Non-Hispanic whites are significantly more likely to have health insurance coverage than most racial/ethnic minorities, and this differential grew during the 1990s. Similarly, wealthier Americans are more likely to have health insurance than the poor, and this difference also grew over the 1990s. A connection between hospital consolidation and health insurance primarily occurs through the cost of inpatient care. Increases in hospital concentration raise the price of inpatient care. These higher costs are potentially passed on to health insurance consumers in the form of higher premiums. Higher premiums, in turn, decrease health insurance coverage. Insurance take-up among racial and ethnic minorities and lower-income households is likely more sensitive to premium increases than is the case for whites and higher-income households.

HOSPITAL CONSOLIDATION AND RACIAL/INCOME DISPARITIES IN HEALTH INSURANCE COVERAGE, By RTown, D Wholey, R Feldman and L Burns, Health Affairs July/August 2007

The percentage of people without health insurance increased in 2006 from 15.3% in 2005 to 15.8% in 2006 to 47.0 million (as underestimated every year in the official census data). The percentage and the number of children under 18 years old without health insurance increased by 7% to 8.7 million in 2006. The percentage of uninsured Blacks increased nearly 8% to 7.6 million in 2006. The percentage and the number of uninsured Hispanics increased to 34.1% and 15.3 million in 2006.

Current Population Reports, INCOME, POVERTY, AND HEALTH INSURANCE COVERAGE IN THE UNITED STATES August 2007

Five years ago, when Mr. Hendrickson was 66, routine blood work found something amiss with his liver. One test led to another, and then to an awful diagnosis: pancreatic cancer, one of the deadliest kinds. His doctors thought he was among the lucky few with pancreatic cancer found early enough to be cured by surgery. But they warned him not to have the surgery in his home city, Albuquerque. They said the operation he needed, a Whipple procedure, was so risky and complicated that it should be done only by a surgeon who performed it often and at a hospital with many similar cases. But neither was available locally. One morning, Dr. Bordenave, his internist, canceled her other appointments to spend hours on the phone finding a major cancer center that would quickly admit him. It turned out to be the M. D. Anderson Cancer Center in Houston. But his insurer, the Presbyterian Health Plan, refused to pay for treatment in Houston. The company insisted that the operation be done in Albuquerque and sent him a list of five local surgeons. [So you see "waiting times" may not be your biggest problem.]

OBSTACLES TO CARE: Doing Battle With the Insurance Company in a Fight to Stay Alive, By DENISE GRADY, July 29, 2007, NYTimes

Congressional Democrats are mulling how to counter sweeping new policy changes by the Bush administration that will make it nearly impossible for states to expand SCHIP the popular health care program for children. It was created in 1997 to provide health coverage for children whose families earn too much to qualify for Medicaid, but not enough to afford private health insurance. Pres Bush and many GOP lawmakers oppose the coverage expansions states have enacted, saying they go well beyond the low-income children the program was intended to cover. To limit the program to low-income children, the Bush administration has told state officials that before they can enroll children from families earning above 250% FPL or $51,625 for a family of four - states must first enroll at least 95% of children from families earning below twice the poverty level AND those new enrollee children will have to wait one year after application to be enrolled. "They have set a hurdle that's impossible. They might as well just come out and say let's kick kids off the rolls."

FIGHT PLANNED OVER CHILD HEALTH CARE, McClatchy Newspapers, August 22, 2007

The study found that the hedge-fund·chiefs average $12.6 Average is 22,255 million a week, or $210,700 and times US. worker's 53,510 per minute. Top private-equity and hedge fund managers made more in 10 minutes than average-paid U.S. workers earned all of last year. That'.s $35,100 every 10 minutes, compared with $29,500 a year for the average worker. The 20 highest-paid fund managers made an average of $657.5 MIL. In 2006, the 20 highest-paid fund managers also made 3,315 times the average pay. "There are 20 officials in the U.S. government's executive branch, including the president claiming company executives are underpaid."

TOP MANAGERS', PAYOUT OF SIGHT By Ian Katz Bloomberg News, Aug 30 2007

Ten years after a rule change allowed drug companies to advertise directly to US consumers, the overall amount spent promoting medicines is 2.6 times what it was in 1996. The researchers also found evidence that regulators are doing less to police such ads. Total spending on pharmaceutical promotion grew to $29.9 BIL in 2005 from $11.4 BIL in 1996, an average annual growth rate of 10.6%. [Remember that's all coming out of the dollars we spend for health care, they've got an unlimited resource with non-negotiated drug prices.] While ad campaigns make brand names familiar to consumers, they may also spark cynicism over drug safety when heavily marketed brands come under fire for safety reasons. The FDA has been sending out fewer letters to drug companies warning them that their commercials are minimizing risks or exaggerating effectiveness. In 1997, 142 such letters were sent. Last year there were only 21. The Government Accountability Office found that FDA warning letters often were not sent out until false or misleading ad campaigns had run their course.

STUDY TRACKS BIG GROWTH IN US DRUG ADS, By Gene Emery, Reuters Health Information Aug 16 -2007

A new presidential report on cancer takes on not only tobacco companies but the food industry while calling on the federal government to "cease being a purveyor of unhealthy foods" and switch to policies that encourage Americans to eat vegetables and exercise. Federal, state, and local policies have actually made healthful foods more expensive and less available, limited physical education in schools and created an environment that discourages physical activity, the report said. "Ineffective policies, in conjunction with limited regulation of sales and marketing in the food and beverage industry, have spawned a culture that struggles to make healthy choices -- a culture in dire need of change". Margaret Kripke of the University of M.D. Anderson cancer center, a member of the President's Cancer Panel, said "What became clear to me is that we simply don't have the political will to protect the public health." Several reports have shown that one third of all cancers are caused by tobacco use and another one third by obesity and inactivity.

CANCER PANEL ATTACKS US FOOD SUBSIDIES, By Maggie Fox, Reuters Health Information Aug 16 - 2007

Terminally ill patients do not have a constitutional right to experimental drugs not approved by regulators, a US appeals court ruled. The USFDA requires a wide battery of research, ranging from animal and laboratory tests to advanced trials with people, before it will consider approving a new drug. Manufacturers say the process can take up to 10 years. [Critics say approval rests largely on industry funded and biased studies approved by current and former pharmaceutical executives on the FDA panel.] Two advocacy groups have sued the FDA seeking greater access for dying patients to unapproved medicines that have cleared early safety tests, which usually include 20 to 80 people. The Abigail Alliance for Better Access to Developmental Drugs and the Washington Legal Foundation argued that patients have a constitutional right to try experimental drugs that have passed that hurdle, if they choose. "The FDA's policy of limiting access to investigational drugs [EVEN to dying patients with little hope of extending their lives otherwise]is rationally related to the legitimate state interest of protecting patients, including the terminally ill, from potentially unsafe drugs with unknown therapeutic effects," Judge Thomas Griffith wrote. In a dissenting opinion, Judge Judith Rogers wrote: "There is no logic to be found... in the conclusion that the right to save one's life is unprotected" by the Constitution.

US COURT SEES NO RIGHT TO UNAPPROVED MEDICINES, By Lisa Richwine, Reuters Health Information Aug 08 - 2007

Adults aged 19 to 29 are the biggest group of the newly uninsured. That age group made up 30% of the 45 million Americans without health insurance in 2005, according to the Commonwealth Fund. Young adults, many who are just entering the workforce and can't afford the high cost of individual insurance, are the big drivers of an increase in uninsured adults. US employers, especially smaller businesses, are increasingly opting not to offer health insurance, leaving workers to fend for themselves in the health insurance market. US Census and other data cited by the report show 40% of the uninsured young are in households earning less than the federal poverty level. Seventeen US states have passed laws requiring insurance companies to cover dependent children until at least age 24. Most of these reforms have been passed in the last two years.

YOUNG US ADULTS LEAD IN LACKING HEALTHCARE, By Kim Dixon, Reuters Health Information Aug 08 - 2007

Increasingly, underinsured children cannot receive vaccines, in either the public domain or in the private sector. As a result of substantially increased costs of full coverage over the last few years, many states are restricting access to selected new vaccines for several immunizations, particularly for underinsured children. The cost of full vaccination has increased from $155 per child in 1995 to $1170 in 2007. For this study "Underinsured children" were defined as those whose families have employee-provided private health insurance plans that do not cover the cost of vaccines, or "catastrophic health insurance plans" that require high deductibles before insurance kicks in. Ten states have changed their policies by restricting access to selected new vaccines for underinsured children. For example, in 2006, underinsured children were unable to receive publicly purchased meningococcal conjugate vaccine in the private sector in 70% of states, or in the public sector in 40%.

