The US House of Representatives has passed a bill requiring group health plans to provide coverage for mental illnesses that is more comparable to that for physical illnesses. The Paul Wellstone Mental Health and Addiction Equity Act, HR 1424, which was passed March 5 by a vote of 268 to 148, extends the parity in annual and lifetime dollar limits for mental healthcare provided by the Mental Health Parity Act of 1996 to include parity in cost-sharing requirements such as copays and deductibles and treatment limitations such as day and visit limits. The House bill mandates that if a health plan offers coverage for mental health or substance abuse disorders, it must offer coverage for all disorders listed in the Diagnostic and Statistical Manual of Mental Disorders. The Senate bill requires only that plans comply with existing state and federal standards. Both bills exempt employers and group health plan sponsors with 50 or fewer workers and have cost-increase exemptions that would waive the parity agreement for 1 year for plans in which premiums would rise more than 2% as a result of complying with the bill.

MENTAL HEALTH PARITY BILL PASSES HOUSE, BUT DIFFERS FROM SENATE BILL Susan Jeffrey March 7, 2008 Medscape Medical News 2008.

Tiny amounts of pharmaceuticals -- including antibiotics, hormones, mood stabilizers, and other drugs -- are in our drinking water supplies. Drinking water supplies in 24 major metropolitan areas were found to include drugs. The drugs get into the drinking water supply through several routes: some people flush unneeded medication down toilets; other medicine gets into the water supply after people take medication, absorb some, and pass the rest out in urine or feces. Some pharmaceuticals remain even after wastewater treatments and cleansing by water treatment plants. Although levels are low -- reportedly measured in parts per billion or trillion -- and utility companies contend the water is safe, experts from private organizations and the government say they can't say for sure whether the levels of drugs in drinking water are low enough to discount harmful health effects. "Ever since the late 1990s, the science community has recognized that pharmaceuticals, especially oral contraceptives, are found in sewage water and are potentially contaminating drinking water," Janssen said. Concern among scientists increased when fish in the Potomac River and elsewhere were found to have both male and female characteristics when exposed to estrogen-like substances, characteristics like both testes and an ovary. We don't have evidence of a health effect,but especially when it comes to pharmaceuticals that are synthetic hormones, there is concern, because hormones work at very low concentrations in the human body."

LOW LEVELS OF DRUGS FOUND IN DRINKING WATER March 11, 2008 by Kathleen Doheny WebMD Health News 2008. © 2008 WebMD Inc.

I recently corresponded with Sam Solomon, an editor for the Web site Canadian Medicine. I asked this dual citizen (he grew up in the USA) about the differences he perceives in our 2 countries' systems and about how his site helps to communicate the details of Canadian healthcare. Dr. Genes: If you had a choice, where would you go if you felt sick or needed a procedure? Sam Solomon: I'm in a pretty good position to answer this question; I'm a dual US-Canadian citizen, and I've lived in and around both Boston and Montreal. Even though the American system might be better for one individual, it's hard to argue that it's better for society at large. The Canadian system is seen here as a sort of national treasure, and for good reason: It provides more equitable access to healthcare than the American system, and that alone fosters a more equitable society, I think. Of course, if one is a fan of President Bush's tax policies of the past 7 years and equity is not your goal, then I suppose the American system would seem more attractive.

AMERICAN VS CANADIAN HEALTHCARE: HOW DO THEY RATE? Nicholas Genes, MD, PhD Medscape Med Students. 2008; ©2008 Medscape

Merck & Co said more than 93 % of the 47,000 people who allege the arthritis drug Vioxx caused their heart attack or stroke have submitted claims in the company's settlement offer. Merck withdrew arthritis pill Vioxx from the market in 2004 after research found it doubled heart attack and stroke risk [suit alleges company knew facts for much longer, of course]. Its settlement agreement with people alleging injury from the drug calls for the company to meet an 85 % threshold for receiving enrollment documents in various claims categories. Another 5,500 eligible heart attack and stroke claimants alleging death have initiated enrollment, and more than 26,500 eligible heart attack and stroke claimants alleging more than 12 months of use have initiated enrollment in the suit.

MERCK SAYS THOUSANDS FILE FOR VIOXX PAYMENTS Susan Kelly Mar 03 Reuters Health Information 2008

Overall, 14% of participants reported cost-related medication underuse, but 23% of Latino participants and 17% of black participants reported underuse compared with 13% of white participants. However, after multivariable adjustment, only Latino participants had more medication underuse than white participants (14% vs 10%). Health disparities among racial/ethnic minorities, including greater prevalence of diabetes and its complications and poorer control of risk factors, have been widely reported. Poorer medication adherence has been equivocally associated with race/ethnicity but clearly associated with socioeconomic factors, especially income. The current study examined ethnicity in a large population-based sample. In any case, these results suggest that in the US health system, it is not sufficient to merely prescribe the right drugs for chronic conditions. Good quality care requires the clinician to understand the patient's economic capacity to use the drugs as prescribed.

COST-RELATED MEDICATION UNDERUSE IN DIABETES PATIENTS Tseng CW, Tierney EF, Gerzoff RB, et al Diabetes Care. 2008;31:261-266

DirecTV has substantially improved productivity among its employees through an aggressive commitment to workplace health, according to findings from a 3-year pilot program presented here at Prevention Medicine 2008, the annual conference of the American College of Preventive Medicine. Matria Healthcare Inc initiated the program with research support from the Centers for Disease Control and Prevention in collaboration with DirecTV and academic investigators at Harvard University, Cambridge, Massachusetts, and Cornell University. The full cost of poor employee health to a company is like an iceberg, he said. Industry has focused on the most visible part of the equation -medical pharmacy costs- but the larger danger lurks below the waterline: "For every $1 of medical pharmacy costs that the employer pays out, they are paying around $3 for health-related productivity losses." Monetary payments to patients can be one tool used to leverage behavior. The payments were little or no net cost to the company when productivity gains were considered in the equation, but they were significant to the employees. He cautioned against thinking that a lesson from one setting would be applicable to all settings.

WORKPLACE HEALTH PROGRAM IS COST-EFFECTIVE, IMPROVES PRODUCTIVITY Bob Roehr February 22, Prevention Medicine 2008: Session 12. Presented February 21, 2008.

South Africa's health minister signalled that the government planned to further regulate the private health care sector, saying it was profit-driven and not accessible to the poor majority. Efforts to make health care more affordable and accessible were moving too slowly. Fourteen years after democratic elections in 1994, South Africa's health care system remains skewed between the haves and have-nots, with an under-staffed and under-resourced public sector system in marked contrast to the care given at private hospitals. Membership of the 133 private medical schemes operating in the country is growing but is available mostly for middle- and high-income earners, and remains unaffordable for the vast majority of the country's poor. [South Africa had been the only other industrialized not to have some universal health care for all residents, since 2004 the USA has stood alone with that distinction.]

