CT: A bill would turn the tables on managed care has health insurers hustling to protect their ability to deny claims, while consumer advocates and doctors are lobbying hard for the change. The proposal would shift the burden of proof to insurers that deny coverage, requiring them to show why a particular medical service is not medically necessary. Currently, consumers and their doctors who appeal insurers' decisions must show that something is medically necessary. This legislation seeks to restore consumer control over health care decisions by creating a presumption ... that a physician's diagnosis and treatment is medically necessary. The Connecticut Association of Health Plans urged legislators to reject the bill, saying the state has a successful "external appeals" process to settle medical necessity disputes - a process the industry initially opposed.

Measure Targets Managed Care, Would Shift Burden Of Proof To Insurers, Feb 23, 2007 By DIANE LEVICK, Courant Staff Writer

NATL: John Edwards has a better plan for solving US health care woes than those offered by most presidential candidates and the governors in California and Massachussetts. At least the Edwards plan involves the government negotiating the insurance plan for the pool of Americans not otherwise insured and people will have the option of choosing a public Medicare type plan. And no private company would be able to screen out high-risk clients. They'd have to insure the whole pool. The system may evolve toward a single-payer approach if individuals and businesses prefer the public plan.

NY Times February 9, 2007, "Edwards Gets It Right" By PAUL KRUGMAN

NATL: Access to affordable health care is at the top of the public’s domestic agenda, ranked far more important than immigration, cutting taxes or promoting traditional values. Only 24% said they were satisfied with President Bush’s handling of the health insurance issue, and 62% said the Democrats were more likely to improve the health care system. Americans showed a striking willingness in the poll to make tradeoffs to guarantee health insurance for all, including paying as much as $500 more in taxes a year and forgoing future tax cuts. While Democrats are traditionally strong supporters of expanding health coverage, this survey found many Republicans and independents in agreement. The nationwide telephone poll of 1,281 adults was conducted Feb. 23- 27, and has a margin of sampling error of plus or minus three percentage points. The poll found Americans across party lines willing to make some sacrifice to ensure that every American has access to health insurance. Sixty percent, including 62% of independents and 46 % of Republicans, said they would be willing to pay more in taxes.

NY Times, March 2, 2007, "Most Support US Guarantee of Health Care" By ROBIN TONER and JANET ELDER

NATL: When the AFL-CIO Executive Council meets March 6-8, it will be deciding what to do about the nation’s most important domestic problem, health insurance for all Americans. It should recognize the wishes of MILs of union members and endorse and campaign for the United States National Health Insurance Act (H.R. 676) that would establish a single-payer health insurance system with guaranteed coverage for all Americans. Even if you are unemployed or lose or change your job, your health coverage goes with you. It ends the insurance companies’ interference with care. There is no denial of coverage due to pre-existing conditions or cancellation of policies for "unreported" minor health problems. The amount of money that single-payer can save will be enormous. Insurance agencies and drug companies are notorious for their high administrative costs, exorbitant executive salaries, and profits for the stockholders. And perhaps best of all, the single-payer system doesn’t have to start from scratch. It builds on Medicare, which has served MILs of Americans for four decades.

MILs of AFL-CIO Members Support Universal, Single-Payer Health Insurance By Harry Kelber

NATL: Doctors increasingly complain that the insurance industry uses complex, opaque claims systems to confound their efforts to get paid fairly for their work. Insurers say their systems are designed to counter unnecessary charges and help keep down soaring health-care costs. Fighting over denials is costing medical providers and insurers around $20 BIL in unnecessary administrative expenses. There is also a denial-management industry profiting from arming both sides. Ingenix sells insurers systems to screen doctor's claims while promising doctors its software for them will "help you take a more assertive stance on fair and accurate payment."

The Wall Street Journal "Fights Over Health Claims Spawn a New Arms Race" By Vanessa Fuhrmans, February 14, 2007

NATL: A senior US National Institutes of Health official said Pres Bush's limits on federal funding for human embryonic stem cell research have blocked potential medical breakthroughs. Bush used the only veto of his presidency last July to reject an identical bill and has promised another veto. Advocates of such research call it the best hope for potential cures for ailments such as Alzheimer's disease, diabetes, Parkinson's disease and spinal cord injuries. But because such research requires destruction of days-old embryos, opponents call it immoral. Landis said there is a "compelling need to pursue both embryonic and non-embryonic stem cell research," and no one can predict which might lead to cures.

US Official Faults Bush Stem Cell Funding Limits By Will Dunham, Reuters Health Information 2007 Jan 22

NATL: General practitioners added their voices to a growing call for health care reform with a proposal to completely change the way patients and their doctors interact. The American College of Physicians suggested putting internists and family doctors at the center of patient care, paying them to coordinate prescriptions and specialists to help prevent disease and avoid unnecessary treatments. The ACP, which represents 120,000 internal medicine physicians and medical students, said the changes need to go further than AMA recommendations. The US system is costly and not always effective in part because there is no oversight of a patient's care. Expanding health insurance is essential. But it is equally essential that we reform the way that care is organized, financed and delivered. "Physicians would be paid for taking responsibility for coordinating the care of the whole patient" Doherty added.

US Doctor Group Joins Call for Healthcare Overhaul By Maggie Fox Reuters Health Information 2007 Jan 22

NATL: Health insurers and some corporate friends proposed what they called a politically practical plan to provide health insurance to more than half of the 47 MIL Americans who lack it [leaving at least another 23 MIL hard-working Americans uninsured]. The plan envisioned more federal funds to help more children enroll in existing public programs, new tax credits and expanding eligibility for the Medicaid insurance program. Its backers were unable to say how much this would cost taxpayers [but they were certain that it would advance their profits]. The AFL-CIO and the SEIU labor union that represents service workers pulled out before the plan was finished, as did the National Association of Manufacturers.

Health Care Players Offer Plan for Uninsured By Will Dunham, Reuters Health Information 2007, Jan 19

NATL: Insurer UnitedHealth Group, which is trying to emerge from a stock options scandal, reported fourth-quarter net earnings of $1.2 BIL, slightly above estimates, helped by the killing it made in the Medicare prescription drug plans for seniors. UnitedHealth said it expects 2007 net income of $4.7 BIL to $4.75 BIL, or an increase of as much as 14% from 2006's $4.17 BIL, subject to adjustments for expenses tied to the stock options review.

UnitedHealth Posts $1.2 BIL Quarterly Profit By Lewis Krauskopf, Reuters Health Information 2007.Jan 18

NATL: The adequacy of nurse staffing and proportion of registered nurses is inversely related to the death rate of acute medical patients within 30 days of hospital admission. [Lower nurse to patient ratios lead to less patient death.] Just as hospitals and clinicians caring for patients focus carefully on completing accurate diagnosis and appropriate and effective interventions, so too should hospitals carefully plan and manage structures and processes of care such as the proportion of Registered Nurses in the staff mix, percentage of baccalaureate-prepared nurses, and routine use of care maps to minimize unnecessary patient death.

Adequate Hospital Nursing Care Improves 30-Day Survival for Acute Medical Patients by Laurie Barclay, MD J Adv Nurs. 2007;57:32-44.

NATL: Supporters of a bill to bar discrimination against people because of their genetics have launched a push for congressional passage even as some business leaders oppose it. The measure would ban group health plans and health insurers from denying coverage to a healthy person or charging higher premiums based solely on a genetic predisposition to a disease. It also would prohibit employers from using genetic information in hiring, firing, job placement or promotion decisions. The US Chamber of Commerce is fighting the bill. But at a hearing before a House subcommittee, IBM endorsed it, noting that in 2005 it became the first major corporation to ensure nondiscrimination based on genetics as part of its official employment policy.

Backers Push for US Genetic Nondiscrimination Bill, By Will Dunham, Reuters Health Information 2007 Jan 31

NATL: Pres Bush brushed aside criticism of his new health care plan as "reflexive" partisanship and urged Congress to work with him on the issue. The president's proposal, to offer tax breaks to people to encourage them to buy health insurance on their own while taxing some with employer-provided health coverage, has received a chilly reception from Democratic lawmakers, labor unions and some consumer groups. Critics say Bush's approach would not help enough of the uninsured and would undermine employer-provided coverage that is a mainstay of the US health system.

Bush Brushes Aside Criticism of Health Plan By Caren Bohan, Reuters Health Information 2007 Jan 29

NATL: Television drug advertisements rely heavily on emotional appeals rather than comprehensive disease information to attract consumers' attention, according to one of the first studies to analyze such commercials. Choosing the wrong prescription drug can cause serious health problems and it can also be very costly to the larger society. While TV promotions are frequently used for other consumer products, they raise questions when it comes to pharmaceuticals, Frosch and other researchers wrote. Our findings suggest the need to reconsider the distinction between selling soap or other consumer products and selling prescription drugs.

TV Drug Ads Play on Emotions, US Study Says By Susan Heavey, Reuters Health Information 2007. Jan 30

NATL: Wal-Mart Stores Inc. and a labor union with which the retailer often clashes joined forces to call for universal health care coverage for all Americans by 2012, but offered no specific proposals. "The current health care system doesn't work for many Americans... We need to change the current system and we need to start now," said Lee Scott, CEO of Wal-Mart, which is the largest US private-sector employer and the world's biggest retailer. Wal-Mart has endured criticism over the years from labor unions that say it pays inadequate wages and pushes employees onto government aid programs. Kelly Services CEO Carl Camden suggested that Washington may soon find itself overtaken by the states on health care.

Wal-Mart, Union Call for Universal US Health Care By Kevin Drawbaugh, Reuters Health Information 2007. Feb 07

NATL: A new survey has found further evidence of disparities in cardiac care, this time in the emergency-department (ED) evaluation of chest pain. Race, gender, and insurance differences affected the likelihood of a person presenting to the ER with chest pain receiving one of four common noninvasive diagnostic tests. The time trend data show that the disparity seems to be worsening rather than improving. "Our findings reveal striking differences by race and gender on the probability of ordering an ECG, CM, O2 sat, and CXR testing in the ED," the researchers observe. Overall, African American males were 25% to 30% % less likely to receive any of the tests than non-African American males.