ECONOMIC BARRIERS DENY VACCINATIONS TO UNDERINSURED CHILDREN, Reuters Health Information Aug 07 - 2007, JAMA 2007;298:638-643,680-682

For-profit hospitals, which are blaming unpaid medical bills for tamping down profits, are struggling with a simple question: Which patients have the ability to pay their hospital bills? [Or maybe, can any of us afford to get sick?] Hospital officials and experts say a rising share of uncollected debt is coming from patients who have health insurance coverage. As these patients bear a greater share of their health care costs, it becomes more complex for hospitals to determine which patients can pay their bills, experts said. "The increase in patients' responsibility is putting hospitals in this unusual position of having to negotiate with patients who have insurance". Hospitals have for several years struggled with unpaid bills from the uninsured, whose numbers swelled to 45 million in 2005, up 13% from 2000. "Our operations people feel we have been writing off too many accounts -- accounts that are at 400, 500, 600, 700% of federal poverty -- that can pay something,".

US HOSPITALS STRUGGLE OVER WHO CAN AFFORD TO PAY, By Kim Dixon, Reuters Health Information Aug 06 - 2007

The government plans to renegotiate an agreement with drug companies on medicine pricing to ensure taxpayers get value for money. The move is the latest example of governments around the world studying new ways to rein in the cost of medicines as medical advances and ageing populations strain healthcare budgets. Surprised? Well of course it's not the Bush administration, it's the government of the UK where a report by Britain's consumer watchdog, the Office of Fair Trading (OFT), had concluded last February there should be a more value-based approach within the current Pharmaceutical Price Regulation Scheme. For the Bush administration government negotiation of drug prices is out of the question, even for federal programs. Britain's National Health Service spends around $16.25 billion a year on branded prescription medicines under the 50-year-old pricing arrangement, which caps companies' profits and can also cut prices across the board.

GOVERNMENT TO RENEGOTIATE DRUG PRICING SCHEME, By Ben Hirschler, Reuters Health Information Aug 02 - 2007

Federal officials may be planning to subpoena filmmaker Michael Moore seeking information about a trip he took to Cuba for his documentary, "Sicko,". In an appearance on NBC's "The Tonight Show with Jay Leno," Moore said he was notified at the TV studio in Burbank, California, that a subpoena had already been issued. The director took several Americans, who became ill after working in the ruins of New York's World Trade Center following the Sept. 11 attacks, for free treatment in Cuba. In May, the US Treasury Department informed Moore it was investigating his trip to the communist state as a potential violation of Washington's long-standing embargo restricting US citizens' travel to the communist nation. The Weinstein Company, the studio behind "Sicko," declined to comment on a possible subpoena. Weinstein Co. plans to donate 11% of the movie's box office on Aug. 11 to a fund to help rescue workers suffering from ailments relating to their work at Ground Zero.

US OFFICIALS MAY SUBPOENA FILMMAKER MOORE, By Bob Tourtellotte, Reuters Health Information Jul 30 - 2007

A senior FDA scientist has told congressional investigators that the FDA removed him or her from work on GlaxoSmithKline Plc's drug Avandia after voicing concerns about the safety of the diabetes pill, two senators said on Tuesday. The officer at one time was the primary reviewer for Avandia. The scientist has believed since 2005 that there was enough evidence for a strong "black box" warning on Avandia about a risk of congestive heart failure. "This new allegation is especially significant and raises our level of concern about FDA interference in safety decisions regarding Avandia," the letter said. Concerns about Avandia's heart risks arose in May when a study linked Avandia to a 43% higher chance of having a heart attack. The FDA has said other evidence conflicts with that finding. Millions of patients take Avandia, and sales topped $3 billion last year.

US SENATORS: FDA PULLED REVIEWER OFF GLAXO DRUG, Reuters Health Information Jul 25 - 2007

Reforming the tottering US health care system should start at the very beginning of the process -- in medical school, the top US public health official said on Saturday. Dr. Gerberding called for changing the way doctors, nurses, veterinarians, pharmacists and dentists are educated. Not only are more schools needed, Gerberding said, but these professionals need to start their education all together, to foster cooperation and a sense of common mission. "I believe that what we really need in this country are schools of health,". "If we are seriously thinking about building a health system, then we need to be training professionals in a collegial and collaborative manner." The US system is a conglomeration of public and private insurance, with the education of medical professionals left to state universities and private academic centers. "We have to get our voice heard above the cacophony of the junk science that is being heard."

START WITH MEDICAL TRAINING TO FIX US HEALTH CARE: CDC HEAD, By Maggie Fox, Reuters Health Information Jul 16 - 2007

One of every six adult New Yorkers has no health insurance, even though nearly two-thirds of these individuals have jobs. The high cost of medical care discouraged 41% who had no insurance from seeking care -- about four times as many as those who did have benefits. One in 10 whites had no benefits, compared with one in four Hispanics who lacked insurance, one in five Asians, and one in six blacks. "All of this adds up to people landing in emergency rooms with costly, devastating health problems that could have been prevented or treated". In 2005, some 435,000 patients who lacked health insurance were treated at the city's public hospitals, costing the hospitals some $515 MIL.

ONE OF 6 NEW YORKERS LACK HEALTH INSURANCE, Reuters Health Information Aug 23 - 2007

Infectious diseases are emerging more quickly and spreading faster around the globe than ever and becoming increasingly difficult to treat, the World Health Organisation (WHO) said. With billions of people moving around the planet every year, an outbreak or epidemic in one part of the world is only a few hours away from becoming an imminent threat somewhere else. No country can shield itself from invasion by a pathogen incubating in an airline passenger or an insect hiding in a cargo hold. The U.N. agency warned that there was a good possibility of another major scourge like AIDS, SARS or Ebola fever with the potential of killing millions appearing in the coming years. It warned global efforts to control infectious diseases had been "seriously jeopardised" by widespread drug resistance, a consequence of poor medical treatment and misuse ofantibiotics.

INFECTIOUS DISEASES SPREADING FASTER THAN EVER, Reuters Health Information Aug 23 - 2007 By Laura MacInnis

The Bush administration has adopted new standards that would make it much more difficult for states to extend health coverage to children in middle-income families. The letter from Dennis Smith, the director of the federal Center for Medicaid and State Operations, set a high standard for states that want to raise eligibility for the program above 250 percent of FPL. California wants to increase its income limit to 300 percent of the poverty level, from 250 percent. Pennsylvania recently raised its limit to 300 percent, from 200 percent. The New York state legislature recently passed a bill that would increase its income limit to 400 percent of the poverty level, up from 250 percent, according to the newspaper.

WHITE HOUSE MOVES TO LIMIT HEALTH PLAN-REPORT, Reuters Health Information Aug 21 - 2007

The chief executive of the biggest health maintenance organization in the US backs key elements of Gov. Schwarzenegger's proposal to extend health-care coverage to millions of uninsured individuals. Schwarzenegger's $12 BIL pitch to provide health insurance in the estimated 6.5 million without insurance in the most populous U.S. state would seek higher taxes from doctors and hospitals and asks health plans to limit profits. "I think it's attainable and achievable," George Halvorson, the CEO of Kaiser Permanente. Schwarzenegger's proposal requires that individuals have insurance, and mandates that employers offer it, or pay into a fund. He also said he supports a requirement that health plans not reject coverage based on preexisting medical conditions. For health plans, a controversial element of Schwarzenegger's plan is a proposal that would require health plans to spend at least 85 cents of every dollars in premiums on medical care [i.e. must limit administrative waste to just 5-7 fold what the medicare program requires for administration].

KAISER PERMANENTE HMO CEO BACKS CALIF HEALTH REFORM, By Kim Dixon, Reuters Health Information Aug 17 - 2007

Regence BlueShield began notifying 137,000 individual-plan customers that their premiums are rising an average of 19% in July in the steepest increase for individual plans this year by a Washington health insurer. And for 16,000 of those enrollees, the rate increase will be 40% because they also happen to be moving into an older, more expensive age group. Charlie Fleet, said it needed to raise "We offer good value to our members," said a spokesman for Regence.

The Seattle Times, May 16, 2007, GULP! REGENCE RATE BOOST AVERAGES 19 % FOR INDIVIDUAL PLANS, By KM Song

Most states require that doctors obtain a minimum number of credit hours of continuing medical education each year to maintain their medical licenses. Not so long ago, most of these courses were produced and paid for by universities and medical associations. But this has changed drastically over the past decade. Drug-industry financing of CME has nearly quadrupled since 1998, from $302 million to $1.12 BIL. Half of all continuing medical education courses in the USA are now paid for by drug companies.

