare decisions differently--as long as this incident remains fresh in our minds.

As I was raised as most of us to think that anything spiritual was beyond understanding, I carried out a kind of pilot study that proved to me the possibility of an evidence-based medicine of the soul so that would make healthcare truly holistic. Drawing on my forty years of practice as a psychiatrist and twenty five years of decoding my own spiritual experiences, I collected the spiritual experiences on which several hundred people's beliefs were based. What seemed like random acts of help and guidance now seemed more like the results of a system of feedback -- spiritual reactions to our thoughts feelings and actions -- that were different from the kind of influences my common sense and experience as a psychiatrist had taught me to expect. I called this feedback spiritual messages because it also affects our thinking in ways that convey a deeper level of information that only now are we in a position to decode by using the modern scientific methods of psychology to define basic laws of human nature that govern our highly personal and unique interactions with material reality.

I realized from my pilot study that although each of our experiences is very limited our collective knowledge of the spiritual dimension is actually quite vast. No matter what question a person might have there were thousands of people around the world who had already faced and resolved that same issue -- albeit in the highly personal terms of his or her own life circumstances. Similarly if someone had learned something in his or her life, then there were thousands of others who could benefit from it. If we could use the internet to formulate our collective wisdom in resource centers that would be freely accessible to all, then progress could be made far faster than was possible in the past. Such resource centers could function as advocacy groups do in medicine today, pulling together our experiences and our concerns in one or another facet's of our spiritual health so that it could be used to prod the religious and spiritual institutions that we are involved with to be more attentive to our collective evidence.

If words like data or evidence seem a bit scary to you, let me give an example of the kind of common sense thinking that will begin a revolution that we can all be a part of and benefit from. When our body feels weak and we can't get ourselves to do what we want to do, we might wonder if the cause is that we are hungry, malnourished, overweight, out of shape, tired, sick, weak, depressed, or preoccupied. We draw on all we know from past experience to come up with the right diagnosis and treatment. So when we are feeling weak spiritually and can't keep our attention on what we know is important or find ourselves doing things that we wish we hadn't, we can start to wonder why. Is our soul in some way hungry, malnourished, overweight, out of shape, tired, sick, weak, depressed, or preoccupied? We can think about which remedies work well with which diagnosis. Each time we act on a given plan and observe the results, whether they be what we anticipated or not we gain a more concrete understanding of our own soul.

When we integrate our experiments with those of thousands of others who diagnose, treat and observe the outcome of their own lapses in a similar way by analogy to common everyday experiences, our own treatments will become better -- and our overall appreciation of the value of evidence increase. We learn in this way to make adjustments for the nature of our own soul, doing the equivalent of comparing the diet and how many calories per day others found were necessary to maintain their weight to orient us to what might be a good diet for us but adapting it to the actual needs and preferences of our own body.

Bits of evidence become meaningful and useful as we understand how it informs us about an aspect of a far larger coherent system. That's why I think of spirituality as the medicine of the soul, for just as we organize the experiences of our body as parts of a larger physical ecosystem so we do better organizing our experiences of our soul by thinking of it as being a part of a larger spiritual ecosystem. It's far more useful than thinking of it this way than as a nebulous blob of infini-potential energy living in a dimension beyond understanding. As we gather more and more evidence of the effects of our soul and the spiritual dimension in general on us, I am confident that it will bear out initial data suggesting that the material and spiritual dimensions of life are two aspects of a larger system that are well integrated and in constant interaction. Then our understanding of how things work in the material dimension will provide the basis of systematic analogies that help us make even better sense of spiritual experiences.

This kind of evidence-based approach to spirituality will have, I maintain, a ripple effect that will positively influence both the healthcare debate and debates with my wife over who does what at home. The more our spiritual approach is based on evidence the stronger our investment in spiritual values will become. It will thus help us to be more honest and help others. It will decrease our tolerance for greed and self-centeredness. This will make us even less susceptible to the kind of self-serving emotional logic that politicians, those close to us and even ourselves use to say blatantly false things with complete conviction that we have a right to do so.

Peeling the more irrational elements from our way of thinking has very positive effects on our emotional life as well--both psychologically and spiritually. You can see it clearly in our close relationships where a good understanding of the other's position and good communication skills are now more necessary than ever before. And just as keeping our body healthy makes us able to love someone better, so keeping our soul healthy helps our spiritual love life as well. By being attentive to evidence, one can enter the twenty-first century with the faith and love of a scientist who is so confident in his spiritual beliefs that he is determined to prove their validity rather than the faith and love of a pilgrim who follows his spiritual path without trying to understand.

