Earlier this year polls indicated that we were pretty much convinced of the need for health care reform. But when it comes to actually doing it we are backing down. It's a bit like a smoker's desire to quit, "I want to, but not now." Some of our loss of enthusiasm can be attributed to media coverage of the screaming supporters of the status quo in the recent "town hall" meetings.

Status Quo Bias

We have a deep-seated psychological resistance to change - some call it a "status quo bias". We would rather put up with something we kinow, even if it's broken, than change to something we don't know. When it comes to health insurance, most people tend to stick with whatever they start with even when premium rates double in five years. Some of this can be explained by the law of intertia - things tend to stay as they are.

Fear of Loss is a Strong Motivator

We are more motivated by fear of loosing something than getting something better. This is especially true if we feel pressured to change by a looming and arbitrary deadline, like health reform legislation by year end. A year ago, less than one-third of us rated our health care system good or excellent, now over half of us do. The system has not improved, but our perception of it has. The approaching threat of change has made us overvalue what we have.

Sold the Wrong Benefits

Recent polls show that almost half of us disapprove of the way the Obama administration has handled healthcare reform. For instance, they have concentrated on selling the benefits of lowering health care costs over the long term by extending coverage to the uninsured and offering a new public option. The problem is that most of us already are insured and all the cost cutting talk get's us thinking about what we might have to give up. To President Obama's credit, he's always said that if people like the health insurance they have they can keep it. But he needs to sell some of the very personal benefits certain to be included in the final version of the health care bill - like removing the pre-existing condition barrier. What that means to us is that we can each buy the health insurance we want and that it cannot be taken away from us. Keeping our medical insurance no longer means keeping our job. That's a huge benefit to many of us, those who may have a chronically ill family member and are barred from starting a small businesses or can't take the job they want because they would loose their group health insurance.

Maintaining the status quo is not no longer an option so let's do this thing.

A promise by the pharmaceutical industry to save the nation $80 billion over a decade in exchange for protection from further givebacks under health care reform pending in Congress was confirmed recently by the White House. Apparently, the pharmaceutical companies got spooked by action in the House that would give the feds negotiating authority for drug prices and bigger rebates from the industry. So the industry got an explicit affirmation of protection from deeper cuts.

The trade group PhRMA explained the quid pro quo -- drugmakers stepped up first with a cost-saving pledge, and, in return, got "a rock-solid deal" not to make further cuts in prescription drug prices beyond the $80 billion. The White House confirmed the deal.

Neither party mentioned what is apparently a side deal - drug companies will bankroll a TV ad campaign in support of health care reform. The ads would bolster the administration's plans to remake health care and expand insurance coverage to nearly 50 million people.

The drug industry, already a big spender on commercials for its medicines, is an unlikely patron for the planned ad blitz, which could cost $150 million or more, until you stop to think about all the new customers an expansion of coverage might bring to pharmacies. To put the size of the ad campaign in perspective, Sen. John McCain spent $126 million on TV ads in his bid for the presidency.

Some of the TV ads expected this fall will carry the name of the Pharmaceutical Research and Manufacturers of America, the main trade group for brand-name drugmakers, which has pushed hard for an $80 billion limit on price concessions under an overhaul.

I think medical bankruptcy is more a reflection of middle-class financial immaturity than it is an indictment of our health care system. OK Calm down for a minute. Hear me out.

According to the popular media, middle-class American families, most with private health insurance, are being forced into bankruptcy because of their medical bills. For instance, a CNN.com article called, Medical bills prompt more than 60 percent of U.S. bankruptcies. makes the following points: more than 60 percent of bankruptcies are linked to medical bills, and three-quarters of people with a medically-related bankruptcy had health insurance. There have been scores of stories like this in the past month based on the Himmelstein, Harvard University study. The story alarms us because most of us consider ourselves to be middle-class and most of us have health insurance. We thought we were protected from medical catastrophe. Many supporters of a single-payer government health plan say this story supports their case for government health insurance.

The following story is fictional, but conforms to the statistical facts of the Harvard study.

A year ago John and his wife, Ronnie, earned a combined $85,000 yearly. Living in high-priced Nassau County, NY, they barely considered themselves middle-class. They pretty much lived from paycheck to paycheck. Shortly after Ronnie was diagnosed with breast cancer, she had to quit her job. The family now has to make do on John's income of $60,000 per year. He didn't want to worry her, so he used their credit cards to pay bills. Now, John is running out of money and credit. He can't pay all his bills. He has to prioritize. At the top of the list go those bills with obvious consequences for nonpayment. Paying the mortgage is obviously a high priority. Don't pay and the bank will foreclose and take away the family home. He's seen it happen to a neighbor. Likewise, his car can be repossessed. The utilities can be turned off. The consequences of not paying his medical bills are not so obvious, so those bills go to the bottom of the list. He can rationalize not paying. He tells himself, "Doctors are rich. Why should I give them my last dollar? Besides, my insurance company has already paid most of the bill anyway. Can't they let me off the hook for the balance?" But John is surprised by how aggressive the doctors and hospitals are at collecting what he owes. His daughter's pediatrician has even filed in Small Claims Court to recover a lousy $210. Even so, John can't pay, so he goes into survival mode - paying the essentials and everything else will have to wait. Finally, the pressure from the constant phone calls and collection notices becomes overwhelming and John and Ronnie file for bankruptcy to get protection from their creditors and to try to save their home.

If John and Ronnie had been part of the sample group in the Harvard study, they would have been categorized as a "major" medical bankruptcy case. Major meaning that medical debt was the primary cause of the personal bankruptcy filing. John's total debt excluding his mortgage was just over $75,000 at the time of filing for bankruptcy. Yet, his medical debt was less than $10,000, (typical of the Harvard study), only 13% of his total debt. His health insurance covered over $80,000 in medical expenses and prescription drug claims for his wife and daughter in the year previous to his filing for bankruptcy.

The biggest cause of John and Ronnie's financial troubles was the loss of income from Ronnie's job because of her illness. There is state disability insurance. New York State made short-term disability payments of $170 per week for 26 weeks (total benefit of $4,420) and that helped, but not enough. While Ronnie has recovered from surgery and radiation treatments, it will be some time before she is ready to work again.

What if John and Ronnie had been covered by a single-payer government health insurance plan like Medicare? Would they have been better off? Yes, a little better. As Medicare patients, they would have had less out of pocket medical costs due to a smaller deductible than their private plan. But it would not have made a significant difference. It would not have saved them from medical bankruptcy. In fact, a large percentage of those listing medical debt as the reason for their bankruptcy are over 65. These people are already on a single-payer government health insurance plan called Medicare.

