MT: In the face of growing public angst over health care costs, St. Patrick Hospital in Missoula decided it wanted to shed some light on the subject by posting their prices on the Internet. That was 18 months ago. It still hasn't happened. "We (were) trying to organize our pricing so that it's consumer friendly and understandable". It's a little more difficult than I anticipated." Last week, Jacobson said the project has been shelved for now. For anyone who's tried to decipher a medical bill or delved into health-care pricing, the difficulty encountered by the Missoula hospital should come as no surprise.

Hospitals struggle to explain costs By MIKE DENNISON Missoulian State Bureau, Sept 6, 2006

NATL: Most private hospitals can only dream of the futuristic medicine Dr. D Shroff practices today. Shroff, a specialist in internal medicine, works at the Veterans Affairs hospital in Washington, where the vets who come for the cutting-edge treatment are mostly poor. If you're surprised, that's understandable. Until the early 1990s, care at VA hospitals was so substandard that Congress considered shutting down the entire system and giving ex-G.I.s vouchers for treatment at private facilities. Today it's a very different story. The VA runs the largest integrated health-care system in the country, with more than 1,400 hospitals, clinics and nursing homes employing 14,800 doctors and 61,000 nurses. And by a number of measures, this government-managed health-care program--socialized medicine on a small scale--is beating the marketplace.

How VA Hospitals Became The Best, Time Magazine of Sunday, Aug. 27, 2006, By DOUGLAS WALLER

NATL: Although more than 80% of 2637 physicians regarded the error as serious and believed the physician to be largely responsible for the error, only 65% said they would definitely disclose the error to the patient. 29% would probably disclose the error, 4% would disclose the error only if asked by the patient, and 1% would definitely not disclose the error, the authors report. Fewer than half the physicians (42%) would actually use the word "error" in their disclosure, whereas 56% would mention the adverse event but not the error. "The fact that U.S. and Canadian physicians' attitudes transcend country boundaries suggests that these beliefs may relate to the norms, values, and practices that constitute the culture of medicine," the investigators say.

Many Physicians Would Not Disclose Medical Errors to Patients, Sept 4, 2006 Reuters Health, By Will Boggs, MD, Arch Intern Med 2006;166:1585-1593,1605-1611.

NATL: Emergency rooms at many hospitals are routinely stretched to the breaking point, raising concerns that they would not be able to handle victims during a terrorist attack or natural disaster. Between 40% and 50% of ERs experienced crowding during 2003 and 2004. The study deemed an ER to be crowded if so many patients flooded in that ambulances had to be diverted to other hospitals; if people in urgent need of care had to wait an average of more than an hour; or if at least 3 % of patients simply gave up and left before being seen. The annual number of visits to ERs rose 18% from 1994 to 2004. At the same time, the number of hospitals operating 24-hour emergency departments declined by 12%. The problem is exacerbated by a shortage of nurses. More than 5% of nursing staff positions were vacant at half of all ERs in metropolitan areas.

Crowded ERs Raise Concerns On Readiness, By Christopher Lee, Washington Post September 28, 2006

NATL: The bill is coming due for years of generous benefits bestowed upon the nation's public employees, and it's a stunner: hundreds of billions of dollars over the next three decades, threatening some local governments with bankruptcy. This staggering burden is coming to light because of new accounting rules, requiring disclosure of the future cost of health-care and other benefits promised to the nation's estimated 24.5 million active and retired state and local public employees. Many cities and state agencies already are struggling to fully fund their pension obligations, but experts say those liabilities pale in comparison to the debt accumulated for other retirement benefits. At the least, experts say, the public can expect increased taxes and fees or reduced public safety and public works services as governments adjust their budgets to amortize the debt. [Essentially another savings source for universal care, as none of this would be an "extra billing" with universal care.]

States to owe billions soon, Raleigh News and Observer, Published: Sep 25, 2006 12:30 AM, Associated Press

NATL: Nonprofit hospitals routinely overcharge or deny care to patients least able to pay, raising questions about whether the institutions should be eligible for tax exemptions that cost the U.S. Treasury (taxpayers really) billions annually. Many of the hospitals that say they offer charity care fail to inform patients about such assistance. While federal law requires charity care in exchange for tax-exempt status, a 37-year-old IRS rule implementing the law is so vague that nonprofit hospitals have been able to exploit it by offering some free services but often little aid to the poorest people in their communities. Nonprofits frequently charged higher prices to poorer people with no health insurance than they did to better-off patients who had coverage. At the same time, many of the same non-profit hospitals' top executives enjoyed generous perks such as paid country club memberships and stays at expensive hotels [not to mention some impressive salaries]. Several state attorneys general are looking into possible abuses by tax-exempt hospitals.

Hospital Charity Care Is Probed - Investigators Find Nonprofits Overcharge or Deny Services, By Kathleen Day, Washington Post September 13, 2006

MA: The Massachusetts health reform plan has generated more favorable press plaudits and political projections than its shaky foundations merit. Achieving a sustainable balance of long-standing political tensions involving the affordability, comprehensiveness, and tax-subsidized cost of health insurance guarantees remains an elusive goal. No state has succeeded in requiring that all of its residents be covered by health insurance, let alone guaranteeing it. A previous near-universal health care law for the state, relying on an employer mandate, was approved in 1988 but was ultimately repealed in the mid-1990s. Proclaiming an individual mandate to purchase insurance and actually enforcing it are two different things. The temporary spring blossoms of shallow bipartisan compromise in the Bay State will fade away in the next few years amid inescapable fiscal conflicts, implementation shortcomings, and still-unreconciled political differences.

Health Affairs, 14 September 2006, Massachusetts: More Mirage Than Miracle, by Tom Miller

NATL: Imagine if you were told that the only car you could buy stopped working after 7,000 miles until you paid another hefty fee to get it going again? You'd likely think the car a poor investment at best and question the motives of the folks selling it. That's essentially what the Bush administration has done with prescription drug coverage for older and disabled Americans. They can buy it. but the typical person with Medicare is forced to lose drug coverage -- "falls into the doughnut hole" -- on or around Sept. 22 and is without drug coverage until she spends $3,600 of her own money (excluding premiums) meeting her medication needs. Of course, the congressional leaders who supported this drug benefit would like us to focus only on their allocation of $760 billion over 10 years to subsidize the drug benefit, which has reduced by about half the cost of medications for millions of this counry's elderly and disabled. But what they do not tell you is that, as designed, the drug benefit provides a large subsidy to the pharmaceutical and health insurance industries.