Disparities in Cardiac Care Seen in ED from Heartwire a news service of WebMD, February 2, 2007

NATL: A bill that would require health insurers to cover more of the costs of treating mental health conditions moved forward in Congress with wide backing from employers and insurers. The bill requires health insurance plans that offer mental health coverage to provide that coverage on par with financial and treatment coverage offered for other physical illnesses like heart disease, diabetes or asthma. The 1996 Mental Health Parity law only provided parity for annual and lifetime limits between mental health coverage and medical surgical coverage. The new bill expands parity by including deductibles, co-payments, out-of-pocket expenses, coinsurance, covered hospital days, and covered out-patient visits.

US Mental Health Bill Moves Forward in Congress, Reuters Health Information 2007, Feb 15

NATL: Health insurer WellCare Health Plans Inc. said its quarterly profit more than quintupled on strong results from Medicaid plans for low-income Americans and Medicare prescription drug plans for seniors. Net income jumped to $57.0 MIL from $10.8 MIL a year earlier. Total revenue more than doubled to $1.2 BIL. The company also said it boosted its first-quarter and 2007 forecasts. [Proving Bush's work has been successful in achieving goals for Medicare "reform".]

WellCare Profit Soars, Forecast Raised, Reuters Health Information 2007. Feb 14

NATL: Although Medicare coverage for colorectal cancer screening has increased in recent years, there are still significant gender and racial gaps in screening uptake. Approximately 18.3% of study subjects underwent a colon screening test during this period. The investigators found that nonwhite persons were 48% less likely to undergo colon cancer screening than their white counterparts. Specifically, "Blacks (9.7%) and Hispanics (8.1%) had lower rates of colon cancer screening compared with whites (19.3%)." In subjects 80 years of age and older in the highest income tertile, women were 36% less likely to be screened than men.

Disparities in Colon Cancer Screening Seen in Medicare Population Reuters Health Information 2007. Feb 12

NATL: US lawmakers sought information about the prices drugmakers charge through the Medicare prescription drug benefit for seniors after a hearing dealing with charges of waste, fraud and abuse in pharmaceutical pricing. This information will be critical as our committee assesses whether high drug costs are increasing beneficiary costs and wasting taxpayer dollars in the Medicare drug program," House Oversight and Government Reform Committee Chairman Henry Waxman said. Waxman wrote to insurers and pharmacy benefit managers asking for details about profits and administrative costs of their Medicare prescription drug plans. He also asked about any discounts negotiated with drug makers and pharmacies and if the concessions were passed on to Medicare patients. The House has approved a bill to let the government negotiate lower drug prices instead of leaving it to private companies to secure discounts.

US Lawmakers Seek Medicare Drug Price Data, Reuters Health Information 2007. Feb 12

NATL: US spending on prescription drugs, hospital care and other health services is expected to double to $4.1 TRIL annually over the next decade, up from $2.1 TRIL in 2006. Despite relative stability in recent years, nearly 20 cents of every dollar spent in 10 years will go toward health care. Greater spending for prescription medications is expected to fuel much of the increase, Poisal and his team said, especially amid more aggressive treatment of diabetes, heart issues and conditions affecting the central nervous system. [No mention in article of overhead costs from insurance, or excessive CEO packages.]

US Health Care Spending Seen Doubling in 10 Years, By Susan Heavey, Feb 21

INTL: Britain's consumer watchdog called for a radical overhaul of drug pricing which it said could save the state health service around 500 MIL pounds ($977 MIL) a year. Britain's National Health Service spends around 8 BIL pounds a year on branded prescription medicines under a 50-year-old pricing arrangement which caps companies' profits and can also cut prices across the board. But the OFT concluded, after an 18-month review, that the current Pharmaceutical Price Regulation Scheme ( should be replaced with one focused on value, with the price of drugs set to reflect the therapeutic benefit they bring to patients. Britain is a major centre for drug research and development, though the local market represents only 3 to 4% of global drug sales.

Watchdog Seeks $1 BIL in Savings on UK Drugs Bill By Ben Hirschler, Reuters Health Information 2007. Feb 20

CA: The California AFL-CIO and the state's top nurses union blasted "The Terminator" healthcare plan unveiled Jan. 8. The governor's plan has "the same gaping holes" that a Massachusetts plan, enacted last year and signed by then-Gov. Mitt Romney (R), has, says CA Nurses Association President Deborah Burger " it's little more than a fresh coat of paint on a collapsing house." This will be a boon to insurance companies, but a bust for most workers, in that it requires all Californians to buy health insurance with no guarantee that it will be affordable or that coverage will be adequate. The CA GOP governor's plan is part of a nationwide trend where states are [pretending] to come up with ways to make sure all of their residents are covered, [while they devise ways of throwing more public money into the bulging pockets of the insurance industry]. Schwarzenegger's plan may leave many people in the nation's largest state with cut-rate plans that discourage people from using their health coverage, have huge out-of-pocket costs, and expose them to financial ruin in the event of a serious illness or accident". A perfect solution for the insurance industry.

Press Associates, Inc. (PAI) -- 1/15/2007, "STATE FED, TOP CALIF. NURSES UNION HIT SCHWARZENEGGER HEALTH CARE PLAN"

NATL: For the seventh straight year, the Department of Veterans Affairs (VA) has received significantly higher marks than the private health care industry on a leading independent survey of customer satisfaction. Our patients are the best judges of our health care system, and for the seventh consecutive year, VA has received high marks from its customers in this independent study said Jim Nicholson. The VA scored 84% in customer satisfaction for inpatient services. The rating of 82% for outpatient care was two points higher than last year’s mark. VA significantly outscored the private sector in both categories, by 10 points for inpatient care, and eight points for outpatient care. Earlier this year, VA won the prestigious "Innovations in American Government" Award from Harvard University’s Kennedy School of Government for its advanced electronic health records system and performance measurement system.

"VA Health Care System Outscores Private Sector Again", Jan 15, 2007, 07:00

NATL: Nearly one-quarter of Americans said they had problems paying their medical bills and of those, more than 60% had health insurance, according to a Kaiser Family Foundation report from 2005. "Nearly three in ten adults reported that they or someone in their household skipped medical treatment, cut pills, or did not fill a prescription in the past year because of the cost." (100-million Americans) It's been estimated that 50-million Americans have no insurance coverage whatever and this lack is a primary cause of driving up the bankruptcy rates, not to mention enormous unnecessary suffering in American families.

January 14, 2007 "More Americans Dying From Lack of Health Insurance Than In Iraq", by Sherwood Ross

NATL: According to a study released by the Justice Department in September, 56% of jail inmates in state prisons and 64% of inmates across the country reported mental health problems within the past year. Over the past 40 years, the United States dismantled a colossal mental health complex and rebuilt "bed by bed" an enormous prison. After more than 50 years of stability, federal and state prison populations skyrocketed from under 200,000 persons in 1970 to more than 1.3 million in 2002. That year, our imprisonment rate rose above 600 inmates per 100,000 adults. With the inclusion of an additional 700,000 inmates in jail, we now incarcerate more than two million people, resulting in the highest incarceration number and rate in the world, five times that of Britain and 12 times that of Japan. In the 1940s and ’50s we institutionalized people at even higher rates -only it was in mental hospitals and asylums. Simply put, when the data on state and county mental hospitalization rates are combined with the data on prison rates for 1928 through 2000, the imprisonment revolution of the late 20th century barely reaches the level we experienced at mid-century. Our current culture of control is by no means new.

NYTimes, January 15, 2007, "The Mentally Ill, Behind Bars", By BERNARD E. HARCOURT

NATL: A group of business and consumer groups [actually not so much consumer groups as insurance sellers these] doctors, hospitals and drug companies laid out a major proposalto provide health coverage to more than half of the nation’s 47 million uninsured by expanding federal benefit programs and offering new tax credits to individuals and families. The proposal was endorsed by AARP, the American Hospital Association, the American Medical Association, the Blue Cross and Blue Shield Association, Johnson & Johnson, Kaiser Permanente, Pfizer, the Chamber of Commerce, America’s Health Insurance Plans and Families USA. As a first step, they urged Congress to put more money into the Children’s Health Insurance Program and create tax breaks for the purchase of private insurance covering children.

"Groups Offer Health Plan for Coverage of Uninsured", By ROBERT PEAR, January 19, 2007, Washington Post

CA: Schwarzenegger would use the magnificent power of the state to tell every Californian that you must buy a health plan. He doesn't care much what the plan gives you -- he just wants you to have a health card, so he can say everyone has health care. Democratic speaker of the state assembly Fabian Nunez called Schwarzenegger's plan "good work" and "a good start". Democratic senate president Don Perata welcomed the fact that Schwarzenegger's plan has something "for everyone to hate," because that is a sign of a good compromise . They are all ganging up on the populace. The Schwarzenegger plan is for "requiring all individuals to have a minimum level of coverage." He insists that "everyone present a coverage card at the point of service," a card it is your responsibility to buy. This country still has a law that if you show up at an emergency room, you get treated, but the Schwarzenegger mandate would empower hospitals and doctors to turn you away if you do not have a card, or at least it helps them justify delays in your care, evading responsibility for the medical outcome. Some health cards will provide real security of care. The well-to-do will have them. For the masses, a valid health plan can sock you with spending out of your own pocket up to $10,000 per year for a family.

"Equal Care for All, or Roll-the-Dice Care for Most?", by Charles Andrews

CA: Health insurers in California refuse to sell individual coverage to people simply because of their occupations or use of certain medicines. Entire categories of workers, including roofers, pro athletes, dockworkers, migrant workers and firefighters, are turned down for insurance even if they are in good health and can afford coverage. Blue Cross, Blue Shield, PacifiCare and Health Net all look at prescription drug use to decide to whom they will sell individual policies. Dozens of widely prescribed medications, including Allegra, Celebrex and Prevacid, may lead to rejection, according to the underwriting guidelines that the health plans provide to insurance brokers but not to the public.

