The chief executive of Aetna Inc, one of the biggest US health insurers, told lawmakers the escalating cost of insurance is driven by factors other than excess profits at insurers. "The point I want to drive home is that health insurance premiums are primarily a reflection of overall cost of health-care services," Williams said. Aetna earned $1.8 BIL in net income in 2007, or a 6.6 % profit margin, according to Reuters Estimates. "The health insurance market is failing to keep premiums in check," said finance panel member Max Baucus, a Democrat from Montana. But he and others did not grill Williams on insurers' profits, a frequent target of Democrats. Requiring the same premiums for all regardless of medical history will drive up the cost for everyone, he said.

AETNA, LAWMAKERS DEBATE HEALTH COSTS, UNINSURED By Kim Dixon and Georgina Coolidge Jun 10 Reuters Health Information 2008

GW Bush will seek support from the European Union to help combat treatable diseases in Africa and provide additional health care workers there. "These diseases are treatable and beatable by medicines that are available today," Price said, adding that it would cost around $1 BIL. The United States has already committed $350 MIL over the next five years, he said. Bush will also propose boosting the number of health care workers in Africa, he said without elaborating. "It is critical that the G8 demonstrate that it is accountable and it is fulfilling the commitments that it has made," he said. The United States has already allocated the money to that effort, according to the White House.

BUSH TO SEEK EU SUPPORT FOR NEW HEALTH PROJECTS By Jeremy Pelofsky Jun 10 Reuters Health Information 2008

Leaders of the Group of Eight (G8) rich nations meeting in Japan must tackle health scourges in developing countries to boost global prosperity and security, eight international organisations said. They called on the G8 leaders to coordinate single-disease initiatives by funding and strengthening health systems, commit to new long-term predictable financing linked to results in healthcare and disease reduction and increase efforts in nutrition, clean water and sanitation. "A world that neglects the health of people is neither stable nor secure," they said. The G8 comprises Britain, Canada, France, Germany, Italy, Japan, the United States and Russia [only the USA denies that it has any obligation to provide access to care for all its residents].

INTERNATIONAL BODIES CALL FOR G8 ACTION ON HEALTH Jun 09 Reuters Health Information 2008

Failing NHS hospitals in the UK will be given a two-year deadline to shape up, or risk having private companies brought in to overhaul them. Critics immediately attacked the proposals as amounting to privatising the health service -- a claim denied by ministers. Bradshaw denied it was privatising the health service, adding that no NHS assets or staff would be transferred into private ownership. He said there was no evidence that private sector people could do a better job than their NHS counterparts. Conservative Health spokesman, Andrew Lansley, warned that proper safeguards were needed to protect taxpayers' money. "We cannot repeat the situation experienced so often under Labour, where private sector companies are brought in -- with all the benefits if things go right but without the risk of any financial loss being transferred to them if things go wrong," he said in a statement.

PRIVATE FIRMS COULD RUN FAILING NHS HOSPITALS By Andrew Hough Jun 04 Reuters Health Information 2008

UnitedHealth Group Inc's AmeriChoice unit, which just closed a deal to help propel it to become the largest provider of Medicaid health plans, will focus on its existing business for growth over acquisitions. AmeriChoice, the unit which oversees UnitedHealth's Medicaid plans for low-income Americans, will look to expand within its current markets or broaden its product offerings,. Medicaid is a US government health program. Companies bid for Medicaid contracts awarded by states, which administer the program and fund it along with the federal government. Jelinek said AmeriChoice was on track to reach its forecast of $5.8 BIL to $6 BIL in revenue this year, while its Medicaid costs have been in line with expectations. The rocky economy may pressure state budgets and lead to increased scrutiny on their Medicaid expenses. But such a focus could benefit AmeriChoice as states turn to managed care companies to help control costs.

UNITED HEALTH EXEC TARGETS MEDICAID GROWTH Lewis Krauskopf Jun 03 Reuters Health Information 2008

UnitedHealth Group Inc's Oxford Health Insurance unit has agreed to refund $50 MIL to nearly 37,000 small businesses in New York for overcharging on health insurance policies in 2006. The refunds will be paid to 36,746 small business policyholders in New York City, Long Island and the city's northern suburbs with about 300,000 employees and family members, Paterson and New York State Insurance Department Superintendent Eric Dinallo said in a news release.

UNITED HEALTH UNIT TO REFUND NY BUSINESSES $50 MIL May 30 Reuters Health Information 2008

The number of uninsured US young adults, who already represent a major chunk of the American population without health coverage, rose again in 2006. Based on census data, 13.7 million people aged 19 to 29 had no health insurance, either public or private, in 2006, up from 13.3 million in 2005. Those aged 19 to 29 represent one of the largest and fastest-growing segments of the US population lacking health insurance, the report said. The US uninsured rate rises dramatically at age 19 -- from 12 % of children up to age 18 up to 30 % among men and women aged 19 to 29, according to the report.

NUMBER OF UNINSURED US YOUNG ADULTS GROWS By Will Dunham May 30 Reuters Health Information 2008

California's state Senate failed to pass a bill approving nearly $7 BIL in bond financing for prison health-care facilities but its advocates plan to bring the legislation back for another vote. Gov. Arnold Schwarzenegger remains hopeful lawmakers will pass a bond bill to help Kelso overhaul health-care delivery in California's overcrowded prisons.

BOND BILL FOR CALIFORNIA PRISON HEALTH CARE FAILS May 28 Reuters Health Information 2008

Ads for prescription drugs need to be clear and direct and government needs to study the effects these ads have on consumer behavior, particularly among the elderly and minorities, said the US FDA finally today. Data shows that advertisements for drugs prompt people to see their doctors, but it is not clear if consumers understand potential benefits and risks of the drugs being promoted by pharmaceutical companies. Legislation that took effect in March allows the FDA to ask to review ads before the public sees them and to impose fines if an ad is misleading. It also empowered the FDA to study the effect of such advertising on the public. Last year, 68,000 promotions including commercials and print ads, magnets and pens, were submitted to the FDA.