Medicare RX benefit has doughnut hole , SEATTLE POST-INTELLIGENCER, September 22, 2006, by DIANE ARCHER

NATL: A widely followed national survey reported that the cost of employee health care coverage rose 7.7% this year, more than double the overall inflation rate and well ahead of the increase in the incomes of workers. The increase was the lowest since 1999, but the average cost to employees continued an upward trend. Since 2000, the cost of family coverage has risen 87% while consumer prices are up 18% and the pay of workers has increased 20%, the survey noted. That is without counting the cost of deductibles and other out-of-pocket payments, which have also been rising. The national cost trend would probably have been higher, analysts said, but regulators in a number of states were able to push nonprofit Blue Cross plans that are prosperous to hold down their increases, at least for a while.

Health Care Costs Rise Twice as Much as Inflation, StarNewsOnline.com September 27. 2006, New York Times

NATL: Congress created the citizens' group in late 2003 when it established a prescription drug benefit under Medicare. During 18 months, the group heard from 6,650 people at 84 meetings around the country. More than 14,000 people responded to its Internet poll.So what do Americans want when it comes to health care? Two things: protection for all from high medical expenses and guaranteed coverage for specific checkups and treatments. The group's call for universal health benefits will be delivered to President Bush. The recommendations clash with Bush's stance that consumers should bear more responsibility for their initial medical expenses.

Citizens' Health Care Working Group, Sept 27, 2006, By KEVIN FREKING, Associated Press

NATL: Homeland Security Cuts and Runs. Since November 2005, U.S. Customs and Border Protection agents have seized prescription drugs that 40,000 Americans had ordered from Canada. Customs will no longer intercept the drugs or issue letters to postal carriers indicating it is illegal to import prescription medications. The policy change was due to political pressure from lawmakers and people who complained they were no longer receiving their medicine. "It's a great victory, particularly for the senior citizens who are having difficulty making financial ends meet in a time in which, sadly, some senior citizens have to make a decision between buying their prescription drugs and buying their groceries" [while the Bush Administration proves ever faithful to the pharmaceutical industry].

Gov't to stop seizing drugs from Canada, By STEPHEN MAJORS, ASSOCIATED PRESS WRITER, Published: Oct 4, 2006

NATL: Health insurance premium costs for job-related family coverage varied by as much as $4000 a year between the most expensive and least expensive state in 2004. The most expensive average cost for family coverage -- $11,742 -- was in the District of Columbia, and the lowest cost -- $7,800 -- was in North Dakota. The national average cost for family coverage was $10,006. See how your state ranks at EINO website (current news). CLICK HERE

District of Columbia, New Jersey, Charge the Most for Job-Related Health Insurance Coverage, 09/12/2006, Agency for Healthcare Research and Quality (AHRQ)

NATL: The time is at hand for health and productivity management to cross the chasm from early adoption to a wider acceptance among the majority of corporate leaders and national policymakers. Sen Kennedy: "to cut costs and promote quality, we can do much more to stop illness before it starts. Health promotion and disease prevention must be as central to our health system as hospital and physician care." Gregg O. Lehman, President and CEO, Inspiris: "employers are learning that the more they help employees determine their health risk and the more opportunities they provide employees to make better choices, the greater the rewards a healthier, more productive workplace." In the face of the growing crisis in rising national and corporate health expenditures fueled by the aging workforce and the increasing prevalence of chronic medical conditions, health and productivity management promises to be an expanding, valuable field.

An Aging Workforce: Health-Related Productivity and the Economic Value of Health Promotion Posted 08/25/2006 by Ryung Suh

NATL: Nurses' rounds conducted regularly, every 1 or 2 hours, may help decrease patients' use of call lights, as well as increase safety and level of patient satisfaction [effectively limiting malpractice claims as well]. The practice of conducting rounds varies widely from hospital to hospital. Nurses say that normally "rounds are conducted on a haphazard basis at best" and usually in response to a timed interaction, such as medication administration, or in response to a patient request. Nurses who initially expressed concern about who would perform the more intensive rounding. "However, at the end of the study...they were more satisfied with the additional time they had to care for their patients as well as to perform other tasks".

Frequent Nursing Rounds Decrease Call-Light Use by Emma Hitt, PhD, Am J Nursing. 2006;106(9):744-753.

NATL: Universal vaccination against influenza could have enormous cost benefits, given the percentage of outpatient visits and hospitalizations due to influenza. Among subgroups determined to be at "high risk" - ie, those formerly recommended to receive yearly influenza vaccine such as asthmatics and children with other medical conditions -- the rate of receipt of influenza vaccine was still less than 30%! This low rate of vaccine receipt occurred among high-risk children during an era suggesting universal coverage for all children 6-23 months old. We still have a long way to go in covering just the high-risk groups alone. However, it also means that there is a substantial upside to more aggressive influenza vaccination -- we are still far removed from the concern of reduced returns on the investment of increasing influenza vaccine coverage!

Increasing Influenza Coverage in Young Children?, 09/05/2006, Poehling KA, Edwards KM, Weinberg GA, et al, Jr, MD, FAAP, N Engl J Med. 2006;355:31-40

NATL: Long work hours for interns and residents continue for interns, and raise needlestick risk. Extended work increased the likelihood of a percutaneous injury by 61% compared with nonextended work. Lapse in concentration and fatigue were cited as contributing factors in 64% and 31% of injuries, respectively, the authors note. With the ACGME limits, a trainee should not work more than 30 consecutive hours and no more than 80 hours total each week. Moreover, for 1 day in 7, the trainee should be free of all work duties. In the year after the limits were imposed, 83% of interns reported working hours that, for at least 1 month, were in violation of the ACGME rules.

Long Work Hours Continue for Interns, and Raise Needlestick Risk, Sept 5, 2006, JAMA 2006;296:1055-1070.

NATL: US hospitals may be contributing to unhealthy lifestyle choices by housing fast-food establishments on their premises. "The medical community must practice what it's preaching," lead author Lesser says. "It is deplorable for a doctor to lecture a patient on taking more careful precautions against heart disease, while there is McDonald's in the hospital's lobby serving a fried-food lunch." Of 233 hospitals, 98 (42%) had at least 1 Fast Food served on campus (Taco Bell, Pizza Hut, McDonald's, Wendy's and Dunkin Donuts). In light of publicity campaigns by leading hospitals to promote healthy diet and lifestyle, AMSA suggests that their survey results are disappointing.