DIAGNOSIS: CONFLICT OF INTEREST, NY Times Contributor DANIEL CARLAT, June 13, 2007

Actuarial value is the proportion of claims expenses for covered services paid by the insurance plan for a large standardized population. From 2003 to 2006, the actuarial values of plans purchased in the small-group market remained statistically unchanged at 0.83; they ranged from 0.54 to 0.96 in 2006. In contrast... actuarial values in the individual market declined 27% from 0.75 to 0.55. In the individual insurance market families would have to spend 19% or 68% of their income for family coverage for median and poverty-level incomes respectively.

Health Affairs of June 14, 2007, TRENDS IN THE GOLDEN STATE: SMALL-GROUP PREMIUMS RISE SHARPLY WHILE ACTUARIAL VALUES FOR INDIVIDUAL COVERAGE PLUMMET, by J Gabel, J Pickreign, R McDevitt, H Whitmore, L Gandolfo, R Lore, and K Wilson

Where you live may help determine how long you live.The rate of premature death in Minnesota, Utah, Vermont, Wyoming and Alaska is half of that of the lowest-performing states, South Carolina, Tennessee, Arkansas, Louisiana and Mississippi. Premature death is defined as dying before age 75 from conditions that could be delayed or prevented by appropriate medical care.

USAtoday and CNN 2007-06-13, SOUTH LAGS IN REPORT CARD ON HEALTH CARE, By Julie Appleby

Health care ranks second among Democrats and independents, while Republicans rank immigration slightly ahead of health (20% vs. 18%). The poll also measures the public’s perceptions of the presidential candidates on health issues. To date, most people don’t know or can’t name the candidate who they feel is placing the biggest emphasis on health or the candidate who most matches their own views. Few people name any of the Republican candidates as placing the biggest emphasis on health care, with 2% overall naming former New York Mayor Rudy Giuliani. When asked what concerns them about rising health care costs, the poll found people are twice as likely to cite having to pay higher premiums and increased out-of-pocket costs (38%) as they are to say increases in spending on government health insurance programs like Medicare and Medicaid (18%) or increases in what the nation as a whole spends on health (18%). These views vary little based on party identification.

HEALTH IS TOP DOMESTIC ISSUE THE PUBLIC WANTS PRESIDENTIAL CANDIDATES TO ADDRESS, Kaiser Poll Finds Democrats and Independents Rank Health Second Overall

Defense Sec Gates promised to speed up changes to the military's much-criticized mental health system. A study released last week said more money and people are needed to care for military personnel suffering depression, anxiety, post-traumatic stress symptoms and other mental health problems because of their war experiences. It also said the Pentagon needs to build a culture of support throughout the military to help remove the stigma of asking for and getting psychological help. Gates said. "It is our moral obligation and duty to ensure that they are properly cared for in mind, body and spirit when they return from the battlefield. ... They have done their duty, we must do ours."

GATES VOWS TO FIX MENTAL HEALTH CARE, Friday, June 22, 2007, News and Observer Raleigh

Based on discussions with private insurers, medical costs are expected to rise by 9.9% for both preferred provider organizations (PPOs) and health maintenance organizations (HMOs) and 7.4% for consumer-directed (CDHPs) health plans. Enrollment in CDHPs is still fairly low, and it’s probably too early to determine whether these plans can lower medical costs long term.

BEHIND THE NUMBERS: HEALTHCARE COST TRENDS FOR 2008, PricewaterhouseCoopers Health Research Institute

The number of adults without health insurance [continually from Jan 1 - Dec 31] jumped by 2 million from 2005 to 2006, according to a new federal report. Uninsured Americans numbered 43.6 million last year, a 6 % increase from 2005, according to the US CDC. Almost all the increase was in the non-elderly adult population -- a trend attributed to diminishing employer coverage and pricier private insurance. Between 2005 and 2006 there was also a 4.6% increase in the number of uninsured children -- from 6.5 million to 6.8 million. Rising health insurance costs have caused employers to drop coverage and stopped people from buying it privately, experts said. "The real key issue is we've got to find means to make health care more affordable," said Ken Thorpe, an Emory University health policy professor.

US UNINSURED UP BY 2 MILLION - SWELL SEEN AMONG NON-ELDERLY ADULTS, AP June 26, 2007

A new AMA survey, paints a bleak picture of physicians' experiences with Medicare Advantage plans. More than half of the physicians report that their patients in a Medicare Advantage HMO or PPO plan were denied coverage of services typically covered in the traditional Medicare plan, and 84 % reported patients have had difficulty understanding how the plan works. Also, 51 % of physicians report that Medicare Advantage payments are below the traditional Medicare rate. Of the physicians with patients in a Medicare Advantage private fee-for-service plan, 45 % have experienced denial of services typically covered in traditional Medicare. The private health plans were supposed to inject competition into the Medicare program, but instead we've ended up with a federal handout to the insurance industry.

AMA CALLS FOR FINANCIAL NEUTRALITY IN MEDICARE ADVANTAGE, American Medical Association, May 22, 2007

California's largest health insurer has set aside $2 million for what is likely to be a deep-pocketed campaign to undermine the health care reforms being pushed by Democratic lawmakers and Gov. Arnold Schwarzenegger [who vetoed single-payer legislation for the state one year earlier]. The first shot in that campaign came when Blue Cross ran a three-quarter-page ad in The Sacramento Bee warning that the proposed insurance reforms could have unintended consequences like the energy deregulation that ushered in California's electricity crisis. A doctors' group, the California Medical Association, called the Blue Cross ad "an abomination" and accused Blue Cross of a cynical attempt to maintain high profits. Health Access, a union-backed group that advocates for the poor, said that if the health care debate is like energy deregulation, then Blue Cross is playing the role of Enron.

BLUE CROSS FUNDING CAMPAIGN AGAINST GOVERNOR'S HEALTH REFORM, The Mercury News of May 24, 2007 By Laura Kurtzman

State regulators are investigating whether a $950-million dividend Blue Cross of California sent to its Indianapolis-based parent violates an agreement the companies made to limit such payments to keep premiums down and maintain the quality of healthcare benefits. Officials said the parent, healthcare giant WellPoint Inc., should have taken no more than $141 million out of California. They called the higher amount excessive, particularly as Blue Cross, which serves more than 7 million state residents, has continued to raise premiums. WellPoint's total profit last year was $3.1 BIL on $57 BIL in revenue. "Health insurance is a competitive industry that does not exhibit excessive profit margins," WellPoint spokeswoman Troughton said.

WELLPOINT DIVIDEND IS QUESTIONED, Los Angeles Times of May 26, 2007 By Lisa Girion

The CDC's National Center for Health Statistics, found that 54.5 million Americans of all ages, or 18.6 % of the population, had no insurance for at least part of the year in 2006. "Among working-age Americans (those ages 18-64), there were 19.8 % who did not have health insurance in 2006, a 6% increase from 2005". Texas had the largest percentage of people without health insurance in 2006.

US SURVEY LOWERS UNINSURED NUMBERS TO 43.6 MILLION, Reuters Health Information Jun 25 - 2007

When Karen Armatrout died of cancer in 1997, her husband, Richard, collected a modest amount in life insurance benefits from her employer, Wal-Mart. But Armatrout claims that, unbeknownst to him, Wal-Mart also collected on a life insurance policy, one the company took out on Karen Armatrout years before without her knowledge.... This week, Armatrout filed a class-action complaint seeking what his lawyers estimate might be $80,000 in benefits that Wal-Mart supposedly collected "in bad faith" on a corporate-owned life insurance policy. Delaware, Georgia, New Jersey, North Carolina, Pennsylvania, Vermont, allow companies to take out life insurance policies on their employees without notifying them.

WALMART SECRETLY FILED LIFE INSURANCE POLICIES ON 350,000 OF ITS EMPLOYEES NATIONWIDE By Emanuella Grinberg, Court TV

For the first time in Massachussetts, many low-income patients seeking free care at hospitals will face deductibles and copayments similar to those charged to insured patients, under proposed rules designed to push more Massachusetts residents to get health insurance. In addition, the state will no longer reimburse hospitals and community health centers for care they provide if the patients are eligible for insurance through the state Medicaid program, state-subsidized Commonwealth Care, or affordable coverage through their work. Hospital officials said that they would not turn away patients needing urgent care, but that they probably would be more aggressive in billing those patients. "Patients should expect more rigorous collection and enforcement efforts" from hospitals if the new rules are imposed.

FREE CARE MAY COME AT A COST TO POOR, By Alice Dembner, Globe Staff July 13, 2007

Although there are signs of improvement in some conditions, differences in the quality of healthcare provided to men and women continue to persist. Women were more likely than men to be hospitalized for high blood pressure in 2003 -- 56 vs 38 per 100,000 population. Hospitalization for high blood pressure can usually be avoided if patients have good quality primary care. There are disparities among women by race and ethnicity. For example, although only half of all white women are screened for colorectal cancer at age 50 or older, among Hispanic and black women, the rates are even lower -- 38% and 44%, respectively. Only 71% of American Indian-Alaska Native, 76% of black, and about 78% of Hispanic women start prenatal care in the first 3 months of pregnancy, compared with 86% of white women.