Let's bring spirituality into the twenty-first century and change the way we think about everything that is important to us. Let's move the debate to a whole new level. It won't be heaven on earth, but it will be a start.

However, since everyone else seems intent on getting what they want packaged into healthcare reform and the change I am thinking of is long term, I'm going to withhold my vote for the reform package until several billions of dollars of funding for research in the medicine of the soul is included.

Will Marshall: RIP Compassionate Conservatism

2009-11-23T15:18:01Z

The Republican message on extending health care coverage can be summed up in two words: "Bah, humbug."

In taking a purely obstructionist stance, the GOP has evinced scant empathy for tens of millions of fellow Americans who lack basic protection against illness or injury. So much for compassionate conservatism.

On Saturday, not a single Republican voted to allow the Senate to even consider a bill to expand coverage and reform health insurance markets. When the House passed its version of health reform, just one Republican voted aye. He is Rep. Joseph Cao, a freshman from normally Democratic New Orleans.

Republicans, of course, are under no moral or political compunction to support Democratic proposals for health reform. But since they haven't offered any credible alternatives of their own, it's reasonable to conclude that they don't care all that much about fixing America's broken health care system.

Sure, House Republicans proffered their version of "reform" earlier this month. It would spend just $61 billion over 10 years and leave the percentage of insured Americans in 10 years exactly where it is today -- at 83 percent. Thanks to population growth, there would actually be more uninsured people than today.

In opposing serious efforts to expand coverage, Republicans say they are trying to protect Americans against runaway deficits, not to mention death panels, publicly financed abortions and other confected horrors. They rail against President Obama and the Democrats for proposing to pile a costly new health care entitlement atop others we don't know how we'll pay for.

That's actually a valid concern, one that progressives should take more seriously. But the GOP's newfound fiscal piety would be more convincing if President Bush and party leaders had not muscled through Congress a massive new Medicare drug entitlement just six years ago.

Showing their customary solicitude for America's haves -- Medicare offers all seniors the basic health coverage the uninsured lack -- Republicans insisted on creating a universal entitlement, rather than targeting help on truly needy seniors. At first projected to cost $534 billion over 10 years, revised estimates in 2005 put the bill's price tag at $1.2 trillion. That's several hundred billion dollars more than the bill passed this weekend by Senate Democrats. David Walker, former U.S. Comptroller General, called the 2003 prescription drug bill "probably the most fiscally irresponsible legislation since the 1960s."

In contrast, the Senate Democrats' bill is paid for. In fact, the Congressional Budget Office estimates that it would cut the federal deficit by $130 billion in the first decade and by more than $500 billion in the second decade.

But there's a hitch, and it's a big one. Cutting future deficits refers only to the public costs of expanding medical coverage and reforming U.S. health care markets. That's not at all the same thing as "bending the curve" of health care cost growth. Slowing the unsustainable pace at which medical costs in America are growing requires confronting the perverse incentives and inefficiencies that plague health care delivery. It also means rebalancing the big entitlement programs, as retiring baby boomers swell the number of people receiving Medicare benefits.

This is the big piece of unfinished business facing both health care reformers and President Obama. The Senate bill expands coverage and cuts the federal deficit. According to some leading budget analysts, however, it doesn't do enough to slow down the rising health costs that plague the vast majority of U.S. workers and that handicap many U.S. firms in global competition.

They deserve some compassion, too.

Marshall is the president of the Progressive Policy Institute. This item is cross-posted at ProgressiveFix.com.

Johnathon Briggs: Chicago's Public Health Budget Gets The Flu

2009-11-23T14:04:25Z

By Johnathon E. Briggs and John Peller

With the ongoing economic recession, Mayor Richard M. Daley and City Council members unquestionably face agonizing choices to balance the city's 2010 budget.

While funding cuts and other budgetary reforms will undoubtedly be needed, some essential city services are too important to do without. Alarmingly, Mayor Daley's 2010 budget plan calls for a $2.1 million funding reduction (6.7% cut) for public health. This doesn't account for the $2.5 million budget transfer for information technology to a different city agency.

These reductions could have a far-reaching and detrimental impact on the health of Chicago residents and the quality of life of our city, worsening the health of individuals and increasing health disparities.