DRUG AD EFFECTS ON PEOPLE NEED MORE STUDY: FDA PANEL By Susan Heavey May 16 Reuters Health Information 2008

A shortage of nurses in US hospitals is not about to ease any time soon because of shortcomings in the educational system. "It's likely to be bottle-necked for several years, if not decades, to come". The US health-care system must serve an aging population at a time when more of the people who provide care are leaving and too few replacements enter the work force. The problem is not a lack of people willing to enter the profession as much as a dearth of faculty to teach them. Nurses with advanced degrees prefer work as a hospital administrator, earning some $150,000 a year, to teaching in a nursing program for about $60,000, Nowakowski said. [The Nursing Shortage" was engineered a decade or more ago, in order to defeat efforts to unionize nurses].

NO RELIEF FOR US NURSING SHORTAGE: AMN CEO By Nick Zieminski May 14 Reuters Health Information 2008

A revised US Senate bill would require drugmakers and medical device makers to publicly report gifts over $500 a year to doctors, watering down the standard set in a previous version. Lavish gifts to doctors from industry -- ranging from golf vacations to pricey dinners -- have come under fire from lawmakers for influencing doctors' prescribing habits. The industry says such gestures are part of its doctor education, but critics say they taint independent decision-making. "Transparency brings about accountability and benefits everyone, consumers most of all," Sen. Chuck Grassley, an Iowa Republican, said in a statement. Grassley is sponsoring the bill with Democrat Sen. Herb Kohl of Wisconsin. "It is absolutely unacceptable. The whole idea of the registry is it provides a gift by gift annotation," said Peter Lurie, deputy director of Public Citizen's health research unit, who testified at an earlier hearing on the topic. "Penalties need to be significant otherwise these companies will treat it as a cost of doing business," Lurie said.

US SENATE REVISES DRUGMAKER GIFT BILL May 14 Reuters Health Information 2008

A group representing health plans and hospitals proposed health insurance reforms that would revise payment systems, clashing with a private foundation that proposed much more extensive reforms. The idea from Commonwealth Fund, published in the May/June issue of the journal Health Affairs, calls for all companies to be required to help fund health insurance in the USA and for the establishment of a government entity to sell low-priced plans to small businesses and individuals, as part of a plan to dramatically shrink the rolls of the uninsured. The industry group of health-care insurers and providers, including the big insurer Aetna Inc and drug wholesaler McKesson Corp , released its own reform bid. The industry plan, introduced at a briefing in Chicago, includes revising payment systems to reward quality as opposed to volume.

HEALTHCARE INDUSTRY, FOUNDATION OFFER REFORM PLANS By Kim Dixon May 13 Reuters Health Information 2008

The UK government promised that its planned reform of the National Health Service (NHS), which would see the creation of large health centres, would benefit patients and be driven by clinical needs not cash concerns. Darzi has already said the future of patient care is in large local centres or "polyclinics" where GPs, nurses and specialists would be grouped together, spelling the end of a single doctor working alone in a practice. The five government promises are: 1) Change will always be for patient benefit, 2) Change will be clinically driven, 3) All change will be locally led, as different places will have different needs requiring different solutions, 4) Patients, carers, and key partners will have their say, 5) Existing services will not be withdrawn until new and better services are in place.

UK GOVERNMENT VOWS NATIONAL HEALTH SERVICE CHANGE WILL BENEFIT PATIENTS By Michael Holden LONDON (Reuters) May 09 Reuters Health Information 2008

Companies that sell Medicare Advantage plans would have to modify sales commissions to stop salesmen from switching beneficiaries to a new plan each year to earn the highest possible fee, a US government agency proposed. The US Centers for Medicare and Medicaid Services (CMS) also said it plans to ban cold-calling and door-to-door solicitation by the companies to sell the lucrative Medicare Advantage plans. A 2003 law created the Medicare Advantage program, in which companies like Humana Inc and UnitedHealth Group contract with Medicare to sell private fee-for-service or managed-care plans to beneficiaries. Under traditional Medicare, the government pays for care through a system letting beneficiaries choose doctors and hospitals [but public Medicare doesn't rake in profits].

US MEDICARE TO TIGHTEN RULES FOR PRIVATE PLANS May 08 Reuters Health Information 2008

Researchers are inconsistent about disclosing financial conflicts of interests, and journals are inconsistent in how they use or publish disclosure information. The findings call into question the whole purpose and efficacy of a process intended to preserve integrity and eliminate bias in medical literature, investigators say. It was difficult to tease out from the analysis whether authors were intentionally failing to disclose a conflict, whether they were unsure what constituted a "relevant" conflict, or whether it was the journals not requesting information or not publishing disclosure information.

BOTH RESEARCHERS AND JOURNALS ARE TO BLAME FOR INCONSISTENT DISCLOSURE OF CONFLICTS OF INTEREST from Heartwire May 7, 2008

Because the incidence of cancer increases with age, the prevalence of the disease is expected to increase in the United States as the population grows and ages. Experts estimate that Medicare costs will surpass $21 BIL for elderly cancer patients treated over 5 years. This study appears to be the first to integrate up-to-date estimates of cost of care and survival to derive long-term (in this case, 5 years) national-level estimates of incidence cost for a broad array of the most common types of cancers. They suggest that further evaluation, prioritization, and implementation of cancer control interventions are warranted given the magnitude of these costs and American population trends.