The message of the cautionary tale of John and Ronnie is not about health insurance but about personal responsibility. Nobody wants to hear it, but here it is. The government is not going to save us from financial ruin, even if it's caused by illness. It is our responsibility to spend less than we make and save for a rainy day. Sorry. No government bailout for us

We are beginning to see a two tiered system of health care delivery in America - the publicly insured and the privately insured. Medicare is single payer public insurance. Virtually every American age 65 or over is covered by Medicare. Medicare dictates the fees that they pay for medical services that are below cost for the providers .Those of you on Medicare have probably been shocked to see how little Medicare pays doctors, hospitals, and other health care providers. It's not unusual to see Medicare pay only 10% of the providers' bill, leaving them to write off 90%.

Second Rate Treatment

Most health care providers need Medicare patients for volume - pays the overhead, etc. So they are figuring out how to provide a lower level of service for Medicare patients - similar to a retailer creating products with lower price points for less affluent customers. I'll give you an example: Yesterday, I was treated at the Newport Beach Orthopedic Surgery Center for a procedure I've had several times over the last couple of years - an epidural steroid injection (ESI) to treat back pain. Previously, I was treated in a state of the art operating room with lots of staff showing great concern for my well being. The procedure was done under sedation so I was very comfortable throughout. That was when I was covered by private insurance. My Medicare experience was different. This time I was not treated in the surgery center but in one of the regular examination rooms crammed with equipment. The same highly trained doctor performed the ESI procedure, but she was assisted by only one x-ray technician. I was told there would be no sedation. I discovered that enduring an ESI procedure without sedation is on a par with enduring a root canal - about 30 minutes of tedium punctuated by moments of pain, all the while imagining that at any moment something terrible will happen. I was shown out of the room as the next patient was ushered in - mass production style. I had just experienced what I consider to be second rate treatment. I was not a happy camper. A day later, I'm thinking, "The outcome is what really matters. My back is pain free today. So the "bare bones" epidural treatment was apparently just as effective as the "premium" treatment." If American medicine comes to this, I may not like it, but I can live with it.

The Public Good

As a nation, we are struggling to reform the most expensive health care system in the world. It's gotten to the point that health care spending threatens our nation. We are undoubtedly going to end up with a lot more people on public health plans, not a universal single payer plan like Medicare for everyone, but certainly an expansion of Medicaid to cover the uninsured poor and an expansion of CHIP for the children of low income families. We may also get a public healthcare option to compete with private health insurance.

Private Insurance for the Affluent

Germany has a two tiered health care system of public insurance and private insurance. People with public insurance get good treatment for low premiums. People who pay more for private insurance get spa-like treatment that seems over the top even by US standards. Private health insurance in the US should find it easy to capture the affluent market, offering plans that provide personalized services, 24/7 access to their doctors, private rooms when hospitalized, etc. As public health care continues to expand as it inevitably will, private insurance will not be able to compete with public insurance for the masses. One option will be to develop "Cadillac" health plans for those that want preferred treatment.

Barack Obama's American Recovery and Reinvestment Act of 2009 was signed on February 17, and is already beginning to filter out funds to hopefully stimulate the economy. One of the principal goals of the package is to reform the health care system while creating jobs and insuring more Americans. Through measures to support the unemployed, integrate cutting-edge information technology systems into medical networks, and insuring more children, the act may in some way affect how you receive health care. Find out how.

1. Health care industry set to go tech

One of Obama's umbrella strategies for reforming health care and stimulating the economy involves pumping money into health care technology systems. He hopes to create a health information network for hospitals, rural and urban clinics, and other health care centers by making all medical records electronic; making existing medical technologies more accurate and effective; and reducing errors in medical care. This technology boost to the health care system will, Obama hopes, save money, create jobs, and improve the standards and delivery of health care and medical information. The Dallas Business Journal reports that the stimulus package will invest $19 billion for health information technology.
2. The unemployed will still receive health care benefits, at least temporarily

Obama plans to ease the burden of health care costs for the unemployed and reduce the number of uninsured Americans by extending Medicaid benefits to the unemployed, at least for a time. Individuals who get unemployment checks would also be able to receive Medicaid, as would their spouses and children who are under the age of 19, reported the New York Times in January. States will receive federal aid to help ease Medicaid costs. In late February 2009, TheState.com reported that Obama "released $15 billion in economic stimulus Medicaid funds for states" to disperse.


3. Children's Health Insurance Program Reauthorization Act of 2009

The Senate and House reformed the Children's Health Insurance Program under this legislation, which extends insurance to nearly 4 million more children by reworking the Social Security Act. The program will help families of low-income children who do not qualify for Medicaid pay for their health insurance, and states will still be able to set their own income eligibility requirements. The program is funded by a tax increase on cigarettes.
4. Governors hold power over releasing funds

While the federal government has designed and approved the health care stimulus package, governors are in charge of actually releasing funds, creating eligibility requirements when appropriate, and overseeing the implementation of the stimulus plan in their states. In late February, governors like Louisiana's Bobby Jindal, opposed many parts of the economic plan and may reject at least some of the money that is coming to their state from the federal government. The New Orleans Times-Picayune reports on Nola.com that Jindal will most likely accept the Medicaid supplements, but according to Medical News Today, other governors are begrudging about accepting funds that are meant to be used in a specific way. Instead, governors like New Hampshire Gov. John Lynch (D) are arguing for more flexibility in how they disperse the federal funds.
5. Federal government helps states fund COBRA for unemployed.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives individuals who are laid off, retired,switching between jobs, or have dependents at the time they stop working the option to continue their group health benefits for a limited time. Some beneficiaries may have to pay for the group rate insurance, however, but the U.S. Department of Labor holds that "COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage." Under Obama's stimulus plan, the federal government will provide states with subsidies to help offset the costs of COBRA. They will pay for up to 65% of COBRA premiums "for eligible workers who are involuntarily terminated," according to the accounting firm Amper, Politziner and Mattia. Qualifying workers include those who have been involuntarily terminated on and after September 1, 2008, and qualifying employers include those who are subject to COBRA legislation, as well as small employers who are subject to State Continuation legislation.
6. Job training funding for those entering health care industry

In another measure to stimulate the economy while improving health care standards, Obama plans to increase job training opportunities for those entering the health care industry. The stimulus budget has allotted $750,000,000 "for a program of competitive grants for worker training and placement in high growth and emerging industry sectors," $500,000,000 of which will go to renewable energy programs. The rest will be distributed by the Secretary of Labor "giving priority to projects that prepare workers for careers in the health care sector."
7. Preventive care takes precedent

In his address to Congress in February, Barack Obama outlined the promised benefits of his economic stimulus benefits, highlighting the fact that the health care reform boasts "the largest investment ever in preventive care, because that is one of the best ways to keep our people healthy and our costs under control." According to a report by NPR, this move would also create jobs, at least in the short term, even if it did not result in sustainable medical research projects, as hoped.
8. A contract for accountability

In order to promote accountability in health care reform and to make sure that all of this funding is actually helping the economy and the health care industry, Obama's plan includes a contract between the federal government and the Institute of Medicine. The stimulus package outlines that the $1.5 million contract will require the Institute to "produce and submit a report to the Congress and the Secretary [of Health and Human Services] by not later than June 30, 2009, that includes recommendations on the national priorities for comparative effectiveness research" that will eventually be subjected to public commentary and review.
9. Health IT dominates in all areas of medical industry

The stimulus package lists several ways in which new health care information systems and technologies will help the facilitation of medical care and the industry as a whole. These include the exchange of patient medical records and a subsequent reduction in wait times at hospitals and health care facilities; the increase of telemedicine technologies for those living in rural areas and who do not have access to cutting edge medical resources; "technologies that help reduce medical errors;" and "technologies that meet the needs of diverse populations."
10. Total health care stimulus cost: $150 billion

The total cost of all these (and more) health care reforms under the American Recovery and Reinvestment Act of 2009 is $150 billion, according to the Dallas Business Journal, including $17 billion for Medicare and Medicaid incentive programs, $2 billion for technology grants, and $19 billion for a health information technology movement.