In past years, Mayor Daley has championed public health, and particularly HIV prevention and care funding. Most recently, the Mayor and City Council increased HIV prevention funding by $500,000 in 2006, and AIDS housing funding by $250,000 in 2007.

The recent H1N1 vaccination drive has shown the nation the importance of public health. Unfortunately, it has not slowed a severe divestment in public health across the country. The Association of State and Territorial Health Officials reported in October that two out of three jurisdictions saw public health budget cuts this year. Services were reduced, programs eliminated, and staff laid off.

HIV programs have faced similar cuts . Three-quarters of state HIV programs saw their prevention dollars reduced this year, with $167 million axed from programs in 2009 alone.

Chicago's own Dr. Will Wong, who directs sexually transmitted disease (STD) and HIV prevention and control for the Chicago Department of Public Health, noted this week that STD prevention resources are strained nationally. Sixty-nine percent of STD programs surveyed experienced budget cuts, and 39 STD clinics around the nation shut their doors.

The tangible impact of funding cuts for STD control programs is being felt across the country. STD data released this week by the U.S. Centers for Disease Control and Prevention (CDC) showed that STD rates in the U.S. are at an all-time high. CDC estimates that approximately 19 million new STD infections occur each year, at a cost of up to $15.9 billion. Chlamydia rates increased 9.2%, while syphilis rates rose by a staggering 18%.

"The burden of STDs is becoming worse in this country at the same time that the resources we need to fight these illnesses continue to shrink," Dr. Wong noted. "None of this bodes well for the future health of our nation and our communities."

In fact, Cook County has the highest number of gonorrhea cases in the nation, according to CDC. Cook County ranks second for chlamydia cases, second only to Los Angeles, and third for syphilis, a disease that not too long ago was nearly eliminated in the United States.

Chicago's health disparities are staggering, and funding reductions are likely to make them only worse. New statistics released by the Chicago Department of Public Health (CDPH) earlier this year indicate that 30% of young African-American men who have sex with men (MSM) are HIV-positive, a rate that is seven times higher than among their white counterparts. Eleven percent of Latino MSM are living with HIV, a rate that is almost three times higher than their white peers. If Chicago is to make any progress against health disparities and the HIV epidemic in the most impacted populations, including African-Americans, Latinos, and gay men and MSM of all races, the city must continue to invest in HIV prevention and other programs.

So what do proposed budget reductions mean for Chicago? A 6.7% budget cut for public health would mean fewer city services for an array of essential health activities. Here are just four examples:

• Substance abuse treatment services would need to eliminate $500,000 in services (a 12-15% reduction);
• Sexually transmitted disease treatment clinics would lose four staff positions, straining already overwhelmed city clinics;
• The city's maternal and child health program would conduct 1,000 fewer home visits for vulnerable mothers and children.
• Essential HIV services would receive $175,000 less for HIV prevention and care programs. While lower than the cut for other sections, the 4% reduction comes on the heels of an $800,000 funding loss to Chicago from the state needed to keep the AIDS Drug Assistance Program afloat.

Since 2006, the Chicago Department of Public Health has lost 176 staff positions, or 39% of its staff. The additional proposed reductions this year are likely to further erode Chicago's ability to keep residents healthy, reduce chronic and infectious diseases, respond to outbreaks such as H1N1, and protect Chicago's most vulnerable residents.

Chicago's health doesn't have to be another casualty in a bad budget year. Seventy-four organizations wrote Mayor Daley and City Council members earlier this year urging them to restore funding for public health. Concerned Chicagoans are also calling on their aldermen to restore public health funding.

The moment of truth may come on Nov. 25, when the mayor is likely to introduce amendments to the introduced budget that could restore funding. Public health is an essential city service, just like police, fire and education, which should not be shortchanged when economic times are tough.

Johnathon E. Briggs, a former "Chicago Tribune" urban affairs reporter, is vice president of communications at the AIDS Foundation of Chicago.

John Peller is director of government relations at the AIDS Foundation of Chicago.

Jerry Chautin: Health Care Debate Looms Large At Thanksgiving

2009-11-23T13:21:34Z

Turkey, cranberry sauce, and a side of health care debate is dominating Thanksgiving tables this year. As such, my opening assertion is that government shall do what the governed are unable to do for themselves. Sure, the cost and how you get there are important. But unless every American who wants health insurance can get it, that is not my idea of health reform.