SOUTH AFRICA TO REFORM PRIVATE HEALTH CARE Feb 26 Reuters Health Information 2008 by Wendell Roelf

US health-care spending will devour an expanding share of the US economy during the next decade, almost doubling to about $4.3 trillion in 2017, government officials forecast. Economists at the US government's Centers for Medicare and Medicaid Services, known as CMS, forecast that health-care spending will account for 19.5% of the US gross domestic product by 2017, up from 16.3% in 2007. The projections come as runaway health-care spending and lack of medical coverage for millions of Americans have emerged as central issues in this year's US presidential campaign. An estimated 47 million people in a country of 300 million have no health insurance, either private or through the government. [Actually that's counting only those uninsured continually Jan 1 - Dec 31, not in other 12 month periods or even longer than 12 months in periods spanning two years.] Medicare spending by 2017 is expected to reach $884 billion -- more than a fifth of all national health-care spending. This compares to $427 billion in 2007.

US HEALTH CARE SPENDING SURGE SEEN IN NEXT DECADE By Will Dunham Feb 26 Reuters Health Information 2008

The US Congress needs to place a moratorium on implementing proposed Medicaid regulations that will increase costs for states that are already grappling with rising health-care costs, Arizona Gov. Napolitano. The Bush administration's pending regulations would shift to states an estimated $13 billion in costs for Medicaid, the health program for the poor that is jointly administered by states and the federal government, meanwhile state revenues are declining from the US economic downturn.

ARIZONA GOVERNOR SEEKS BAN ON NEW MEDICAID RULES Feb 26 Reuters Health Information 2008

Private Medicare plans often cost beneficiaries more than the traditional government-run Medicare program, Congressional investigators say. Many private plans advertise extra benefits and low costs. But in a recent report the GAO, an investigative arm of Congress, says that many people in private plans face higher costs for home health care, nursing homes and some hospital stays after joining "Medicare Advantage". About one-fifth of the 44 million Medicare beneficiaries -9 million people - are in private plans. Medicare spends more per beneficiary in Medicare Advantage than it does for beneficiaries in the original Medicare fee-for-service program, at an estimated additional cost to Medicare of $54 billion from 2009 through 2012, despite the fact that people are paying in extra premiums to join the so-called "supplemental insurance program" Bush administration officials and insurance executives say the private plans provide a bargain. Last year, the GAO found 19 % of Medicare Advantage beneficiaries were in plans that projected higher cost-sharing for home health services, and 16 % of beneficiaries were in plans that projected higher cost-sharing for inpatient services. GAO suggested that if the policy objective is to subsidize health care costs of low-income Medicare beneficiaries, it may be more efficient to directly target subsidies to a defined low-income population than to subsidize premiums and cost-sharing for all Medicare Advantage beneficiaries, including those who are well off.

PRIVATE MEDICARE PLANS? COST QUESTIONED NYTimes By ROBERT PEAR Feb 28, 2008

A furor has been growing over retroactive policy cancellations that have saddled some patients with big medical bills and sparked lawsuits. Critics say that the practice of unfair policy rescissions suggests that private health insurers aren't up to the task of ensuring that sick people maintain coverage.

HEALTH INSURERS ADDRESS ISSUE OF NIXED POLICIES, The Wall Street Journal February 27, 2008 By Rhonda Rundle

US health-care spending will devour an expanding share of the US economy during the next decade, almost doubling to about $4.3 trillion in 2017, government officials forecast. Economists at the government's Centers for Medicare and Medicaid Services, known as CMS, forecast that health-care spending will account for 19.5 % of the US gross domestic product by 2017, up from 16.3 % in 2007. The report pegged US health-care spending in 2007 at $2.2 trillion, and forecast that this spending would grow annually by about 6.7 % through 2017. That would far outpace GDP growth, expected to rise by 4.7 % annually, and inflation, expected to rise 2.4 % annually.

HEALTH CARE SPENDING SURGE SEEN IN NEXT DECADE By Will Dunham Feb 26, Reuters

The New York attorney general said his office plans to sue UnitedHealth Group Inc. as part of a broader investigation into the way the health-insurance industry sets payment rates for hospitals and doctors outside of their networks. The move takes aim at a common practice among health insurers that can result in higher medical-bill payments for many consumers. Out-of-network providers are reimbursed "usual and customary" or "reasonable" charges. These charges are set according to what insurers have determined is the going rate for a given procedure or service in a specific area. When the usual and customary payment is much lower than what the provider charged, patients are often billed for the difference. Doctors and hospitals have long complained that the methodology is opaque and sets reimbursement artificially low. "Real people get stuck with excessive bills and are less likely to seek the care they need," Mr. Cuomo said.

The Wall Street Journal February 14, 2008 PROBE TARGETS HEALTH INSURERS ON PAYMENTS By Vanessa Fuhrmans and Theo Francis

CA's largest for-profit health insurer is asking physicians to look for conditions it can use to cancel their new patients' medical coverage. Blue Cross CA is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history," including "pre-existing pregnancies." "Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately," the letters say. The Times obtained a copy of a letter that was aimed at physicians in large medical groups. "We're outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality," said Dr. Richard Frankenstein, president of the California Medical Assn.

Los Angeles Times February 12, 2008 DOCTORS BALK AT REQUEST FOR DATA By Lisa Girion

BCBS-FL wants you to buy health insurance the way you might buy a cell phone. They opened the first insurance store in South Florida. Situated in the new Pembroke Lakes Square shopping center in Pembroke Pines, the store allows most consumers to walk in and buy health coverage and dental and life insurance in one visit or have questions about policies answered. Unlike most insurance offices, Florida Blue features wi-fi access, a flat-screen TV and a PlayStation for kids. The store has computer stations where customers can look up insurance information with help from an agent. This weekend, Florida Blue will host a grand opening with free health screenings, chair massages and giveaways.

South Florida Sun-Sentinel February 7, 2008 BLUE CROSS AND BLUE SHIELD OPENS STORE IN PEMBROKE PINES By Jaclyn Giovis

CA Gov. Schwarzenegger's "universal" health-care plan was shot down by a committee in the state's Senate, 7-1. The most vociferous opponents were not fiscal conservatives, but labor unions that launched a last-minute revolt against its most crucial feature: an individual mandate that would have forced everyone to buy coverage. This defeat has national political implications. Hillary Clinton, for example, has denounced Barack Obama for refusing to include an individual mandate in his health-care plan. Yet many California unions argued that a mandate would force uninsured, middle-income working families to divert money from more pressing needs toward coverage whose price and quality they cannot control. In MA mandate plan if a family of four makes $60,000 annually than they have to buy their own health insurance without subsidy.

Wall Street Journal SAYING NO TO COERCIVECARE By SHIKHA DALMIA January 31, 2008

After four decades of promising Sonoma County CA public employees generous health benefits upon retirement, the county now is warning thousands of current employees and retirees they face precedent- setting reductions. The administration also proposes to dramatically alter health benefits for new hires by, in the future, not funding anything upon retirement. The shift in thinking about the way governments view obligations to pay future retirement benefits comes about because the private, independent Governmental Accounting Standards Board in July 2004 ruled public agencies from states to city governments to school districts needed to assess the value of their promises and explain how they plan to pay for them.

The Press Democrat of February 5, 2008 RETIRED PUBLIC EMPLOYEES MAY FACE HIGHER HEALTH CARE COSTS, FEWER BENEFITS UNDER PROPOSAL BY CASH-STRAPPED SONOMA COUNTY By Bleys W. Rose

Web MD reported Poll results on how well Americans understand "socialized medicine" but misunderstand the term themselves and propagate myth that Single-Payer health care is "socialized medicine". By putting single-payer together with government-run the authors demonstrate they have no appreciation for the two independent concepts. Single Payer is, in fact, a system where all costs are paid directly by the government but practices, clinics and hospitals are not necessarily government run. Nonetheless they report a poll in which people were asked how well they understood the term "socialized medicine." About two-thirds -- 67% -- said they understand the term "very well" or "somewhat well." Thirty percent said they don't understand the term very well or at all. The rest said they didn't know or didn't answer that question.