MEDICARE EXPECTED TO EXCEED $21 BILLION FOR ELDERLY CANCER PATIENTS, May 6, 2008 Medscape Medical News 2008, J Natl Cancer Inst. April 29, 2008.

A 1-day snapshot of emergency room conditions at 34 US hospitals shows they are all overwhelmed and none is prepared to handle a big event like a disaster or attack. The government report shows ERs in Washington and Los Angeles operating over capacity on an ordinary day. None could have handled a surge of new patients. Bush says states need to pay more of the costs of maintaining emergency services and has proposed $18.2 BIL in cuts to Medicaid over 5 years. Rep. Waxman says "The proposed Medicaid regulations will directly result in further reductions in hospital and ED (emergency department) capacity and, ironically, specifically target trauma centers and teaching hospitals -- the very institutions whose surge capacity we must maintain if they are to function in the time of disaster or terrorist attack". The survey included seven major cities. "After the Madrid attack of 2004, 966 victims were transported to 15 hospitals, and 270 victims arrived at a single hospital for emergency care". "Not one of the seven cities studied here had sufficient treatment spaces in emergency rooms of their Level I trauma centers to handle the volume of victims seen at a single Madrid hospital."

US HOSPITAL ERs OVERWHELMED, ONE-DAY STUDY FINDS By Maggie Fox May 06 Reuters Health Information 2008

"There is no question there are fundamental, Grand Canyon-like differences on health care between the two parties," said Drew Altman, president of the Kaiser Family Foundation, a nonpartisan health policy group. McCain, who has clinched the Republican presidential nomination, and Democratic Sens. Barack Obama of Illinois and Clinton of New York have unveiled ambitious but very different plans to overhaul the health care system. McCain finished a week-long campaign swing in Denver on Friday that highlighted his plan, which would use tax credits to help shift from employer-based insurance coverage to an open market system where people can choose from competing policies. Clinton and Obama seek universal health coverage for the 47 million Americans without insurance. Clinton would mandate coverage, while Obama would require it only for children. The Democratic plans would keep the existing job-based insurance system but expand government involvement in a hybrid public-private system.

US HEALTH CARE WAITS TO IGNITE AS CAMPAIGN ISSUE By John Whitesides, Political Correspondent, Reuters Health Information 2008 May 05

US states with high malpractice claims and high malpractice-insurance premiums experienced a 5% increase in the number of practicing neurosurgeons and so-called "noncrisis" states realized a 2% decrease in the number of practicing neurosurgeons. According to Dr. Litvack, neurosurgeons incur some of the highest annual malpractice premiums of any specialty, averaging more than $100,000 and going as high as $300,000 per year in some states. In 2005 alone, neurosurgeons paid out a total of $28 MIL in malpractice claims, with the highest average payment per specialist surgeon ($465,000) and the single highest payment of any claim in any specialty ($5.6 MIL). As a direct result of malpractice claims and increasing malpractice insurance premiums, 43% of the survey respondents said they were considering limiting the scope of their practice; 30% said they were planning early retirement; and up to 20% said they planned to relocate to another state with better malpractice conditions. "We think neurosurgeons have done exactly what they said they were going to do - they've limited their practice in order to limit their liability." As a result, said Dr. Litvack, a given region can support a larger absolute number of neurosurgeons because now it takes 2 or more of these specialists to provide the same care and the same access to care that was once provided by a single individual in an unrestricted practice.

AGGRESSIVE MALPRACTICE ENVIRONMENTS DICTATE HOW, NOT WHERE, NEUROSURGEONS PRACTICE, May 1, 2008 Medscape Medical News 2008 and American Association of Neurological Surgeons 76th Annual Meeting: Abstract 602. Presented April 28, 2008.

A federal judge in Seattle suspended state rules that required pharmacies to dispense "Plan B" and other emergency contraceptives that prevent fertilized eggs from implanting, which some people believe is the same as abortion. The justices granted the state's motion to speed up the appellate proceedings, which were set for oral argument on June 3 in Seattle.

FEDERAL APPEALS COURT WON'T YET OVERTURN "PLAN B" RULING, Reuters Health Information 2008 May 01

A landmark bill to forbid discrimination against people whose genetic information shows a predisposition to certain illnesses won final US congressional approval. Thirteen years after such legislation was first introduced, the House of Representatives passed the bill, 414-1, and sent it to President George W. Bush, who has promised to sign it into law. The Senate approved the bipartisan measure last week, 95-0. The bill would bar health insurers from rejecting coverage or raising premiums for healthy people based on personal or familial genetic predisposition to develop a particular disease such as cancer, diabetes, heart ailments or many others. In addition, it would prohibit employers, unions and employment agencies from using genetic information in hiring, firing, pay or promotion decisions. It would also forbid health insurers from compelling a person to take a genetic test. Backers of the measure said people have declined genetic tests that could help lead to treatment of their ailments out of fear they could lose their jobs or insurance coverage.

US CONGRESS VOTES TO BAN GENETIC DISCRIMINATION By Will Dunham and Thomas Ferraro Reuters Health Information 2008 May 01

High-deductible health plans, touted by some health insurers as a way to contain runaway medical costs, are attracting wealthier individuals than typical plans, a government report on Wednesday found. The plans charge steeper yearly deductibles, typically about $1,000 for individuals, in exchange for cheaper monthly premiums. The higher out-of-pocket limits are aimed at encouraging patients to make wiser treatment decisions. These plans attract the healthiest and wealthiest, leaving sicker people in the wider insurance pool and boosting overall health care costs. They also say the plans push costs onto patients and are too pricey for the poor and uninsured. "They aren't the answer for providing adequate health insurance coverage for the average American," Stark said in a statement. More than 6.1 million people were covered by such plans by the beginning of 2008, up from about 3.2 million in 2006.