Leading US Hospitals Serving Fast Food Send Mixed Message, Laurie Barclay, MD, J Am Board Fam Med. 2006;19(5):526-527.

NATL: Aetna Chief Executive Ron Williams said the company's second-quarter medical cost ratio -- a key industry barometer that measures medical costs as a percentage of premium dollars [their success is patient loss, less care paid for]-- now looks better, given additional data it received in the past two months. Aetna shares were up $2.10, or 5.8 %, at $38.60 in afternoon New York Stock Exchange trade after rising as high as $39.01 earlier in the session. [That benefit to shareholders is $2.13 BIL paid in premiums for care not covered by insurer.]

Aetna Shares Rise After Comments on Medical Costs, Reuters Health Information 2006, Sept 11

NATL: Americans are beginning to realize that childhood obesity is a real problem and are even starting to do something about it, but there is no way to tell what actually works. At least one program that succeeded just lost its federal funding, the experts at the Institute of Medicine said. "There was a national campaign called VERB done by CDC and the federal government to increase children's awareness of being physically active," he added. "That was shown to be effective in doing those things but then it ceased to be funded." The program ends this month [even though it would save nation billions in long run].

U.S. Trying, but Often Failing, to Help Obese Kids, By Maggie Fox,Reuters Health Information Sept 13

NATL: Everyone in the U.S. between the ages of 13 and 64 years should undergo routine screening for HIV infection, the US Centers for Disease Control and Prevention announced. All health-care providers should also incorporate routine, voluntary HIV screening into their daily practice. About 25% of HIV-positive adults in the US are unaware of their infection. The new guidelines are intended to simplify the HIV testing process and increase early HIV diagnosis. Fully 30% of new infections could be reduced annually if infected persons who know their HIV status adopt changes in high risk behaviors. They also raise the issue of funding for the increased care. "Testing more people obviously takes money, and CDC doesn't have it," Dr. Schouten adds. "Who's going to pay for it?" [Even thought it's terribly more costly to let unknowing citizens infect others. No one will pay for cost-savings?]

Everyone Between 13 and 64 Should Be Screened for HIV: CDC, Reuters Health Information 2006, Sept 21 & Mor Mortal Wkly Rep CDC Surveill Summ 2006

CA: On a largely party-line 43-30 vote, the Calif Assembly approved a bill that would eliminate private medical insurance plans and establish a statewide health insurance system that would provide coverage to all Californians. The state Senate had already approved the plan once and is expected this week to approve changes. Schwarzenegger has said he opposes a single-payer plan like the one Kuehl's bill would create, but the governor has not offered his own alternatives for fixing the state's health care system. As many as 7 million people are uninsured in the state, and spiraling costs have put pressure on business and consumers. SB840 would provide comprehensive medical, dental, vision, hospitalization and prescription drug coverage to every California resident. Anyone could see any doctor or go to any hospital. The bill does not account for the costs of the program since it would take several years before any plan was up and running. The plan would create a commissioner and a blue-ribbon commission to examine how the structure would work. An analysis by the Lewin Group, an independent health care consulting firm, said the plan could be paid for with all of the money now being spent on health care.

ASSEMBLY APPROVES UNIVERSAL HEALTH CARE, Lynda Gledhill, Chronicle Sacramento Bureau, August 29, 2006

NATL: Under the hospital-run health insurance plan, nurses or their family members would have to pay a fixed fee of up to $700 for each hospital admission and each outpatient procedure performed outside of the network of doctors and hospitals in the plan. Ms. Clark, the union representative, said the proposed fee was different from a deductible. This isn’t a deductible as the hospital wants to call it, but a penalty. The union had found other plans that did not include such a feature. Our members come from four states in this region and cannot always get to providers that are in the network and to the hospitals that are covered.

NURSES STRIKE OVER HEALTH PLAN AT HOSPITAL IN NEW JERSEY, By RONALD SMOTHERS, NYTimes, August 25, 2006

NATL: Virtually all respondents (95%) in a United Methodist Health Ministry survey said they had health insurance continuously over the past 12 months. However, nearly a third (29%) of the non-elderly respondents said they had medical debt. Many respondents with debt reported avoiding care to keep away from accruing new debt and many struggle to pay down their bills using significant portions of their savings, and transferring the debt to credit cards. These findings call into question insurance policy approaches that advocate shifting more of the costs of health care onto policyholders.

MEDICAL DEBT IMPACTING KANSAN FARM FAMILIES, THREATENING HEALTH CARE ACCESS, The Access Project, August 16, 2006

NJ: Customers shop around when they buy an airline ticket or a new car, so why not when they need a hip replacement or treatment for a sore throat? An executive order being signed today by President Bush is designed to help people make more informed decisions about doctors and hospitals. "We're all about being cost-conscious," Bush's HHS Sec. Leavitt. It's just the American way. We clip coupons. We check for bargain flights on the Web. We carefully research major purchases." BUSH TO OK HEALTH-CARE COMPARISON LAW, By Kevin Freking, The Associated Press, August 22, 2006

CA: Lawmakers launched the pool 14 years ago to make coverage more affordable businesses with fewer than 50 workers. Once off the ground, the law called for the program to be privatized. In the meantime, lawmakers also guaranteed the availability of coverage for small businesses. PacAdvantage's downfall began to take shape in the spring after Blue Shield said it was losing money in the program and announced plans to withdraw after this year, the other large insurers have now opted to follow suit.

INSURANCE-POOL PLUG PULLED, The Sacramento Bee, August 12, 2006, By Gilbert Chan

CA: LA Superior Court Judge CJ West rejected a request from the California Hospital Association (CHA) to prohibit Blue Cross of California from paying differing fees to physicians who perform colonoscopies in hospitals vs. private surgical centers. In denying the request for an injunction against Blue Cross, West declared that the CHA has "provided no evidence demonstrating that the policy will interfere with a physician's medical opinion as to what is best for his or her patient." According to Blue Cross, the price range for these procedures is dramatic. Hospitals typically charge two to three times more for a colonoscopy compared to ambulatory surgery centers. [The decision paves the way to increase the flight of all profitable procedures from the hospitals. Leaving hospitals in greater insecurity, debt and need for public bailout. It matches the way we allow insurers to specialize in policies for the young and healthy while all the older and sicker of us are paid for out of public funds.]