US Split on Socialized Medicine Miranda Hitti from WebMD February 15, 2008 WebMD Health News 2008

Insurer Coventry Health Care Inc posted an 18% rise in fourth-quarter profit, matching estimates, as premium revenue and membership increased. Fourth-quarter net earnings rose to $184.3 million, or $1.18 per share, compared with $156.1 million a year earlier. The Bethesda, Maryland-based company reported 283,000 members in its [very profitable] full-service Medicare Advantage plans, up by roughly 200,000 over a year ago. Excluding acquisitions, the percent of premium revenue spent on medical costs for its commercial plans for employers improved slightly to 77.3 % from 77.4% a year ago.

Coventry Health Profit up 18 Pct, Meets Street View Feb 08 Reuters Health Information 2008

New York Attorney General Andrew Cuomo is conducting an industry-wide probe of health insurers into an alleged scheme to defraud consumers by manipulating reimbursement rates. At the center of the scheme is Ingenix, the nation's provider of health care billing information, which serves as a conduit for rate data to the largest insurers in the country, Cuomo said in a statement. Cuomo intends to sue Ingenix, its parent, UnitedHealth Group Inc, and three additional subsidiaries. Cuomo has issued 16 subpoenas to the nation's largest health insurance companies, including Aetna Inc, Cigna Corp and Empire Blue Cross Blue Shield.

NY Attorney General Probes Health Insurers Over Reimbursement Feb 13 Reuters Health Information 2008

Insurer Health Net Inc posted a 46 % rise in quarterly profit, helped by its Medicare plans for older Americans. Net income rose to $123.4 million, or $1.10 per share, from $84.8 million, or 72 cents per share, a year earlier.

Health Net Profit Rises, but Forecast Is Weak Feb 05 Lewis Krauskopf Reuters Health Information 2008

Health experts denounced GW Bush's 2009 federal budget request, calling it a disaster for the health of Americans and saying they would look to Congress to change it. Bush's $3.1 trillion spending plan proposes a 7 % cut in funds for the Centers for Disease Control and Prevention as well as less money for Medicare and Medicaid -- the joint federal-state health insurance programs for the poor and elderly. The National Institutes of Health and the Food and Drug Administration would receive more funds, but critics said the increases were too small to counteract rising costs. "At a time when healthcare costs are skyrocketing, we should be investing more to keep Americans healthy instead of cutting funds for disease prevention," added Jeff Levi, executive director of Trust for America's Health. "At a time when physicians are in short supply, this budget calls for cuts to teaching hospitals that prepare tomorrow's physicians. At a time when our economy is faltering, this budget cuts hospitals serving some of America's poorest patients".

Bush Budget Disastrous for Health Care, Groups Say By Maggie Fox Feb 05 Reuters Health Information 2008

The lack of access to primary care services and insurance for black Americans contribute to that population disproportionately seeking care at emergency departments (EDs), said John E. Clark. The Centers for Disease Control and Prevention (CDC) recently reported that black Americans had higher rates of visits to EDs than did whites in 2005, the year for which the most recent data is available. Americans with no insurance that year had about twice the ED visit rate of those with private insurance. The use of the ED by high numbers of black patients, Clark said, may be related to a number of complex issues-including a lack of insurance and immediate access to their primary care provider, low or no income, and having a number of unmet health needs-that could lead to an overall decline in health. For instance, he said, if a patient does not have prescription drug coverage, the person is less likely to be compliant with the prescribed medication regimen, which may result in the person's condition declining, leading to an emergency care visit.

Lack of Primary Care, Insurance Lead to Urgent Conditions 02/04/2008 Donna Young 31 July 2007 American Society of Health-System Pharmacists

A mentally ill paraplegic man filed a lawsuit against a hospital that dumped him in a gutter on Los Angeles' "Skid Row" -- a case that highlighted the plight of the city's vast homeless population. Gabino Olvera, 42, sued the Hollywood Presbyterian Medical Center for negligence and elder abuse after it discharged him in February 2007, took him across town in a van and left him in a soiled hospital gown without a wheelchair in the heart of the city's homeless area. Witnesses who came to Olvera's aid said they saw him dragging himself on the ground with hospital papers and documents clenched in his teeth while the driver sat in her van and applied makeup before driving off. The incident was captured by security cameras at a nearby homeless shelter. The Olvera case was one of about 50 reported incidents in the past 12 months of sick, confused and homeless patients being left by ambulances in the 50-block area of downtown Los Angeles thought to have the highest concentration of homeless people in the USA. Estimates of the number of homeless in the USA ranges from 500,000 to more than a million.

Paraplegic Man Dumped in LA Gutter Sues Hospital By Jill Serjeant Jan 18 Reuters Health Information 2008

A US health insurance giant presented a proposal to reduce the number of Americans without medical coverage and said it was intended as a blueprint for US policymakers. The Blue Cross and Blue Shield Association, whose 39 regional companies insure about 100 million Americans, unveiled a plan which would combine tax credits to encourage people to buy coverage with ideas to improve the quality of health care. The proposal would extend coverage to 30 to 35 million of the 47 million people who are uninsured in the country of about 300 million people, Serota said. Blue Cross did not name specific levels for its proposed tax credits but said they would go to low-wage workers in small businesses, people whose health premiums represent a large share of their income, people without access to employer coverage and those who have lost a job enabling them to buy private insurance (mostly from BCBS). BCBS said the tax credits envisioned would cost the US government $50 to $100 billion per year, but the overall proposal also would yield other savings as uninsured people get coverage and cut down, for example, on hospital emergency room costs.

Blue Cross Proposes Fix for Uninsured Americans By Will Dunham Jan 23 Reuters Health Information 2008

Vaccines and drugs will not be enough to slow or prevent a pandemic of influenza, according to a US government report. The pharmaceutical industry cannot be relied on alone to protect the world from bird flu. "The use of antivirals and vaccines to forestall the onset of a pandemic would likely be constrained by their uncertain effectiveness and limited availability," the GAO report reads. Many countries have no way to even keep track of outbreaks, meaning the virus could spread unnoticed. "The delayed use of antivirals and the emergence of antiviral resistance in influenza strains could limit their effectiveness," the GAO report said.

Don't Rely on Drugs to Delay Flu Pandemic: US Gov't Jan 23R euters Health Information 2008

The US House of Representatives failed to override GW Bush's second veto of bill to expand a popular federal children's health program. On a vote of 260-152, the Democratic-led House fell short of the needed two-thirds majority to override Bush on a measure certain to be an issue along with the slowing economy in this year's congressional and presidential elections. Pushed by Democrats but also supported by many Republicans, the bill was aimed at providing health insurance to about 10 million children in low- and moderate-income families. Taxes on cigarettes and other tobacco products would have been increased to pay for the additional coverage. The program is designed to help families unable to afford private health insurance, but who earn too much to qualify for the Medicaid health care program for the poor.