Los Angeles Times, January 8, 2007, "Health insurers deny policies in some jobs" By Lisa Girion

CA: Four healthcare proposals are now before the CA Legislature, including one crafted by Gov. Schwarzenegger. Unfortunately, that plan and two others are short-term solutions that have the potential to expand coverage but at the end of the day can't be relied on to achieve what 80% of Californians say they want: a government guarantee of access to affordable healthcare coverage in the state. In SB 48, all employers could either spend a percentage of their payroll toward employee health insurance or pay an equivalent amount into a healthcare trust fund, which would offer plans from private insurers. AB 13 covers otherwise uninsured employees and their dependents through a purchasing pool paid for by employers that have two or more employees and do not offer healthcare coverage. As with the AB 13 this pool would offer healthcare coverage from private insurance companies. Both bills emphasize covering the employed and because they mandate that insurance will be funded by a percentage of wages, which may not be enough for all workers in the state, much less all Californians. Nor do these bills specify what is meant by basic coverage, which may mean that the insurance that is offered isn't adequate.

"A second, third and fourth opinion on healthcare", By Sheila James Kuehl, LA Times, January 9, 2007

NATL: Pat Combs, president of the National Association of Realtors, said 28 percent of the nation’s 1.3 million Realtors do not have any health insurance. This is nearly double the percentage of uninsured members in 1996. If we add family members to the total, the final estimate for the Realtor family is close to 886,000 individuals," stated Combs. "We are ready to work with you to fix an insurance delivery system that is not meeting the needs of working Americans".

National Association of Realtors, January 10, 2007, "Realtors, Other Small-Business People Face Health Care Crisis"

MD: When Maryland legislators passed a first-of-its-kind law in 2006 forcing Wal-Mart Stores to spend more on employee health care, the measure was held up as a model for other states grappling with mounting bills for Medicaid, the publicly financed health care plan for the poor. A second court found however that Maryland's health care rule violated U.S. labor laws, the concept that states can compel companies to offer more generous health care is suddenly in doubt. By a 2-to-1 ruling, a U.S. appellate court in Baltimore found that the Maryland requirement, which affected only Wal-Mart, violated a 32-year-old U.S. labor law known by its shorthand, Erisa. The law was intended to allow big companies to set up uniform health benefits across the country, rather than navigate state-by- state requirements. [Ending employment-based private insurance would solve this and many other problems. Some states are proposing to do exactly that.]

The International Herald Tribune, "Ruling casts doubt on states' health care remedy", By Michael Barbaro, January 18, 2007

NATL: Mr. Bush’s health care proposal won’t go anywhere. Treating "health insurance more like home ownership". Those are the words of someone with no sense of what it’s like to be uninsured. Going without health insurance isn’t like deciding to rent an apartment instead of buying a house. It’s a terrifying experience, which most people endure only if they have no alternative. The uninsured don’t need an incentive to buy insurance; they need something that makes getting insurance possible. Most people without health insurance have low incomes, and just can’t afford the premiums. And making premiums tax-deductible is almost worthless to workers whose income puts them in a low tax bracket. Of those uninsured who aren’t low-income, many can’t get coverage because of pre-existing conditions everything from diabetes to a long-ago case of jock itch. Again, tax deductions won’t solve their problem.

New York Times, January 22, 2007 "Gold-Plated Indifference", By Paul Krugman

NATL: Denise Wheeler, an artist in Laguna Beach, Calif., thought she and her family had health insurance. But she was left with tens of thousands in unpaid medical bills when insurers a major companies retroactively canceled their policies after they faced expensive health problems. "It's the most devastating thing that's ever happened to us". Their stories illustrate a little-recognized fact about insurance purchased by individuals: Even after being approved, policyholders can see their coverage amended to exclude certain medical conditions or revoked entirely, sometimes long after the policies are issued. "Insurers love to market the promise, 'We'll take care of you. Just sign here,' " says Karen Pollitz of the Institute for Health Care Research and Policy at Georgetown University. "Then there is all this opportunity for the insurer not to keep the promise, and you don't find out until it's too late." Insurers say they rarely revoke policies, and generally do so only because of misleading or omitted information on applications.

"People left holding bag when policies revoked", USA TODAY, 1/29/2007, By Julie Appleby

NATL: The nation's major insurance companies applauded President Bush for proposing to revamp tax breaks on health coverage. If successful, Bush's proposal could help drive millions of people into the arms of many of the nation's carriers. But whether the Bush proposal will have any traction is in serious doubt. Having more people in the health-insurance pool, said the Industry Association, would drive down the costs for everyone. "From a business standpoint, it makes more sense to have more covered," Ghose said. "There is ample opportunity to get this jump-started this year." Jim Kappel, spokesman for WellPoint called the Bush proposal "constructive" but said it's too early to tell whether the plan would work. [Someone's happy with Bush plan.]

"Insurers want Bush's health plan to be considered", MarketWatch, Jan 22 2007

MA: The panel charged with turning the MA's landmark health care law into a reality got a rude reality check when it was told by insurers that the average price for the new plans could cost about $380 a month - almost twice what former Gov. Romney predicted when he signed the measure last year. Welcome to the real world. The private sector has wrestled with this 800-pound gorilla for more than a decade and found that every year costs rapidly escalate. So, where do we go from here? Members of the Connector board did the only thing they can do at this point. They sent the insurers back to the drawing board, saying they need to do a better job at coming up with low-cost health care plans. The board also set new guidelines for minimum health care plans, a proviso that might make lower cost premiums difficult [unless a single-payer system were to be considered].

"New health care law receives reality check", Wednesday, January 24, 2007, The Republican, MassLive.com

NATL: Consistent with what is seen in adults, overweight and obese children have increased healthcare utilization and higher expenditures than their normal-weight peers, new research shows. With or without a formal diagnosis, obese children utilize more healthcare resources. Increased laboratory use was the main change in healthcare utilization seen in obese children, but is cost effective to look for the complications of obesity immediately. Compared with healthy-weight children, those with diagnosed or undiagnosed obesity were 5.49- and 2.32-times more likely, respectively, to have used laboratory services. Moreover, children with diagnosed obesity had average healthcare expenditures that exceeded those of healthy-weight children by $172. Two main factors that likely contribute to the underdiagnosis of obesity in children: failure to assess and record BMI during office visits and not recording "obesity" on billing forms out of fear of not being reimbursed.

Obesity Raises Healthcare Expenditures in Children, By Anthony J. Brown, Arch Pediatr Adolesc Med 2007;161:11-14.(Reuters Health) Jan 01

Systematic treatment for depression in patients with diabetes results in healthcare cost savings [as does treatment for most mental illnesses]. For patients with diabetes and co-occurring depression, investing additional resources to effectively treat depression will not increase (and may actually decrease) overall health care spending. During the second year, the approximately $100 higher outpatient depression treatment costs in the intervention group was more than offset by lower outpatient costs of approximately $1400, the researchers note. Reducing human suffering remains the most important reason for improving care for depression. If reducing that burden of suffering also reduces costs of care, then depression management programs should be routinely integrated into diabetes care. [What do you think we'd find if we studied depression in those diagnosed with cancer? We'd find greater compliance and better, longer recoveries -I'd bet. Do we need to study the benefits of treating depression for each disease?]

Systematic Treatment of Depressed Diabetic Patients Reduces Healthcare Costs, By Will Boggs, (Reuters Health) Jan 10 Arch Gen Psychiatry 2007;64:65-72.

NATL: Shares of WellPoint slumped nearly 3 percent on worries that a proposal by California's governor to boost health insurance coverage could eat into industry margins. The troublesome aspect of the plan for health insurers is a proposal to require those companies to spend at least 85% of every dollar in premiums on medical care [even though that's about five-fold the overhead that medicare needs to operate]. WellPoint Chief Financial Officer David Colby said that efforts by government to require insurance of those without it would inevitably be good for the company, however.

WellPoint, HMO Shares off on Calif. Health Plan Worry Reuters Health Information Jan 09

CA: Gov. Schwarzenegger is expected to propose extending health care to the 10 percent of California children who are uninsured, even if they are in the state illegally. Everything we're hearing is that the governor will propose health care coverage for all kids. There were 763,000 uninsured children in California in 2005, according to the California Health Interview Survey. Of those, about 400,000 are ineligible for public health programs because they are undocumented or their families exceed maximum income limits. About 6.5 million Californians (all ages), or one in five residents, are uninsured. In 2005, Schwarzenegger vetoed legislation that would have expanded coverage to every child in the state, saying lawmakers had not provided a way to fund it.

Schwarzenegger Eyes Health Coverage for Calif. Kids, By Lisa Baertlein, Reuters Health Information 2007, Jan 05

NATL: U.S. House of Representatives Democrats introduced legislation that would require the health secretary to negotiate lower prices for prescription drugs covered by the Medicare insurance program for the elderly and disabled. The measure is one of the bills Democrats are promising to bring to a vote within the first 100 legislative hours of the new Congress. A House floor vote is expected on January 12. Drugmakers have opposed movement toward government negotiation, arguing it would amount to "price controls" that would cut their budgets for developing new drugs.

Bill Would Require Medicare Price Negotiation, Reuters Health Information 2007 Jan 05

NATL: The U.S. government could not negotiate lower drug prices for the Medicare drug benefit without restricting access to some therapies, says Bush's head of CMS, as lawmakers prepare to consider a related bill. Leslie Norwalk, said the only leverage in bargaining for discounts with drugmakers is to block some products from the list of covered drugs. But such an action under the Medicare insurance program for the elderly and disabled would limit patients' access to various drugs. It's not negotiation -- it's interference, Norwalk said.

Medicare Chief Rejects Negotiation, By Susan Heavey Jan 09 Reuters Health Information 2007

NATL: U.S. spending on healthcare hit nearly $2 TRIL in 2005. Healthcare spending grew 6.9% from about $1.86 TRIL, outpacing the 3.4% rise in inflation. Leading the increase were hospital services, which grew 7.9% to $611.6 billion and accounted for 31% of all U.S. healthcare dollars in 2005. Doctor and clinical services rose 7% to $421 BIL, while nursing home and related care went up 6% to $122 BIL. Growth in prescription drug costs under Bush's Medicare-D rose the most -- 19.7%, while spending for Medicaid grew 7.2%.