JUDGE DENIES PRELIMINARY INJUNCTION IN CHA LAWSUIT, Medical News Today, August 4, 2006

NATL: Patients generally can't tell whether doctors are making the right diagnosis or prescribing the right treatment, but patients do make judgments on the quality of care they receive. Their perceptions are affected by their interactions with the practice on the telephone, the ease of finding parking, and their interactions with staff and healthcare providers. Results of an online patient satisfaction survey service, www.DrScore.com, [Seems to prove how horribly wrong are any ideas that consumer-driven health care will lead to better quality medical attention.]

WHAT ARE PATIENTS LOOKING FOR?, Posted 08/18/2006, Steven R. Feldman

NATL: Adult women now have access to the emergency contraception called "Plan B," without a prescription after a 3-year political battle over wider access. Barr's Plan B must stay behind pharmacy counters and women must show proof they are at least 18 to buy the emergency contraceptive pills and younger girls still need a doctor's order. Two Plan B pills can prevent pregnancy when taken within 72 hours of sexual intercourse. "While we still feel that Plan B should be available to a broader age group without a prescription, we are pleased that the agency has determined that Plan B is safe and effective for use by those 18 years of age and older as an over-the-counter product". Throughout the process, two Democratic senators blocked votes on GW Bush's nominees to run the FDA. In December 2003, a panel of outside advisers voted 23-4 to recommend switching Plan B to over-the-counter sales. Some research suggests Plan B also may keep a fertilized egg from attaching to the womb, with some opponents considering this equivalent to abortion. Plan B is different from RU-486, a pill that induces abortion early in pregnancy.

Reuters Health News, FDA APPROVES OTC SALE OF EMERGENCY CONTRACEPTION PLAN B, By Lisa Richwine, Aug 24, 2006

TX: Doctor-owned hospitals are set to proliferate now that federal funding will become available again. These hospitals skim off the most profitable patients from an already overburdened health care system, leaving it with the sickest and poorest clientele. Some also fear that the doctor-owners could put their financial interests ahead of their patients. Meanwhile, proponents of the 200 or so doctor-owned hospitals in the USA say they are streamlining medical care, with their surgical centers practicing with Henry Ford-like efficiency. "Physicians are making recommendations which increase their income substantially," said R Berenson, of the Urban Institute. "It creates a 'medical arms race,' which increases costs." Compared with the approximately 5,000 general hospitals, the doctor-owned group is still small. But big chains say these specialty competitors are crimping their profits in key markets. Texas alone has 58 physician-owned hospitals, and about two dozen others are waiting for approval upon expiration of the ban, according to the state's hospital association.

PHYSICIAN-OWNED NICHE HOSPITALS SEEN BOOMING AGAIN, By Kim Dixon, Reuters Aug 24 2006

NATL: A federal jury found Merck was negligent and knowingly made misrepresentations about its withdrawn pain medicine, Vioxx and awarded the 62-year-old male plaintiff $50 million in compensation. Merck has now won five cases and lost four in its defense of Vioxx. "It will probably get knocked down in an appeal. It's hard to know what they're going to do.... Right now, it looks like they have to try them all, unless they make some sort of settlement... They probably are going to wait out a few more cases. "You got to figure out the average cost of the awards...This is the biggest... This one is coming from a district that has always been anti-corporate... If the awards come down to $1 million (on appeal) it's probably not something they're going to change policy on right away."

FEDERAL JURY FINDS MERCK NEGLIGENT IN VIOXX CASE,(Reuters) Aug 17, 2006

NATL: Pres GW. Bush renewed his call for Congress to curb medical malpractice lawsuits and signed an executive order aimed at providing Americans more information about the cost and quality of health care services. "These trial lawyers need to back off," Bush said. "A lot of OB/GYNs are leaving the practice because they're getting sued out of existence." Bush campaigned for the presidency on an agenda that included capping malpractice damages, arguing that they were driving up the cost of health care. [A contention shown to be false by all hard evidence.] Legislation with a $250,000 cap has passed the GOP-controlled House of Representatives repeatedly but has been blocked in the Senate.

BUSH PRODS CONGRESS ON MEDICAL LIABILITY LIMITS, By Jeremy Pelofsky,(Reuters) Aug 23 2006

NATL: Under Bush's Medicare Part D, most end-stage renal disease (ESRD) beneficiaries will fall into the "doughnut hole," where they are not covered for drug expenses between $2250 and $5100. Medicare Part D beneficiaries with ESRD will have mean total drug expenditures that are roughly twice those of other beneficiaries, along with substantial month-to-month variability in medication costs. This patient group differs from other Medicare beneficiaries because they automatically qualify for Medicare no matter how old they are, and they use far more medications. The study is published in the August issue of the Journal of the American Society of Nephrology. President of the Renal Physicians' Assoc, explained that there is not necessarily any cost saving in at-risk populations such as ESRD patients, who have several comorbidities, are often minorities and socioeconomically disadvantaged, and are likely to have difficulties in absorbing any out-of-pocket expense increases.

MOST ESRD MEDICARE PART D BENEFICIARIES WILL FALL INTO DRUG-COVERAGE GAP, Marlene Busko, August 23, 2006

NATL: Tenet, the second-biggest US private hospital chain, resolved a four-year-long US Department of Justice probe into Medicare and other billing disputes for about $900 million two months ago. Now, University of Southern California is seeking to end its contract with Tenet, owner of the 329-bed University of Southern California hospital system. The University claims years of government investigations have marred Tenet's cash position and seeks to take control over the hospital system. The university filed suit because negotiations broke down in the past week and the university ended up with more than $100 million less than it sought for capital improvements. "Tenet gave oral assurances over the last few months that money would be forthcoming, and in the last week, Tenet reneged on that," he said. Tenet runs about 57 hospitals nationwide, most of which are in California.

TENET HEALTHCARE SUED BY CALIFORNIA UNIVERSITY, (Reuters) Aug 23 2006

NATL: A free Viagra prescription or a no-cost trial of sleeping pills are examples of growing offers to US consumers, but regulators and critics worry about the side effects of pitching medicines like selling soap. Drug makers say the coupons, rebates and similar promotions lower patient costs or provide the chance to try new medicines. Consumer groups say they may draw people to risky drugs they may not need, without long-term savings. [Not to mention wasting a huge portion of limited time with their physicians in discussing irrelevant industry propaganda.] Coupons "can increase the patient's desire to take a drug that may or may not be the most suitable drug... This is not shampoo," said Susan Sherry of Community Catalyst. The offers are appearing across the prescription drug business, trying to grab customers' attention in magazines and on Web sites. Pfizer Inc., for example, offers a free prescription of impotence drug Viagra for every six filled. Patients can try seven days of the Sanofi-Aventis sleeping pill Ambien at no cost. The trade association says abuses were rare and urged regulators to study coupon offers case-by-case rather than limiting them. Harvard's Avorn says "They are getting so preoccupied with marketing, and unfortunately they seem to be less successful in coming up with creative drug solutions," he said.