US House Sustains Bush Veto of Health Bill Jan 23 Reuters Health Information 2008

A citizen initiative to amend Massachusetts' state constitution and establish health care as a recognized legal right, a five year effort, was killed by illegal actions on the part of the Massachusetts legislature (the illegality is clear in the opinion issued by the state supreme court). The proposed amendment language also sought to establish health reform standards by which the public could hold policymakers and legislators accountable for their actions. How ironic, then, that the obstructionist tactics intended to stymie the proposed amendment were led by Senator Richard Moore, (D-Uxbridge), Chair, Health Care Finance Committee. Dr. John Goodson, co-chair of the campaign said "Change must come. We need to proudly recall that our efforts were correct and justified." While Anne Eldridge-Malone maintains "a fervent hope that as a community of health care justice advocates we will find a way to build on this courageous effort and to amplify our unswerving commitment to the creation of an ethical and humane health care system."

Letter from Alliance to Defend Health Care

Veterans have no legal right to specific types of medical care, the Bush administration argues in a lawsuit accusing the government of illegally denying mental health treatment to some troops returning from Iraq and Afghanistan. Congress, they claim, left decisions about who should get health care, and what type of care, to the VA and not to veterans or the courts. A federal law providing five years of care for veterans from the date of their discharge establishes "veterans' eligibility for health care, but it does not create an entitlement to any particular medical service" Bush Admin lawyers said. [It's fine though that Vets have been maimed or died to get the Right to Health Care written into the new Iraqi Constitution though.]

VETERANS NOT ENTITLED TO MENTAL HEALTH CARE, US LAWYERS ARGUE Bob Egelko, February 5, 2008 San Francisco Chronicle

The Bush administration would cut roughly $560 billion from Medicare over the next decade but would leave intact program subsidies to insurers worth an estimated $150 billion over the same period. The White House has fought congressional efforts to cut subsidized payments to insurers in the past. And now argues that the payments allow insurers to offer beneficiaries greater choices and higher-quality health care.

Budget Proposes $560 Billion Cut In Medicare; Insurance Subsidy Intact By JOHN GODFREY February 4, 2008

Educators nationwide are protesting a Bush administration move to curtail hundreds of millions of dollars in Medicaid funding for disabled students that could force some schools already in budget straits to trim health services or cut back instructional programs. The shift in federal reimbursement policy threatens to strip about $635 million from schools in the next academic year and $3.6 billion over five years. The rule, to take effect in June 08 will bar schools from billing Medicaid for busing special education students to and from school and for certain administrative expenses, including enrolling children in Medicaid and coordinating and scheduling services.

Area Schools Set To Lose Millions Under Medicaid Policy Changes By Maria Glod Washington Post February 3, 2008

Gov. Arnold Schwarzenegger's audacious plan to arrange medical insurance for nearly all Californians was rejected in late January by the state Senate, obliterating the chance of anything but piecemeal healthcare changes this year. Lawmakers called the plan "fundamentally flawed" and "a fairy tale". Senators said the proposal, while laudable in its ambitions, might fall apart financially in a few years, leaving the state to cancel its new healthcare services or put taxpayers on the hook for billions of dollars more. The defeat may be a poor omen for national efforts as the three leading Democratic presidential candidates -- Hillary Clinton, Barack Obama and John Edwards -- all have proposed similar programs.

Los Angeles Times January 29, 2008 Panel kills Schwarzenegger's health plan By Jordan Rau

California regulators are seeking as much as $1.33 billion in penalties from PacifiCare. In an investigation prompted by widespread complaints, the state Department of Insurance uncovered 133,000 alleged violations of state laws and regulations regarding payments for medical care. Each violation carries a maximum penalty of $10,000 for a possible total of $1.33 billion. Also 30% of the medical claims the state reviewed were improperly denied. That agency is seeking an additional $3.5 million in fines.

Los Angeles Times January 29, 2008 Health plan faces fines of $1.33 billion By Lisa Girion

As health care generates debate in this year's presidential campaign, about 68 % of Americans say individuals should be required to have medical insurance, with government help for those who cannot afford it. According to the survey health insurance mandates were supported by 80 % of Democrats, 52 % of Republicans and 68 % of Independents. The group said that while both leading Democratic and Republican candidates want to expand health coverage through the private insurance market, there were several key differences: None of the Republican candidates would require that people have health insurance. On the Democratic side, Sen. Hillary Clinton and former Sen. John Edwards would require that all Americans eventually have coverage. Sen. Barack Obama would require that children have coverage. Leading Democratic candidates would require employers to continue participating in the health insurance system either by providing coverage directly or contributing to the cost of their employees' coverage, while Republicans largely support changes in the tax code that could cut the role of employers in providing health insurance. In some ways, the Republican proposals seek bigger changes to the way most people currently obtain coverage. Most of their plans propose a diminishing role for employers, whereas the leading Democrats favor keeping employers in the game.

MOST IN US BACK MANDATORY HEALTH COVERAGE Carey Gillam Reuters Health Information 200 Jan 15

Shares of WellCare Health Plans Inc soared more than 20 % after enrollment and contract developments with its Medicare plans encouraged investors. The insurer's shares remain off about 50 % from October, when federal agents raided the company's Tampa, Florida headquarters. Monthly enrollment data showed that WellCare increased its Medicare Advantage rolls by about 11,000 to 169,000 members.

WELLCARE SHARES RISE ON ENCOURAGING MEDICARE DATA Lewis Krauskopf Reuters Health Information 2008 Jan 15

Patients seeking urgent care in US emergency rooms are waiting longer than in the 1990s, US researchers reported. They found a quarter of MI patients waited 50 minutes or more before seeing a doctor in 2004. Waits for all types of emergency department visits became 36% longer between 1997 and 2004, the team at Harvard Medical School reported. Especially unsettling, people who had seen a triage nurse and been designated as needing immediate attention waited 40% longer -- from an average of 10 minutes in 1997 to an average 14 minutes in 2004, the researchers report in the journal Health Affairs. Heart attack patients waited eight minutes in 1997 but 20 minutes in 2004, Dr. Andrew Wilper and colleagues found. Harvard's Dr. David Himmelstein, who worked on the study, mentions "One contributor to ED crowding is Americans' poor access to primary and preventive care, which could address medical issues before they become emergencies". [Opponents of single payer in the USA claim waiting times is the biggest problem with the Canadian system, but the worst waits are undoubtedly those where every few minutes your chances of survival may be decreasing by several %. And those waits are in the USA not in Canada.]

EMERGENCY WAITS GET DANGEROUSLY LONG IN US Reuters Health Information 2008 Jan 15

For the sixth consecutive year, the number of Americans living without health insurance has risen, according to US Census Bureau data. Approximately 2.2 million people were added to the uninsurance rolls in 2006 the largest one-year increase in the number of uninsured Americans since 2002.[The official rolls include only those without insurance continuously Jan1 - Dec31. If uninsured for 22 months Feb 1 04 - Oct 31 05 you are not counted as uninsured for either year] Annual Census Bureau estimates released in August show 15.8 % of the US population, were without health insurance during 2006 a 4.9 % increase. In 2005, census figures showed that 44.8 million people, or about 15.3 % of the population, lacked health insurance coverage. The number of uninsured Americans has increased 22 % since 2000, at which time 38.4 million people lacked health insurance. The percentage of people covered by employer plans fell from 60.2 % in 2005 to 59.7 % in 2006. According to the Commonwealth Fund, the difficult nature of obtaining and keeping health insurance coverage in entry-level jobs has resulted in major increases in the numbers of uninsured younger adults ages 25-34 and uninsured older adults ages 45-64. The new census data revealed that those hardest hit in 2006 were families with incomes between $25,000 and $75,000, but even when family income exceeded $75,000, the numbers of uninsured Americans grew by 1.3 million in 2006, suggesting that family premiums are becoming increasingly unaffordable.