Kiyoshi Fukuda, a dentist from Santa Rosa, California, is a registered sex offender. He admitted to having sex with a child under 16 and even though he disclosed his status to the state licensing board his record remained "clean" on the bureau's website. Even Fukuda was surprised by that one.

Over a third of California's 937,100 licensed healthcare workers have not been fingerprinted - a crucial step in vetting workers by checking criminal databases and intended to prevent rapists, drug addicts and others with rap sheets from becoming licensed to provide health care services.

Incredibly, over three-quarters of psychiatric technicians; nearly half of family therapists, social workers and dentists; and 12 percent of physicians were not fingerprinted by their relevant licensing boards.

Among them was Michael Marcus, a dentist from San Jose who was arrested in July 2005 after allegedly fondling a 17-year-old patient. He was charged with three misdemeanor charges of sexual battery, on top of three others he had received in 1996. So far, he's only gotten a slap on the wrist - five years of probation - and says he has the right to continue practicing until he is found guilty by a court of law.

Sure, Michael.

The cases, which are numerous, also included some off-the-job criminality that eventually found its way into the examination room. Escondidio nurse Mary Eileen Cahill-Therrien was convicted of vandalism, driving under the influence, and disturbing the peace in 2000 and 2001.

Despite showing up at a home-care assignment drunk (and being asked to leave after stupidly leaving a patient's catheter in) she managed to find another job, where she was fired only weeks later for - surprise! - being drunk.

BUT WAIT. Undeterred by her spat of bad luck with, you know, the whole drunk at work thing, Cahill somehow got yet another job which she ultimately lost due to - wait for it - her unholy love of drinking. While Cahill sounds like a girl worth going out on the town with (or an aunt worth calling for a beer-run on prom night), I'm not so sure I'd want her taking charge of my catheter experience -just a thought.

These cases are among some of the most brazen abuses that can occur in a doctor-patient relationship. If the licensing board won't protect us from being anesthetized under the hands of child molesters, rapists, violent criminals and drug addicts, do they really serve any function at all?

The state of Florida has passed health insurance legislation that will allow insurance carriers to offer bare-bones coverage for as little as $150 per month. Aimed at Florida's 3.8 million uninsured residents, the plans would be exempt from existing state-mandated coverage requirements. For instance the plans would not be required to offer coverage for long-term hospitalizations or treatment from specialists, but would cover preventive care and office visits.

Sadly, the California Senate Health Committee defeated a ground-breaking proposal to reform the state's health insurance system and extend coverage to millions of uninsured residents. In the end, it was the economic downturn that killed the well-intentioned plan. The state already has a $14.5 billion deficit, so the pprobability that the ambitious proposal would not be self-sustaining was just too risky to bear at this time.

The nation was watching California on this one and the proposal's failure doesn't bode well for health insurance reform at the national level, regardless who gets elected.

Group health insurance is too expensive for many small businesses and it's not surprising that almost 70% of the working uninsured are employed by businesses with fewer than 100 employees.

A majority of small business owners (57%) say they will support an individual health insurance mandate - where individuals are required to insure themselves. It stands to reason that small businesses would jump at the chance to get their employees covered by individual plans especially if they wouldn't be required to contribute very much to offset the lack of group coverage.

Presidential candidates Clinton and Edwards, both Democrats, have proposed universal health insurance with individual mandates. Interestingly, small business owners, typically Republican, find at least one of their business interests aligned with the opposition.

Using comparative effectiveness research, we could reduce health care costs in the US by 30%. There is a significant opportunity to remove costs from the system without harming health outcomes by eliminating medical treatments and tests that are of questionable value. Using comparative effectiveness research is the key.

The aging population is not to blame for the rise in health care costs. Congress and health care policymakers need to promote cost effectiveness and evidence-based medicine.

American health care is often compared unfavorably to health care in Canada, France, Great Britain, and others, based on shorter life expectancy and higher infant motrality rates in the US. Critics also point to 47 million uninsured Americans and the relatively high cost of health care in the US.

Professor N. Gregory Mankiw, an economist at Harvard University, currently an adviser to Massachusetts Gov. Mitt Romney, spoke out recently about "true but misleading statements about US health care that politicians and pundits love to use to frighten the public."

The difference in life expectancy between the US and Canada has more to do with higher rates of obesity and more teenage pregnancies in the US resulting in low birthweight babies. While contributing to big differences in comparative health outcomes between the two countries, they have little to do with the American system of health care.

The often quoted statistic of 47 million uninsured Americans exaggerates the magnitude of the problem as well. The Census Bureau number includes about 10 million non American citizens, many undocumented, who would probably not be covered if the US had national health insurance. The actual uninsured number far less than 47 million and accounts only a few percent of the population, which is why the U.S. should be wary of sweeping reforms of our health system.

The final statement is that Americans spend a greater share of their income on health care -from about 5% of a person's income in 1950 to 16% now. The increase is not due to waste, fraud and abuse, but advances in medical technology and prescription drug cost increases. Americans should not to be fooled by statistics into thinking that the problems we face are worse than they really are.

If you need a heart bypass operation in California, you can now check your doctor's report card before going under the knife. The Office of Statewide Health Planning and Developmen published a report (available at the office's website) that rates 302 surgeons who performed coronary bypass surgeries at 121 hospitals during 2003 and 2004.

The average death rate was 3.08% of more than 40 thousand bypass surgeries (1 in 30) over the 2 year period. The surgeons' ratings factored in degree of difficulty issues like prior heart surgeries, related medical conditions, age, and gender.

This is part of the transparancy movement to give health care shoppers better information to make informed decisions.

Moore's attack of American health care, the documentary film - Sicko, is unfair to say the least. Early in the film, Moore tells health care horror stories - a man who died because a bone-marrow transplant that might have extended his life was refused as "experimental" . A baby with a high fever died when her mother took her to the nearest emergency room where she was refused treatment, rather than taking her to a Kaiser Permanente hospital where she was insured.These and other examples will make anyone viewing the film feel that something must be done about our "broken" health care system.