Consequently the Republicans' attempt to offer an alternative is unacceptable because it would extend insurance coverage to only 3 million more people within the next nine years. That leaves 52 million people without insurance, according to the Congressional Budget Office. By contrast, the Democrat’s bill covers 30 million. Furthermore, I am for the government option unless either party shows me an alternative to cover everyone who wants to purchase insurance.

But the debate gets more heated when individuals and groups worry that their situation will be adversely affected and covering everyone is not their goal.

"The entire reform is pure wealth redistribution, cost shifting, higher passed through taxes, and does nothing to bring down costs except for price controls and intervention," Bill Steffen says. "You can't insure 40 million more people, provide free preventative care, including $1,500 colonoscopies, cover all preexisting conditions, no lifetime maximum, low deductibles and have it all paid for and budget-deficit neutral."

Steffen is an independent health insurance agent in Florida and Arizona and says that his business will suffer as a result of the proposed health care legislation. He believes that the need for an independent agent will be diminished if the government gets involved. "The role of the agent might be eliminated if it turns into the federal health benefits plan where they choose off a large menu of options with a handbook."

Understandably, businesspersons that believe their livelihood will be adversely affected are worried.

But if you have preexisting conditions and are unable to buy health insurance, you are applauding President Barack Obama's initiative to prevent insurance companies from denying you coverage. If you meet the lower income requirements to receive federal subsidies, you are happy that the insurance will be more affordable.

"There is also a belief among many, that access to healthcare is an entitlement to every citizen and it is the federal government’s responsibility to make it available to everyone," Barney Bishop says. "I think not."

He is CEO of Associated Industries of Florida, a nonprofit that represents a diversified membership of Florida’s business owners in government matters that affect them. Bishop says that this bill will be a "jobs-killer" for small businesses. "There is simply too much big government in this proposal," he says. "This could look like catastrophic insurance for the chronically uninsured with heavily subsidized premiums to see if the feds could really handle this large population."

Meanwhile, AARP endorsed the House healthcare reform bill on November 5. On November 21, the Senate got the 60 Democratic votes needed for the full Senate to debate its bill. Presumably AARP will also stand behind the Senate version if Harry Reid, the Senate majority leader, can keep his party in lockstep to pass it. The ultimate test will be reconciling the House and Senate version for Obama to sign into law.

AARP has 40 million members that are 50 years or older. It joins the American Medical Association, Consumers Union, the American College of Physicians and other groups that support Obama’s healthcare reform.

AARP established an online community to update interested persons about the status of healthcare reform, debunk myths and voice their opinions.

AIF’s Bishop says, "Ideally, you'd want to cover everyone, but then you get into the Gordian knot of (illegal) immigrants and everything that goes along with that." In other words, he believes that the bill has complex and clouded provisions to cover illegal immigrants with undesirable consequences.

Insurance agent Steffen hopes that the final legislation will be kinder to his business than what he sees so far. If not, he may use his expertise to market his industry knowledge instead of selling insurance. "I'll figure out a way to be the health reform consultant and get paid," he says.

Jerry Chautin is a volunteer SCORE business counselor, business columnist and SBA’s 2006 national "Journalist of the Year" award winner. He is a former entrepreneur, commercial mortgage banker and business lender.

George Halvorson: Point 6: Connectivity Is Key To Care Improvement

2009-11-23T12:57:51Z

Health care is remarkably unconnected.

The lack of connectivity tools in health care is absolutely stunning.

Health care providers in America have a very hard time connecting and sharing patient information with each other. Most medical records are still sitting in individual paper files locked in metal cabinets, totally isolated by doctor and care site. Those paper records are not interactive or accessible in any convenient way.

It is sad and ironic that an information-dependent profession is denied convenient access to needed information in an age when we connect other aspects of our infrastructure easily and often.

Seventy-five percent of health care costs in America come from patients with chronic conditions. Eighty percent of those costs come from patients with co-morbidities -- multiple health care problems -- and that means multiple doctors from different specialties for most of those patients. Those multiple doctors very often do not have access to the patient information they need to deliver optimal care.

With rare exceptions -- like organized multi-specialty group practices -- most American doctors who share patients have no mechanisms to also share information about diagnosis, care plans, patient studies, or even the various prescription drugs that they are each prescribing.

Doctors and hospitals also tend not to share important elements of basic medical information with each other. Each care site and care "business entity" has its own isolated data set for each patient -- and the data sets do not usually link up.

It's a functionally unlinked world, when it comes to basic information about care.

Patients tend to have minimal convenient connectivity to their caregivers, and caregivers tend to have even more minimal connectivity with each other.