CENSUS BUREAU: NUMBER OF US UNINSURED RISES TO 47 MILLION AMERICANS ARE UNINSURED: ALMOST 5 % INCREASE SINCE 2005 Posted 01/08/2008 Teddi Dineley Johnson Nations Health. 2007;37(8) ©2007 American Public Health Association

California voters by nearly a 2-to-1 majority support increasing their state's cigarette tax by $2 per pack to help raise cash for a state effort to provide health-care insurance to the uninsured. Gov. Arnold Schwarzenegger is rallying support in the state's Democrat-led legislature for a bill that aims to extend medical coverage to millions of uninsured Californians. The bill, approved by the Assembly and estimated to cost the state $14 BIL, would also raise money for the health-care program by taxes on hospitals and on employers who do not provide medical coverage, and by cigarette taxes.

CALIFORNIANS BACK HIKING CIGARETTE TAX BY $2--POLL Reuters Health Information 2007 Dec 24 by Jim Christie

A consumer group asked a US court to force regulators to decide if stronger warnings should be added to certain antibiotics to alert doctors and patients about the risks of tendon rupture. The antibiotics -- fluoroquinolones widely prescribed for gastrointestinal, respiratory and urinary tract infections -- include Johnson & Johnson's Levaquin and Bayer AG's Cipro and Avelox. In August 2006, consumer group Public Citizen petitioned the Food and Drug Administration to add a "black box" warning, the strongest type available for prescription drugs, to fluoroquinolones about the risk of tendon injury and rupture. Stronger warnings could lead patients to switch to other antibiotics soon after tendon pain develops and before the tendon ruptures, the group argued in a complaint filed with the US District Court for the District of Columbia. Public Citizen also argued that the FDA was violating federal law by not ruling on the petition. The agency said in February 2007 it had not yet reached a decision because the petition raised complex issues requiring extensive review. "While the FDA sits idly by and ignores the problem, more people will suffer serious tendon ruptures that could have been prevented," Wolfe said.

GROUP SUES US IN PUSH FOR NEW ANTIBIOTIC WARNING Reuters Health Information 2008 Jan 04

A growing number of US private sector workers are covered by health plans that require them to meet a deductible before any benefits are paid by their insurer, according to the latest News and Numbers from the Agency for Healthcare Research and Quality. The amount of that deductible also is increasing sharply. The number of workers with plans that require that a deductible be met rose from 48% in 2002 to 64% in 2005; For workers with single-person coverage, the average deductible increased 46% -- from $446 to $652; For workers with family coverage, the average deductible rose 29% -- from $958 to $1232; and Workers in small firms that have fewer than 50 employees had steeper increases in their average deductible than workers in large firms.

INCREASING NUMBERS OF INSURED WORKERS REQUIRED TO MEET A DEDUCTIBLE Posted 01/08/2008 Agency for Healthcare Research and Quality (AHRQ) Medscape Business of Medicine. 2008

Ending months of deadlock with the White House, the US House of Representatives gave final bipartisan approval to legislation that would temporarily extend the state health insurance program that covers about 6.6 million poor children. The Senate on Tuesday approved the same bill and the White House has indicated that President GW Bush will sign it. Lawmakers predicted that they would have to revisit Medicare payments early in 2008. Bush vetoed more ambitious earlier bills that would have expanded the health program to cover about 10 million children, even though they had bipartisan support. The president said they were too costly and would push more children into government-run health care instead of private plans. Bush also objected to raising tobacco taxes to pay for the proposed expansion of the State Children's Health Insurance Program. The health legislation costs about $6 BIL, but was paid for by savings in other health programs.

US HOUSE PASSES EXTENSION OF CHILD HEALTH PROGRAM Joanne Kenen Reuters Health Information 2007 Dec 20

More than 17 million Americans under age 65 -- almost a third of whom are middle income -- could be considered continuously uninsured. This means that they have not had health insurance to help cover their medical bills for at least 4 years, according to the Agency for Healthcare Research and Quality. Middle-income Americans are defined as living in families earning between 200% and 400% of the federal poverty thresholds, which vary according to family size and composition. In 2004, the base year for these data, poverty level income for a family of four averaged $19,307. Poor Americans, those in families with incomes at or below the federal poverty line, comprised about a quarter of the continuously uninsured. In contrast, fewer than 10% of continuously uninsured persons lived in families with incomes over 400% of the federal poverty line. Fully 17% of Hispanics were continuously uninsured, compared with 7% of blacks and 4% of whites.

MORE THAN 17 MILLION AMERICANS CONTINUOUSLY UNINSURED Posted 01/03/2008 Agency for Healthcare Research and Quality (AHRQ) Medscape Business of Medicine. 2008

San Francisco's universal health-care plan, a first-of-its kind local program to be funded in part by fees on employers, may go forward while under appeal, a US appeals court panel ruled. San Francisco is likely to successfully defend a court challenge to its health plan, which aims to provide medical insurance to all adults residents of the city at an estimated annual cost of $200 million. A restaurant association had challenged San Francisco's plan and won an early round when a US District Court judge ruled local governments could not compel employers to pay into medical insurance programs.

US COURT SAYS SAN FRANCISCO HEALTH PLAN CAN PROCEED Jim Christie Reuters Health Information 2008 Jan 10

Dengue fever may be poised to spread across the United States, health officials said. Cases of the mosquito-borne disease have been reported in Texas and this may be the beginning of a new trend. A warming climate and less-than-stellar efforts to control mosquitoes could accelerate its spread northwardsd. "Widespread appearance of dengue in the continental United States is a real possibility". "Worldwide, dengue is among the most important reemerging infectious diseases, with an estimated 50 to 100 million annual cases, 500,000 hospitalizations and, by World Health Organization estimates, 22,000 deaths, mostly in children."

DENGUE FEVER MAY THREATEN U.S.: REPORT Reuters Health Information 2008 Jan 09

Seniors and the disabled flocked to the pharmacy counter in 2006 with their new Medicare drug cards, fueling a 6.7 % increase in health spending. In most other areas of health care, there was a welcome slowdown in spending. It still cost more to go to the hospital or doctor, but the increase was not as great as in the previous year. The $2.1 trillion spent on health care in 2006 came to an average of $7,026 per person. Health-care spending represents 16.1 % of the economy. The increase in drug spending occurred even as consumers relied more on generic drugs and prices remained relatively stable for many brand-name medicines. Nearly two of three prescriptions filled were generics, which helped restrain drug expenditures. Under the drug benefit, many of the poorest beneficiaries were moved from Medicaid into Medicare, where private plans administer the drug benefit. Those private plans failed to negotiate discounts as large as those that the states received. Officials said the discounts that drug manufacturers were required to give states typically lowered costs about 30 %. Meanwhile, the private plans typically negotiated discounts of 5 % to 10 %. Besides drug spending, the other important exception was the cost of private health insurance, up 8.8 % in 2006, more than double the increase that occurred the previous year.