PRESCRIPTION DRUG GIVEAWAYS DRAW COMPLAINTS IN US, By Lisa Richwine, (Reuters) Aug 14 2006

NATL: US Medicare officials said they would start requiring specialty hospitals to report information about physician investment and compensation to make sure they are not violating anti-kickback laws. Critics say specialty hospitals, typically owned by groups of doctors, focus on highly profitable surgeries such as heart procedures and send sicker, harder-to-treat patients to general hospitals. "Although the survey responses do not show disproportionate returns or non-bona fide investments, we note that many hospitals did not respond to our request for physician investment and compensation information," CMS said in a summary. Hospitals that fail to report information promptly to CMS could face fines of up to $10,000 a day.

NATL: Screenings for blood pressure, colorectal cancer and alcohol use are among the top preventive services that can bring Americans the most health gains for their investments, according to a new study from the Partnership for Prevention. "Currently, about 95% of health care dollars in the USA are spent on treating diseases, with relatively little attention paid to preventing diseases, which should be a national priority," said former US Surgeon General David Satcher. But the preventive health services that can bring the greatest return on investment have delivery rates of 50% or lower for the general population, "and that is unacceptable." "For the poor and racial and ethnic minorities, the delivery of preventive services is even worse," said Maciosek who continued, "co-payments and other financial barriers decrease uptake of preventive services, especially for disadvantaged populations," Maciosek told The Nation's Health. "These are services we think should be covered by health plans without co-payments." [Why are Americans willing to pay extra, so that some needy Americans will not receive care?]

PREVENTIVE SERVICES A GOOD INVESTMENT FOR HEALTH, Posted 08/02/2006, Teddi Dineley Johnson

NATL: Now that a cervical cancer vaccine has won federal approval and has been recommended for routine vaccinations, questions remain over who will actually receive the vaccine and when. The CDC Advisory Committee on Immunization Practices recommended that 11 and 12-year-old girls routinely receive the vaccine to have a maximum impact, as vaccine immune response is higher in younger teens. Ideally, the vaccine should be administered before a female is sexually active. "The goal should be to get this vaccine to the largest number of people at the most effective time". Will the vaccine be a mandatory requirement for school attendance? The advisory committee recommended that the HPV vaccine be included in the federal Vaccines for Children Program, a victory for those who were concerned only the wealthy could afford the estimated $360 price tag for the three-shot regimen. The Vaccines for Children Program provides free shots to an estimated 40% of US children and is aimed at children enrolled in Medicaid, American Indian and Alaska Native children and the uninsured. Currently, Merck is the only company with an FDA-licensed vaccine, but GlaxoSmithKline is expected to come out with a cervical cancer vaccine within a year. CDC estimated there are 9,710 new cases and 3,700 deaths from cervical cancer in the USA each year.

NEW VACCINE FOR CERVICAL CANCER VIRUS RAISES ACCESS QUESTIONS: VACCINE APPROVED, Posted 08/02/2006, Donya C. Arias

NATL: Healthcare spending in the USA has remained heavily concentrated in a small portion of the total population, according to the Dept of HHS and AHRQ. An increasing portion of these expensive individuals remained in the highest-cost groups from one year to the next, according to data from 2002 and 2003. The top 5% of the population accounted for 49% of healthcare expenditures in 2002, and 34% of these individuals retained this ranking in 2003 (30.6% in 1996-97). The top 10% accounted for 64% of overall healthcare spending in 2002, and 41.8% of them remained in the top decile in 2003 (38.1% in 1996-97). At the other end of the spectrum, the lower half of the population (144 million persons) accounted for only 3% of overall healthcare spending ($27.6 billion out of the $810.7 billion total). [Next question: Who insures care for nearly all within the top 5% ANSWER: You do through your tax dollars. And that keeps the private insurers content to rake in profits insuring the young and healthy. These statistics will never change, what we need is one large risk pool.]

ONE PERCENT OF AMERICANS ACCOUNT FOR 22 % OF HEALTH CARE SPENDING, Posted 07/28/2006, Agency for Healthcare Research and Quality

TX: In response to the swelling ranks of the uninsured, the health insurance industry has been undergoing a quiet transformation. New low-cost products that offer more than a bare bones benefit and require an abbreviated applications process are being targeted to specific segments of the uninsured market -- young adults, seasonal or temporary workers and employees in retail and service sector jobs. These plans often cap services and exclude certain benefits such as pregnancy coverage. Huge retailers like Costco are dipping a toe in the health insurance market, selling discounted plans to small business owners and those without employer coverage. Others like Wal-Mart are offering basic health care services directly to in-store shoppers. "Medical tourism" plans that provide deep discounts to those who are willing to go abroad for medical procedures are growing in popularity. These innovative products are portable and allow consumers to pick and choose what they need and can afford. [New cheap offerings to the young and healthy is a winning formula for insurers, of course, while avoiding policies to those who might need care.]

CA: Sutter Health has agreed to settle a class-action lawsuit that alleged price-gouging of patients without insurance, potentially costing the Sacramento-based health system hundreds of millions of dollars. The settlement ends a lawsuit filed in September 2004 that alleged uninsured patients who received treatment at Sutter hospitals were charged unreasonably high prices compared to the rates paid by people with insurance. The agreement requires Sutter to send notices to all uninsured patients treated at Sutter letting them know they may be eligible to have their bills recalculated and eligible for a refund. The number of patients affected by the settlement could be in the hundreds of thousands. The settlement amount is estimated at about $276 MIL. The agreement also requires Sutter to abide by a new charity-care policy adopted in March for at least three more years.

NATL: "Free to Choose: A Conversation with Milton Friedman" Question: Is there an area here in the United States in which we have not been as aggressive as we should in promoting property rights and free markets? Milton Friedman: Yes, in the field of medical care. We have a socialist-communist system of distributing medical care. Instead of letting people hire their own physicians and pay them, no one pays his or her own medical bills. Instead, there's a third party payment system. It is a communist system and it has a communist result. [What could be more American than price-gouging the sick and poor? Friedman believes that without a fat wallet you should be left on the curb with the trash, even if your health could be easily restored. Anything else, including private insurance -that's commie!]