But from there the film slides downhill in a hurry. Moore pulls a stupid, insensitive prank by boating sick people to Guantanamo, where he knows they won't receive treatment. It gets worse. Moore walks through Havana and gets directions to a health clinic from some people on the street. Subsequently his patients get free treatment in Cuba. As if he didn't know that healthcare is free in Cuba and why hide the part that local officials played in getting American patients treated in Havana?

Moore claims that most Americans want universal health care and will to pay more taxes to achieve it. If so, why not show us what works in other countries and what could be applied to the American system? The difficult stuff is ignored, instead Moore takes us to Canada, England, and France. At each stop, he pulls the same sophomoric act of pretending to be surprised that health care is free in these countries. No mention is made of the delays in treatment or the instances of second-rate care.

Moore is condescending to his audience, thinking of us as stupid enough to be easily satisfied with superficial stories and easy solutions, the very thing of which he accuses the powerful in American business.

Discribed as "exaggerated, biting, unfair", Michael Moore's new documentary "Sicko" about US health care industry, is unlikely to change US health policy. While Moore taps into widespread dissatisfaction with the current system in America, most voters have been listening to similar complaints for a long time and are still not ready to deconstruct the health care system. The film details accounts of insurance companies denying people coverage and, while this makes people angry, I doubt whether the film will have a significant effect on health care policy.The middle class is still being served by things as they are.

The documentary makes its U.S. debut on June 29.

A coalition of 36 big US companies including Pacific Gas and Electric, General Mills, PepsiCo, Safeway, Bumble Bee Foods, and health industry giants Aetna, Cigna, Eli Lilly and Blue Shield of California, have joined together to lobby congress for market-based universal health care.

The coalition has laid out some core principles that health care reform should follow:

Health insurance will be mandatory
Low income citizens are to be subsidized
Health insurance will cover pre-existing medical conditions
Plans will include coverage for preventive care and incentives for healthier lifestyles
The self-insured will get tax relief
Medical treatment costs will be transparent.

What's new here is that big business traditionally oppose health care reform at the national level.

Among the states considering universal health insurance - Massachusetts, Vermont, California, Pennsylvania and Illinois - the impact of mandatory health insurance on small businesses is a big concern. All of these proposals require employers to provide health insurance or to contribute state pools. Opponents of change, say that the proposed plans will hurt small businesses. But when you look closer at these proposals, you see that they can actually help small business by providing an option, the state pool, to either being uninsured of paying for group health insurance. Very small companies - less that 10 employees - and self employed individuals would see the gratest benefit. They make up the the biggest part to the working uninsured because insurance costs too much or because they are uninsurable due to pre-existing health conditions. State sponsored plans will provide them anoption they don't have now.

Who cares what's going on with health care in Maine?

After all, it's a sparsely populated and relatively poor state surrounded by Canada. But in the world of Universal Health Care, Maine is a leader - the first state to pass universal health care into law. Maine Gov. John Baldacci pushed universal health insurance through the legislature over two years ago. Maine's, DirigoChoice, the state's subsidized insurance program, is open to all residents regardless of pre-existing health conditions. The premiums of low income residents are subsidizeed by the state.

Even so not enough people signed up for the program. Now Gov. Baldacci, is proposing making health insurance mandatory. Those who can afford to pay (incomes more than 400% of the federal poverty level) would have to buy health insurance. The premiums of lower income individuals would be susudized by the state. Employers could either pay - offer group health insurance to employees - or play - contribute to a state fund.

The mandatory element was missing in the original Maine plan as it is also in New York and New Jersey with disastrous results. Basically the healthy avoid paying premiums and wait until they need medical care before signing up. Insurance is based on the claim-free paying the costs of the claimants. Everybody has to be in the pool.

Politicians are once again beating the drum for "mental health parity". Basically they want insurance companies to be required to provide similar health insurance benefits for mental health care as they provide for physical health care. For example, insurance should cover a psychotherapy office visit with a nominal copayment. It's the kind of feel-good issue that politicians love because it enjoys widespread support and after all, who's going to speak against it? ....I will.

Too much of what passes for mental health care is untested or faddish. For instance, family interventions for drug addiction and alcoholism, while currently popular with the media (there's a TV show called "Intervention"), are totally without statistical evidence of success. In fact, less confrontational treatment modalities are more successful. Insurance mandates that give money to mental health practioners with virtually no strings attached are not going to help the tens of millions of Americans with drug addiction or alcoholism.

Insurance companies need to cover treatments that are proven to work. Coverage needs to be tied to outcomes. We're not ready for blanket mandates in mental health care.

Ten California counties will get $540 million in federal money over the next 3 years to cover 180,000 low-income adults who don't qualify for "Medi-Cal". This program targets adults because virtually all California children have health insurance - through either private coverage or public programs.

Governor Schwarzenegger helped negotiate the deal with federal officials with a promise of new approaches for providing care to people who would otherwise get health care at emergency rooms. The counties will provide preventive care and follow-up treatment for chronic conditions like diabetes.

Americans worry more about health care costs than the Iraq war. Harris Interactive conducted an online survey in February that analyzed responses from 2,758 adults accross the U.S.. When asked about healthcare costs, 85% of those surveyed were "concerned" or "very concerned" whereas 79% said they were similarly concerned about Iraq.

Doctors get paid the same when they make mistakes, run unnecessary tests and have to redo their work. Recently, health insurers have been proposing pay for performance programs for providers.

California has pioneered the rating of physician groups and rewards with cash - paying out $145 million since 2003 - for improving their ratings on such benchmarks as offering preventive care or patient satisfaction. California's program is voluntary, with more than 200 medical groups participating. Also, California and five other states will join a Federal pilot project that could lead to national standards that measure physicians' clinical performance. The pilot will study Medicare claims and claims of the largest prihealth insurance companies in California. This will extend the ratings to about 25,000 California physicians.

See full story at Los Angeles Times Online, Rethinking criteria for doctors' pay

About two thirds of the 9 mil uninsured kids in the U.S., could qualify for state health insurance programs. Texas leads all states with 20.3% uninsured children are Texas. Ohter states with a high proportion of uninsured cchildren are Florida and New Mexico. Among the states with lowest number of uninsured children are Vermont, New Hampshire, and Michigan.

The Childrens Health Insurance Programs (SCHIP) is being reauthorized in congress now. Lawmakers are debating the funding levels for SCHIP. They need enough money for all children currently enrolled and the millions more who remain unenrolled and are eligible. This is a "feel good" issue that most in congress would love to get behind. Unfortunately, the eligibility guidelines are being lowered to the point that people who can afford to insure their children will qualify for SCHIP. The money would be better spent on innovative ways of getting truly needy kids signed up.

If we fail to deal with the problem of the uninsured, more and more people without insurance will see their health deteriorate from mostly preventable illnesses. This truth was brought home recently by Jack Hadley, Ph.D., of the Urban Institute. He looks at uninsured individuals who have had a health shock - the onset of a chronic illness or injury. Only half of the uninsured studied sought medical care. If the uninsured received care, they were less likely to comply with recommended follow-up care. The uninsured reported incomplete recovery more frequently than insured individuals. The uninsured people studied reported worse health 7 months after the health shock,.