Tues Jan 8, 2008 $2.1 TRILLION SPENT ON HEALTH The Associated Press WASHINGTON

It makes for a compelling stump speech. And the leading Democratic candidates for president were all saying pretty much the same thing, as of late October 2007: : adapt the health care program that covers Congress and offer it to the 47 million Americans currently without insurance. However, not everyone makes the $165,000 a year or so that members of Congress do. In fact, at least 100,000 federal workers at least 5 % of the active work force do not have health insurance. In many cases, according to the union that represents the workers, they consider even the cheapest options within the federal plan unaffordable. This is a private-based solution, with all of its foibles,said Jonathan Gruber, a professor of economics at Massachusetts Institute of Technology who is advising various Democrats about the federal program as a possible model.

The New York Times, October 20, 2007, HEALTH PLAN USED BY US IS DEBATED AS A MODEL By Reed Abelson

The tedious, hair-splitting debates over health care that we’re getting from the presidential candidates -those who talk about health care at all- seem out of sync with the enormity of the problem. For families without the protection of health insurance, the devastating combination of serious illness and imminent financial ruin can be absolutely mind-numbing, stunning in its tragic intensity. For Sandra Hightower, the nightmare began in the summer of 2005 when Brittney had to have a cyst on an ovary removed. More cysts developed and in early 2006 doctors found that Brittney had cancer. She underwent surgery in Houston and the prognosis, according to Ms. Hightower, was good. The cancer recurred three or four months later and more surgery was required, followed by chemotherapy. The 15-year-old who loved to dance, and who wasn’t sure whether she wanted to be a model or a pediatric nurse, was now having to battle for her life like a warrior in combat. The next round of bad news came in a double dose. One night, after coming home from school, Brittney suddenly found that she couldn’t walk. The cancer had attacked her spinal cord. As the doctors geared up to treat this new disaster, Ms. Hightower received word that her insurance policy had maxed out. The company would not pay for any further treatment. She hadn’t understood that there was an annual limit of $75,000 on benefits.

The New York Times, November 17, 2007 It’s Not Just the Uninsured By BOB HERBERT

Total US health benefit cost rose by 6.1 % in 2007, the same pace as last year, to an average of $7,983 per employee. Among employers with fewer than 200 employees, health coverage prevalence fell from 66 % five years ago to 61 % in 2007. "Mini-med" plans, which strictly limit the total amount of benefits payable in a year ($10,000 is a common limit) are now offered by 7 % of all large employers and 19 % of large wholesale/retail employers as a way to provide some kind of low-cost coverage to part-timers not eligible for the regular plan or to full- time employees not yet eligible for coverage.

Mercer November 19, 2007 US EMPLOYERS’ HEALTH BENEFIT COST CONTINUES TO RISE AT TWICE INFLATION RATE, MERCER SURVEY FINDS

A US senator said Genentech's plan to restrict availability of its Avastin drug so doctors might be forced to use the more expensive medicine Lucentis to treat an eye disease will cost taxpayers $1 BIL to $3 BIL annually. The quandary is more than just two drugs that could potentially be used to fight the same eye disease. Lucentis costs about $2,000 per monthly dosage; Avastin could cost about $40. Some have asked Genentech to conduct a study comparing the effectiveness of Lucentis and Avastin in treating AMD, but the company has no plans to do so.

Contra Costa Times November 29, 2007 US SENATOR CHIDES GENENTECH PLAN By David Morrill

Anthem Blue Cross and Blue Shield unveiled a bare-bones health insurance plan designed for employers struggling to offer benefits to their workers because of the rising cost of premiums. The new plan, called Blue Access Hospital Surgical PPO, provides "catastrophic" coverage for most hospitalizations and surgeries, as well as limited coverage for doctor visits and other services. Deductibles -- or out-of-pocket costs before any coverage starts -- range from $1,000 to $5,000 for a single person and $3,000 to $15,000 for a family. After the deductible is met, a patient would be responsible for a $20 co-pay, plus 50 % of the total charge for an outpatient doctor visit, according to Anthem. An emergency-room visit requires a $150 co-pay plus 20 % of the total charge.http://www.indystar.com/apps/pbcs.dll/article?AID=/20071129/BUSINESS/711290426

The Indianapolis Star November 29, 2007 ANTHEM ROLLS OUT BARE-BONES HEALTH PLAN By Daniel Lee

California families must earn far more than the minimum wage and in some cases as much or more than the median hourly income just to keep up with the bare-bones expenses of living. A family of four with two working parents needs a yearly income of $72,343 just to cover such costs as housing, medical care, transportation and food, according "Making Ends Meet," Many Californians who make less than what it takes to pay the bills wouldn't qualify for government programs, such as tax breaks and health insurance for children.

The Sacramento Bee, "THE COST OF KEEPING UP", By John Hill

The US government's Medicaid program for the poor may put more financial burden on overcrowded hospital emergency rooms than the nation's 47 million uninsured. What surprised us was that uninsured patients actually pay a higher proportion of their emergency department charges than Medicaid does,. This runs counter to the widespread impression that the uninsured are universally poor payers,said Hsia, who noted that the ranks of uninsured include healthy young people who are employed full-time. Declining reimbursement ratios will cut into the ability of emergency departments to recover their actual costs of providing care. According to the Centers for Disease Control and Prevention, the number of hospital emergency departments fell 9 % to 3,795 from 4,176 in the decade leading up to 2005. During that same period, the number of annual emergency room visits increased by nearly 20 % to 115.3 million.

GOVT PROGRAM A STRAIN ON US EMERGENCY ROOMS: STUDY By Lisa Baertlein Reuters Health Information 2007 Nov 08

Republican presidential front-runner Rudy Giuliani acknowledged his cancer statistics were outdated but said his point remained the same -- beware of British health care. Giuliani, who has suffered prostate cancer, has taken criticism from British and US health officials for saying in a radio ad this week the US survival rate for the disease was 82 % while the survival rate under Britain's "socialized medicine" was 44 %. Health officials in both countries say the most recent statistics show five-year survival rates for prostate cancer are 99 % in the United States and 74 % under Britain's National Health Service. Giuliani told reporters "Even if you want to quibble about statistics, you find me the person who leaves the United States and goes to England for prostate cancer treatment, and I would like to meet that person" he said. The Commonwealth Fund, reported this week that Americans spent double what people in other industrialized countries did on health care, but had more trouble seeing doctors, were the victims of more errors and went without treatment more often. Its annual survey comparing the US health-care system to those of countries with national health plans finds the United States consistently last in most categories.

GIULIANI TAKES ANOTHER SHOT AT BRITISH HEALTH CARE By John Whitesides, Political Correspondent Reuters Health Information 2007 Nov 05

US regulators inspect few foreign makers of pharmaceutical ingredients and have no accurate count of how many companies supply the American market, a watchdog arm of Congress said. Data from the Food and Drug Administration suggest the agency inspects only 7 % of foreign drugmakers each year, the Government Accountability Office (GAO) told lawmakers. Until FDA responds to systemic weaknesses in the management of this important program, it cannot provide the needed assurance that the drug supply reaching our citizens is appropriately scrutinized and safe. Foreign-made medicines are common in Americans' medicine cabinets. More than 80 % of active pharmaceutical ingredients now come from other countries, with more than half from India and China, lawmakers said. So why has the Bush Admin been leading such a vigorous battle against allowing Canadian pharmacies to send in US-made drugs into the US (if it's not a safety issue, as they have claimed)?