WEALTHIER PICK HIGH-DEDUCTIBLE HEALTH PLANS: US GAO By Kim Dixon Reuters Health Information 2008 May 01

US troops who seek psychological care after combat will no longer face the possibility of losing their security clearances, a major policy shift that may lead more military members to seek needed help. Defense Secretary Robert Gates said this week after 5 years of the war in Iraq, the form used throughout the US government in the security clearance process will be changed to free troops from an obligation to acknowledge mental health care if it is related to combat. More than 1.5 million US troops have been sent to Iraq and Afghanistan. About 300,000 of those service members suffer symptoms of post-traumatic stress disorder or depression, but only half receive care, according to a study by RAND Corp.

NEW MENTAL HEALTH POLICY MAY HELP MORE US TROOPS By David Morgan May 01 Reuters Health Information 2008. © 2008 Reuters Ltd.

Contamination of the worldwide heparin supply, which resulted in a substantial increase in adverse events and an estimated 81 deaths in the US, appears to have been a deliberate act to increase profits in Chinese workshops. The contaminant, oversulfated chondroitin sulfate, was apparently added to crude heparin in China at some stage in the production process by parties that have yet to be identified. "This contaminant has anticoagulant properties that mimic heparin, but at a much lower production cost--about $20/kg vs $2000/kg to produce crude heparin. Accordingly, there is speculation that the contaminant was added deliberately to increase profits for the workshops and/or consolidators that ship the crude material to Changzhou SPL, SPL Wisconsin, and other heparin [active pharmaceutical ingredient] API producers," he reported. "What due diligence did Baxter Inc. perform to determine that it could safely manufacture heparin API for the US market before using this facility?" he asked, adding that committee staff found several facts that should have alerted Baxter to potential problems but that appear to have been ignored. "Baxter's own records indicate that they were aware that the plant had never been inspected by FDA. It seems very odd that Baxter accepted the risks of using this facility to obtain the API used to manufacture a sterile biologic without an FDA inspection," Nelson reported, adding that when the company did eventually inspect the plant, it did not report any problems. He said this raised "troubling questions" about the FDA relying on third-party inspection or self-inspection as a substitute for its own efforts.

HEPARIN CONTAMINATION WAS DELIBERATE ACT TO CUT COSTS? from Heartwire Sue Hughes April 30, 2008 Heartwire 2008.

Medicare is lurching toward disaster and it is too late for the Bush Administration and Congress to do anything about it, US Health and Human Services Secretary Michael Leavitt said. "Higher and higher costs are being borne by fewer and fewer people. Sooner or later, this formula implodes," Leavitt said in a speech to the right-leaning Heritage Foundation and American Enterprise Institute think-tanks. "There is serious danger here," he added. "Medicare is drifting towards disaster." But the administration of President Bush and the current Congress are out of time, Leavitt said. Last week the Government Accountability Office blamed HHS in part for this, saying the agency had not used its powers to force hospitals to provide better care and less waste.

MEDICARE 'DRIFTING TOWARDS DISASTER': US OFFICIAL, Reporting by Maggie Fox, editing by Philip Barbara, Reuters Health Information 2008. © 2008 Reuters Ltd. Apr 30

The economic slowdown has swelled the ranks of people without health insurance. But now it is also threatening millions of people who have insurance but find that the coverage is too limited or that they cannot afford their own share of medical costs. Many of the 158 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be - often because of some combination of higher premiums, less extensive coverage, and bigger out-of-pocket deductibles and co-payments. With medical costs soaring, the coverage many people have may not adequately protect them from the financial shock of an emergency room visit or a major surgery. For some, even routine doctor visits might now take a back seat to basic expenses like food and gasoline. Already, many doctors say, the soft economy is making some insured people hesitant to get care they need, reluctant to spend a $50 co-payment for an office visit. Parents "are waiting longer to bring in their children," said Dr. Richard Lander, a pediatrician in Livingston, N.J. "They say, ‘The kid isn’t that sick; her temperature is only 102.’ " In a recent survey by Deloitte’s health research center, only 7 % of people said they felt financially prepared for their future health care needs.

EVEN THE INSURED FEEL THE STRAIN OF HEALTH COSTS, NY Times May 4, 2008, By REED ABELSON and MILT FREUDENHEIM

The American People Are Desperate For A Universal Health Care Plan, Said Us Sen. Christopher J. Dodd, D-Conn., During His Keynote Address At The Regional Action Summit Of Latino Voices In Universal Healthcare On Saturday. All Three Presidential Candidates' Health Plans Promise To Make Health Insurance Available To All, But None Of The Plans Address All Of The Concerns Expressed By The Summit's Panel Of Speakers. Dr. Olveen Carrasquillo, The Principal Investigator And Director Of The Columbia Center For The Health Of Urban Minorities, Examined The Three Plans And Found That None Were Explicit Enough In How They Were Going To Make Health Care Affordable For Latinos, And Said That None Included Coverage For Undocumented Residents. Key To The Summit's Discussion Was The Issue Of Racial And Ethnic Disparities In Health Care, In What Some Speakers Called A "Health Care Apartheid" And "Enforced Poverty." In July 2007, The Nation's Hispanic Population Was Recorded At 45.5 Million, More Than 15 % Of The Us Population Of 301.6 Million. However, Latinos Make Up More Than 40 % Of The Nation's Uninsured, With The Highest Numbers Existing In Undocumented Immigrants From Mexico. Many Latinos Are Covered Under Medicaid, Which Carrasquillo Said Was Considered By Many To Be Second-Rate Coverage With Respect To Medicare. Speaking From His Position As A Doctor, Carrasquillo Related How Latinos Were Waiting Months For Operations That With Better Coverage Would Have Been Taken Care Of In Days.