Chronic conditions usually need medical care over a a long time and the uninsured are less able to comply with treatment recommendations .The study's finding at the first follow-up interview that the uninsured frequently report no longer being treated indicates inadequate care. They will depend on emergency room care will make it more likely their care will lack continuity.

From March 14, 2007 issue of JAMA. American Medical Association (AMA)

Tennessee Gov. Phil Bredesen announced the launch of the CoverTN program. The program provides insurance for low-income employees and is administered by BlueCross BlueShield of Tennessee starting April 1.

The goal of CoverTN is to expand coverage options for uninsured, low-income working adults who are not eligible for Medicaid. Average premiums for CoverTN will be $150 per month, with employers, employees and the state paying equal portions. To be eligible for the program employers must have 25 employees or less, at least 50% of whom have earn less than $41,000 per year. They need to have not offered health benefits for at least six months.

Typical copays for the CoverTN members will not exceed $25 for a physician office visit, $10 for a generic prescription, $100 for an ER visit, $25 for hospital outpatient treatment and $100 for an inpatient treatment. Inpatient hospital benefits are capped at $10,000 per year, with the maximum total benefit being capped at $25,000 per year.

See full story at Memphis Commercial Appeal Online, Tennessee Governor Launches Insurance Program For Low-Income Workers

Health insurance consumers are looking to comparison shop for medical procedures, which seem to be priced in a frustratingly arbitrary manner. Typically medical procedure costs have been kept under wraps, although the internet has started to make this information more readily available, allowing consumers to compare prices and even evaluate affordable alternatives.

Patients rarely receive information on costs before treatment, and even the insurers themselves do not know what other companies are paying for a given procedure. On average doctors have somewhere between five and 100 different reimbursement rates for the same procedure. Worse, a hospital with multiple geographic locations may have upwards of 150 rates for a single procedure.

Of the 50 states, 32 require that hospitals provide specific pricing information to the public. Consumers do not often find this information useful, however, because the hospital does not have to disclose the discounted rates they contractually provide to insurers, which can vary greatly. In essence patients are less interested in what the hospital charges, and more interested in the bottom line cost to them once the discount has been applied.

I've been reading a lot of opinions on President's Bush's proposal to tax health care benefits. The one that's closest to my opinion is this one from the Wall Street Journal. "The Bush health insurance proposal would make insurance more affordable for most Americans than the current employer-sponsored health care system, which leads to inequities and insulates individuals from the real cost of their treatment decisions. The biggest problem with Mr. Bush's plan is that it wasn't offered two years ago, when it had a better chance to pass. Bush is finally offering a GOP reform based on market principles that these pages have encouraged for years.

Good advice to Legislators from the Washington Post, "The Bush health insurance proposal would improve progressivity and fairness and help contain health care costs. As written, the proposal has flaws, but those can be addressed -- if Democrats are willing to do more than hurl criticism. Congress should engage, not reflexively dismiss."

"If a liberal president proposed reforming the tax code to give working families a bigger tax break for health care than corporations and giving poor families direct assistance to buy health care to boot, the New York Times and the rest of the mainstream media would be choking back tears as it praised an initiative that was so bold in its compassion and desire for fairness. But you won't find the president's critics supporting his fair and compassionate plan. Instead, they support an expansion of Medicaid that is like forcing people into the medical equivalent of public housing. Washington Times

Until recently, when hospitals and physicians made errors when dealing with patients, the hospital risk managers and insurers generally recommended "defend and deny" policies.

A growing number of health care providers are adopting "disclosure and apology" policies for dealing with patients who have experienced a medical error. Several states have passed laws protecting doctors' apologies from being used at trial, and more hospitals are implementing policies requiring that doctors and nurses quickly reveal errors to patients and families when warranted.

The stance of risk managers and insurers has changed in part because of mounting evidence that disclosure and apology programs, which often include an upfront offer of a financial settlement, can sharply reduce malpractice costs.

Pennsylvania Gov. Ed Rendell announced a proposal that would expand access to health care services, improve quality and reduce the state's health costs. The "Prescription for Pennsylvania" proposal would phase in a requirement that state residents whose annual incomes exceed 300% of the federal poverty level obtain health insurance. Residents with lower incomes would not be required to obtain coverage but would have the option of buying it at reduced rates.

The proposal also would expand Cover All Kids -- a program that aims to provide affordable health coverage for children -- to create a new initiative called Cover All Pennsylvanians that would help uninsured adults and small businesses obtain basic coverage through private insurers. Premiums for the plans would be determined by a sliding scale based on income. Rendell's proposal would create financial penalties for businesses that do not offer health insurance coverage to employees. In addition, four-year colleges and universities would be required to guarantee that students are insured or have access to a health clinic. Rendell also plans to meet with other large purchasers of health care to develop a pay-for-performance program that would link payments for health care services to the quality of care.

President Bush proposed sending federal money to help the states that are coming up with innovative ways to cover the uninsured. States would be free to come up with their own plans --as Massachusetts, California, and others are doing as long as they met certain standards. Instead of new spending, the White House plan would take federal money now used for charity care at hospitals and redirect it to the state initiatives.

In an interview this week, Tommy Thompson, who served as Health and Human Services Secretary during Bush's first term, endorsed using the states as "laboratories" for health reform, saying Congress has lacked the political courage to tackle the problem.

According to some state proposals for expanded coverage, companies will have to pay into a state fund if they don't provide health insurance for their employees. This has some smaller companies worried because they are more likely not to provide group health plans.

Some larger companies could benefit from the proposals because of a reduction in the number of uninsured residents should decrease health care costs. Companies cover some of the cost of uncompensated care for uninsured residents through higher reimbursement rates paid to hospitals and other health care providers.

American consumers and business leaders are ready to have a very bipartisan solution. Now everyone is on the same side saying, "We want universal coverage.' The only question is 'How?'" Clearly, there are states that are looking into this. Whether Washington will do more than talk about the problem remains to be seen.

California Gov. Arnold Schwarzenegger announced a proposal, based on a Massachusetts law enacted last year, that would require all state residents to obtain health insurance, and Pennsylvania Gov. Ed Rendell announced a similar proposal. More than six additional states also are "actively debating the idea. Governors in Colorado, Illinois and Kansas recently have called for universal health insurance for residents, and governors in Arizona, Indiana, New Mexico and New York have called for expanded coverage.

A coalition of 16 organizations last week announced a proposal that would provide health insurance to more than half of uninsured U.S. residents, and a bipartisan group of lawmakers last week introduced legislation that would provide grants to states to test health care reform proposals. In addition, Sens. Ron Wyden (D-Ore.) and Edward Kennedy (D-Mass.) and Rep. John Dingell (D-Mich.) also have said they will seek to pass legislation that would extend Medicare to all residents and allow them to select from health plans offered to federal lawmakers.