US INSPECTS FEW FOREIGN DRUGMAKERS, CONGRESS TOLD By Lisa Richwine Reuters Health Information 2007 Nov 02

Britain's health secretary complained about an advertisement run by Rudy Giuliani, saying the US Republican presidential candidate had maligned Britain's health care system with bad statistics. In the radio ad, Giuliani, who has suffered prostate cancer, said the US survival rate for the disease was 82 %, but the survival rate in Britain was just 44 % "under socialised medicine". "Our rate of prostate cancer survival is actually much higher than has been claimed. The latest data show a survival rate of over 70 % and rising." Giuliani spokeswoman Maria Comella has said the former New York mayor got his figures from a magazine article and used it at a campaign stop, which was recorded and used in the advertisement. The Times said roughly the same proportion of men -- 25 out of 100,000 -- die of prostate cancer in the United States and Britain each year.

BRITAIN COMPLAINS ABOUT GIULIANI HEALTH CARE AD by Peter Graff Reuters Health Information 2007 Nov 02

One year after a report issued by the Institute of Medicine (IOM) concluded the nation's emergency care system was "at the breaking point," the House of Representatives Oversight and Government Reform Committee heard testimony on June 22, 2007, regarding emergency care in the United States. With America's emergency departments operating at or over capacity, the nation's healthcare safety net, the quality of patient care and the ability of ED personnel to respond to a public health disaster are in severe peril. Three emergency physicians from rural, suburban and urban areas testified that some hospitals do not have enough beds to admit patients, forcing an ED backup or diverting ambulances to other EDs. Additionally, the shortage of healthcare professionals -particularly surgeons to provide emergency and trauma care- was highlighted as one aspect of the overall problem. Reimbursement for emergency care services was also noted as an issue within the current crisis.

EMERGENCY CARE SYSTEM STILL AT THE BREAKING POINT Posted 11/13/2007 Kathleen Ream From American Academy of Emergency Medicine

Death rates from heart attacks have plummeted for people who get to hospitals, but many countries still have trouble treating and preventing chronic diseases. Among the countries struggling to provide quality health care is the United States, which spends far more per capita than any other OECD member but does not always deliver the best care, the OECD said. The OECD compared various measures of health care across its 30 members and found large variations. But there was also some good news. The United States scored poorly for infant mortality rates, which ranged from a low of two to three deaths per 1,000 live births in Japan, Sweden and Norway to 24 deaths per 1,000 live births in Turkey. The United States had 6 deaths per 1,000 live births, higher than the 5.4 average for OECD countries.

OECD HEALTHCARE REPORT SHOWS BIG QUALITY VARIATION By Maggie Fox, Health and Science Editor Reuters Health Information 2007 Nov 14

President GW Bush vetoed a measure to fund education, job training and health programs, marking the sixth veto of his presidency and the latest salvo in a fight with congressional Democrats over domestic spending. Bush signed a separate bill to give the Pentagon about $460 BIL for the fiscal year that began on Oct. 1, even though he was disappointed the military bill had less money than he had sought. Even so, the Pentagon would get about $40 BIL more than last year, a 9 % increase. The White House said the bill to fund labor and human services was bloated and filled with special projects. House Appropriations Committee Chairman David Obey, a Wisconsin Democrat, said Bush was "pretending" to protect the budget deficit while "asking us to spend another $200 BIL on the misguided war in Iraq." <

BUSH USES SIXTH VETO TO REJECT HEALTH-LABOR BILL By Caren Bohan Reuters Health Information 2007 Nov 14

For all the talk about aging baby boomers bankrupting the US health care system, the real cost culprits may be tests and treatments of dubious value (spurred on by high profits to be made by private companies for the unneeded tests they market). It appears possible to reduce costs without harming outcomes. "The nature of the long-term fiscal problem has been misdiagnosed," with policymakers placing too much emphasis on the aging population and not enough on cost effectiveness and quality. The aging population is one factor in the cost explosion "but it is not by any means the main factor," he argued. For instance, he said, technology like magnetic resonance imaging or MRI provides a valuable diagnostic tool -- but the costly screening is now used very widely without a lot of evidence on when it is truly beneficial. "It gets applied in lots of settings where the benefits are dubious" Orszag said.

TESTS OF DUBIOUS VALUE DRIVE UP HEALTH COSTS: STUDY By Joanne Kenen Reuters Health Information 2007 Nov 13

Talks between public health officials and the drug industry on a deal to ensure that people in poor countries can receive medicines at affordable prices ended inconclusively. The Geneva meeting, sponsored by the United Nations' World Health Organisation, was suspended after delegates exhausted the six days allotted for negotiations and agreed to meet again in late April 2008. The goal of the talks is to produce guidelines that would encourage research and development of affordable drugs to treat diseases prevalent in poor countries while respecting intellectual property rights of big pharmaceutical firms. The industry argues it needs strong revenues from drug sales to finance research and development into new treatments, including for diseases prevalent in developing countries.

TIME RUNS OUT ON TALKS ON DRUGS FOR POOR COUNTRIES Reuters Health Information 2007 Nov 12

The cost of providing health care for workers rose again in 2007 to nearly $8,000 annually per employee, prompting more businesses to drop the benefit. Costs rose by 6.1%, about the same pace as last year but lower than the double-digit rates of prior years. But that's still more than twice the rate of inflation, and costs to businesses would be even higher if they had not shifted more of it to the workers and their families. The survey found that only 62% of large employers cover part-time workers, who make up an increasingly large share of the work force. Some of these businesses are now offering "mini-med" plans that offer limited health coverage for part-timers.

US HEALTH COVERAGE SHRINKS AS COSTS UP AGAIN: STUDY Reuters Health Information 2007 Nov 19

GlaxoSmithKline PLC sent misleading letters to health professionals touting its breast cancer drug Tykerb, US health officials said. The FDA said Glaxo's letters, part of the launch campaign for Tykerb, "are misleading in that they omit and minimize the most serious and important risk information" and "selectively present efficacy information for Tykerb, thereby overstating the efficacy of the drug." "Most important, the letters minimize the important risk of decreased left ventricular ejection fraction," a measure of the amount of blood pumped out of one section of the heart, the FDA said in a letter to Glaxo. The six-page letter also calls the materials misleading because they "fail to present the most serious and important risk information" about the drug, including warnings about pregnancy, patients with liver impairment and diarrhea.

FDA WARNS GLAXO ON CANCER DRUG PROMOTIONS By Lisa Richwine and Kim Dixon (Reuters) Nov 27

Lives are at risk because the FDA is woefully behind in the latest scientific advances and is under funded. Inadequate staffing, poor retention, out-of-date technology and a lack of resources mar the FDA's ability. FDA's inability to keep up with scientific advances means that American lives are at risk. The US Congress passed more than 100 laws expanding the FDA's authority since 1988, but has not increased the funding appropriately. The panel "was extremely disturbed" at the state of the agency's information technology infrastructure, calling it the "weakest but most critical link."