It's really pretty sad.

So what should we do?

We are about to spend the better part of a trillion dollars to reform health care in America. Connectivity needs to be on the front burner of that reform agenda. Health care reform in America should insist on a world of data availability, data sharing, and patient focused data care support for American health care.

Insurers should be required to use their databases to help connect caregivers.

Funding for electronic medical records should insist on caregiver connectivity as an absolute condition of the funding. Funding electronic medical records that do not and can not connect with each other is breathtakingly stupid if we want to use patient information to improve patient care.

Doctors need better information. Doctors treating patients in America should have real time data about patients and that information should be updated as care is being delivered.

Patients should also have all of their own medical information -- easily available in an absolutely secure way wherever the patient happens to be.

The goal and the result of computerizing the health care delivery sites of America should not be to turn today's isolated paper siloes into tomorrow's isolated electronic siloes.

Asthma is the fastest growing disease for kids in America. It is expensive and it is the leading cause of death for kids. What is pathetic is that we know that the American infrastructure of care gets care right for American kids with asthma only 46 percent of the time.

What's worse -- we do not know which 46 percent. There is no mechanism in the highest cost health care infrastructure in the world to track care for kids with asthma. There is also no mechanism for hospitals who have kids suffering from a life threatening asthma attack to notify the kid's clinics, or physicians, or other non-hospital caregivers that the crisis actually happened.

We need universal coverage as a key step in the process.

When kids don't have insurance coverage, there isn't even a computerized insurance payment database that can be tapped to look back at the asthma care insurance claims filed by the doctors and hospitals to figure out which kids are not getting enough care or the right care.

We can and should do a lot better. We need a well-thought-through data flow agenda for America that focuses the caregivers and the care support on the kids who need care the most.

We need computerized data files to track care for each kid.

When the right computerized support systems are in place, the rate of crisis level asthma attacks can be cut in half.

Similar databases combined with focused care support teams can cut the number of congestive heart failure crisis in half -- and can significantly reduce the death rate from heart attacks.

We need care connectors for American health care. Setting up needed connectors should not be left to chance or someone's good intentions. Every payor should be required to support patient-focused care connectors and care registries. Caregivers who use registries to improve care should be rewarded -- and caregivers who duck supporting coordinated care and who cut off or don't support data flow for their patients with those conditions should be paid less and should also tell their patients that have chosen non-connected care.

We need the right tool kit to make care better in America.

Connectors should be right in the middle of that tool kit.

We should not fund a national health care IT agenda that doesn't end up directly supporting well coordinated patient care.

We need to cover everyone in America. We also need to better connect our caregivers so that care gets better and less expensive and we can afford to cover everyone in America.

Connectors should be part of the reform package.

Bill Scher: The Insincerity Of The Public Option Haters: Lieberman's Weasel

2009-11-23T11:47:38Z

When Sen. Joe Lieberman first announced he would filibuster any health care bill with a public option, I noted that he lied, falsely calling the public option an "entitlement program" that would be "trouble ... for the national debt." In fact, the public option is an "option," not an entitlement, which would help our federal government save money.

Yesterday on Meet The Press, Lieberman didn't exactly lie, but deployed -- as his Senate colleague Al Franken coined in his old radio program's "Wait, Wait, Don't Lie To Me" game show segment -- the "Weasel."

And Lieberman's Weasel brightly illuminates the blatant insincerity on the part of the crusaders against the public option.

Lieberman said on Meet The Press:

[The public option] won't even lower the cost of health insurance, which the advocates said it originally would, because the Congressional Budget Office has now said to us that the public option in Senator Reid's bill will actually charge more for insurance than the average charge by health insurance companies.

Yes, it's true that the CBO estimates that Reid's version of the public plan would end up offering premiums that are "somewhat higher than the average premiums for the private plans" it would compete against in the proposed health insurance "exchanges."

But Lieberman willfully leaves out two key pieces of information.

1. All insurance premiums would be reduced. The CBO also concluded that Reid's reform package, including the public option, would reduce the overall average premium for all plans in the exchanges, public or private. An earlier CBO report of the similarly structured House public option determined the mere existence of a public option "would place some downward pressure on the premiums of private plans".

2. The public option was weakened to appease insurance industry defenders like Lieberman. All year long conservatives, and some alleged "moderates," have accused the public option of being a Trojan Horse intended to decimate private insurance, not compete with it.