U.S. Healthcare Spending Hits Nearly $2 Trillion, By Susan Heavey, Reuters Health Information Jan 09 2007

NATL: Despite spending more per capita on health care than any other nation, the United States lags behind other industrialized nations in all major health outcome measures. This is due to 2 main factors: (1) relative to the rest of the world, the US places far less emphasis on public health and primary care, and (2) because socioeconomic disparity in the US is high and one sixth of the people lack health insurance, the United States has a large medically vulnerable population. Title VII of the Health Professions Education Assistance Act is the only federal program that has increased the production of primary care physicians who serve medically vulnerable populations. Yet each year over the past 2 decades drastic cuts for this program have been made by the Administrations. Until this year, Congress has annually restored the major portion of the funding for Title VII.

Title VII: Our Loss, Their Pain, 01/12/2007, Joshua Freeman and Jerry Kruse, Annals of Family Medicine

CA: Gov. Schwarzenegger's plan to extend health insurance to California's 6.5 million uninsured could help put universal health coverage back on the national agenda at a time of political change in Washington. Doubts have been voiced about whether the celebrity governor would be able to fully fund the ambitious, $12 billion proposal he put forwardy. But after more than a decade since the last big national health care reform push, Schwarzenegger's timing just may be perfect with a new Democrat-run Congress taking over in Washington and presidential elections less than two years away. "We're really seeing the return of universal health coverage to the national dialogue," Diane Rowland, of Kaiser Commission on Medicaid and the uninsured. "It propels the discussion and puts more pressure on national candidates, Congress and the president," she said.

Schwarzenegger Takes Center Stage in US Health Reform, Reuters Health Information Jan 15, 2007, By Lisa Baertlein

INTL: Canada's pharmacists said they were banding together to fight a U.S. bill that could see a flood of brand-name prescription drugs exported south of the border. They warn the bill could deplete the supply of prescription drugs in Canada and they are urging Canadian Health Minister Tony Clement to introduce a ban on bulk and retail exports of prescription drugs to the United States. The Democratic Party-controlled U.S. Congress intends to move legislation allowing prescription drug imports from Canada as a way to address the high cost of U.S. prescription drugs. The CPA estimates that at its peak in 2003, the cross-border drug trade was valued at more than $850 MIL (US$).

Canada Pharmacists Seek Ban on Drug Exports to U.S., Reuters Health Information 2007, Jan 15

Drugmakers to Pay for TV Ad Reviews Under FDA Plan, Reuters Health Information Jan 11 2007 NATL: Drugmakers would have to pay $6.25 million in new fees next year to help fund an FDA review of television commercials for their products. The advertising plan accompanies an agreement for proposed legislation to renew industry funding for FDA drug reviews through 2012. About $29.3 million of those fees would be used next year to modernize the agency's ability to monitor drug safety after a product hits the market. The plan would allow the agency to hire 27 additional staff reviewers who would evaluate the ads in 45 days.

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PA: Pennsylvania became the fifth U.S. state to seek "near universal health coverage" for its citizens when it unveiled a plan to provide medical insurance for some three-quarters of a million residents who currently have none. Pennsylvania Gov. Ed Rendell said the plan, called Cover All Pennsylvanians, would provide affordable basic health coverage to small businesses and uninsured individuals through the private health insurance market at a time when many cannot afford it. Unlike residents of Massachusetts and California, individuals would not be required to buy health insurance but Pennsylvania might introduce a mandate after the first three years, depending upon how many people buy into it voluntarily, officials said. The plan will be paid for in part by a 3 percent payroll tax on all companies that do not provide health insurance. An exemption would be made for the first 50 employees in the first year, a number that will decline in subsequent years.

Pennsylvania Launches Health Insurance Plan, By Jon Hurdle Jan 17 Reuters Health Information 2007

NATL: The new leaders in Congress will have to deal with the problems of scarce new federal revenues, a deep partisan division over the direction of health policy, and resistance by many conservative members to new plans for health care spending. In addition, as the presidential election of 2008 approaches, opposition by members of each party to the other's health care proposals will intensify. In this environment, important new health reform initiatives are unlikely, and the congressional focus will be on incremental policy changes.

The New England Journal of Medicine, November 2, 2006, "Voters and Health Care in the 2006 Election" By R Blendon, DE. Altman

NATL: Following 60 years of gridlock on a desperately-needed overhaul of the nation’s health care system, US Senator Ron Wyden, a member of the Finance Committee, unveiled a proposal to provide affordable, high quality, private health coverage for everyone regardless of where they work or live. During a two-year transition phase, employers who have been providing health insurance will cash out the value of that health insurance and provide that amount in wages to their employees. After the two years, all employers will make a shared responsibility payment, meaning they pay up to 25% of the average premium for essential care.

Wyden Proposes Historic New Health Care Plan December 13, 2006

NATL: "Employer-based coverage is melting away like a Popsicle on the sidewalk in August," Wyden said. Wyden, a Democrat and a member of the Senate Finance health care subcommittee, said his plan would "guarantee health coverage for every American that is at least as good as members of Congress receive and can never be taken away." The plan, dubbed the "Healthy Americans Act," would provide universal coverage for no more money than the country spends on health insurance today, Wyden said. Stern said the health care system had failed to create jobs while adding to trade deficits and holding wages stagnant. For the nation's uninsured, "it is a failed moral policy as well," Stern said.

"Senator Wants Universal Health Care Plan" By MATTHEW DALY Associated Press Dec 13,

NATL: Sen. Wyden’s proposal is an individual mandate to purchase private health plans. A plan with mandate's won't work because low-income workers still won't be able to afford their portions of the private insurance. And now you'll be sending the IRS and courts after each of them? The Wyden plan would shift health care away from being considered as part of an employer's compensation package, over into the realm of personal responsibility. Price competition between health plans won't help costs. Since consolidated efforts of employers have been unable to control costs and waste, how can individual purchasers ever expect to exert market pressures to achieve these efficiencies? Costs will continue to increase and wage earners will have to face those costs alone with fewer able to buy in each year.

About Wyden Plan By Don McCanne, MD, PNHP

NATL: Republican lawmakers, with little public debate, quietly added a billion-dollar health-care benefit to legislation that was rushed through Congress just before it adjourned for 2006. Acting at the urging of several major business lobbies eager to reduce their medical-insurance costs, lawmakers adopted the provision even though only a single committee had approved it. The provision, which materialized without fanfare inside a massive tax-cut measure, expands the amount of money that can be contributed tax-free to health savings accounts (HSAs). The legislation allows anyone to shelter thousands of dollars annually in HSAs, regardless of how much that person pays for a health-insurance deductible. Current law limits HSA contributions to the amount of a person's deductible. The expansion would cost the government $1 BIL in lost tax revenue over the next decade.

"GOP Lawmakers Add Provision to Passing Tax Package" By Jeffrey H. Birnbaum and Lori Montgomery Washington Post Staff Writers Monday, December 11, 2006

KS: Three of Wichita's largest insurance carriers are introducing new plans called "mini-medical" plans because they typically have limited or capped benefits and high deductibles -- can save employers or their employees up to 40% from their traditional group coverage. BCBS of Kansas rolled out a new, limited-benefit plan that caps benefits at $30,000, but covers routine and preventive care after a co-payment. [Great! Insurance that only covers that, for which you least need insurance in the first place.]

The Wichita Eagle, November 2, 2006, "Insurance plans target employers" By Andi Atwater

CA: Hundreds of actors, artists, musicians and writers in California are facing massive increases in their health insurance premiums. It's a situation that could face other consumers who don't have employer- sponsored health plans. Cigna Corp., which has sold insurance to members of the entertainment industry through their professional associations for 25 years, is raising premiums for actors and others by an average of 82%, with some hikes as high as 254%. State Sen. S Kuehl, a proponent of single-payer universal coverage, explained "people believe that they are secure because they have a job. But, in an employer-based system, you lose your job, you lose your insurance. And even those who are paying a significant premium on their own have no guarantee this won't happen to them in terms of their premiums being jacked up to an unaffordable place." [Don't think of your favorite stars, most actors work one or two low-income jobs and barely scrape by while pursuing acting.]

Los Angeles Times November 23, 2006 "Healthcare premiums to soar for entertainers" By Lisa Girion

NY: The narrow hallways and drab plaster walls of Manhattan’s Cabrini Medical Center don’t suggest the cutting edge of medical science. The facility’s niche, Lolita Compas said is "providing health care to people from all walks of life, many of them minority patients." The hospital houses bilingual staff and programs for special-needs groups, ranging from AIDS survivors, to psychiatric patients, to the home-bound elderly. But some say places like Cabrini are a thing of the past. According to a commission launched by Gov Pataki, Cabrini and many other NY hospitals are becoming a liability, rather than an asset. Suffering financial strains and low occupancy rates, the panel argues, the hospitals are saddled with "overcapacity" - an excess of beds and buildings that purportedly lead to high costs and inefficiency. Dozens of healthcare advocates, unions, and community groups have formed the Save our Safety Net coalition (SOS), a political counterweight to the 54-member commission. "Just to look at bricks and mortar, and bed counts and bottom lines, is just not an effective way to go about making changes in the healthcare system, people [are] looking for simple solutions to a complicated problem."

Closures Loom for Community-Focused Hospitals in New York, by Michelle Chen, "Healthcare advocates say a state commission's plan to consolidate hospitals is wrong-headed, glossing over the real problem and real reforms".

NATL: A new federal database for the first time allows companies, consumers, health care analysts and others to compare health insurance costs among the Nation's largest cities and other geographical areas. For family health insurance plans, Seattle workers contributed the most (an average $3,299 per year). Average premiums for family coverage were highest in New York ($11,244). Premiums for single coverage were highest in San Francisco ($4,185) and lowest in Riverside, ($3,012). In the northern and central counties of New Jersey and part of the New Jersey shore, workers contributed an average of $1,676 for family coverage. But in areas of New Jersey further from New York City workers contributed an average $3,079.