MIXED RESULTS IN ELIMINATING GENDER DISPARITIES IN HEALTHCARE QUALITY, Data from the 2006 National Healthcare Quality Report and the 2006 National Healthcare Disparities Report. Medscape Business of Medicine. 2007

Healthy Wisconsin, would provide comprehensive coverage and preserve freedom of choice of doctors for all residents who are under age 65 and don't qualify for expanded Medicaid programs. Under the plan, there would be no monthly premiums and minimal co-pays and low annual deductibles. Healthy Wisconsin would be financed with a simple payroll tax paid by employees (2-4% of social security wages) and employers (9-12% of wages). Similarly, sole proprietors would pay 10% of Social Security wages and unemployed individuals not eligible for public programs would pay 10% of their adjusted gross income. To ensure affordability for low-income residents, Healthy Wisconsin expands BadgerCare, the state's Medicaid program, to 300% of income for families and to 200% for childless adults. Healthy Wisconsin is estimated to save state and local governments $1.3 BIL per year, which the Senate leaders pledged to use to reduce property taxes. The Lewin Group estimates the program will save the state $13.8 BIL over the next ten years.

VALUING FAMILIES, By Adam Thompson, for Progressive States

Researchers examined the cost-effectiveness of improving diabetes care under the HDC. Data on the impact of the Diabetes Disparities program were obtained from a serial cross-sectional follow-up study of the program in 17 Midwestern health centers. Multiple processes of care improved significantly from 1998 to 2002. With these improvements, the effort to control disparity of care was estimated to reduce background retinopathy, proliferative diabetic retinopathy and blindness. The lifetime incidence of end-stage renal disease and coronary artery disease were also reduced. Dr. Huang pointed out that the study has important implications for current public investment in health care.

IMPROVED DIABETES CARE IN COMMUNITY CENTERS SEEN TO BE COST-EFFECTIVE, By Michelle Rizzo, Health Serv Res 2007, Reuters Health Information 2007

Medicare patients will likely have a harder time seeing a doctor if proposed cuts to the program are implemented, according to a survey of doctors released by the AMA. Congress is expected to cut Medicare, the state-federal health insurance plan for the elderly, by 10 % in 2008. Some 14 % of the nearly 9,000 doctors surveyed said they would stop providing care to Medicare patients, 60 % would limit the number of new patients they would accept and 40 % would shift services to hospitals. The program covers about 43 million people who are disabled or aged 65 and older.

US DOCTORS SAY MEDICARE CUTS WILL HURT PATIENTS, By Stephanie Beasley, Reuters Health Information Jun 05 - 2007

Concerns about cost delayed or prevented about 12% of Americans from receiving healthcare in 2005, according to results of the US National Health Interview Survey. [News article incorrectly states 12% of patients, but survey was of all Americans including all those with no illness or injury for the year]. The survey also excluded dental care. The survey also asked respondents to rate their own health and that of family members living in the same household as excellent, very good, good, fair, or poor.

COST PREVENTED ABOUT 12% OF AMERICANS FROM RECEIVING US HEALTH CARE IN 2005, BY Laurie Barclay, MD, MMWR Morb Mortal Wkly Rep. 2007;56(21):535

A committee, which includes executives from IBM and Tyco International Ltd., spent more than a year studying how to overhaul corporate health and retirement benefits to rein in soaring employer costs. "Deficiencies in the current system clearly are challenging employers and, in some cases, the viability of the benefits system in general," the committee. For the nearly 45 million Americans lacking any health coverage [for a full calendar year] from an employer or government programs for the poor and elderly, the committee's proposal would make available a package of benefits. That portion of the proposal would require subsidies from state and federal government and individual contributions. Earlier this year, Wal-Mart Stores Inc. and the Service Employees International Union launched a campaign calling for universal health care coverage for all Americans by 2012, but offered no specific proposals.

BIG US EMPLOYERS PROPOSE HEALTH BENEFITS OVERHAUL, Reuters Health Information Jun 13 - 2007

Scientists has published a damning indictment of head-to-head statin trials, finding that company-sponsored studies were much more likely to report conclusions favoring their own product than the comparator agent. Most of the studies included were small and done for marketing purposes, and almost all used surrogate end points, such as lipid levels, rather than hard outcomes. Researchers were not surprised that bias was identified but "were amazed by the size of the effect." Because the trials seem to be so biased, "they don't help you to decide between drugs,", "the bottom line is that a lot of these trials don't need to be done; they are performed purely for marketing purposes."

COMPARATOR STATIN TRIALS SUFFER MASSIVE SPONSORSHIP BIAS, from Heartwire June 11, 2007 www.theheart.org, by Lisa Nainggolan/font>

One out of every eight US federal health care dollars is spent treating people with diabetes and advocates are calling for the creation of a government post to oversee coordination of spending on treatment and prevention among federal agencies. An analysis of Medco's 2007 Drug Trend Report found that, by 2009, spending just on medicines to treat diabetes could soar up to 68 % from 2006 levels. The sales of diabetes drugs in the USA reached $9.88 BIL in 2005. "Over the next 30 years, diabetes is expected to claim the lives of 62 million Americans. Surely this health crisis warrants the appointment of a manager charged with aligning budgets and programs for diabetes at the federal level". "Our findings suggest that there are many missed opportunities for the federal government to enhance its impact on diabetes prevention, detection, treatment and management of complications".

US STUDY FINDS STAGGERING COST OF TREATING DIABETICS, By Bill Berkrot, Reuters Health Information Jun 19 - 2007

The AMA said it will ask state and federal authorities to investigate retail health clinics such as those offered in CVS/Caremark stores, Wal-Mart Stores and Walgreen Co. for possible conflicts of interest. The group objects to the growing trend of drug-store chains that can write and fill prescriptions. "We asked for that clear, inherent conflict of interest to be investigated". Health insurers are allowing store-based clinics to waive or lower patient co-payments, while forcing doctors to collect these fees. octors said the clinics do not offer comprehensive care and they disrupt the standard physician-patient relationship.

AMA TO SEEK PROBE OF RETAIL HEALTH CLINICS, By Julie Steenhuysen, Reuters Health Information Jun 26 - 2007

As rising health-care costs hurt workers and retirees alike, America's trade unions are seen inching toward a broad-sweeping agreement with US corporations on health-care reform. The Better Health Care Together coalition, an unlikely mix of major companies such as Wal-Mart Stores Inc. and unions was set up to find a compromise solution on universal health care that is palatable to both business and labor. Specific proposals on the ground are thin, but universal coverage is expected to be funded jointly by employers, employees and the US government -- creating a solution that falls somewhere between the current private sector dominated US system and Canada's state-funded health-care program. Health-care costs have eroded profits to the point where many major US companies -- such as General Electric Co. and AT&T Inc. -- have spoken out on the US health-care crisis, saying reform is urgently needed.

US UNIONS MOVE TOWARD HEALTH-CARE REFORM DEAL, Reuters Health Information Jun 25 - 2007, By Nick Carey

The first US surgeon general appointed by President GW Bush accused his administration of political interference and muzzling him on key issues like embryonic stem cell research. "Anything that doesn't fit into the political appointees' ideological, theological or political agenda is ignored, marginalized or simply buried," Dr. Richard Carmona told a House of Representatives panel. The problem with this approach is that in public health, as in a democracy, there is nothing worse than ignoring science, or marginalizing the voice of science for reasons driven by changing political winds. The job of surgeon general is to be the doctor of the nation, not the doctor of a political party. Carmona said Bush administration political appointees censored his speeches and kept him from talking out publicly about certain issues.

FORMER BUSH SURGEON GENERAL SAYS HE WAS MUZZLED, Reuters Health Information Jul 10 - 2007

Electronic health records -- touted by policymakers as a way to improve the quality of health care -- failed to boost care delivered in routine doctor visits. Of 17 measures of quality assessed, electronic health records made no difference in 14 measures, according to a study published in the Archives of Internal Medicine. The study was based on a survey of 1.8 billion physician visits in 2003 and 2004. Electronic health records were used in 18 % of them. The 14 quality indicators for which electronic records made no significant difference included such factors as prescribing recommended antibiotics; diet and exercise counseling for high-risk adults; screening tests; and avoiding potentially inappropriate prescriptions for elderly patients. President GW Bush has set a goal for all Americans to have electronic medical records by 2014.