To reassure critics, both the House and Senate versions rejected the "robust public option" we at Campaign for America's Future originally championed, in which the public option could fix reimbursements to health care providers at rates akin to Medicare, currently lower than what private plans offer.

The Congressional Budget Office agreed that such a structure would provide more competitive pressure and cut more costs, without undermining the private insurance industry -- only an estimated 4 million in our nation of 300 million would end up choosing the Senate's version of a public option.

But right-leaning Dems continued to abandon their supposed interest in reducing the deficit to protect the insurance lobby, and congressional leaders had no choice but to offer a weaker version, which couldn't fix rates, but would have to negotiate with providers just as private plans do.

While CBO said the weaker version wouldn't save as much money, it still saves some and, as noted above, helps reduce premiums overall.

How does Lieberman respond to winning such a concession? He spits on it.

He twists the CBO analysis. He pretends "advocates" were misleading about the public option's potential when it was weakened to appease myopic politicians like him. He makes the completely contradictory argument that public option premiums that are a little higher than private plans somehow constitute a devastating threat to his insurance company CEO constituents.

Surely he's read the CBO report. So he knows he's a weasel. He knows he does not have a sincere argument against the public option, and he is merely shilling for the insurance industry. Which makes it incredibly difficult to deal with him, and the political reality is, his vote is needed.

But if the non-insurance industry CEO constituents of Lieberman, and those of the other holdouts Sens. Ben Nelson, Mary Landrieu and Blanche Lincoln, hold their Washington representatives accountable for their insincere arguments, those Senators may recognize that there are more people in their states worried about skyrocketing health care costs than there are CEOs worried about skyrocketing health care profits.

Originally posted at OurFuture.org

Will Schwartz: Going Broke in Albany, Part 1: Explaining The Budget and How We're Botching It

2009-11-23T11:20:45Z

How bad is it up there in our capital? Are you trying to follow the story of our state budget, but find New York politics to be needlessly complex and boring? I'm writing three opinion pieces that describe what's happening in Albany with the budget, its severity, its media coverage, and possible solutions.

Uh-oh.

The State Senate has our budget in its clutches.

The State Senate: home of dysfunction, bastion of corruption --
a place where most bills leave as shadows of their former selves,
battered by special interests, wearing rags and begging for spare
signatures. Unfortunatley, they’re the last division of our state government that hasn't joined the general consensus with the rest of Albany that we need painful budget cuts to ensure the future of our schools and health care. That leaves us catering to their demands.

What’s happening with the budget in Albany right now is called a “Quick Start.” The Senate, the State Assembly, and the Comptroller’s office all write mid-year reports, which basically describe the fiduciary state-of-the-state. They each submit these reports to the Department of Budget, which in turn writes a comprehensive joint-report. This way, instead of researching and presenting budgetary information on April 1, the state government starts analyzing economy, revenue and spending in November, which allows for a more thorough investigation into our budget, earlier in the year.

This time, however, the investigation uncovered some unexpectedly ugly stuff.

The Controller’s office reported a 4.1 billion dollar deficit for the current Fiscal Year, with 37% growth in spending and 3% growth in revenue over 4 years. The Assembly forecasted a 3.7 billion dollar deficit for the current fiscal year, 500 million dollars more than Governor Paterson and the DOB’s 3.1 billion dollar prediction.

The Controller, Assembly and DOB’s reports all admit a deep, fundamental flaw within our budgetary structure, and suggest its long and short term instability. All three reports admit that we can't afford our spending and we're running out of places to find dough. According to the DOB, over half of our funding has come from non-renewable resources over the last 7 fiscal years. According to Controller DiNapoli, we'll reach our cap on outstanding debt by 2013.

So while the numbers may range, all three departments stepped up rhetoric on the severity of the current deficit and the need for serious spending cuts. Over 55% of our spending goes to social services, the largest amount in the US. It’s never politically popular to admit a need for education or health care cuts in New York State, and our representation in Albany is being uncharacteristically candid, serious and effective in uniting against the largest deficit in the history of the state.

But I’m not, of course, talking about the State Senate. Their report tells us a massively different story. An irresponsible, poorly sourced, and long-winded story.

The Senate's story is 70-pages, compared to the Controller’s and DOB’s 15. It's a story of miraculous impending economic recovery, enormous enough to boost consumption and business taxes to a level that could keep our deficit in a healthy range. They predict higher gains in employment, income, wages than the Assembly, Controller, or DOB, across the board for national and local growth.