The Bush administration has proposed federal tax deductions of $7,500 for individuals or $15,000 for families who acquire health insurance on their own or through an employer. The deduction would be available to all individuals and families who purchase health insurance, regardless of the value of their policies or whether they itemize deductions on their tax returns

For U.S. residents who receive employer-based health insurance, the deduction would be offset by the cost of their coverage. The proposal would for the first time levy an income tax on the value of employer-sponsored health insurance in some cases. Currently, employees are not taxed on the value of their employer-sponsored health insurance. Under the proposal, individuals and families with employer-sponsored health insurance plans worth more than the proposed allowable deductions would pay income taxes on the difference.

This proposal indeed levels the playing field regarding tax treatment and should motivate employees to select more spartan coverage to maximize their tax deductions.

Paper prescriptions are dangerous because of the risk for medical errors. The technology for electronic prescribing has existed for some time, yet fewer than 5% of practicing physicians in the U.S. currently use electronic prescribing. Many physicians are reluctant to adopt electronic prescribing largely because of the cost of the systems and a perception that the technology requires too much time to learn and install.

The National E-Prescribing Safety Initiative -- a coalition of technology and health care companies -- has launched an Internet-based electronic prescribing program that physicians can access at no cost. The software, called eRx NOW, is available free to any health care provider with legal authority to prescribe medication, and requires no download, no new hardware and minimal training. Health care information technology company Allscripts and Dell developed eRx NOW with contributions from Cisco Systems, Google and Microsoft. Other members of NEPSI include Aetna, Wellpoint, Sprint Nextel and SureScripts. The initiative will cost more than $100 million over five years.

The American Medical Association and the American Academy of Pediatrics have voiced concern over the trend to retail-based health clinics. Retail-based clinics, located in stores like Wal-Mart, Target and CVS, promise quick attention for routine visits with no appointments. The AMA opposes retail-based clinics as an appropriate source of medical care for infants, children and adolescents and strongly discourages their use.

Anne Pohnert, Washington, D.C.-area manager of operations for retail clinic chain MinuteClinic, said, "Many patients would like to get in to see their primary care physician, but when they call, there is no appointment available." She added, "We believe that a visit to MinuteClinic instead of an [emergency department] on a Friday evening for a five-minute strep test is a win-win for patients and insurers trying to save time and health care costs."

Rick Kellerman, president of the American Academy of Family Physicians, said, "The retail clinics are sending physicians a message that our current model of care is not always easy to access." Kellerman said that physicians, who are concerned about retail clinics "encroaching on the economics of their business," already have begun adapting to the trend by expanding office hours, opening on weekends and offering online scheduling. AAFP also has launched a national project to test ways to improve patient care and "make primary care practices more welcoming to patients.

See full story at WashingtonPost.com, Is 'Quick' Enough?
Store Clinics Tap a Public Need, but Many Doctors Call the Care Inferior

Powerful business interests that once teamed up to defeat Democratic healthcare plans now advocate extending medical insurance to millions of Americans. Among the champions of change is the trade group representing the nation's leading health insurance firms. That industry developed the "Harry and Louise" television ad campaign, which helped turn public opinion against the universal healthcare plan proposed by President Clinton and then-First Lady Hillary Rodham Clinton in 1994.

Today, the president of the Service Employees International Union will stand with the director of the Business Roundtable, which represents the nation's leading corporations, to announce one campaign to overhaul healthcare. On Thursday, private health insurance companies will join with doctors' organizations and health-activist groups on the left to announce a plan for universal coverage.

The two plans being announced this week — the details of which were not available — come in the wake of ambitious blueprints for universal health coverage put forward by two prominent Republicans: in California by Gov. Arnold Schwarzenegger and in Massachusetts under Gov. Mitt Romney, who has since left office and is a 2008 presidential candidate

Now, Democratic constituent groups, including labor and seniors' organizations, are joining with big business to demand a substantive response to the nation's healthcare problem, which has left 46 million people uninsured and has undermined American corporations' ability to compete internationally.

See full story in the L A Times, Unlikely allies advocate healthcare overhaul

California's proposal to mandate health insurance covrage for all demonstrates that with Congress stalled on enacting comprehensive health care reform, the states are beginning to take matters into their own hands. Schwarzenegger said, "If you can't afford it, the state will help you buy it, but you must be insured".

Karen Davis, president of the Commonwealth Fund, said, "This is a very significant proposal. It is not just children he is talking about. It is really dealing with the whole problem of the uninsured, with concrete positions to raise revenues to pay for that coverage and the philosophy of shared responsibility."

Diane Rowland, executive vice president of the Kaiser Family Foundation, said, "Health care for the uninsured is back on the agenda," adding, "The governors are trying to lead the way, but it's also going to take national action to try to address this problem"

California Governor Schwartzenneger wants to require everybody in California to carry health insurance. That means illegal immigrants too. No way, say most Californians. Not for people who sneaked into the state illegally.

Schwartzenneger puts it this way, "Let me be clear about this one issue … the debate over covering undocumented or illegal immigrants. I don't think it is a question or a debate if they ought to be covered…. A federal law requires us to treat everyone who shows up at an emergency room and needs care….Therefore, the decision that [we] made was not should we treat them…. The question really is, how can we treat them in the most cost-effective way? Because right now they go into an emergency room, and that means sometimes thousands of dollars are being rung up. But in the meantime, we can do it cheaper by sending them just to a doctor…. We are trying to be realistic here and not live in denial."

Read full story in Los Angeles Times, Part of Schwarzenegger's health plan faces tough sell to public

Some states - like New York and New Jersey - already promote individual coverage by requiring insurers to offer it to all comers through what are known as "guarantee-issue" laws. Studies show guaranteed issue can price people out of the market, and, as public policy, it achieves the opposite goal of getting more people insured. In New York and New Jersey individual health insurance rates are much higher than most other states. Consequently, only those who really need it (the sick and those needing medical treatment or procedures) buy health insurance.

In California, Gov. Schwarzenegger has said he favors requiring individuals to obtain health insurance in the same way drivers must carry automobile coverage. He certainly knows that such a mandate won't work if insurers are allowed to exclude all but the healthiest customers as current law in most states allows.

One health plan believes that private insurers ought to share the risk and that selective underwriting ought to be abolished. "We think it's a bad system," said David Seldin, a spokesman for Blue Shield of California. "We operate the same way as everybody else in the marketplace does, using the same actuarial data that everyone else in the marketplace does, because it's the only way to remain economically viable," he said. "But we would really like to see the system changed."

I'll admit it. I fell for one of those weight control scammers. About two years ago, I threw away about $100 on CortiSlim tablets. Their incessant radio ads appealed to me because they were spoken by a principal of the company, Dr. Somethimgorother, in a low-key, matter-of-fact pseudoscientific presentation that made me call their 800 number. The pills produced no noticable result and I moved on.

This week the FDA fined CortiSlim and three other weight control con artists (Xenadrine EFX, TrimSpa, One-A-Day WeightSmart) $25 million in false advertising claims. The common theme in these cases is the marketers made claims that their products contain new, breakthrough ingredients which are proven to cause weight loss or control weight. But the claims aren't supported by sound science.