City vs. City: When It Comes to Health Insurance Costs, Geography Matters Press Release: December 21, 2006 AHRQ Public Affairs

NATL: Pfizer's former chief executive, HA McKinnell, who was forced into an early retirement in part because of investor anger about his rich retirement benefits, will get every penny of them and more. McKinnell's package, which the company disclosed in a filing with the SEC, totals $180 million. It includes an estimated $82.3 million in pension benefits, $77.9 million in deferred compensation, and cash and stock totaling $20.7 million. [What importance is a few hundred more millions of dollars moving into one or two private pockets, while our government claims that caring for all Americans is unaffordable? Well every month we do report on or two additional similar cases don't we? What does that add up to?]

Dec 22, 2006 The Associated Press Pfizer ex-CEO gets $180 million

NATL: The US health care system is a scandal and a disgrace. But maybe, just maybe, 2007 will be the year we start the move toward universal coverage. Apologists for our system try to minimize the significance of these numbers. Many of the uninsured, asserted the 2004 Economic Report of the President, "remain uninsured as a matter of choice." And then you wake up. A scathing article in yesterday’s Los Angeles Times described how insurers refuse to cover anyone with even the slightest hint of a pre-existing condition. Some say that we can’t afford universal health care, even though every year lack of insurance plunges millions of Americans into severe financial distress and sends thousands to an early grave. But every other advanced country somehow manages to provide all its citizens with essential care. The only reason universal coverage seems hard to achieve here is the spectacular inefficiency of the US health care system. Americans spend more on health care per person than anyone else almost twice as much as the French, whose medical care is among the best in the world. Yet we have the highest infant mortality and close to the lowest life expectancy of any wealthy nation. How do we do it?

NY Times, January 1, 2007, "A Healthy New Year" By PAUL KRUGMAN

NATL: Most Americans over the age of 42 misjudge their need for long-term medical care and the costs entailed; that's a dangerous ignorance. With the 77 million-strong baby boom generation nearing retirement age, use of nursing homes, assisted living and home-care workers is likely to increase significantly. About 9 million people will need long-term care services in 2007, with that number rising to 12 million by 2020. Fewer than one in 10 surveyed came within 20% of estimating the national average for nursing home costs. Less than a quarter came within that range for assisted living facilities. Older Americans in need of long-term care are facing rising prices for increasingly popular assisted living homes, an alternative to more pricey and labor intensive nursing homes. The average annual price tag for a private one-bedroom unit in an assisted living facility rose 7% in 2006 to $33,000.

Most Americans Misjudge Long-Term Care Needs: AARP Dec 13 - Reuters Health Information 2006

NATL: When it comes to finding the best deal on prescriptions under the Medicare health insurance program, 68-year-old Carol Paremske said she knows all the tricks. The Internet-savvy senior knows about step therapy, which requires a patient to try a less expensive drug favored by the insurer before using the one prescribed by a doctor. She knows about the so-called doughnut hole, where coverage is limited after spending tops about $2,300. She's called the private companies that run the plans and the government help lines. Still, a week before the Medicare agency suggests seniors decide which Medicare prescription drug plan to choose for 2007, she is perplexed. "The thing is so complicated and convoluted. You don't really know if you are saving money or if it is just going to the drug companies".

Elderly Perplexed Over US Medicare Choices Reuters Health Information 2006 By Kim Dixon Dec 04

NATL: People with high-deductible health plans designed to raise awareness of costs and reduce unnecessary care are causing consumers to scrimp on health care. The plans charge higher deductibles in exchange for lower premiums and cheaper preventive services to cut overall health care costs. They also offer a tax-deferred savings account that can be used for care. But they have failed to attract the uninsured and people who were in the plans were more likely to cut back on basic care like prescriptions or doctor visits. The plans attract the healthiest individuals and leave sicker people in the wider insurance pool, which will raise overall health care costs. The plans, which typically have a deductible of about $1000, are too expensive for the poor and uninsured.

Much Hyped Health Plans Lead Some to Cut Care: Study By Kim Dixon Reuters Health Information 2006 Dec 07

NATL: The restrictions on resident work hours implemented 3 years ago appears to have significantly reduced fatigue in pediatric residents, resulting in fewer errors in patient care. With implementation of the limits, the proportion of residents working more than 80 hours during rotations fell from 49% to 18%. Both residents and program directors rated resident well-being as the factor most improved by the limits. Further analysis linked the ACGME limits with a reduction in patient errors due to fatigue and with a drop in the proportion of residents falling asleep while driving home from work.

Work Hour Limits for Pediatric Residents Tied to Fewer Errors Dec 05 Reuters Health Information 2006; Pediatrics 2006;118:e1805-e1811

NATL: An analysis of 2004 survey data has revealed that cost is the leading cause for lack of health insurance among individuals younger than 65 years. Of approximately 17% of persons lacking insurance, 53.3% did not have coverage because of cost, and 26.9% cited loss of a job or change in employment. Less common causes were inability to obtain coverage through an employer or insurance company (14.1%), cessation of Medicaid benefits (10.0%), and changes in marital status or parental death (less than 3%).

Morbidity and Mortality Weekly Report 2006;55:1321-1344.

NATL: Several major US retailers have sued AstraZeneca Plc for using illegal tactics to maintain its monopoly over the heartburn medication Prilosec even after the drug's patent expired in 2001. "While this product-switching strategy was enormously successful and profitable for AstraZeneca, it was an economic disaster for American consumers," the lawsuit said. The lawsuit says AstraZeneca has maintained 70 percent share of the market and blames exclusionary tactics known as the Shark Fin Project, to preserve its market position, according to the suit.

US Retailers Sue AstraZeneca Over Nexium Strategy By Peter Kaplan Reuters Health Information 2006

INTL: The French humanitarian agency Doctors Without Borders (MSF) urged Swiss drugmaker Novartis to drop a case over drug patents against India, which it said could risk access to cheap drugs for the poor. India is a crucial source of cheap generic medicines, but Novartis is challenging an Indian law which blocks the patenting of minor improvement in known molecules. The group relies on India for 80% of the drugs it uses in AIDS projects involving some 80,000 people in more than 30 countries. Novartis does not sell HIV medicines. A spokesman for Novartis reaffirmed the group's position that the issue of patent protection was separate from that of access to medicines and that Glivec was available to patients worldwide who were not able to afford it.

MSF Urges Novartis to Drop Patents Case in India, Reuters Health Information 2006 Dec 20 -

NATL: A senior US government Alzheimer's disease researcher pleaded guilty to a conflict-of-interest charge for accepting about $300,000 from drug giant Pfizer Inc. without approval. "Dr. Sunderland violated the fundamental rule that government employees cannot accept payment from interested private parties without the permission of their supervisors". Meanwhile, the LA Times reported that an internal government review found another senior NIH researcher, Dr. Thomas Walsh, entered into unauthorized private arrangements with drug companies and did not report money totaling more than $100,000. Walsh, who has helped lead major clinical trials involving cancer patients, he has not been charged with any crime.

US Researcher Pleads Guilty in Pfizer Money Case By Will Dunham Reuters Health Information 2006 Dec 11 -

NATL: The recent revision in the recommended testing strategy for HIV infection in the US is cost-effective when the prevalence of HIV is above 0.2%. Earlier this year, the US CDC shifted their advice, from testing only high-risk individuals to routine testing of all of persons aged 13 to 64 in all healthcare settings "unless a formal survey documents the prevalence of undiagnosed HIV infection to be less than 0.1%". They estimate that one-time testing would cost $37,100 per "Quality of Life Year" (QALY) gained. Rescreening after 5 years would raise the cost/QALY to $60,100; if testing was repeated every 3 years, it would cost $96,800. Routine testing will be more cost-effective than the study estimated. Their model included pretest counseling, which costs 3 times more than the rapid HIV test. He suggests reserving counseling effects for patients most likely to benefit: those with positive test results and those who engage in high-risk behaviors.

Routine HIV Screening Deemed Cost-Effective in Average-Risk Populations Dec 04 - Reuters Health Information 2006; Ann Intern Med 2006;145:797-806,857-859.

NATL: The Bush administration said it would strenuously oppose legislation authorizing the government to negotiate with drug companies to secure lower drug prices for Medicare beneficiaries. In an interview, Leavitt said he saw no prospect of compromise on the issue. "In politics, most specific issues like this are a disguise for a larger difference. Government negotiation of drug prices does not work unless you have a program completely run by the government. Democrats say they want the government to negotiate prices. What they really want is government-run health care." Federal price negotiations would unravel the whole structure of the Medicare drug benefit, which relies on competing private plans, Leavitt said. "The government negotiates big discounts for the prices of drugs for our veterans," said Sen.-elect Amy Klobuchar. "But the drug companies got Congress to make it illegal to negotiate for lower prices under Medicare."

Robert Pear, The New York Times - WASHINGTON - Nov 13, 2006

NATL: The health insurance industry proposed an expansion of Medicaid and new tax breaks with the goal of guaranteeing coverage for all children in three years and for virtually all adults within 10 years. "We believe that every American should have access to affordable health care coverage," said JG Thomas chairman of America?s Health Insurance Plans, the main lobby for the industry. The industry proposed these steps, estimated to cost $300 BIL over 10 years in tax subsidies.

Health Insurance Industry Urges Expansion of Coverage, By ROBERT PEAR, November 14, 2006, NYT

CA: The Los Angeles city attorney's office filed false-imprisonment and endangerment charges against hospital giant Kaiser Permanente in the first criminal prosecution of a medical center accused of "dumping" patients on skid row. The charges stem from an incident earlier this year when a 63-year-old patient was videotaped as she left a taxi in gown and socks, and then wandered skid row streets. In addition to the criminal charges, the city attorney filed a civil lawsuit against Kaiser, using a state law on unfair business practices that city prosecutors usually implement against unscrupulous slumlords to force them to clean up their buildings. The suit seeks a judge's order to forbid all Kaiser medical facilities from dumping homeless patients on skid row. The indictment marks a turning point in the city's yearlong effort to halt the practice by hospitals, as well as some outside law enforcement agencies, of dumping patients and criminals on downtown's troubled skid row.