They tell us a story of wildly effective “one-shot” deals: budget adjustments that don’t alter the structure of the system, that are non-recurring and short-term. To give you some perspective, we just ran through the benefit of 9 billion dollars worth of one-shots that lasted us 9 months and led us to this current crisis. The Times reports that 75% of the Senate’s current deficit reduction plan is based on “one-shots” as well.

Their story is adorned with long-winded, indecipherable passages on irrelevant national economic data, dozens of Byzantine charts and graphs, and ultimately, only one source for the economic data in their story, the private economic forecaster IHS Global Insight. The Controller’s report uses IHS as well, along with 7 other sources, including state departments and State University research. The DOB uses every state department in addition to the three office reports to source their work.

They've created an irresponsible and potentially damaging document, just to save their personal reputations among constituents and to keep their state-funded projects alive. If the Senate gets their way, in just a few years we’ll end up having to gut education, Medicaid, and public assistance. In just a few months, we’ll have to lay off a huge percentage of state employees.

Unfortunately, they end up empowered by their short-sightedness. They hold the trump card, because they’re the only public servants left in Albany who are politically short-sighted enough to shoot down the budget proposal. They’re afraid to go back to their constituents with education cuts, and when our schools get gutted in a state of emergency once we can't borrow anymore, I suppose they'll have our unpopular governor to blame. They’re also the loudest voices, under the inflammatory and oafish financial leadership of Finance Chair Carl Kruger.

I have to give it to the Senate for their consistency; how steadfastly they disappoint and find political upper-hand through the lowest forms of political appeasement. They’re also inventive, always finding new ways to damage the state. Hopefully, this time they get held accountable before they vote on the budget, and not when it’s too late for our schools and public services.

Next up: Part 2 - Should we Panic? The News-Media and the State Budget.

David Sirota: How the Media and the GOP Turn Lies Into Zombie Lies: A Health Care Case Study

2009-11-23T10:39:58Z

In my column two weeks ago, I made this very simple point about the reporting surrounding the cost of the health care bill:

Political headlines of late have all been some version of Dow Jones newswire's recent screamer: "CBO Puts Health Bill Cost At $1 Trillion." That's as true as an Enron press release touting only one side of the company's ledger. Though the bill's expenditures do total $1 trillion, the CBO confirms its other provisions recover more than that, meaning headlines should read "CBO Says Health Bill Saves $110 Billion."

This is not speculation or my own interpretation -- this is a concrete fact, which you can see right on the CBO's website. And yet, other than this single Financial Times headline and article which tells the real story, the media hasn't stopped pushing the "health care will increase the deficit" lie. Indeed, the media has helped turn this Republican lie into a full-on zombie lie - ie. a lie that will not die.

As both Media Matters and the Washington Post's Ezra Klein show, the lie is now framing the discussion over the Senate version of the health care bill. That's to be expected -- it's Washington, D.C. after all, the beating heart of the American Idiocracy. But where that standard D.C. lie becomes a zombie lie is at the local level. When a lie starts getting repeated as fact in local news outlets where most average non-Beltway Americans get their news, it quickly becomes a zombie lie.

Colorado (where I live) provides a perfect example. Check out this blaring front page of the Denver Post from last Thursday:

Now watch this clip from the top of KDVR's local news broadcast right after the Senate's big health care vote on Saturday night -- specifically, watch the very end:

So, if you are the typical non-political junkie who glanced at the front page of the Denver Post, giant red font and a whopping 9 zeroes (for extra effect, of course) misled you to believe that the CBO says the Senate health care bill costs $849 billion -- not that the CBO actually says the Senate health care bill will reduce the deficit by $127 billion over 10 years and up to $650 billion over 20 years.

Likewise, if you are the typical non-political junkie who caught the evening news on Saturday, you were given at least a little more accurate information -- but only in a he-said-he-said way that calls into question the whole numbers. Specifically, you heard only that one guy - David Sirota -- claims the bill will reduce the deficit, and that another guy -- Colorado Republican Party chairman Dick Wadhams -- insists the bill costs $2.5 trillion. You didn't hear that, in fact, it wasn't David Sirota who said the bill will reduce the deficit -- it was the nonpartisan Congressional Budget Office that the Republican Party itself cites as an unquestionably credible source. And you didn't hear that Dick Wadhams literally made up his $2.5 trillion number out of thin air.