Health insurance companies are beginning to reveal the costs of health care services, a move that might ultimately change what providers charge and how much consumers pay. Charges for services can vary by as much as 30% depending on the provider, according to Cigna. In January 2007, Cigna in 58 markets will begin to offer the Cigna Care Network, which will include doctors who score well on quality and cost-efficiency measures.

The American Medical Association in November passed a resolution seeking laws that would prohibit insurers from creating networks "based solely on economic criteria." Nancy Nielsen, head of AMA's House of Delegates, said, "You have to look very carefully at those efficiency numbers. Some are only about costs. That's where it gets tricky. That's where the biggest fights and negotiations are."

Insurers contend their efficiency measures will not be based solely on costs but add that actions need to be taken to address the cost disparities in health care. Charles Cutler, national medical director for Aetna, said, "The more people understand the cost of health care, the better off we will be." Brian Klepper of the Center for Practical Health Reform said, "We're at the leading edge of a huge change" .

Illinois joins a growing list of states taking early steps toward mandatory health insurance. An Illinois state task force on Thursday approved a plan to require all residents to obtain health care coverage through their employers, public health programs or private insurance. The program would cost the state government and employers more than $5 billion annually. Under the plan, all state residents, including undocumented immigrants and college students, would be required to obtain health insurance or face penalties.

A state agency would be established to manage the program. State legislators will meet next year to discuss the proposal.

Read story in at ChicagoTribune.com, A new plan to insure all - Proposal would require Illinoisans to get health coverage

Based on a mix of factors, including personal health (such as exercise and obesity), clinical care, health insurance coverage, and health care policies the nonprofit United Health Foundation in partnership with the American Public Health Association and the Partnership for Prevention published a new "healthiest state" ranking.

The healthiest are:

Minnesota

Vermont

New Hampshire

Hawaii

Connecticut

Minnesota has topped the annual list 11 times since 1990. Minnesota's strengths include a low rate of heart disease deaths, a low premature death rate, and a low percentage of people without health insurance.

At the bottom of the list:

Arkansas

Tennessee

South Carolina

Mississippi

Louisiana

SOURCES: United Health Foundation: "America's Health Rankings: A Call to Action for People and Their Communities," 2006 edition. News release, United Health Foundation.

Probably the best hope for moving health care reform forward lies at the state level rather than the federal. In fact, individual states have taken the lead in health care reform so far. But, there's no way this is going to get done without federal resources - state ingenuity and federal resources.

Federal lawmakers have introduced three bills that would would encourage states to propose health care reform plans, which would be reviewed by a commission or task force that would recommend the best ideas for fast-track approval by Congress.

Comments?

All Maryland residents would be required to purchase health insurance under a draft plan outlined by the Maryland Health Care Commission. If enacted, the plan would make Maryland the second state after Massachusetts to require residents to obtain health insurance. The Residents could choose among different plans offered by insurers. Workers would keep the same coverage when switching employment. Employers would pay the majority of the costs, and each employer would be responsible for determining their contribution amount. The state would provide subsidies for low-income workers, according to the draft plan. The plan would not apply to large employers, though the size requirement has not been determined. Other details yet to be worked out -- the cost of subsidies, eligibility requirements and the penalties for those who do not purchase insurance.

The plan would not impose an employer mandate, but individual responsibility would put greater pressure on employers to contribute to health insurance coverage, according to commission Executive Director Rex Cowdry. Commission Chair Stephen Salamon said the draft plan is "a work in progress," but commission officials hope consultant studies and economic models will provide more details for the commission to propose a plan to the state Legislature in January 2007. Meanwhile, the Maryland Citizens' Health Initiative and MedChi, the state medical society, are promoting a plan that would increase cigarette taxes by one dollar per pack to generate an estimated $200 million annually. Those funds would be used to expand Medicaid coverage to more low-income adults and to subsidize small businesses that cannot afford coverage
(Salganik, Baltimore Sun, 11/17).

Democratic lawmakers are likely to provide new momentum for the generic drug agenda. They are expected to propose to increase restrictions on "authorized generic" medications. After medications lose patent protection, brand-name pharmaceutical companies in some cases continue to market the medications at full price and also allow generic pharmaceutical companies to market authorized generic versions of the treatments in exchange for a share of the revenue. Opponents maintain that authorized generic medications reduce market competition and lead to higher prices for consumers.

A proposal to increase restrictions on authorized generic medications, which might lead to lower drug costs and doesn't involve government-imposed price controls or the controversies surrounding imported medicines, likely would resonate with many lawmakers.

(Wilde Mathews, Wall Street Journal, 11/21)

Some estimates of the total cost of healthcare for illegal immigrants in the United States have exceeded $50 billion annually. Such numbers have been used in the debate over illegal immigration. According to a study released by the Rand Corp. and published in the November/December edition of the journal Health Affairs, the nationwide cost of healthcare for illegal immigrants between the ages of 18 and 64 at $1.1 billion in 2000 — or about $11 per household. The Rand figures do not include costs for children and the elderly. Also, the data were collected in 2000, and the number of illegal immigrant has swelled in the five years since then, and so have healthcare costs.

However, in the midst of the current debate over illegal immigration, it is helpful to have some authorative date to use in the discussion. Let's say they are wrong and have understated these costs by $1 billion — which is a lot — I'd still say that these are relatively small aggregate costs for the nation.

See story in Los Angeles Times, Illegal immigrants' healthcare bill is tallied

Florida's Medically Needy Program covers the cost of medical services for residents whose incomes are too high to qualify for Medicaid but whose medical expenses represent a substantial share of their incomes. This year Medicare assumed responsibility for prescription drug coverage for individuals in the medically needy program, as a result, most will no longer qualify as medically needy - a real Catch 22.

See story in South Florida Sun-Sentinal, 'Catch-22' in U.S. rules could be costly for thousands with chronic illnesses

A new accounting rule requires State and local governments to calculate the total value of the health benefits they have promised to retirees. The rule, imposed by the Governmental Accounting Standards Board, goes into effect in July 2007 and will require public agencies to report the current and future costs of health care and other benefits -- such as dental, vision and life insurance -- for the nation's estimated 24.5 million public employees. Under the rules, public agencies must pay their liabilities over a 30-year period. If state officials choose not to earmark funds to cover the payments each year, the liabilities will count against the state's net assets.

Little, if any, money has been set aside to fulfill these obligations - about $1.4 trillion in retiree health benefits. Some local governments will find that their tax bases have eroded too much to fully fund the health benefits they have promised.