NY: An uninsured resident in Buffalo is likely to pay 60% more for a drug prescription than the federal government. Buffalo ranked 20th on the list of cities. The study checked the price of 10 drugs commonly used by Americans under the age of 65. The average price for those drugs in the Buffalo market was $81.02, just below the national average of $81.31. The federal supply price was $50.71. NYPIRG said the cost to an uninsured Buffalo area resident was about twice what they would pay at a Canadian pharmacy.

WI: The profitability gap between hospitals serving affluent communities and those in poorer urban neighborhoods grew in 2005, a reflection of the continuing challenges in collecting payment from government-funded insurance plans and the uninsured. Profit margins last year at some suburban hospitals in metropolitan Milwaukee exceeded the national average several times over. Meanwhile, several hospitals in the city of Milwaukee barely broke even. Hospital executives have long said the gap is largely driven by the revenue shortfall at hospitals that treat a disproportionate number of patients insured by the state and federal governments [the poor]. While most southeast Wisconsin health systems own both urban and suburban facilities, ProHealth Care, Waukesha, owns hospitals in Oconomowoc and Waukesha. There, the hospitals enjoy low percentages of Medicaid: 4.1% at Waukesha Memorial and 4.9% at Oconomowoc Memorial in 2005.

NATL: Over the next five months, several million Americans with high medicine costs could find themselves in a similar bind. The gap in insurance, popularly called the doughnut hole, is an unusual provision in most of the private plans offered in Medicare's new Part D prescription drug program. Advocates for the elderly say it is misunderstood and problematic. "There's nothing sweet about the doughnut hole," said Deene Beebe of NY Medicare Rights Center. The program was designed to give all participants a certain level of insurance and to protect elderly and disabled recipients with chronic or catastrophic illnesses from huge prescription expenses. To afford those two goals, Part D's designers built in an annual period during which individuals have to pay for medicines themselves. Advocacy groups and some independent health analysts have warned of serious health consequences for older and disabled Americans living on low or moderate fixed incomes. Their resources, though minimal, often are too much to qualify for extra help. They face difficult choices, advocates fear: buy medicines or food and other necessities? Washington July 30, 2006

NATL: People made more than 1 billion visits in 2004 to doctors' offices, emergency rooms and hospital outpatient departments, an increase of 31% from 10 years before, while the population rose only 11% during the same time. Medicaid patients, those with no health insurance and charity cases used hospitals more, and waiting times at emergency rooms, which by federal law must take in everyone who comes, increased significantly, the report found. The amount of time a patient waits before seeing a physician in the emergency department increased from 38 minutes in 1997 to 47 minutes in 2004. Last week the Institute of Medicine reported that emergency departments were overwhelmed in the United States and called for the federal government to help change the structure of emergency services.

NATL: US psychiatric hospitals are ripe for a wave of consolidation as their strong profits and growth potential make them attractive acquisitions for health care companies. For-profit corporations run about one-third of the 500 psychiatric hospitals in the USA, but experts expect that percentage to rise, aided by Psychiatric Solutions, which controls about 12 % of the market and plans to gobble up at least a half-dozen facilities annually for the foreseeable future. As with health care in general, spending on mental health is rising faster than overall inflation. The US government, private insurers, and patients spent $85 billion in 2001, up 73% over the prior decade. About 6% of the US population suffers from a serious mental illness. The psychiatric sector is a lucrative niche within the hospital industry. Psychiatric hospitals have good volume growth, good pricing and no emergency rooms. The number of psychiatric hospitals has dropped sharply.

NATL: Health status, access to care, and utilization of medical services in the US and Canada and disparities according to race, income, and immigrant status were compared. US respondents were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the USA. Canada's waiting times have received substantial press attention in the United States. Nonetheless we found that long waiting times led to an unmet health need for only a small percentage (3.5%) of Canadians. Racial disparities in health, present in both countries, were more extreme in the USA. The reasons for disparities involving Aboriginal Canadians and Asian Canadians may be different from those involving African Americans in the United States.

NATL: US customs and border security agents would be banned from seizing prescription drugs that Americans import from Canada under a measure passed by the Senate. Supporters said the federal government should stay out of the way of Americans seeking cheaper medicines in Canada for personal use. Many Americans import prescription drugs from abroad even though the practice is illegal. "I don't think... taking away small amounts of prescription drugs from seniors crossing back from Canada, et cetera, is the right thing do". The Bush administration has opposed congressional efforts to allow importation of lower-cost medicines from Canada. Critics say Bush and other opponents exaggerate the risks to protect drug industry profits.

NATL: Many more US employers are making their workers pay at least a share of their hospital bills. More than 54% of workers covered by employer-sponsored health plans paid a share of bills in 2003, up from 33 % in 1999. This did not include small co-payments for doctor visits -- required by 92.4 % of plans in 1999 and 95 % in 2003. In 1999 just over 10% of employees were required to pay between $150 to $400 out of their pockets for hospital care. This doubled to 21% in 2003. In May the Robert Wood Johnson Foundation reported that 3 million fewer US workers eligible for employer-sponsored health insurance enrolled in 2003, compared with 1998. It said a 42% increase in premiums was to blame.

NATL: Tenet Healthcare Corp. reached a $900 MIL deal with the federal government to settle allegations it bilked Medicare. The second largest US hospital chain said it will pay $725 million over four years and to waive pursuit of another $175 MIL in Medicare payments. The deal concludes a four-year investigation by the US Justice Department into accusations that Tenet deceived Medicare. Analysts had predicted Tenet would pay well over $1 BIL to settle the charges, which have weighed on the company's stock and operating performance since 2002. The agreement, in which Tenet admits no wrongdoing, does not resolve an ongoing SEC probe into its financial disclosures regarding Medicare payments under managed care contracts. The deal is one of the biggest health care fraud settlements in the last decade. In 2000, No. 1 chain HCA agreed to pay $1.7 BIL to the federal government to settle charges of fraud to Medicare.