FDA SCIENCE DEARTH PUTS PUBLIC HEALTH AT RISK By Kim Dixon Reuters Health Information 2007 Dec 04

More than 40 million people in the United States say they cannot afford adequate heath care and go without drugs, eyeglasses or dental treatment. In 2005, more than 40 million adults did not receive 'needed services' because they could not afford them, the report said. The report found about one third of all children living below the poverty level had not visited a dentist in 2005, compared with fewer than one-fifth of children from wealthier families.

OVER 40 MILLION IN US CAN'T AFFORD HEALTH CARE Reuters Health Information 2007 Dec 04

The American College of Physicians (ACP), the second largest physician group in the US, released recommendations for achieving a quality healthcare system in the US, which they say must start with universal health insurance coverage. In generating the recommendations, the ACP analyzed healthcare systems in 12 industrialized countries, according to the report which was released on the Annals of Internal Medicine web site and will appear later in the January 1, 2008 print edition. "Our recommendations provide evidence-based solutions to our country's many healthcare problems -- including the appalling lack of access to affordable health coverage, the impending crisis caused by the insufficient supply of primary care physicians, rising healthcare costs, and excessive administrative and regulatory costs," ACP President Dr. David C. Dale said in a statement. "Why do Americans tolerate a system that leaves one sixth of its citizens with poor access to basic medical care?" he adds. "Perhaps the example of other countries will motivate some Annals readers to join ACP in demanding decisive action from our own leaders."

PHYSICIANS SAY UNIVERSAL COVERAGE KEY TO IMPROVING US HEALTHCARE Reuters Health Information 2007 Dec 03 Ann Intern Med 2008.

Shares of Schering-Plough Corp and Merck & Co were down after US lawmakers said they would look into allegations that the drugmakers were withholding data from a study of their shared cholesterol medicine Vytorin. Rep. John Dingelland Rep. B Stupak requested information from the companies related to a delay in release of complete data from a clinical trial that ended in April 2006. Vytorin combines Merck's widely used cholesterol drug Zocor, which is now available generically, with Zetia, a cholesterol medicine that works via a different mechanism and is also sold through a joint venture of the two drugmakers. The companies aim to show that Vytorin is superior to Zocor alone by demonstrating plaque regression and enhanced cholesterol lowering, in a bid to fend off competition from generic Zocor, sold as simvastatin. The companies plan to release the data once it is fully analyzed at a major medical meeting in March.

SCHERING, MERCK SHARES FALL ON CONGRESSIONAL PROBE Reuters Health Information 2007 Dec 12

Disadvantaged adults with 3 markers of disadvantage (poverty, disadvantaged minority, uninsured) received 45.6% of their ambulatory visits from family physicians vs 30.5% for adults with no markers. For children with 3 vs 0 markers of disadvantage, the proportion of visits from family physicians roughly doubled from 16.5% to 30.1%. Family physicians constitute the only clinician group that does not show income disparities in access. Patterns of access to family physicians and nurse-practitioners are more equitable than for other clinician types. Primary care clinicians, especially family physicians, deliver a disproportionate share of ambulatory care to disadvantaged populations. A diminished primary care workforce will leave considerable gaps in US health care equity.

PURSUING EQUITY: CONTACT WITH PRIMARY CARE AND SPECIALIST CLINICIANS BY DEMOGRAPHICS, INSURANCE, AND HEALTH STATUS Posted 12/17/2007, Ann Fam Med. 2007;5(6):492-502. ©2007 Robert L. Ferrer, MD, MPH

The definition of pay for performance is combining performance measurement with financial incentives to motivate clinicians and systems change. Although such programs are becoming increasingly popular, they are also controversial because they introduce conflict between the clinician's obligation to the patient and financial rewards for good quality ratings. The study authors state that pay for performance could result in the deselection of patients if clinicians "play to the measures" or "game the system" and shift their focus from the patient as a whole. Clinicians may attempt to improve their ratings on various performance measures by dropping elderly patients with complex medical problems, because the outcome measures of these patients will worsen the clinician's overall profile. If financial incentives reward good performance on a few, limited measures of a single disease, this could result in neglect of other, possibly more important elements of care for that disease. The primary focus of the quality movement in health care should not be on 'performance' based on limited measures, but rather on the whole patient <

ACP ADDRESSES POTENTIAL OUTCOMES OF PAY FOR PERFORMANCE Laurie Barclay, MD Medscape Medical News 2007 December 14, 2007 Ann Intern Med. 2007;147:792-794

The US Senate approved legislation that would extend through March 2009 the State Children's Health Insurance Program that currently covers about 6.6 million poor children. The extension of the program ends for now an intense battle with President GW Bush, who has twice vetoed bills that would extend and expand the children's health program, saying it would cost too much money and shift children from the private marketplace to government-run programs. The bill also would stop a scheduled 10 % pay cut for Medicare doctors for six months and provide a 0.5 % increase instead. Lawmakers have struggled for several years to replace what critics say is a flawed Medicare payment policy but have instead done a series of short-term fixes like this one.

US SENATE BACKS EXTENSION OF CHILD HEALTH BILL Joanne Kenen Reuters Health Information 2007 Dec 19

California's Assembly approved Gov. Schwarzenegger's plan for universal health insurance, as overhauling health care grows as a prominent issue in the 2008 presidential election. "It is inexcusable the kind of health care system that we have right now," said Schwarzenegger. Although the United States spends at least twice as much as other industrialized countries, it has 47 million people without insurance and millions more whose existing health coverage is insufficient to cover a serious illness such as cancer. The US health care system is burdened by inefficiency and excessive administration by for-profit companies. In addition, the vast number of uninsured often seek needed care in hospital emergency rooms, which by law cannot turn anyone away. The bill would provide funding for community clinics in a bid to save money and ease stress on overcrowded emergency rooms, which act as a safety net for the uninsured. Revenue to pay for the new plan would come from taxes on hospitals, cigarettes and employers who do not provide health insurance.

CALIFORNIA HEALTH CARE REFORM GAINS MOMENTUM Lisa Baertlein and Jenny O'Mara Reuters Health Information 2007 Dec 18

The European Medicines Agency said that new warnings for doctors and patients were needed to increase awareness of cases of suicidal thoughts linked to Pfizer Inc's new smoking cessation pill. Pfizer has been asked [in the EU not in the USA] to submit changes to the marketing information for the product -- sold as Champix in Europe and Chantix in the United States -- before December 19. US FDA issued a warning last month about Chantix, amid reports of suicidal thoughts and behaviour, and at least one death potentially linked to the medication.

EU WANTS NEW WARNINGS ON CHAMPIX, PFIZER ANTI-SMOKING DRUG Reuters Health Information 2007 Dec 14

Despite some expansion in programs providing coverage to the poor, many Americans do not have access to basic medical care. Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Fully 87% of uninsured parents reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Access concerns were the most common concerns among publicly insured families, and costs were more often mentioned by families with private insurance. Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere.

INSURANCE PLUS ACCESS DOES NOT EQUAL HEALTH CARE: TYPOLOGY OF BARRIERS TO HEALTH CARE ACCESS FOR LOW-INCOME FAMILIES Posted 12/21/2007 Jennifer E. DeVoe, MD, DPhil; Alia Baez, BA; Heather Angier, BA; Lisa Krois, MPH; Christine Edlund, MSc; Patricia A. Carney, PhD Ann Fam Med. 2007;5(6):511-518.