ELECTRONIC HEALTH RECORDS DON'T LIFT CARE: US STUDY, By Julie Steenhuysen, Jul 10 - 2007 Reuters

NATL: Wal-Mart Stores Inc. said it will contract with local hospitals and other organizations to open as many as 2,000 clinics in Wal-Mart stores over the next five to seven years. "We think the clinics will be a great opportunity for our business. But most importantly, they are going to provide something our customers and communities desperately need -- affordable access at the local level to quality health care" said CEO Scott.

WAL-MART TO OPEN 400 IN-STORE CLINICS, Reuters, April 24, 2007

NATL: Rep. John Dingell (D-Mich.) and Sen. Ed Kennedy are introducing legislation to extend Medicare to all Americans, from birth to the end of life. In addition, our plan will reduce costs and improve quality, including more effective use of health information technology. It also puts a new emphasis on preventive care, because preventing illness before it occurs is always better and less expensive than treating patients after they become ill. Our proposal will be entirely voluntary. Americans who wish to stay in their current employer-sponsored plans can do so. Those who prefer private insurance can choose any of the plans offered to members of Congress and the president.

THE TIME IS NOW: MEDICARE FOR ALL, April 24, 2007, The Politico, By Sen E Kennedy

ME: When Maine became the first state in years to enact a law intended to provide universal health care, one of its goals was to cover the estimated 130,000 residents who had no insurance by 2009, starting with 31,000 of them by the end of 2005. So far, it has not come close to that goal. Only 18,800 people have signed up for the state's coverage by spring 2007 and many of them already had insurance. While some people have benefited from the subsidized insurance, others have found it too expensive. And premiums have increased, not become more affordable, because some of those who signed up needed significant medical care, and there are not enough enrollees, especially healthy people unlikely to use many benefits.

AS HEALTH PLAN FALTERS, MAINE EXPLORES CHANGES, by Herb Swanson for The New York Times, Published: April 30, 2007

NATL: Insurance companies have used improper hard-sell tactics to persuade Medicare recipients to sign up for private health plans that cost the government far more than the traditional Medicare program, federal and state officials and consumer advocates say. Federal officials said that the fastest-growing type of Medicare Advantage plan generally does not coordinate care, does not save money for Medicare and has been at the center of marketing abuses. These private fee-for-service plans allow patients to go to any doctor or hospital that will provide care on terms set by the insurer. In most cases, no one manages the care. And some patients have found that they have less access to care, because their doctors refuse to take patients in private fee-for-service plans. Moreover, those plans may be more expensive than traditional Medicare for some patients.

HARD SELL CITED AS INSURERS PUSH PLANS TO ELDERLY, By ROBERT PEAR, May 7, 2007

NATL: Blue Cross of California which has been under scrutiny for retroactively canceling health insurance policies leaving patients with unpaid medical bills has agreed to a class-action settlement that would sharply alter its practice and could set a precedent for other insurers. At issue is a longstanding industry practice: canceling coverage after patients make costly claims, if insurers find mistakes or omissions on application forms completed by policyholders. The practice, called "rescission," affects people who buy their own insurance, not those covered under group plans, such as job-based coverage. [Hey, they're in the business of insuring those well enough, not to need it.]

BLUE CROSS TO SETTLE CASE IN CLASS ACTION, USA TODAY, May 14, 2007, By Julie Appleby

NATL: The results of the new AMA survey of physician experience with Medicare Advantage plans are troubling. More than half of the physicians report that their patients in a Medicare Advantage HMO or PPO plan were denied coverage of services typically covered in the traditional Medicare plan, and 84% reported patients have had difficulty understanding how the plan works. The private health plans were supposed to inject competition into the Medicare program, but instead we've ended up with a federal handout to the insurance industry.

AMA CALLS FOR FINANCIAL NEUTRALITY IN MEDICARE ADVANTAGE, American Medical Association, May 22, 2007

NATL: A committee of US senators got an earful about controversial private Medicare plans that have caused hundreds in North Carolina to complain about their over-aggressive marketing and questionable value. The Senate's Committee on Aging is looking into allegations of abuse among insurers who market Medicare Advantage policies, which are private medical plans for seniors that are paid with federal Medicare dollars. It could recommend changes in how the plans are policed. "I want to assure each of your companies that I am not going to work 10 years to get this corrected -- we are going to drain this swamp," Sen. Ron Wyden, D-Ore., told the industry representatives.

INSURANCE ABUSE CLAIMS AIRED, News and Observer, Raleigh NC May 17

NATL: Over the past decade, health plans have sought to save money by shifting costs to workers and encouraging them to use lowercost generics. But the new model - which involves lowering or eliminating co-payments on medications for chronic illnesses makes better medical sense. And it may save even more money by preventing costly health crises down the road. For instance, a heart-attack patient who no longer has to pay for a costly but essential blood thinner is more likely to take it regularly - and reduce the chances of a second attack or eventual surgery. Employers such as Marriott International, Procter & Gamble and Eastman Chemical have now reduced or eliminated copayments for drugs for certain chronic conditions, such as heart disease. Pitney Bowes, which gives away diabetes and asthma drugs, has lowered copayments this year for osteoporosis treatments, antiseizure medications and prenatal supplements. And at least one major insurer, Aetna, is studying whether to implement the approach with certain drugs and patients across its health plans.

CUTTING DRUG CO-PAYS TO CUT COSTS, May 13 By Vanessa Fuhrmans The Wall Street Journal

INTL: Americans have ,the costliest health-care system in the world, and it gets poorer results than programs in the U.K., Canada, Germany, Australia and New Zealand, according to a new report. The U.K. had the best healthcare system in the world in "quality care, access, efficiency, equity and healthy lives" according to the Commonwealth Fund study. The U.K. also spends less per person than either the US or Canada. The US differs from the other nations studied in one "notable way": it doesn't have universal health insurance. There were 45.8 million officially uninsured people in the US in 2004. The number ,represents 15.7% % of the civilian population that isn't in a long-term care facility [but it would be 50% higher if it included people uninsured for 3 months or more of the year, rather than just Jan 1 - Dec 31 consecutively]. Total health-care spending in the US was an average of $6,102 per person in 2004. Canada, which ranked fifth in quality among the countries, was the next-highest spender, with $3,165 per person. Germany, second in quality, spent $3,005 or 50% of that in the USA.

PEOPLE IN OTHER COUNTRIESPAY LESS, GET BETTER TREATMENT, Bloomberg News New York May 16

NATL: The US Medicare Hospital Insurance trust fund will exhaust its assets in 2019 instead of the 2018 date forecast and the Social Security trust fund also extended its exhaustion date by a year to 2041 says the Bush administration both programs needing urgent reform. President GWB said the new Medicare prescription drug program, which relies mostly on private insurers to deliver the benefits to seniors, should serve as an example during the Medicare reform debate, adding, "competition works, competition can lower price, and improve the quality" for beneficiaries. The report warned that financing for the drug program and other parts of Medicare will have to increase rapidly to match expected cost increases.

MEDICARE FUND EXHAUSTED IN 2019, Apr 23, Reuters Health Information 2007. © 2007 Reuters Ltd.

NATL: Outdated US policies are keeping many disabled Americans from getting help they need. "Society must do more now before a crisis is upon us," Alan Jette, director of Boston University's Health and Disability Research Institute and head of the Institute of Medicine panel. "Far too little progress has been made in the last two decades to prepare for the aging of the baby boom generation and to remove the obstacles that limit what too many people with physical and cognitive impairments can achieve," Jette added. Jette told reporters he hoped the return home of thousands of US soldiers who suffered disabling combat wounds in Iraq and Afghanistan would bring greater national attention to the plight of disabled Americans. The 14-member panel urged the government to change rules blocking the disabled from getting equipment and services to help them work and do other activities outside the home. The panel urged Congress to scrap a two-year waiting period for Medicare eligibility for people receiving Social Security disability insurance.

EXPERT PANEL FAULTS US POLICIES ON DISABLED PEOPLE, By Will Dunham Apr 25 Reuters Health Information 2007. © 2007 Reuters Ltd.

NATL: Pres GWB said he was ordering implementation of a government-wide "action plan" to improve health care and related services for US troops and returning veterans. In March, President Bush apologized to wounded US troops who endured dilapidated conditions and bureaucratic delays at Walter Reed Army Medical Center [not a VA facility by the way], the flagship military hospital in Washington. There have also been questions about military mental health care. The GAO reported last year that just 22% of US troops returning from Iraq and Afghanistan who showed signs of Post Traumatic Stress Disorder were referred by the Pentagon for mental health evaluations.

BUSH ORDERS VETERANS HEALTH ACTION PLAN IMPLEMENTED By Todd Eastham Apr 25 Reuters Health Information 2007. © 2007 Reuters Ltd.