NATL: The US HHS has scaled back a new law so that it exempts the elderly and the disabled from having to prove they are US citizens to qualify for Medicaid health insurance. The law, which went into effect July 1, requires people to supply original documents like passports or birth certificates to receive Medicaid benefits. Some 55 million low-income people are covered by Medicaid. But in regulations amending the law, the government made exceptions for certain groups, including those on Medicare and those who get certain Social Security benefits, according to a lawyer challenging the law. That suit, filed last week in the US District Court in Chicago, argues that the law would hurt the most vulnerable people, and that it violated the Fifth Amendment guarantee of due process. Plaintiffs will now amend the complaint to argue that key groups like the homeless and victims of natural disasters still face significant challenges to comply with the law. The law is intended to keep illegal immigrants from getting government-sponsored heath care, but critics say it could throw millions of US citizens off the government health program because they can't prove that they are citizens.

NATL: Physician Toni Martin works both in a city health clinic and as a medical consultant in the Social Security Administration's disability program. What saddens her are the claimants with preventable diseases that aren't prevented because the claimant couldn't pay for treatment. What kind of nation, she wonders, allows citizens to become blind if their blindness could have been prevented? Martin details her medical opinion in a patient's file, which is that the facts support the claimant's allegation. I expect ththe patheint will be judged disabled on a medical-vocational basis . What puzzles me is why we as a society don't want to provide health insurance to all of our citizens to prevent such tragedies. I want to believe that if my fellow Americans really knew what was happening, that if they looked at Mrs. Guzman's photo, as I did, they would want to intervene early on and prevent her from going blind. What is the matter with us? Why won't we fund basic health care benefits for everyone to prevent disability when we can?

NATL: GW Bush used his first veto to block legislation to expand embryonic stem-cell research, putting him at odds with top scientists and most Americans, including some in his own Republican Party. The veto fulfills a Bush promise made to socially conservative supporters whose votes his Republican Party will need in November to help keep control of the Senate and House. Democrats sharply criticized the veto and vowed to keep pressing the issue. "As long as restrictions based on a narrow ideology block progress to new cures, this issue will never be closed. Mr. President. [New law would have allowed federal funding of research only with stem cells already slated for destruction anyway.]

NATL: UnitedHealth Group Inc. reported higher-than-expected quarterly profit, sending shares up 5.2% , as the insurer benefited from an acquisition and an improved performance in its new Medicare prescription-drug business. The company declined to discuss inquiries into its stock options practices, which have hurt its shares. However, investors were encouraged by the quarterly results, which helped buoy other health insurers' stocks. Net earnings rose 26% to $974 million from a year earlier. Revenue jumped 57% to $17.92 BIL. The company cited its recent acquisition of PacifiCare Health Systems and business from Medicare Part D, a new US government program that provides prescription-drug benefits to older people. United said its consolidated medical care ratio [how little it can spend on actual health care] improved a half-percentage point to 82% from the first quarter.

NATL: Medication errors hurt 1.5 million people every year in the USA. If hospitals, clinics and other providers owned up to each and every mistake, it would help to keep track of and eventually reduce them, and systems such as electronic prescribing would also help. "Medication errors are among the most common medical errors, harming at least 1.5 million people every year". Such mistakes kill at least 7,000 people a year. "The extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 BIL a year, and this estimate does not take into account lost wages and productivity or additional health care costs". "The committee estimates that on average each US hospital patient is subject to at least one medication error per day."

NATL: Over the past 25 years, power in our health care system has shifted from the physician to the corporation. As a professional, the physician pledged to put his patient's interests ahead of his own financial interests. The corporation, by contrast, is legally bound to put its shareholders' interests first. For the corporation, decisions about how to allocate healthcare dollars become marketing decisions. Drug makers, device makers, and insurers decide which products to develop based, not on patients' needs, but on what their marketers tell them will sell -- at the highest profit. Why is money-driven medicine so wasteful? First, because rather than collaborating, drug makers, device makers, and hospitals compete, duplicating each other's efforts. In a for-profit healthcare system, what is good for business is more business: more drugs, more devices, more procedures, more tests [except for insurers who want less of everything], more healthcare equals greater profits [as does higher prices for the same or less health care],

NATL: 15% of about 1,000 US FDA scientists say they have been wrongly asked to withhold or alter information or their conclusions in agency documents. The Union of Concerned Scientists said the results were further evidence of interference with science at federal agencies. The group sent questionnaires to nearly 6,000 FDA scientists. Of the 997 who responded anonymously, 15 % said they had been "asked, for non-scientific reasons, to inappropriately exclude or alter technical information or my conclusions in an FDA scientific document." "That number should be zero," said F Grifo, head of the group's scientific integrity program. 17% said they had been asked by FDA officials "to provide incomplete, inaccurate or misleading information to the public, regulated industry, media or elected/senior government officials." 40% said they feared retaliation if they voiced concerns about product safety in public. In a 2002 survey by the Department of Health and Human Services inspector general, about 20 % of FDA scientists said they were pressured to approve or recommend approval of a medicine despite reservations about risks or effectiveness.

NATL: HCA's $21 BIL leveraged buyout raises the chances that other public hospitals will go private, as crushing debts from uninsured patients and weak volume trends have pushed hospital valuations to multiyear lows. The moves come as private equity firms are flush with cash and looking to unlock the value of hospital assets. While hospital company earnings have been extremely disappointing -- driving down valuations -- and the negative industry trends show few signs of reversing, "the companies still produce significant amounts of cash flow and they do own assets that provide the ability to do a lot of financial engineering". [Financial engineering is a nice way to say, going after patients who can't afford to pay, to the point of destroying their families and restricting care to those who are well-heeled in the first place.]

NATL: Health Management Associates Inc., one of the biggest US hospital companies, reported net income fell to $77.3 million, or 32 cents per share, from a year earlier. HMA runs 59 hospitals in non-urban areas mostly in the US Southeast and had warned in June that quarterly and annual results would miss Wall Street expectations. Unpaid medical bills as a percentage of revenue, excluding changes made in the company's reserve policies, rose to 8.9 % in the quarter from 7.4% a year earlier.