See New York Times Story, Once Safe, Public Pensions Are Now Facing Cuts

Healthcare would seem to be a big issue in California, where more than 6 million residents are uninsured, urban emergency rooms teeter on the brink of closure and rising costs are pinching the state budget as well as taxpayers. It is not, however, much of an issue in the gubernatorial campaign. One reason is voters themselves. In a recent poll, just 4% of those likely to cast ballots ranked healthcare as their No. 1 concern in the governor's race. Most voters have insurance and are generally satisfied with the kind of healthcare coverage that they're getting personally.
Schwarzenegger, with a wide lead in the polls, has not seen the need to wrestle with the complexities of the issue, or its many controversies, on the campaign trail. He has made some strides in healthcare. In August, he supported legislation allowing the state to fine hospitals for lapses that cause serious injury or death. His budget this year included about $250 million to prepare for such disasters as a pandemic flu or bioterrorist events. And he reached a deal with Democrats to lower drug prices for more than 5 million Californians and acceded to their demands to allow sanctions against noncompliant drug companies.

The governor believes that the biggest problem facing Californians is affordability and the rising costs of healthcare. That makes sense. According to Peter Lee, chief executive of the Pacific Business Group on Health. "It's really been recently that we've seen the governor embrace the need to try to tackle head-on the full range of cost, quality and access problems in healthcare."

See full Los Angeles Times story, As a campaign issue, healthcare is comatose

A USA Today/Gallup poll, published in USA Today reports that 60% of U.S. adults believe Democrats would work to provide health insurance to the uninsured if they take control of Congress after the midterm elections. According to the poll, 52% of respondents believe Democrats would allow the purchase of prescription medications from abroad and 72% would approve of such a move. In addition, 79% of respondents would approve of efforts to expand health insurance to the uninsured.

In related news, CongressDaily (Lee, CongressDaily, 10/25) reported that Democrats' "first priority ... in their effort" to reduce the number of uninsured residents would be to address funding shortfalls in SCHIP, which is slated for reauthorization next year. Democrats "hope to expand eligibility and increase the number of low and moderate-income children enrolled in the program." In addition, Democrats will look to "correct what [they] consider flaws" in the Medicare prescription drug benefit. A Democratic Congress would address health care information technology legislation that would authorize greater federal funding to help physicians and hospitals purchase new technology.

A majority of Americans would prefer universal health care to the current U.S. health care system, but only if nothing else changes. In other words, they want all medical treatments covered, unlimited choice of doctors without paying increased taxes or health insurance premiums. Yea. And I want to be 21 again.

Fifty-six percent of adults said they would prefer a universal health care system to the current U.S. health care system, according to the ABC News/Kaiser Family Foundation/USA Today survey. However, the survey found that 76% of adults said they would oppose universal coverage if some medical treatments would no longer be covered. However, the survey found that support drops to 18% if some medical treatments would no longer be covered, 28% if universal coverage limits their choice of doctors and 35% if it meant they would pay higher taxes or health insurance premiums (Appleby [2], USA Today, 10/16).

Thousands of Washington residents who qualify for Medicaid - federal healthcare for the poor - even though they are employed by large companies are being offered a way to participate in their employer group health plan. Medicaid officials use benefit applications to identify beneficiaries working at large companies that likely offer health insurance to workers. When employee premiums are less expensive than Medicaid's costs, the state contacts the individual and offers to reimburse him or her share of the employer premium.

Medicaid officials estimate health plans could enroll 5,000 residents and reduce state costs by $3 million annually within two years. So far, about 520 families totaling 1,300 individuals have switched from Medicaid to employer-sponsored plans. The state spends an average of $173 per month for each Medicaid beneficiary, but it pays about $76 per month in premiums for those who enroll in employer-sponsored coverage. The state also spends an additional $16 per month for any services not covered by some employer plans, such as vision and dental.

See Seattle Times Story - State saves by picking up health-care tab

Under a new law (AB 2911), pharmaceutical companies must begin offering discounts to uninsured state residents whose annual incomes do not exceed 300% of the federal poverty level and people with catastrophic medical costs within three years or face restrictions on selling their products to Medi-Cal, California's Medicaid program. The program will provide average discounts of 40% on brand-name drugs and 60% on generic medications.

Medicare prescription drug plan beneficiaries who reach the so-called "doughnut hole" coverage gap also will be eligible for the program. Medicare beneficiaries are responsible for 100% of annual prescription drug costs between $2,250 and $5,100. Medicare covers 95% of annual prescription drug costs that exceed $5,100.

See Los Angeles Times story

Craig Barrett, chairman of Intel, said that U.S. companies should force the health care industry to adopt a more cost-effective system in order to sustain current employment levels. "Every job that can be moved out of the United States will be moved out ... because of health care costs," Barrett said.

Barrett said that companies should do business only with health care providers that meet certain standards, such as fully electronic health records and the use of "best practice" standards of care. Barrett said health care networks should be "competitive centers for excellence" that solicit business by offering the highest quality care at the lowest price.

Barrett noted that health care costs averaged more than $6,000 per person for employers in 2004, adding that increasing health care costs are making it more difficult for U.S. companies to compete abroad.

Read full story in Omaha World Herald

Controlling the cost of healthcare is seldom black and white. How much should we be willing to pay to briefly extend the lives of a few very sick people? For instance, the FDA just approved a mechanical heart for patients who have only a month to live, suffer from failure of both chambers of the lower heart, and aren't eligible for a heart transplant.. The AbioCor system consists of a 2-pound mechanical heart implanted in the chest. The patient's diseased heart is removed during implantation. A power transfer coil across the skin that powers the system and recharges the internal battery from the outside. A controller and battery implanted in the belly. The controller adjusts the artificial heart's pumping rate. The internal battery allows the patient to be free from all external connections for up to 1 hour. During sleep and while batteries are being recharged, the system can be plugged into a normal electrical outlet.

In clinical trials, the device extended patients' lives by only four and a half months, on average. One patient survived 17 months, another 10 months. Only one patient was able to go home. "It is important to recognize that right now the device is a niche device targeted to an extremely sick heart failure population," Bram Zuckerman, MD, director of the FDA's heart device division says. "The vast majority of these patients are bed bound, extremely short of breath, and hooked up to multiple intravenous medications. Just the ability to ambulate, to clearly communicate with loved ones, to take excursions out of the hospital, and to celebrate important family events, were -- in the eyes of the patients and family members -- seen to be an improvement."

I suppose the main reason for going to these great lengths for very little incremental benefit is that these highly restricted applications will give Abiomed, the manufacturer of the device (and its competitors), the experience they need to build smaller, smarter, more elegant artificial hearts for a wider audience at lower cost.

How do you feel about it? Do you think we should continue a long this path?

A big push is on to convert medical records from paper and film to digital records. (See New York Times article, "Smart Care Via a Mouse, but What Will It Cost?" The obvious benefit for us as consumers of healthcare is based on instant access to our medical records by doctors who may be faced with saving our lives, perhaps away from home. The obvious concern is about privacy and security.

What the enthusiasm is really about: not computers and software, but health information in the form of electronic records, stripped of personal identifiers, that can be easily shared, searched, measured and analyzed to determine what treatments and drugs are most effective, and at what cost.

Michael O. Leavitt, the Secretary of Health and Human Services, recently said the rollout of electronic health records was “the most important thing happening in health care.”