LA files patient `dumping' charges, By Richard Winton and Cara Mia DiMassa, LA Times Staff Writers, November 16, 2006

NATL: Health maintenance organizations were all the rage just 10 years ago. Today consumers are bailing out of HMOs in record numbers as their costs have risen faster than high-deductible health-insurance plans that offer more doctor choices and services. In particular, HMOs have lost ground to a kissing cousin, the preferred provider organization, or PPO. Consumers are indicating that the cost saving is not the only important factor. "Employers started to question what they are getting for the additional premium" "However, you only can measure quality in an HMO right now,the other kinds of plans, you cannot tell how they are doing. It's a real concern when you cannot judge the quality of what you are buying."

America bails out on HMOs, By Bruce Japsen, Chicago Tribune November 19, 2006

NATL: Senate Finance Committee Chair Chuck Grassley said the American Hospital Association's guidance that not-for-profit hospitals should report bad debt to the federal government and the public as part of community benefits "perpetuates a murky picture of its member hospitals' charitable care". Not-for-profit hospitals have been under review by the Senate Finance and House Ways and Means committees over the financial benefits they receive under the tax code. Grassley said, "It's important that the public and policymakers have a clear understanding through standard reporting of the level of charitable care and community benefits that tax-exempt hospitals offer. Right now, reporting standards are all over the map, and it's nearly impossible to know what's real and what's accounting gimmickry." AHA said it was "essential that hospitals voluntarily, publicly and proactively report to their communities on the full value of benefits they provide." It said that "quantifiable benefits" such as charity care; bad debt; the "unpaid cost" of Medicare, Medicaid and other health programs; and community benefit programs, such as emergency and trauma services, "present a comprehensive picture of the value of services provided to and for the community".

Sen. Grassley Criticizes AHA Decision To Report Bad Debt to Federal Government as a Measure of Charitable Care, November 21, 2006, Kaiser Daily Health Report

NATL: You wouldn't expect the defense industry to come up with a plan for world peace. So why would anyone turn to the insurance industry to remedy America's staggering health care crisis? A national trade group, America's Health Insurance Plans, has proposed that the existing health care system be expanded so that all kids are guaranteed coverage within three years and virtually all adults within 10 years. It also envisions significant increases in spending for federal and state insurance programs. It would also bring millions of new customers to the insurance industry and leave taxpayers holding the bag for what insurers say would cost $300 BIL over the next decade. For one thing, the cost of insuring all Americans [under this tax-subsidized private insurance scheme] is likely closer to $1 TRIL than $300 BIL. Moreover, the industry's plan is likely to "further erode employer health care coverage" by prompting more companies to scale back health care benefits. When Defense Contractors Promote World Peace

Insurance industry's coverage proposal - David Lazarus, San Francisco Chronicle November 19, 2006

NATL: Future treatment for the 40,000 people infected with HIV in the USA every year will cost $12.1 BIL annually. US patients infected with HIV can expect medical bills for current care related to the disease of $618,900 during their lifetimes Current medical bills for US HIV patients from the beginning of care until death average $2,100 per month. The projected lifetime HIV-related medical costs were based on life expectancies of 24.2 years for patients in optimal HIV care. The Centers for Disease Control and Prevention estimates that 250,000 people with HIV in the USA -- a quarter of the total with the disease -- do not know they are infected [and thus largely due to our underfunded public health system continue infecting new partners]. The $618,000 lifetime HIV medical bill is comparable to the estimated lifetime medical cost for women under age 65 with cardiovascular disease, who can also have long life expectancies with appropriate medical management. Many HIV Cases and Costs Preventable

New US HIV Cases to Cost $12 BIL a Year: Study, Nov 02 Reuters Health Information 2006.

NATL: Some elderly and disabled Americans participating in Medicare's prescription drug benefit will have fewer options in 2007 to avoid a coverage gap and thousands of dollars in out-of-pocket spending. In 13 US states no drug plans in 2007 will offer coverage to completely plug the "doughnut hole". That gap is expected to reach $3,051 in 2007. Under the Medicare benefit, private companies offer insurance plans for prescription drugs with government oversight. Most patients pay a premium for basic coverage, or can pay a higher fee for a plan that plugs the gap. Leslie Norwalk, Bush's CMMS head called the report distorted. But Democrats and other critics have assailed the Medicare drug program as a boost for the pharmaceutical and insurance industries, while too cumbersome and confusing for consumers.

Medicare Drug Plan Users Face Looming Gap, Reuters Health Information Nov 02 2006. By Susan Heavey

INTL: Health workers staged a lobby of parliament to campaign against job cuts and increasing private sector involvement in the UK's National Health Service. The rally, organised by an alliance of 16 unions and professional bodies under the banner NHS Together, brought doctors, nurses and medical staff to Westminster from across England. "NHS Together represents unity and a desire to stop the health service being fragmented -- broken up piece by piece," said Dave Prentis, general secretary of public sector union Unison. "It makes no sense that critical services are outsourced. It makes no sense that services are controlled by unaccountable private healthcare companies," he told the rally.

Health Workers Lobby Parliament Over NHS, Nov 01 Reuters Health Information 2006

NATL: Health insurer Cigna posted a 15% rise in third-quarter earnings, and forecast 2007 profit within Wall Street expectations on strong pricing and stable medical costs, sending its shares up as much as 8%. Strength in Cigna's health-care business and cost cuts [spending on less on patient care] fueled results. Cigna sells insurance to about 9.3 million Americans. Net income at the company increased to $298 MIL from $259 MIL a year earlier.

Cigna Earnings Rise, Shares up After '07 Forecast, By Kim Dixon, Nov 01 Reuters Health Information 2006

CA: Pension fund Calpers, the lead plaintiff in a shareholder suit against UnitedHealth Group wants a federal court to impose a string of financial restrictions on outgoing CEO William McGuire, including a freeze on his retirement package. The departing CEO stands to collect as much as $1.1 BIL in stock options, retirement pay and other benefits. McGuire "was personally involved in nearly every aspect of the stock option backdating scheme". Calpers also wants to restrict McGuire from exercising any UnitedHealth stock option he holds without court approval and to freeze the proceeds of a Feb. 23, 2006 sale of 2.3 MIL shares of company stock. That one sale resulted in "over $135 MIL in ill-gotten gains," the plaintiffs contend. [USA health care dollars down the toilet.]

Calpers Seeks Injunction on UnitedHealth CEO's Options By Martha Graybow, Oct 31 Reuters Health Information 2006.

NATL: Tenet, the second-biggest US hospital chain, forecast a third-quarter loss steeper than expected, citing unpaid medical bills and fewer visits. Tenet shares fell about 11%, while Triad shares fell about 1%. The rising toll of unpaid medical bills has been eating into hospitals' profits in recent years and is taking up a bigger chunk of revenue. Bad debt is rising as the number of people in the USA without health insurance climbs. More than 46 million people -- or about 16 % of the US population -- lack medical insurance [continuously from Jan 1 through December 31 of 2005, increase that number about 70% for those without insurance in any given month.]. "I'd like to tell you guys that we've got this thing under control... but I can't do that," Triad CEO Shelton said. "I know there are a lot of people out there that say 'why can't you collect?' This is a US healthcare issue. It is not a Triad issue." Most hospital companies this quarter cited the unyielding toll of bad debt as marring profit in quarterly results. Most analysts had forecast that bad debt trends would not improve, but they hoped they would at least stabilize.

Tenet, Triad Highlight Sector Woes By Kim Dixon, Oct 30 Reuters Health Information 2006.

OR: Oregon voters are deciding whether the state should start using its collective-buying power to get discounts on prescription drugs and pass savings onto residents by selling them on at cost. The ballot measure could be seen as a challenge to drug companies, by forcing them to negotiate directly with the state. The measure would let anyone in the state who does not have prescription drug coverage, estimated at a third of the population, buy them through a pool. There would be no income or age restrictions. While the concept of states buying in bulk is not new, most states buy for narrower populations such as the elderly, people on low incomes, state employees or those living in state facilities. Oregon's measure has no official opposition and is expected to pass easily because it would not cost taxpayers anything, since participants would pay a small fee tacked on to the drug price to fund the program.

Oregon Measure Seeks to Widen Cheap Drug Program By Teresa Carson, Nov 06 Reuters Health Information 2006.

INTL: Thailand, faced with ballooning costs for HIV-AIDS drugs, has issued its first compulsory license to make a cheap version of a foreign-made drug and fired a shot across the bow of big pharmaceutical companies. The action drew a swift riposte from US drug maker Merck, which holds the patent on efavirenz. The firm denounced the decision, but AIDS activists and health experts cheered loudly. "This is both a brave and a progressive step by the Royal Thai Government to place the interests of people living with HIV in Thailand front and centre," Under World Trade Organization rules, governments may declare a "national emergency" and issue compulsory licences, allowing production of a patented drug without consent from a foreign patent owner. Merck will receive a 0.5 % royalty on sales of the locally produced drug, expected to cost half the 1,400 baht ($38.8) per month charged by the company.

Activists Hail Thai Move to Make Generic AIDS Drug, By Darren Schuettler, Reuters Nov 30

NY: To control soaring medical costs, New York state must shut nine hospitals and reorganize another 48 centers to save $1.5 BIL a year. The state, however, will still have too many hospital beds and so even tougher steps are needed, the commission said. Among the options are revising reimbursement rates to reward preventive care, said Stephen Berger. New York's health-care system faces some unique problems. Its $49 BIL Medicaid program is the nation's costliest. This has helped fuel what the commission called a medical arms race as hospitals vied for the best and costliest technology. Yet one in five nonelderly residents has no health insurance. None of New York City's teaching hospitals or its public hospitals would be closed because they performed well on the measures the commission examined, from charity care to travel time to quality of services. New York's hospitals have $6 BIL of debt backed by federal and state agencies, and have sold additional debt without such guarantees, according to the Greater New York Hospital Association, an industry group.