NATL: Prompted by the Virginia Tech massacre, a US Congress reluctant to tackle gun control may pass limited legislation to help keep firearms out of the hands of the mentally ill. The proposed bill would provide money to the states to help update the national instant-check background system with mental-health adjudications, which ban firearm purchases. In the House of Representatives, Rep. Charles Dingell, a Michigan Democrat and gun-rights proponent, has teamed up on such legislation with Rep. Carolyn McCarthy, a leading gun control advocate. "We're not working to take handguns away from people. But what we do believe is that we need to curb the availability of these weapons to prohibited classes: felons, fugitives, and of course in this case, those who have been adjudicated mentally ill," said Sarah Brady.

US CONGRESS MAY ACT TO KEEP GUNS FROM MENTALLY ILL By Thomas Ferraro Apr 23 , Reuters Health Information 2007. © 2007 Reuters Ltd.

NATL: Fewer US employers are offering health benefits, mostly because many new small employers have chosen not to pay for health insurance. The GAO found an 8% drop in the share of small employers offering benefits from 2001 to 2006 and said many employers that offer health benefits now make workers pay a higher share of out-of-pocket costs. Some also have begun offering consumer-directed health plans, which trade lower premiums for significantly higher deductibles, or mini-medical plans that provide more limited coverage at lower premiums. "Some of these recent changes to health benefits may particularly affect low-wage workers who are less able to afford higher out-of-pocket costs, and less healthy workers who use more health services" added the GAO. At least 46 million Americans have no health insurance at all for the entire calendar year.

FEWER US EMPLOYERS OFFER HEALTH BENEFITS: STUDY May 01 ,Reuters Health Information 2007. © 2007 Reuters Ltd.

NATL: Aetna Inc. reported an 8% rise in first-quarter profit, helped by an increase in enrollment and improved operating cost controls [less payment for care], and the health insurer raised its 2007 forecast. Net income at the Hartford, Connecticut-based company rose to $435 MIL from a year earlier. Aetna shares were up $2.02, or 4.5 % on the New York Stock Exchange.

AETNA SHARES HIT YEAR HIGH AS PROFIT BEATS STREET, By Lewis Krauskopf, Apr 26, Reuters Health Information 2007. © 2007 Reuters Ltd.

NATL: In a setback for supporters of legalizing the import of cheaper drugs into the United States, the Senate voted 49-40 for an amendment to require safety certification of drugs from abroad. The Senate approved the Dorgan importation measure by a voice vote, but Dorgan supporters said the Cochran amendment makes drug importation unworkable and, if ultimately adopted, would preserve the US drug market status quo. Many of the drugs that Americans take are sold in other countries at lower cost [because other countries negotiate prices for their whole populations]. Pres GWB had vowed to veto the entire package of drug legislation if it included an importation provision that failed to address safety concerns [i.e. if importation were viable].

US SENATE BACKS DRUG IMPORT SAFETY CERTIFICATION May 08 Reuters Health Information 2007. © 2007 Reuters Ltd.

NATL: US hospitals are charging uninsured patients about two-and-a-half times more than those with health insurance. The mark-up has been steadily rising despite pressure to level prices. In 2004, the most recent year for which data was available, hospital patients without health insurance and others who pay for medical care out of their own pockets were charged an average 2.6 times more than those with health insurance, according to the study published in the May-June issue of the journal Health Affairs. That number has been rising steadily since 1984, but has jumped more quickly since 2000. Hospitals in the USA have come under fire from patient groups and lawmakers for marking up prices for those lacking the negotiating clout of a health insurer. But the price discrepancies are steadily worsening. For-profit hospitals had the highest discrepancy between costs estimated by Medicare and prices charged.

US HOSPITALS CHARGE UNINSURED MORE, STUDY SAYS, By Kim Dixon May 08 , Reuters Health Information 2007. © 2007 Reuters Ltd.

NATL: At hospitals already running at full or over capacity, high admission rates and low staffing levels are associated with an increased risk of adverse patient events. The data suggest that high workload may be risky at organizations with little slack, and suggest that administrators should adopt an array of measures to try to minimize risk under these circumstances.

BUSY ADMISSION DAYS MAY JEOPARDIZE PATIENT SAFETY AT OVERLOADED HOSPITALS May 04Reuters Health Information 2007. © 2007 Reuters Ltd.

NATL: A growing diabetes epidemic and more aggressive treatment with combination drug therapies could result in a rise of nearly 70% in drug spending on the disease through 2009. The analysis projects that, by 2009, spending on medicines to treat diabetes could soar by 60% to 68% from 2006 levels. Spending on diabetes treatments increased 14.5% from 2005 to 2006 and the use of diabetes drugs increased 5.1%. The US sales of diabetes drugs reached $9.88 BIL in 2005. An aging population and the alarming rise in obesity -- a leading cause of diabetes -- are expected to push spending growth rates on diabetes drugs up 16% to 20% annually. But while new medicines and combination therapies can be expensive, the cost of treating complications from untreated diabetes would create a much larger burden on government and private health plans and patient pocketbooks.

DIABETES DRUG COSTS COULD SOAR 70% BY '09 By Bill Berkrot May 17 Reuters Health Information 2007. © 2007 Reuters Ltd.

INTL: Most English hospital patients are pleased with their care, but hospitals still have room to improve by speeding up treatment and providing more single-sex wards. More than nine out of ten patients described their care as either "excellent", "very good" or "good" in an annual survey. Only two % rated their care as "poor". "Looking at waiting times, trusts need to improve the patient's journey through all parts of the hospital, from arriving at A&E to discharge," she said. "It is also clear that for a significant minority of patients the NHS is performing below standards on segregated accommodation," she said. "It is heartening to see that, contrary to what critics of the NHS say, the overwhelming majority of patients are happy."

ENGLAND HOSPITALS PLEASE PATIENTS BUT CAN IMPROVE By Tim Castle May 16 Reuters Health Information 2007. © 2007 Reuters Ltd.

NATL: Prescriptions for psychotherapeutic drugs were filled by 21 MIL US outpatients in 1997 vs 32.6 million outpatients in 2004. During the same time period, total expenses, total purchases, and average price per purchase also increased for outpatient psychotherapeutics overall and for each of 4 subclasses. The fact that the volume [of outpatient psychotherapeutic drug prescriptions] has increased so radically should be interpreted as a good thing, because we've known that mental illness has been grossly undertreated for many years.

PRESCRIPTION PSYCHOTHERAPEUTIC DRUG SPENDING SURGES May 14, 2007 Medscape Medical News 2007. © 2007 Medscape

NATL: Director Michael Moore says the US health care system is driven by greed in his new documentary "SiCKO", and asks of Americans in general, "Where is our soul?" In "SiCKO" he turns his attention to health, asking why 50 million Americans, 9 million of them children, live without cover, while those that are insured are often driven to poverty by spiralling costs or wrongly refused treatment at all. But the movie, which has taken Cannes by storm, goes further by portraying a country where the government is more interested in personal profit and protecting big business than caring for its citizens, many of whom cannot afford health insurance. One part of the film follows a woman whose young daughter falls seriously ill but who said she was refused admission to a general hospital and instructed to go to a private one instead. By the time she got to the second hospital, it was too late to save the girl.

MOORE FILM ATTACKS US HEALTH CARE By Mike Collett-White May 21Reuters Health Information 2007. © 2007 Reuters Ltd.

PA: The merger of two Pennsylvania nonprofits, if approved by state and federal regulators, would create the nation's third largest health insurer based on premiums collected. The boards of Independence Blue Cross of Philadelphia and Highmark Inc. of Pittsburgh separately approved a merger this week. Though the yet-to-be-named company would collect just over half the amount in premiums compared with the nation's second largest insurer, the announcement was met with some trepidation by doctors, hospitals and lawmakers in the companies' home state. The two insurers said the combined company will have the financial resources to hold down administrative fees for the next two years, saving customers $300 million; better manage drug costs to save consumers $280 million; and provide over $650 MIL to help the state's uninsured get access to health insurance. The company would control over 53 % of Pennsylvania's insurance market.

MERGER WILL FORM MASSIVE HEALTH INSURER, By DEBORAH YAO, The Associated Press, March 29, 2007

NATL: Rising health care costs are eating up more of retirees' savings, with a 65-year-old couple retiring this year needing about $215,000 to cover medical costs over the rest of their lives, Fidelity Investments said. Fidelity estimated that 32 % of the $215,000 estimate _ up from $200,000 a year ago _ would be for Medicare coverage premiums for expenses from doctors' visits, outpatient hospital care and prescription drugs. Another 35 % of the expenses would come from other cost-sharing provisions of Medicare, including co-payments and deductibles. Out-of-pocket costs for prescriptions would account for another 33 %. Fidelity projects that a 65-year-old worker who now earns $60,000 a year and expects to retire at the end of this year should expect that 50 % of his or her pretax Social Security benefit will be eaten up by health expenses in the next 16 to 18 years.