NATION DESIRES UNIVERSAL HEALTH By Ryan J. Phelan, Record-Journal May 3, 2008

The candidates' proposals to expand health coverage are not enough. Americans also need better access to high-quality care that the nation can afford. Unless patients can get in to see the family physicians, internal medicine doctors and pediatricians who provide that first level of contact to the system, we can't achieve the reforms needed in quality, safety and cost. An example of potential problems ahead is seen in Massachusetts, which recently instituted they call nearly-universal coverage by way of a new state law requiring residents to have health insurance. Officials originally estimated that 150,000 newly insured people would be seeking care, but the number turned out to be more than 350,000. Now, The New York Times reports that the state's primary care doctors don't have capacity to manage the demand. Such gaps in health care service loom large just as experts warn of provider shortages. "Primary care, the backbone of the nation's health care system, is at grave risk of collapse," according to a recent report from the American College of Physicians, the group that represents 125,000 internists. Ideally, each person should have access to a primary care doctor for ongoing medical care. Extensive research by Barbara Starfield of Johns Hopkins University and others has shown good primary care helps improve health in populations in a variety of ways, including longer life expectancy and fewer deaths from heart disease, stroke, infant mortality and low-birth weight. The stronger a nation's primary care orientation, the fewer early deaths from asthma, bronchitis, emphysema and pneumonia. In 2005, Starfield reported that increasing the supply of primary physicians by just one doctor per 10,000 people (a 12.6 % increase over average supply) could result in as many as 127,000 fewer deaths per year. Instead, our nation is losing primary care doctors and is falling behind those countries whose systems are based on primary care. Americans' average life expectancy is considerably shorter than that of Canadians, Japanese and Western Europeans.

PRIMARY CARE SHORTAGE UNDERMINES THE HEALTH OF EVERYONE IN THE U.S., May 16, 2008 , By ERIC B. LARSON Seattle Post Intelligencer

In recent weeks, Kaiser says, as many as 6,000 of its Southern California members have received similar bills -- some as high as $50,000 -- from Prime Healthcare Services Inc., a hospital chain based in Victorville. On Friday, Kaiser got a temporary restraining order from Los Angeles County Superior Court against Prime Healthcare. The order bars Prime from collecting from patients or reporting the bills to national credit agencies until a court hearing in early June. Kaiser is involved in separate litigation with Cedars-Sinai Medical Center about similar billing issues. Other insurers, such as Health Net, have faced penalties for such billing controversies. Balance billing occurs when doctors and hospitals claim they've been underpaid by insurers and ask patients to pay the rest. Some patients assume -- wrongly -- that such bills are cleared by their insurer.

BILLING ISSUE LEAVES PATIENTS FEELING ILL, By Daniel Costello, Los Angeles Times Staff Writer, May 17, 2008

The cost of health care for the average US family with employer-sponsored health coverage will increase 7.6% this year, due in part to rising prescription drug prices. The cost of medical services, including premiums, will increase by $1,109, from $14,500 in 2007 to $15,609 in 2008 for an average family of four enrolled in an employer-sponsored PPO. The study also found that the cost of pharmacy services is expected to increase by 10.6% to $2,302, compared with single-digit increases for physician services, inpatient and outpatient care (Knight, Dow Jones, 5/14). Employers are expected to pass on more of the cost to their employees. Employers will shift around 10.5% more of the cost to workers through higher premiums and out-of-pocket costs, such as deductibles, copayments and coinsurance.

AVERAGE 2008 EMPLOYEE OUT-OF-POCKET COSTS FOR FAMILY HEALTH CARE TO INCREASE 10.5%, According to Milliman Index [May 15, 2008]

The nation's largest publicly traded health plans say they don't plan to temper premium increases for the sake of keeping members on their rolls -- particularly not while they are under pressure from Wall Street over what it sees as their disappointing earnings. Wall Street analysts were shaken over the long-term prospects of the health plan business after bellwethers WellPoint and UnitedHealth Group, the nation's two largest private-pay plans, reported less-than-expected profits from the first three months of this year. United CEO Stephen Hemsley told investors: "We continue to protect our margins. ... We are committed to sustaining a quality business without taking shortsighted pricing positions." "We will not sacrifice profitability for membership," WellPoint President and CEO Angela Braly told analysts during a conference call"

HEALTH PLANS SAY THEY'LL RISK LOSING MEMBERS TO PROTECT PROFIT MARGINS, American Medical News May 19, 2008, By Emily Berry

Six out of 10 colleges and universities now recommend specific health insurance plans for their students, and three of 10 require them. But... many of the policies turn out to be scanty at best, and inferior to comparably priced alternatives. This can leave families exposed to crippling medical bills they thought they'd be protected against. Insurers, meanwhile, have found that the student market can be quite profitable. On a number of campuses, students feel pressure to purchase threadbare policies because those are the only ones the school will process. Unless students or their parents take the initiative to shop independently, Connecticut College, a private liberal arts school in New London, signs them up for a plan sold by Chickering Group, a subsidiary of Aetna, offering just $10,000 in maximum benefits for an illness. Meanwhile, the vigorous health of most college students helps make insuring them a lucrative niche. But some schools disclose an indication of the profitability of policies sold to their students: the so-called benefits ratio. This shows the percentage of premiums returned to customers in the form of benefit payouts. Large health insurers typically have overall ratios of about 80%, meaning 20% of premiums goes to profits and administrative costs.

IS YOUR KID COVERED? INSURERS MAKE BIG PROFITS FROM COLLEGE STUDENTS, BUT SOME FAMILIES ARE LEFT WITH HUGE BILLS BusinessWeek of May 8, 2008, , by Ben Elgin and Jessica Silver-Greenberg

With considerable fanfare, Gov. Charlie Crist traveled the length of his state on Wednesday to sign a bill aimed at providing low-cost health coverage to the uninsured by allowing the sale of stripped-down insurance policies. An insurance company could, for instance, choose to limit the number of days of hospitalization it will cover or place a dollar cap on reimbursing certain services. But the best part, as Mr. Crist, a Republican, explained at news conferences in Miami, Tampa and Tallahassee, is that the law "doesn't cost taxpayers a dime." "Even if it's one person," Mr. Crist said, "it would be a success..."