Shut Extra NY Hospitals to Save $1.5 BIL ,By Joan GralK Reuters Nov 29

NATL: With Democrats set to take control of Congress and vowing measures to cut drug prices, the US pharmaceutical industry will have to revamp its huge lobbying operation. After years of lavishing attention mostly on Republicans, the drug industry is expected to hire more Democrats and get ready to defend itself at hearings before congressional committees. Just ahead of the November elections, drugmakers and health care companies contributed more than $9 MIL to Republican candidates and $4 MIL to Democrats, according to the Center for Responsive Politics. After Democrats won a majority in both the House and Senate, many drugmakers saw their shares fall in some cases as much as 5%. Incoming House Speaker Pelosi has promised to bring forward a measure allowing the federal government to negotiate lower prices for prescription drugs under the Medicare program for the elderly and disabled. The Center for Public Integrity in 2005 ranked the pharmaceutical lobby the biggest in the nation, burning up more than $675 MIL and only exceeded by the insurance industry when campaign contributions are included.

US Drug Industry Braces for Democrat-Led Congress, By Susan Heavey Reuters Nov 24

INTL: Illegal drugs may be cheaper than ever before in Europe, with prices of heroin slumping 45% and cocaine down 22 % over five years, according to the first Europe-wide report of its kind on drug prices. The steep fall in heroin prices in 1999-2004 came as drug production in Afghanistan surged so much after the US victory over the Taliban that supply could now be exceeding global demand for heroin. Afghanistan accounts for about 90% of world production of opium - the raw material for heroin - and its production has soared since a U.S.-led invasion ousted the government of the Islamist Taliban in 2001.

Cocaine, Heroin Cheaper Than Ever in Europe, By Axel Bugge, Reuters Nov 23

NATL: Congress must give the US FDA more authority and funding so it can restore its reputation and better protect patients from harmful drugs. Consumer and patient groups joined a leading cardiologist in urging quick action on legislation to give the FDA more power to require new warnings on medicines or post-approval studies. Witnesses also called for a boost to the FDA budget. "The absence of that would leave the agency starved for resources... with unclear authority in terms of being able to deal with the industry," said Burke, co-chair of an IOM panel that urged major reforms. After Vioxx and other safety controversies, "the American people no longer trust the FDA to protect their health," said Nissen, who has served on FDA advisory panels.

Congress Weighs FDA Drug Safety Reforms, By Lisa Richwine Reuters Nov 17

NATL: Emily, 24, had purchased her university's student health insurance when she entered graduate school because, she said, she knew it was the right thing to do. But now Emily was learning that her coverage had complicated limitations, and she was having trouble getting answers to key questions: Would her coverage pay for the out-of-state consultations and referrals to a cancer center? What would happen if her expenses exceeded the yearly $200,000 cap? Would her insurance cover the costs of further diagnostic tests and treatment? As a graduate student, Emily earned about $18,000 a year, before taxes. She'd counted on her student health insurance to cover any medical costs, but now she was unsure if it would. Emily detailed what she new about the costs so far: "About $4,000 for the cancer consultants, $7,500 for the pre-op scans, and more than $35,000 for the surgery and five days in the hospital, and I haven't even received any of the bills for post-surgery follow-up or radiation yet." We asked what she had learned from the insurance company. Nothing, except that all insurance decisions on coverage would remain pending during a lengthy investigation.

Bleeding-Edge Benefits, Posted 11/14/2006, Jay Himmelstein

NATL: Consumer spending on outpatient prescription drugs nearly doubled between 1999 and 2003 -- rising from $94 BIL to $178 BIL a year. The overall $178 BIL spent in 2003 was boosted in part by the increasing portion of Americans purchasing brand-name drugs. This proportion increased from 47.5% in 1999 to just over 53% in 2003. Meanwhile, the proportion of Americans purchasing generic prescription medicines remained essentially flat, with no significant change. The average amount per purchase that Americans spent each time when they purchased a brand-name or generic prescription medicine increased by 39% from $59.49 to $82.53 and for a generic medicine from $23.48 to $33.53 (a 43% increase).

Brand-Name Buying Drugs Fuels Boom in Overall Drug Spending, 11/16/2006, Agency for Healthcare Research and Quality (AHRQ)

NATL: A scorecard that lays out how well a hospital or doctor does on a treatment -- and how much they charge for it -- can help transform US health care, says Bush HHS Secretary Leavitt. Leavitt said the federal government will urge private insurers and employers to help develop and use such a scorecard so patients can make informed choices on where to get care and who to get it from. "It's working. People are happy. They are enrolled," Leavitt told reporters. "We believe that if you give people choices, they make good choices." Democrats and other critics have assailed the Medicare plan as a boon for drug and insurance companies and say it is confusing for the 43 million Medicare beneficiaries. Democrats say they hope to make some changes when they take control of the House and Senate in January. But Leavitt said his plan for a new health system can bypass Congress by going straight to the employers and insurance companies that provide the great bulk of health benefits.

Grades to Transform US Healthcare, Secretary Says, By Maggie Fox, Reuters Nov 14

NATL: For years, private insurers have offered alternatives to the federal Medicare program supposedly to give patients lower-cost options than the government coverage provides. More than 7 million people now subscribe to such plans, out of a total Medicare population of 42.5 million. Suddenly a type of private insurance plan is gaining ground that looks very similar to the basic coverage long available to anyone with a federally issued Medicare card. And the government is paying the private insurance industry a subsidy of 11% per patient to provide it. Since the government substantially increased the subsidies two years ago for these most basic private industry plans known as private fee-for-service enrollment in the plans has grown tenfold to 820,000. Some analysts expect enrollments to double or even triple by 2009. The $7 BIL that Medicare will pay private industry this year to provide this fee-for-service coverage is at least $770 MIL higher than the government would spend covering those patients itself. It is a back-door way of trying to privatize Medicare, though that is explicitly denied by the Bush Administration.

Luring Customers From Medicare, By MILT FREUDENHEIM, NY Times: September 22, 2006

NATL: A few weeks ago, Carl Garrett, a 60-year-old North Carolina resident, was packing his bags to fly to New Delhi and check into a plush Hospital to have his gall bladder removed and the painful muscles in his left shoulder repaired. Mr. Garrett was to be the first company-sponsored worker in the USA to receive medical treatment in low-cost India. His union, the United Steelworkers, stepped in after it heard about Mr. Garrett’s plans, saying it deplored a shocking new approach of sending workers to low-cost countries as a way to cut health care costs. Its officials insisted that Mr. Garrett be offered a health care option within the USA. No US citizen should be exposed to the risks involved in traveling internationally for health care services, Gerard, Steel Workers President said, expressing concern about the willingness of employers to offer incentives to employees to go overseas. Even as the debate continues about insurers’ role in health care outsourcing, hundreds of uninsured and under-insured Americans have already gone on their own to India for treatments.

NY Times, October 11, 2006 Union Disrupts Plan to Send Ailing Workers to India for Cheaper Medical Care, By SARITHA RAI

NC: Much to the chagrin of the state-supported UNC Health Care system's critics, the budget year that ended June 30, 2006, yielded a financial windfall for the executives. The UNC system paid out more than $2.5 million in bonuses. Health system chief executive Dr. William L. Roper led the pack with a bonus of $110,010. UNC Hospitals CEO Gary Park wasn't far behind with a $103,632 bonus. Money diverted for incentive bonuses directly minimizes the amount available to pay for the historic mission of the hospital, which is to care for the people of North Carolina," Hammond said. "These folks are highly compensated already. Roper's annual base salary is $489,030. Park's is $460,780 a year. These executives develop policies on how aggressively to go after debts of lower and middle-incomed North Carolinians who have suffered severe medical conditions.

Big bonuses at UNC Health Care stir anger, Raleigh News and Observer, Oct 13 2006

NATL: A growing number of Americans are upset with rising health care costs and say that covering medical bills is reducing their ability to save. "The 7.7% increase in premiums is double the rate of increase of workers' earnings and double the rate of inflation," Fronstin said. "And people are paying more." The Kaiser study estimated that the health insurance bill for the average family was nearly $11,500 a year; the cost for individuals was about $4,200 a year. More than 36% said they had to reduce contributions to their retirement savings plans, up from 26 % a year ago. At the same time, some 53 % said they had to cut contributions to other savings accounts, up from 45%, and 28% said they had difficulty covering basic expenses, up from 24%.

Survey: Medical costs cut into savings, The Associated Press, NEW YORK

NATL: A new kind of health plan being offered by a growing number of employers appears to save on costs but may lead some patients to forgo needed care. In contrast to traditional plans, in which beneficiaries typically pay a modest deductible and co-payments of $15 or $20 for visits to the doctor, the new plans can require consumers to shell out hundreds and sometimes thousands of dollars of their own money for drugs, doctors and hospital care before most coverage kicks in. The annual deductible in a consumer-directed plan is generally $1,050 to $2,000 for individuals and $2,100 to $4,000 for families -- far higher than the average $220 deductible in a traditional employer-sponsored health plan. Premiums tend to be lower, however. Consumer-directed plans have been heavily promoted by the Bush Admin. The new plans often are linked to health savings accounts (HSAs). With consumer-directed plans, most employers save at least 10 % on health costs. And people enrolled in the plans do appear to be cutting back on their health care. In some cases the greater cost-sharing burden on consumers meant that people were forgoing necessary care and potentially jeopardizing their health. The plans do little to save on costs because these plans will still pay for the catastrophic illness and end-of-life care that is responsible for 85% of health-care spending annually.

Health Plans Raise Concerns, Study Says New Model Leads Some to Skip Necessary Care, By Christopher Lee, Washington Post, October 24, 2006

NATL: Humana, the second-largest provider of Medicare drug benefits, said its profit more than tripled on higher prescription-plan membership. Third-quarter net income increased to $159 MIL. Under Medicare Part D, patients pay for the first $250 of medicines used in a year, and the insurer covers the next $2,000. Coverage for members doesn't begin again until the patient's pharmaceutical bill for the year hits at least $5,100. The gap, known as the ``donut hole,'' is the most profitable period for insurers because they collect monthly premiums from patients during that time without paying for any drugs.