FIDELITY SAYS RETIREE HEALTH COSTS RISE, By M JEWELL AP, Mar 27, 2007

CA: Mary Rose Derks was a 65-year-old widow in 1990, when she began preparing for the day she could no longer care for herself. Every month, out of her grocery fund, she scrimped together about $100 for an insurance policy that promised to pay eventually for a room in an assisted living home. When she filed a claim with Conseco, it said she had waited too long. Then it said Beehive Homes was not an approved facility, despite its state license. Eventually, Conseco argued that Mrs. Derks was not sufficiently infirm, despite her early-stage dementia and the 37 pills she takes each day. After more than four years, Mrs. Derks, now 81, has yet to receive a penny from Conseco, while her family has paid about $70,000. Long-term-care insurers have developed procedures that make it difficult [if not impossible] for policyholders to get paid. In California alone, nearly one in every four long-term-care claims was denied in 2005, according to the state. The bottom line is that insurance companies make money when they don’t pay claims, if they wait long enough, they know the policyholders will die.

AGED, FRAIL AND DENIED CARE BY THEIR INSURERS, By CHARLES DUHIGG, March 26, 2007,

NATL: HSS Sec Mike Leavitt said that cutting managed care payments to insurers serving the elderly is part of a broader effort by some lawmakers to get the federal government to run health care. "There are those who want the government to do the market's job," Leavitt told members of America's Health Insurance Plans, a trade group. "They want to steer Americans into a government run, one-size-fits-all plan." Democratic lawmakers have listed the expansion of the State Children's Health Insurance Program as their top health priority this year. Their goal: Increase enrollment in the program from about 6 million children to about 12 million. The cost would be about $75 BIL over five years _ triple current funding. Many Democrats say some of the money necessary for an expansion should come from the managed care plans that enroll Medicare beneficiaries. Leavitt said the Democrats also wanted to expand the program to middle-income adults. The federal government spent about $56 BIL last year on the managed care plans, also called Medicare Advantage. Enrollment in the plans has been growing quickly in recent years, and they now serve about 20 % of all beneficiaries.

LEAVITT REASSURES INSURERS IN FUND TALKS, March 22, 2007, By KEVIN FREKING 2007 The Associated Press

NATL: For the sixth year in a row, manufacturers' prices of brand-name prescription drugs rose last year at roughly twice the rate of inflation, according to a report released Tuesday. Prices for the 193 drugs most commonly used by that age group increased an average of 6.2 % in 2006, while the Consumer Price Index rose 3.2 %. AARP has been pushing for several changes in federal laws related to pharmaceuticals, including both allowing Medicare to negotiate for lower prices and allowing the importation of medicines from Canada. Both of which the Bush administration has fought. [Negotiation of prices ] would kill the efficient system of competitive negotiation for drug prices now in place, in which pharmacy benefit managers and private plans negotiate on behalf of as many as 200 million people and it could result in Medicare limiting the number of drugs it covers and restricting patient access to potentially life-saving medicines explained the industry spokesperson.

AARP: DRUG PRICES ZOOM, By Larry Lipman, Cox Washington Bureau, 03/07/07

NATL: It sounds simple enough: Get everyone insured by requiring them to purchase health insurance. So-called "individual mandates" are part of Massachusetts' plan to get all residents covered. They are included in a proposal by California Gov. Arnold Schwarzenegger. Just a few weeks ago, this editorial page told the story of Jan and Gary Clausen, who didn't have the option of buying health insurance through an employer. They went out on their own and bought AARP- endorsed plans for about $700 a month. They were left with more than $200,000 in medical bills after Gary was diagnosed with cancer. Some insurance. If the state is going to force people to purchase insurance, it must guarantee necessary services are covered and the bills are paid when health disasters strike. It must require insurance companies to protect Iowans against catastrophic costs.

MANDATING PRIVATE HEALTH INSURANCE IS MISGUIDED TAXPAYER-FINANCED HEALTH COVERAGE IS A BETTER APPROACH, By the Editorial Board, The Des Moines Register, March 5, 2007

CA: Wayne Forbess did a double take after seeing that his monthly premium for health insurance from Kaiser Permanente would shoot up by 50 % this year. The 78-year-old Folsom resident and thousands of other federal workers and retirees in Northern California are coping with double- digit increases in the monthly payments for HMO coverage. Federal workers enrolled in three other plans have seen their monthly payments increase by more than 20 %. "The idea is to keep the government share the same from year to year. The enrollee is stuck paying the difference," said Mark Merlis, a health-care consultant and expert on federal health benefits. "There is a cap on what the government pays. But there's no cap on what the employee pays. We pay a bigger share every year," said Jacqueline Simon public policy director of the American Federation of Government Employees, the largest federal employee union, representing 600,000 members.

HEALTH FEES PAIN FEDERAL WORKERS, By Gilbert ChanThe Sacramento Bee, Feb 11, 2007

NATL: If private health plans are supposedly so great at delivering high- quality care while holding down costs, why does the government have to keep subsidizing them so lavishly to participate in the Medicare program? About a fifth of elderly Americans now belong to private Medicare Advantage plans, which -thanks to government subsidies- often charge less or offer more than traditional Medicare. As Congress struggles to find savings that could offset the costs of other important health programs, it should take a long and hard look at those subsidies. When the Democrats first won control of Congress, it seemed possible that they might eliminate the subsidies -saving some $54 BIL over five years- to finance a $50 BIL expansion of a health insurance program for low-income children. But the insurance industry has mounted a furious lobbying campaign to head off any cuts.

THE MEDICARE PRIVATIZATION SCAM, April 21, 2007, NY Times

NATL: Drug makers spent $155 MIL lobbying the federal government from 2005 to mid-2006, setting a record that they could top this year as Congress considers high stakes legislation for the industry and consumers. Pharmaceutical industry officials said the report distorted the industry's role in Washington, which they say is primarily educational and scientific. Lobbying is only one facet of the industry's influence. Drug company sources also accounted for more than $19 MIL in political contributions to candidates in last year's congressional election, mainly Republicans. And user fees paid by drug makers make up more than half the budget of the Food and Drug Administration centers that evaluate new drugs. The industry's budget enabled drug makers to field about 1,100 agents to lobby congressional committees and administration offices in each of the last two years, the study said. The industry achieved several of its major objectives, the report added, including upholding the government's ban on imports of lower-cost medications from abroad, as well as preserving government hands-off price regulation.

DRUG MAKERS SET LOBBYING RECORD, By Ricardo Alonso-Zaldivar, LA Times April 3, 2007

MA: Massachusetts has moved away from the promise of "universal" health coverage at every step as it implements its insurance mandate, and now turns a blind eye to costs that will stop even the "insured" from getting needed care, said the nonprofit, nonpartisan Foundation for Taxpayer and Consumer Rights (FTCR). "Affordable health insurance" assumes consumers will never get sick because it does not consider the deductibles, co-pays and co-insurance that consumers must pay under the new benefit plans. According to the state's own figures, many consumers cannot afford the lowest-priced existing health plan, even before taking out of pocket costs into consideration. The cheapest health plans currently available are not affordable for any person, of any age, who earns just above 300% of the federal poverty level, including: 1) Individuals making $30,000 to $35,000 2) A couple making $41,071 to $50,000 or 3) A family and children bringing in $51,511 to $70,000. None of those populations can afford even the bare bones coverage.

MASS. PROMISE OF "UNIVERSAL" HEALTH CARE FORGOTTEN -- NEEDED CARE WOULD BE UNAFFORDABLE UNDER INSURANCE MANDATE, April 12, 2007, ConsumerWatchdog.org

NATL: Wal-Mart Stores Inc. is forecasting more than 6,600 in-store medical clinics will open their doors in the next five years in retailers nationwide. With 75 clinics in Wal-Mart stores in 12 states, the company has ended its pilot program and plans a fast roll-out of additional clinics nationwide. Wal-Mart's move into retail health care also includes a program of providing certain generic drugs for $4 for a 30-day supply. In the program's first three months Wal-Mart said consumers and the government saved more than $200 MIL on prescriptions.

WAL-MART SEES MEDICAL CLINIC BOOM IN RETAIL STORES (Reuters) Apr 13 2007

NATL: In general, the Medicare statute provides coverage only for diagnosis and treatment of an illness, injury or impairment of a body part. However, through a series of legislative changes over the years, the Medicare program now covers a broad range of preventive and screening services for Part B beneficiaries. On Jan. 1, 2007, Medicare began paying for preventive ultrasound screening for abdominal aortic aneurysms for at-risk beneficiaries. The screening will be available to men age 65 to 75 who have smoked at least 100 cigarettes in their lifetimes, individuals with a family history of abdominal aortic aneurysm and any other individuals recommended for screening. Medicare expanded the bone mass measurement benefit by increasing the number of patients who qualify due to long-term steroid therapy. Medicare exempted colorectal cancer screening from the Part B deductible, eliminating a potential financial barrier to using this benefit.