NEW FLORIDA LAW ALLOWS LOW-COST HEALTH POLICIES, The New York Times, May 22, 2008, By Kevin Sack

Current retirees will need tens or even hundreds of thousands of dollars in savings to ensure that they can afford health care after leaving the workplace. A married couple of two 65-year-olds retiring this year would need current savings of $235,000 to have a 90 % chance of having enough cash to afford their health costs in retirement. That's assuming the couple supplements Medicare with subsidized insurance premiums from a former employer. Couples who have unsubsidized insurance from an old employer, on the other hand, would need $376,000 in current savings for a 90 % chance of covering their costs. And a couple with individually purchased insurance to supplement Medicare would need $635,000.

RETIREES NEED HUGE SAVINGS FOR HEALTH CARE, Tuesday, June 3, 2008 Washington Business Journal, American City Business Journals, Washington

While politicians debate how best to cover the growing ranks of the uninsured, the federal government -- by outsourcing service jobs -- quietly is adding to those numbers. "As federal employees, we get great insurance," says (Dr. William Rogers, a medical officer at the DHHS). "People who work as contractors often don't enjoy those benefits." Federal contract employees, including cafeteria workers, security guards and cleaning crews, work on Capitol Hill and in federal agencies across the country. Under a 1965 law, called the McNamara-O'Hara Service Contract Act, most contractors with service contracts of more than $2,500 are required to pay locally prevailing wages, plus fringe benefits or the cash equivalent -- $3.16 an hour this year, under a government formula. Employers in industries where health insurance typically isn't offered are exempt. Other employers don't comply with the law because they don't understand it or assume they won't get caught.

HOW GOVERNMENT ADDS TO RANKS OF UNINSURED, The Wall Street Journal, March 25, 2008 By Jane Zhang

The Nebraska Medical Center has joined an increasing number of hospitals nationally that request that patients pay out-of-pocket costs before a scheduled surgery. The trend is driven in part by the popularity of high-deductible insurance plans, which can mean bigger out-of-pocket costs for patients. Jana Danielson, director of patient financial services for the medical center, said the main goal is to help patients know their hospital expenses and eliminate surprises when the bill arrives.

SOME HOSPITALS SEEKING FEES BEFORE SURGERY, Omaha World-Herald, March 26, 2008 By Michael O'Connor

Reflecting a shift in thinking over the past five years among US physicians, a new study shows a solid majority of doctors - 59 % - now supports national health insurance. A survey conducted last year of 2,193 physicians across the USA showed 59 % of them "support government legislation to establish national health insurance," while 32 % oppose it. The findings reflect a leap of 10 percentage points in physician support for national health insurance (NHI) since 2002, when a similar survey was conducted. Support among doctors for NHI has increased across almost all medical specialties.

MOST DOCTORS SUPPORT NATIONAL HEALTH INSURANCE, NEW STUDY SHOWS by DrSteveB DailyKos Mar 31, 2008

Health insurer WellPoint Inc is investigating the cause of a breach involving protected health information for about 130,000 members, the company said on Wednesday. The largest US health insurer by membership said it recently discovered data became publicly available over the Internet in the past 12 months. WellPoint declined to identify which type of members were involved, or which states they were in, beyond saying they were in several. [Other insurers might want the data to exclude sicker employees from switching in to their plans.]

WELLPOINT PROBING DATA BREACH FOR 130,000 MEMBERS, Reuters April 9, 2008

Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases. They are charging patients a percentage of the cost of certain high-priced drugs, usually 20 to 33 percent, which can amount to thousands of dollars a month. No one knows how many patients are affected, but hundreds of drugs are priced this new way. They are used to treat diseases that may be fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some cancers. There are no cheaper equivalents for these drugs, so patients are forced to pay the price or do without.

CO-PAYMENTS SOAR FOR DRUGS WITH HIGH PRICES By GINA KOLATA NYT April 14, 2008

The insurance companies, of course, think the high revenue Medicare Advantage system is just fine, and they spent heavily to keep the status quo. Health Plan Week, an insurance industry trade pub, took a hard look, revealing that overall health insurance payments to lobbyists soared last year and are likely to grow again in the next couple of years as health reform becomes the biggest issue. Special interests spent $17 million for every day Congress was in session, and the drug industry spent most of all, paying lobbyists 25 % more than they did last year. Did Harry Reid forget to mention them? Drug companies spent some $227 million on lobbying activities. The insurance industry was right behind with $138 million, and not far down was the hospital and nursing home industry, which spent some $91 million.

$17 MILLION A DAY TO INFLUENCE CONGRESS: By Trudy Lieberman 6 Apr 2008 Columbia Journalism Review

Some people marry for love, some for companionship, and others for status or money. Now comes another reason to get hitched: health insurance. In a poll released today, 7% of Americans said they or someone in their household decided to marry in the last year so they could get healthcare benefits via their spouse. It's a small number but a powerful result, because it shows how paying for healthcare is reflected not only in family budgets but in life decisions. On a broader scale, the survey found that healthcare costs outranked housing costs, rising food prices and credit card bills as a source of concern. Twenty-eight % of those surveyed said they had experienced serious problems because of the cost of healthcare, compared with 29% who had problems getting a good job or a raise.