Humana Profit More Than Triples on Medicare Plans, By Lisa Rapaport, Oct. 30 (Bloomberg)

NATL: The percentage of employees at large companies who were eligible for health insurance and who enrolled in plans fell from 87% in 1996 to 80% in 2004, or 8.7% in 8 years. The steepest decline occurred among employees of large retail firms where enrollment dropped 18% from 81.5% to 69%.

Insurance Enrollment Falls at Large Firms, Posted 10/05/2006, Agency for Healthcare Research and Quality (AHRQ) http://hcup.ahrq.gov/HCUPnet.asp Medscape Business of Medicine. 2006;7(2)

NATL: Cuts to federal public health funding are hurting public health programs across the country, leading to cutbacks in services and staff. Cuts to public health services and programs were prevalent. More than 40% of PH professionals said they had to cut back on services because of the budget cuts. In particular, injury prevention and immunization programs were cutback and screenings for heart disease and diabetes were eliminated, along with cuts HIV education in prisons, and lead poisoning prevention. Half of US deaths are due to behavioural choices and amenable to public health education and support services, although only 2.6% of health care expenditure is for public health.

Federal Funding Cuts Harming Public Health Services Nationwide: APHA Survey Finds Budget Cuts Being Felt, Posted 10/02/2006, Michele Late, The Nation's Health. 2006;36(8)

NATL: Health literacy explained a small to moderate fraction of the differences in health status and, to a lesser degree, receipt of vaccinations that would normally be attributed to educational attainment and/or race if literacy was not considered.

Impact of Health Literacy on Socioeconomic and Racial Differences in Health in an Elderly Population, Posted 10/02/2006, David H. Howard, PhD; Tetine Sentell, PhD; Julie A. Gazmararian, PhD, MPH, J Gen Intern Med. 2006;21(8):857-861.

NATL: US Customs and Border Protection officials have scrapped the Bush Admin policy of seizing prescription drugs imported through the mail from Canada. The practice had come under fire from lawmakers for depriving American seniors of their drugs and protecting the prices charged by US pharmaceutical companies. Prescription drugs are cheaper in Canada, because its national health-care system negotiates lower prices for its citizens. Only the USA among industrialized nations has no national health care system (a system including whole population).

US to Stop Seizing Canadian Drug Imports: WSJ, Oct 4, 2006. Antibiotic Treatment for Many Outpatient and Inpatient Bacterial InfectionsLearn more about high-dose, short-course therapy, including PK/PD parameters, clinical benefits, and doctor and patient benefits.

INTL: Merkel, a Christian Democrat (CDU), met with the heads of the Christian Social Union (CSU), and Social Democrats (SPD), in a bid to reach a deal on health system reform. The reform is needed in part to plug an expected $8.9 BIL shortfall in the fund this year, caused by spiralling costs and pressure on the system by the relatively high level of unemployment in recent years. It has proved the most divisive issue so far for the grand coalition of left and right parties. Poll ratings for the CDU and the CSU are mired at their lowest levels since German reunification in 1990. The government is unlikely to topple, however.

Merkel Seeks to Break German Health Reform Deadlock, By Tom Armitage, (Reuters) Oct 04 Reuters Health Information 2006.

NATL: WellPoint has cemented its spot as the largest Medicaid provider by winning four state contracts since June 2006. The commercial business is flattening out in terms of coverage and growth, and Medicaid is seen as a place where they can roll up some additional membership and additional top-line growth. While full-service Medicare health plans generally bring five times as much revenue per member as Medicaid plans and have slightly higher profit margins, Medicaid remains an under-the-radar chance for insurers to grow membership and revenue (to extract further profit out of the US health care system). As of June 2005, about 63% of the 45 million Medicaid recipients were covered by some form of managed care. "It's going to be a significant growth opportunity for the industry," CIBC analyst Carl McDonald said.

Not Just Medicare: Insurers Eye Growth in Medicaid, By Lewis Krauskopf, (Reuters) Oct 03 Reuters Health Information 2006 US insurers' expanded role with Medicare health plans this year has drawn the attention of the general public and investors, but the companies also are eyeing another government insurance program: Medicaid plans that cover low-income Americans.

NATL: The American Academy of Family Physicians (AAFP) representing 94,000 US physicians and medical students says doctors must push for reforms in medical malpractice, universal healthcare coverage, Medicare compensation for physicians who treat seniors, technology-related incentives for physician practices, and incentives for medical students to enter the practice of family medicine. The central element of the new workforce policy is a challenge to physicians to take the need for these reforms directly to the US Congress and the American voter. AAFP's President-Elect Rick Kellerman, told delegates that the number of family physicians is decreasing while the number of patients who have more complex chronic care needs is increasing. There is a grave need to increase the number of family practice physicians, which is predicted to decline to 139,531 or 41.6 per 100,000 population by 2020.

AAFP Announces 5-Point Policy Statement on Workforce Reform, Terry Hartnett, September 30, 2006 (Washington) Medscape Medical News 2006

NATL: Companies that provide Medicare prescription drug coverage will offer most seniors cheaper options for 2007 during an enrollment period in November 2006. Average premiums will remain at about $24 a month. Co-payments, deductibles and the drugs that are covered vary with each plan. Some companies are raising premiums on current plans, and those seniors could switch to another option. Many seniors will have dozens of options available in their states. Critics say the large number of choices are confusing. McClellan said companies were offering fewer basic plans but more alternatives with expanded coverage.

US Companies to Pitch Cheaper Medicare Drug Plans, WASHINGTON (Reuters) Sept 29 Reuters Health Information 2006

NATL: A federal judge was inclined to let evidence gathering continue in a lawsuit over the morning-after contraceptive pill, but stopped short of ruling whether the plaintiffs can subpoena documents and testimony from the White House. A lawsuit filed by the The Center for Reproductive Rights alleges the US FDA has repeatedly broken its own regulations in denying women of all ages increased access to the Plan B contraceptive. The CRR, filing first in January 2005, also claims that testimony from depositions it has taken so far show agency officials planned to drag out the approval process for the contraceptive for political reasons. Franklin Amanat, who represents the FDA in the case, said they plan to file a motion to have the case dismissed in light of the agency's decision to allow the "vast majority who would purchase the drug" over-the-counter access to it. Barr Pharmaceuticals Inc. applied for over-the- counter status for Plan B in 2003.

US Judge Likely to Allow Discovery in Plan B Suit, NEW YORK (Reuters) Oct 12, 2006.

MN: Minnesota officials have widened their investigation of UnitedHealth Group to see if the health insurer accelerated stock options without proper disclosure. The Minnesota AG and federal authorities were already investigating UnitedHealth for "back- dating" options. Through backdating, grant dates and exercise prices can be manipulated to increase the value of options. A New York federal prosecutor, the SEC and the IRS are also investigating options at UnitedHealth, which faces shareholder lawsuits on the topic. In May, UnitedHealth said it might have to restate past earnings by as much as $286 MIL as it reviews stock option practices that led to the granting of options worth about $1.6 BIL to its chief executive, William McGuire, at the end of 2005.

Minnesota Probes UnitedHealth for Options Acceleration, By Lewis Krauskopf, NEW YORK (Reuters) Oct 12 Reuters Health Information 2006.

NATL: Unpaid medical debt at publicly traded hospital companies is worsening, and the rising number of individuals without health insurance in the USA will be a worse-than-expected drag on profits into the third quarter of 2006. The toll of unpaid medical bills has been marring hospital profit growth for several quarters and has been a theme as the companies' post results. In August, the US Census Bureau reported that 15.9% of the population, or 46.6 million people, had no health insurance, up from 15.6% in 2004, and a fifth consecutive year of increase. Analysts expect a more rapid erosion of paying patients into the third quarter, estimating inpatient uninsured discharges rising 6.6% of total discharges 12% more than a year earlier. The worst-affected region appears to be the south-central US, where uninsured rates are likely rising 10.7%.

Unpaid Hospital Bills Getting Bigger in US, CHICAGO (Reuters) Oct 10 Reuters Health Information 2006

NATL: Insurer UnitedHealth Group, whose chief executive is leaving amid a stock option scandal posted a 38% rise in quarterly profit, helped by gains from its Medicare drug plans and its PacifiCare acquisition. Third-quarter net earnings rose to $1.1 BIL. UnitedHealth's Medicare Part D business, which involves plans that provide prescription drug coverage, served 5.75 million people as of Insurers are seeing an expanded role in offering coverage this year under Medicare. The company's medical care ratio, a key industry barometer that measures medical costs as a percentage of premium revenues, improved a half-percentage point to 81.1 % for all the company's businesses (Public Medicare spends 97% of funds on care).

UnitedHealth Reports Higher Quarterly Profit, NEW YORK (Reuters) Oct 19 Reuters Health Information 2006.

NATL: Flu vaccine makers will provide 115 million doses to the US market this year, by far the most ever, but vexing distribution problems mean it may still be difficult to get a shot. Doctors should start vaccinating patients as soon as they receive their vaccine orders. They should aim to get high-risk patients, such as the elderly, vaccinated first but there is no advisory calling for such patients to be first in line, as in past years. [Even though clinics might receive vaccine months after private pharmacies at drug stores have been selling shots to the general and unendangered public.] The USA has had continual battles over flu vaccine, with regular shortages due either to manufacturing troubles or distribution woes. [Most troubling is that in much of the nation those most at risk do not receive the vaccine first.] The US system relies almost entirely on the private sector to distribute flu vaccines. "Unfortunately the situation leaves providers with uncertainty about when they can expect to receive their orders," Santoli said.

US to Get 115 Million Flu Vaccines This Year: CDC By Maggie Fox, WASHINGTON (Reuters) Oct 18 Reuters Health Information 2006

INTL: Germany's Joint Committee (G-BA), a self-regulating body of doctors and state health insurers which makes recommendations, said that it had classified Acomplia as a "lifestyle" drug. The G-BA said the decision enacted a law ruling that the cost of medicines for dieting, appetite control or weight loss should not be borne by the German healthcare system. The committee also said that it would not recommend doctors prescribe Exubera, the inhaled insulin product which Pfizer says is more convenient for diabetics to use than traditional, injectable forms of the drug. The G-BA said in a statement that Exubera, on the market in Germany since May