WHAT'S NEW IN MEDICARE PREVENTIVE BENEFITS, 04/23/2007, Kent J. Moore

NATL: The Methodist Hospital's Baccalaureate Nurse Residency Program was implemented to reduce the turnover rate of graduate nurses and to assist with the successful transition to leader at the bedside. Turnover at the end of year was 13%, a dramatic improvement from the 50% turnover rate in 2004. The program is cost effective with a savings of $823,680. Clearly, investment in the residency program influences new hire retention.

RETURN ON INVESTMENT: BENEFITS AND CHALLENGES OF A BACCALAUREATE NURSE RESIDENCY PROGRAM, 04/23/2007, Rosemary Pine

NATL: The U.S. Supreme Court's ruling that outlawed a certain abortion procedure could be a first step of greater government intrusion into private medical decisions, doctors said. The ruling will also almost certainly intimidate doctors who provide any type of abortion services, according to a series of commentaries in the New England Journal of Medicine. "With this decision the Supreme Court has sanctioned the intrusion of legislation into the day-to-day practice of medicine," Dr. Jeffrey Drazen, editor of the journal. Alta Charo, a professor of law and bioethics at the University of Wisconsin, said the law would only directly affect a handful of abortions -- with just 2,200 out of 1 million abortions in 2000 having been intact dilation and extraction procedures. But they are done when physicians consider them medically necessary, she said. This is the first law that does not consider a woman's health, Charo said.

SUPREME COURT ABORTION RULE CHILLS DOCTORS: By Maggie Fox, (Reuters) Apr 24, 2007

NATL: As much as doctors would like to deny it, subtle attention from friendly drug sales representatives can have a big impact on what drugs they prescribe, according to two U.S. studies. Physicians underestimate their own vulnerability. They think they are smarter... but they are not trained in recognizing this kind of manipulation. Reps scour a doctor's office for objects -- a tennis racquet, Russian novels, '70s rock music, fashion magazines, travel mementos or cultural or religious symbols -- that can be used to establish a personal connection with the doctor. A friendly physician makes the rep's job easy because the rep can use the 'friendship' to request favors, in the form of prescriptions. Besides free drug samples, salespeople often bring gifts, lunch for the doctor or office staff, new pens and coffee mugs. The doctor feels subtly, even subconsciously, indebted to the representative.

POSING AS PALS, DRUG REPS SWAY DOCTORS' CHOICES, By Julie Steenhuysen (Reuters) Apr 24, 2007

NATL: Prompted by the Virginia Tech massacre, a U.S. Congress reluctant to tackle gun control may pass limited legislation to help keep firearms out of the hands of the mentally ill. Democrats, who had earlier championed such measures, including a since expired 1994 ban on assault weapons, effectively abandoned the issue when they won control of Congress in 2006. Yet after it was determined that the Virginia Tech killer had been admitted earlier to a psychiatric hospital and deemed "a danger to himself and others," lawmakers dusted off previously rejected legislation. [Great unless the mentally ill go to a gun show.]

U.S. CONGRESS MAY ACT TO KEEP GUNS FROM MENTALLY ILL, By Thomas Ferraro, (Reuters) Apr 23, 2007

NATL: The U.S. Medicare Hospital Insurance trust fund will exhaust its assets in 2019 instead of the 2018 date forecast last year. The Social Security trust fund also extended its exhaustion date by a year to 2041. "Without change, rising costs will drive government spending to unprecedented levels, consume nearly all projected federal revenues and threaten America's future prosperity," said the Bush Treasury Sec Paulson. Prez GW Bush said the new Medicare prescription drug program, which relies mostly on private insurers to deliver the benefits to seniors, should serve as an example during the Medicare reform debate, adding, "competition works, competition can lower price, and improve the quality" for beneficiaries.

MEDICARE FUND EXHAUSTED IN 2019 (Reuters) Apr 23 2007

NATL: Consistent with extensive research and findings in previous reports, this 2006 report finds that disparities related to race, ethnicity, and socioeconomic status still pervade the American health care system. Although varying in magnitude by condition and population, disparities are observed in almost all aspects of health care.1) Blacks received poorer quality care than Whites for 73% (16/22) of core measures. Blacks received better quality care than Whites for 9% (2/22) of core measures. (Blacks had significantly lower rates of physical restraints among nursing home residents and suicide deaths than Whites.) 2) Hispanics received poorer quality of care than non-Hispanic Whites for 77% of core measures (17/22) and better quality care for 18% (4/22) of core measures. (Hispanics had lower rates of late-stage colorectal cancers, colorectal cancer deaths, and suicide deaths and higher rates of adequate hemodialysis.) 3) Poor people received lower quality of care than high income people for 71% (12/17) of core measures and better quality care for 6% (1/17) of core measures. [Apologies for slavery? How about ending second class citizenship in 2008 and recognizing human rights today?]

DISPARITIES REMAIN PREVALENT, The National Healthcare Disparities Report, 2006; Summary From AHRQ, 02/28/2007

NATL: Approximately 14% of Americans who need healthcare get help too late or not at all. Lengthy waits for medical tests or emergency department (ED) treatment are among the most common problems. This ranges from having to wait an overly long time to be seen, to having to wait a long time to have a test done. The lack of timeliness can result in emotional distress, physical harm, and higher treatment costs. Among Americans ages 18 to 64, approximately 19% sometimes or never get timely appointments for routine care, as opposed to 9% of children and 7% of persons age 65 and older; The likelihood of getting timely care for an illness or injury is not much better: 18% of 18- to 64-year-olds, 9% of children, and 5% of elderly patients. This data is based on the 2006 National Healthcare Quality Report.

LENGTHY WAITS FOR TESTS OR EMERGENCY DEPARTMENT TREATMENT COMMON, 03/02/2007, Agency for Healthcare Research and Quality (AHRQ)

NATL: Harmful medication errors are over three times more likely in the perioperative setting than in all other areas of the healthcare system, a finding that may stem from a fragmented surgery system. Children are at particularly high risk for such errors. Roughly 5% of the more than 11,000 perioperative medication errors studied resulted in a harmful outcome, including four deaths. The MEDMARX study is the largest known national report to look at medication errors in the perioperative setting. This higher rate may be because many hospital departments are typically involved in the care of a surgical patient and therefore, there is a greater opportunity for mistakes to occur as information is passed from one department to the next. A lack of comprehensive oversight of medications increases the risk further. The highest rate of harmful medication errors, 7.3%, occurred in the operating room. The postanesthesia care unit had the next highest rate at 5.8%, followed by the outpatient surgery department at 3.3%, and lastly the preoperative holding area at 2.8%.

HIGH RATE OF HARMFUL MEDICATION ERRORS IN PERIOPERATIVE SETTING, (Reuters Health) Mar 06 2007

INTL: Russian prosecutors are investigating a local hospital on suspicions it illegally tested vaccines made by GlaxoSmithKline Plc on toddlers, making them ill and hampering their development. Glaxo vaccines were tested on more than 100 children between one and two years of age at the hospital in Volgograd after Russian health authorities approved the trials in 2005. Prosecutors claim parents were not properly informed and they thought these were routine vaccinations. According to the prosecutors, Glaxo paid the clinic in southwestern Russia $50,000 to conduct the trials, which made some children ill. In this case all children were sent for trials, healthy or unhealthy, and many of them had been diagnosed with diseases. They had no right to put children with health problems through these clinical tests because... it can lead to a deterioration in the child's condition.

RUSSIA PROBES "ILLEGAL" TESTS OF GLAXO VACCINES, By Olesya Dmitracova, (Reuters) Mar 02 2007

NATL: A prescription drug benefit of the U.S. Medicare program is a "financially irresponsible" addition to a system that was already on course for possible bankruptcy, the U.S. government's top accountant said. "The prescription drug bill is probably the most fiscally irresponsible piece of legislation since the 1960s... because we promise way more than we can afford to keep," U.S. Comptroller General Walker said on CBS' "60 Minutes." Walker said $8 TRIL would be needed immediately, invested at treasury rates, to cover the gap between what Medicare is expected to take in and what it is expected to cost over the next 75 years [while keeping profits for the drug companies astronomical and prices non-neotiated]. The first wave of baby boomers begins collecting Social Security benefits next year. "They'll be eligible for Medicare just three years later and when those boomers start retiring en masse, then that will be a tsunami of spending that could swamp our ship of state if we don't get serious," Walker said.

U.S. PRESCRIPTION DRUG PLAN UNAFFORDABLE: OFFICIAL, (Reuters) Mar 05 2007

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