GETTING MARRIED FOR HEALTH INSURANCE By Ricardo Alonso-Zaldivar, Los Angeles Times April 29, 2008

Abbott Laboratories, along with Solvay SA, are being sued in 18 states for allegedly blocking efforts to bring generic versions of their cholesterol-lowering medication to market. In 2007, TriCor generated sales of $1.2 BIL for Abbott, but the company, according to the lawsuit, has conspired since 1998 to maintain a monopoly on the market by obtaining multiple patents. Abbott denies the allegations, with spokesperson Melissa Brotz saying that Abbott's actions are lawful and that the company has not prevented other fenofibrate drugs from being marketed. At issue in the suit is a 2004 decision to market a new dissolvable version of TriCor in 48-mg and 145-mg doses, a decision approved by the US Food and Drug Administration. The dissolvable version keeps TriCor under patent until 2018.

ABBOTT LABS AND SOLVAY SUED IN 18 STATES FOR MONOPOLY EFFORTS WITH TriCor from Heartwire Michael O'Riordan

Medicare spending is increasing so quickly that the president will be required to propose new benefit cuts or higher taxes, trustees for the US senior citizen health care program said. Medicare hospital insurance spending is forecast to exceed tax revenues for 2008 and all future years and the fund will be exhausted in 2019. "Reform is needed and time is of the essence," Paulson said. "The longer we delay, the larger the required adjustments will be and the more heavily the burden of those adjustments will fall on future generations." The White House responded to last year's funding warning in its fiscal 2009 budget plan by proposing to reduce Medicare spending by $12.8 BIL over five years, drawing sharp criticism from Democrats in Congress.

US MEDICARE SPENDING TRIGGERS NEW FUNDING PROPOSAL By David Lawder Reuters Health Information 2008

Eli Lilly and Co said it agreed to pay $15 MIL to settle a lawsuit by the state of Alaska accusing it of concealing possible side effects from Zyprexa, its widely used schizophrenia medicine. The settlement includes no admission of wrongdoing, and will ensure that Alaska is treated as well as any other state that resolves similar claims. Alaska had accused Indianapolis-based Lilly in a March 2006 lawsuit of failing to properly warn the state and healthcare providers that using Zyprexa could result in weight gain, high blood sugar and diabetes. Zyprexa is Lilly's largest product by far, with sales of $4.76 BIL in 2007, including $2.24 BIL in the USA. Lilly said Zyprexa has been prescribed for more than 23 million people since the US Food and Drug Administration approved it in 1996.

LILLY SETTLES ZYPREXA CASE WITH ALASKA FOR $15 MIL Reuters Health Information 2008 by Jonathan Stempel

Americans' views of the US health care system differ widely based on political party preferences, with Republicans far more likely than Democrats to call it the world's best. People taking part in the survey by the Harvard University School of Public Health and Harris Interactive were asked if they thought the USA has the best health care system. Clear differences appeared when the respondents were sorted by political party identification. Among Republicans, 68% said the USA is the best, compared to 32% of Democrats and 40% of independents. The non-profit Commonwealth Fund said in November Americans spend double what people in other industrialized nations do on health care, but have more trouble seeing doctors, face more medical errors and are more apt to go without treatment. In the Harvard survey, 26% of respondents said the USA is better than other countries in providing affordable health care access to everyone, and 21% felt the USA was better in controlling health care costs.

REPUBLICANS, DEMOCRATS DIVERGE ON US HEALTH CARE Reuters Health Information 2008 Mar 20

Out-of-pocket prescription costs are increased when patients are given free pharmaceutical samples, according to a nationally representative, longitudinal study conducted in the US. "Physicians should not assume that just because a patient is given samples, that they are no longer burdened by their prescription costs. In fact, in some cases, sample use may be penny-wise and pound-foolish, while in others it may provide patients with valuable economic relief without leading to greater long-term prescription costs. Fourteen % of patients received at least one free sample during the analysis period. The odds of receiving a drug sample decreased with age and income (OR 0.96 per $10k increase). Chronic disease prevalence was higher in sample recipients. After controlling for demographics and health care utilization, the average out-of-pocket prescription expense per 180-day period was predicted to be $178. Before the free samples were given, expenditures did not differ significantly for either group. However, the average out-of-pocket cost jumped to $244 when one group received free drug samples and remained higher at $212 after the samples were given.

FREE DRUG SAMPLES MAY RESULT IN HIGHER PRESCRIPTION COSTS Reuters Health Information 2008 By Karla Gale Apr 01 Med Care 2008;46:394-402.

Two new studies comparing published research articles with insider documents obtained during the Vioxx lawsuits offer a glimpse into the behind-the-scenes influence of industry. Many manuscripts were written by the sponsor or by third-party medical-publishing ghostwriters, then attributed to an academic who, in some cases, was paid to have his or her name used. Mortality rates of patients taking Vioxx, reported in published manuscripts, were lower than those described in internal company documents. The studies are published in the April 16, 2008 issue of the Journal of the American Medical Association. An accompanying editorial by journal editors Drs CD DeAngelis and PB Fontanarosa explores what steps can be taken to reduce the influence of for-profit companies on clinical research, making it clear that the issues detailed in this week's issue are likely not infrequent. "Make no mistake--the manipulation of study results, authors, editors, and reviewers is not the sole purview of one company."

VIOXX DOCUMENTS OFFER GLIMPSE INTO GHOSTWRITTEN MANUSCRIPTS, "HIRE-A-PI," AND DATA MANIPULATION from Heartwire April 16, 2008 by Shelley Wood

The US FDA does not have the funding it needs to adequately protect the nation's increasingly global supply of food and drugs, a bipartisan Senate panel said. The lawmakers said the agency needed millions more dollars than the $2.4 BIL that the Bush administration requested for 2009 if it is to keep pace with needed inspections of overseas manufacturing plants as well as monitor drug side effects and food contamination. "There is no new money for food safety, medicinal products safety or anything else." The panel is weighing how much taxpayer money to provide the FDA for fiscal year 2009 starting in October. The discussions come as the agency grapples with the latest drug scare, the contamination of blood thinner heparin, which has a raw ingredient made in China. Tainted pet food and bacteria-laced peanut butter, spinach and lettuce also have made headlines recently.