While the Republican spin is obviously deliberately dishonest, the media's misleading frame is more likely a product of pressure for oversenationalism and a lack of reporting resources. With newspapers desperately trying to attract readership, it's a better, more outrage-generating headline to put a giant number in bold red type on a cover, rather than to have a headline saying that a bill will actually save taxpayers' money (and I have to give the Denver Post's opinion editors -- who are distinct from their front-page news editors -- at least some credit for printing my original column about this kind of budgetary misinformation in its opinion section). Similarly, a general local correspondent on deadline who covers everything from local fires to state budget issues to national health care debates might not have the time nor the researchers to verify numbers -- and so it's just easier to cite them in the he-said-he-said way (and hey, at least a shred of the real story was reported in some way, even if it was delivered in a he-said-he-said form).

Regardless of the motives or explanations, however, this is how a standard Washington lie becomes a zombie lie -- a lie that simply will not die. It is repeated over and over and over again -- sometimes deliberately, sometimes negligently -- until it becomes conventional wisdom that the most trusted nonpartisan experts in the CBO say the health care bill will balloon the federal deficit...even when those nonpartisan experts are saying exactly the opposite.

Miles J. Zaremski: When Can A Public Option Not Be A Public Option?

2009-11-23T09:34:48Z

The public option is the most contentious issue the Senate will debate about in its health care reform bill. Viewpoints go the length of the spectrum, from Roland Burris (D-Il) declaring he won't vote for a bill that does not include a strong public option, to Blanche Lincoln (D-AR), vowing not to vote favorably on reform that includes any form of a public option. In between we have suggestions for opt-out, opt-in, or "triggered" public options. What are Americans to think or to do? Let's get back to basics.

The sine qua non of a public option is affordability of health care.

A public option means competition for the private sector that offers health care policies.

A public option provides choice to consumers, so that every one can pick the most cost-effective product for themselves and their loved ones.

In both the Senate and House bills, the public option would be part of an insurance exchange that would not be up and running for 3-4 years after passage of health care reform.

Now, there are those who do not want the government to run a health plan for fear that the private sector will go the way of dinosaurs, or that the government will take over health care completely, or because of some other ill-founded and made-up reason. But, let's take the Blanche Lincolns of our Senate as all-knowing folks who see things that others of us cannot comprehend or fathom.

Now, Senator Lincoln would (or should) have to agree that Arkansans want to have quality benefits for as low a price as possible through competition in the marketplace. After all, that is the American way--it is capitalism in its truest form. Due to its present exemption from antitrust laws, the insurance industry would not necessarily agree nor have to agree. As Wendall Potter, the noted former CIGNA executive turned whistleblower tells us, insurance companies know how to make money by finding loopholes in what regulates them; they are good at that.

So, we don't want a public option because we don't want the government putting its nose where it does not belong, but we want to prevent the insurance company from ever after gouging us citizens with outrageous premium costs. We want a public option that is not a public option.

So here goes; call it the No Public Option Plan.

1. For each year that the insurance exchange in health care reform is not up and running, premium prices will be rolled back an equal number of years. In other words, if we have to wait three years for an insurance exchange to start, then what we are charged by insurers during this three-year time frame will be what we paid for premiums three years ago. This has the effect of eliminating cost and premium increases that the insurance industry will start charging now and until health care reform takes effect in order to offset the new regulations that will be set up to reduce their profits. Freezing premium prices in this manner will also provide consumers with a "credit" of sorts for being overcharged premium costs to unnecessarily increase insurance company revenues that then bolstered their bottom lines.

2. There will be a mandate that all insurers who write health care insurance policies must participate in the insurance exchange. This seems only fair since there will be a mandate on all Americans to buy health insurance or face a penalty. The amount of their annual insurance premium based on benefits to those eligible to participate in the exchange will be no more than a certain percentage tied to an index, like the consumer price index, revisited once a calendar year. There will be a cap per year on any increases.

3. Those eligible to initially participate in the exchange will be those either not covered through a health plan provided by employers with greater than 100 employees, or who are covered or who are eligible for government-run programs, notably Medicare and Medicaid. A recent analysis pegs the number who should initially be eligible to participate in a public option, or no public option plan, at 80 million Americans.

Thus, with lifting the antitrust exemption, and implementing the new insurance regulations, what is proposed in this post is a public option that is no longer a public option. What is proposed serves the same purpose as a government-run public insurance plan without the government running one: making health insurance affordable for every single American.

To all the Blanche Lincolns or the Roland Burrises of the Senate, what would you say now?

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