US SENATORS: FDA FUNDS DO NOT MEET GLOBAL NEEDS Reuters Health Information 2008 Apr 15

US Republican presidential candidate John McCain will outline economic proposals that would increase drug costs for wealthy seniors and freeze billions in government spending for a year. Holtz-Eakin and another economic adviser to McCain, Carly Fiorina said McCain will propose reducing spending in the federal government's Medicare prescription drug program. He would require older couples making $160,000 to pay higher premiums for the benefit if they are enrolled in the program. McCain will also call for a one-year freeze in many areas of the federal government -- but not the US military and veterans benefits and pension programs for the poor and elderly -- in order to conduct a review of every federal program, department and agency to determine if it is needed.

McCain WOULD HIKE DRUG COSTS FOR WEALTHY AMERICANS By Steve Holland Apr 15 Reuters Health Information 2008

A new IOM study describes a shortage of healthcare workers for the elderly and provides recommendations for improvement. Concern over the impending demographic surge of seniors and their demands for healthcare has focused on the solvency and sustainability of the Medicare Trust Fund, "but even if there is enough money, there isn't going to be anybody there to provide the care," said Dr. Rowe founder of the division on aging at Harvard Medical School. "The combination of the aging of the baby boom generation and the increase in life expectancy is going to yield a doubling of the numbers of older people" by 2030, he said. Seniors "account for a disproportionate amount of the utilization of healthcare resources," with those older than 65 years constituting 12% of the population, but 26% of physician visits and 34% of all prescriptions. As the older population doubles, Dr. Rowe noted, "It would follow that geriatric care is going to dominate healthcare in the USA." Yet there are only about 7000 certified geriatricians in the USA -a decline of 22% from 2000. "Less than 1% of nurses, pharmacists, and physician assistants are specialists in geriatrics, and less than 4% of social workers specialize in geriatrics," he said.

IOM Report: BOLD CHANGES NEEDED TO MEET HEALTHCARE NEEDS OF ELDERLY Bob Roehr Medscape Medical News 2008

NYC Mayor Bloomberg called on the US government to pay $150 million a year to cover medical bills for workers and residents whose health suffered due to the September 11, 2001 attacks. The federal government created a $1 BIL insurance fund to help ground zero workers sickened by the toxic fumes and dust released when the World Trade Center was destroyed. The fund, however, has been hobbled by lawsuits and criticized for the lack of payments to sick workers.

US GOV'T SHOULD COVER 9/11 HEALTH COSTS By Edith Honan and Joan Gralla Reuters Health Information Apr 17 2008

The USA may be facing a shortage of general surgeons, even as a growing and aging population creates a rising need for their broad capabilities. There was a 26 % decline in the number of practicing general surgeons per 100,000 Americans between 1981 and 2005, according to an analysis of data from the American Medical Association. "There is some question as to whether there will be an adequate number of general surgeons to care for an increasingly elderly population, with its attendant increased demand for surgical care," srote Dr. D Lynge, in the Archives of Surgery. The trend could cause a crisis in some rural areas where finding any type of surgeon can be difficult, Dr. Lynge wrote. Fewer than one in five general surgeons practice in rural areas of the USA, and Dr. Lynge said they are aging faster than their urban counterparts, and hospitals are having trouble finding replacements for them. She said there is an understandable reluctance to face the pressures of being one of few doctors serving a wide area.

US MAY FACE SHORTAGE OF GENERAL SURGEONS Reuters Health Information Apr 22 2008

An online advertisement with men praising Viagra to the tune of an Elvis Presley song has drawn objections from US regulators, who said drugmaker Pfizer failed to list the impotence drug's risks. The Food and Drug Administration sent a written warning to Pfizer. The video raises public health and safety concerns through its complete omission of risk information for Viagra by suggesting that Viagra is safer than has been demonstrated," the FDA said in its letter. Viagra's prescribing instructions warn against use by men taking heart drugs known as nitrates and caution about sudden vision and hearing loss and other problems.

US FDA OBJECTS TO ONLINE AD FOR PFIZER'S VIAGRA by Lisa Richwine Reuters Health Information 2008 Apr 22

Over 17 million women in the US have no health insurance, and approximately 13% of pregnant women are uninsured. "The sad and alarming reality is that the uninsured rate of 20.4% for women of childbearing age (age 15-44) is greater than for all Americans under age 65 (17.8%).

WOMEN MOST HURT BY LACK OF UNIVERSAL HEALTH CARE 25 Apr 2008 Medical News Today

Employer-based health insurance premiums have skyrocketed at a pace that far exceeds the rate of American wage increases since 2000, a new study reveals. According to an analysis of government statistics being released by the Robert Wood Johnson Foundation, the average dollar amount employees must pay per year for family health coverage went up by 30 % from 2001 to 2005. During that time, incomes increased by just 3 percent. "Nationally, insurance premium costs are going up ten times faster than people's incomes," said RWJF spokesman Michael Berman. "And in some regions, the gap is even greater. So what we've tried to do with this report is highlight for the nation's leaders what families already know; that it's getting harder and harder to afford health insurance in America." RWJF notes that currently 47 million Americans are uninsured [for whole calendar year] of whom almost 9 million are children. "The state of health insurance today is a pretty gloomy picture".

HEALTH INSURANCE PREMIUMS SKYROCKET US News & World Report By Alan Mozes April 29 (HealthDay News)

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.