NATL: Private equity firm Blackstone Group may try to trump a $21 BIL takeover of the No. 1 US hospital chain HCA Inc. On Monday HCA said it agreed to be acquired by a consortium in what would be one of the largest leveraged buyouts in history. Under the terms of the agreed deal, HCA would be acquired for a premium of 18% to the company's closing price lJuly 18. [health care dollars are lost in a deal like this to the extent that giant premiums go out to either shareholders or executives for sake of deal, otherwise capitalization transfer is not necessarily a loss from the health care system]

NATL: US health care is heading for a wall. By 2013, one fifth of the population under 65 will be uninsured [officially, ie for that whole calendar year]. And that assumes that healthcare inflation slows, while personal income rises faster than in recent years,making insurance more affordable. By 2020, health care will consume 21% of the GDP. Most US families cannot afford coverage that now approaches $11,000 annually. In 2000, nearly 70% of employers subsidized insurance. Now 60% offer benefits. A 2003 survey of physicians showed that 49% supported national health insurance. A 2005 Pew poll reported that 65% of their patients favored universal insurance -- even if it means raising taxes. As we approach 2008, a bill now in Congress, "Medicare for All," could gather support.

NATL: Although only 12% of the US population was 65 years of age or older in 2003, DHHS' Agency for Healthcare Research and Quality says that this group accounted for one third of all patients admitted to the nation's community hospitals in that year -- over 13 million hospital stays. The elderly also accounted for 44% of all hospital charges. The proportion of elderly patients who died while hospitalized was 5 times higher than that of younger patients. [Remember if we are lucky, we'll all be elderly one day. So, these are in a sense costs for our collective care.]

CA: Rising medical costs are sparking efforts to cap profits of California's health insurers in the same way that surging gasoline prices are fueling proposals for a windfall oil profit tax. Two bills in Sacramento seek to limit insurers' profits as well as cap consumers' out-of-pocket payments for medical treatment. The state Department of Insurance has a separate plan to limit profits. Such proposals, if enacted, could result in the nation's most sweeping financial reform of for-profit health plans. Other states, including Connecticut and New York, regulate how much health plans can charge in premiums, and Minnesota allows health maintenance organizations to be run only by nonprofit groups. The California proposals may not survive industry and political opposition. Health insurers such as Blue Cross of California say these moves would kill innovation and limit the types of insurance California residents can buy. Some experts say profits are not a major factor in rising health costs. But the proposals underscore a growing backlash against the health insurance industry from consumer advocates and lawmakers who say insurers must absorb a greater share of rising costs. The issue also is renewing calls for a government-sponsored healthcare system.

CA: Catholic Healthcare West, one of the largest hospital chains in the state has reached a preliminary agreement to settle a class-action lawsuit alleging that it overcharged uninsured patients at its hospitals in California, Arizona and Nevada over the past five years. As part of the proposed settlement, uninsured members of the class will be able to make a claim for refunds or deductions from their prior hospital bills. In addition, they said, CHW has agreed to maintain the new pricing and collections policy for uninsured patients for at least four years. "We hope it serves as a model for other hospital systems to follow". Attorneys for the uninsured patients praised the Catholic system for its willingness to change its policies and reaching a negotiated settlement rather than "wasting resources litigating these cases." CHW described the issue of hospital pricing as part of a broader crisis in health care, marked by a growing number of uninsured Americans and a growing gap between reimbursements from the government and private insurers and the actual cost of delivering care.

MA: Ryan Lee Crosby, one of the approximately 370,000 uninsured working adults in Massachusetts, worries about exactly how the health care reform law requiring all Massachusetts residents to purchase health insurance by July 2007 will affect him. "That makes me totally nervous. I definitely couldn't afford that right now. There's no way. I'm barely paying my rent," said Crosby, who is in his mid-20s. "It sounds like (the state) wants to say, 'Oh, yeah, everyone has health insurance.' But now I have to pay for a bad version of that. What's the point of getting it, if it's going to be terrible?" A graduate of Northeastern University, Crosby works part-time at a Cambridge bar, and, as an aspiring musician, sings and plays the guitar during his off hours at clubs around the city. Crosby, who has not followed news about the sweeping health care reforms, says he cannot afford health insurance on a doorman's wages and can't get a plan through work. "My lady and I constantly talk about moving," said Crosby. "One reason is that the cost of living here is more than I can deal with." Crosby, who earns roughly $15,000 annually, is one of thousands of working uninsured looking at additional expenses. The state's Department of Revenue will enforce the law, and uninsured individuals will be barred from taking the personal exemption on their income tax returns.

TN: They're young and relatively healthy, but lack health insurance. Collectively, they number more than 10 million and provide challenges to the health care sector, but new ideas to get them enrolled are arriving from a variety of sources. Focusing on employers only tells just half of the story. Recent data suggest that those who work at companies that offer insurance are simply dropping out of the system. Nationally, the percentage of private-sector employees who enrolled in insurance programs at companies offering the benefit slid from 66 % in 1998 to 63% in 2003, according to recent data from the Robert Wood Johnson Foundation. In Tennessee, the drop was similar, but not as severe. Those accepting insurance dropped from 67.2 % to 64.7%.

NATL: It's hard to imagine a more tragic notation in a deceased heart patient's hospital discharge notes than this one: "All attempts at transplant were thwarted by lack of funding." Not for want of a suitable donor heart -- but for lack of money. One in four donated hearts in the United States comes from an uninsured person, according to the study titled "Health Insurance and Cardiac Transplantation: A Call for Reform." Yet, the same uninsured heart donor likely could not qualify to receive a heart if the situation were reversed. That's because the ability to pay for a donated heart is one of the requirements to become a candidate on the United Network of Organ Sharing waiting list used by hospitals. About 70 people a day receive a heart transplant, the study says, but another 16 die waiting. It's likely some of those who died were not able to get a transplant because they couldn't pay. It's an upsetting situation, but not one any government official or agency has seemed willing to tackle.

WI: The financial burden of providing free health care for the poor increased at nine of 12 Milwaukee-area hospitals in 2005, a trend industry experts said is likely to continue as the ranks of the uninsured rise and health plans become less generous. Hospital industry officials also pointed to broader economic problems that force more patients to seek free care. Most notably, out-of-pocket health care expenses have soared as high-deductible plans have become more common and personal income has remained flat. The impact of unpaid bills -- whether planned charity care or uncollected debt -- reverberates throughout the industry, squeezing hospitals' bottom line and forcing prices up. The six largest hospitals averaged an increase of 57% in one year.

MO: The numbers tell a sad story about the state of US health care: $2 TRIL in annual spending, 45 million uninsured (by the official census statistics, barely half the Americans uninsured in any given month) and 100,000 dead from medical errors each year. In search of a happier ending, the Kansas City Business Journal asked local leaders from various facets of the medical community one question: If you could rebuild the US health care delivery system from scratch, what would it look like? "If God came down and said, 'Rich, you get to decide,' I'd start at the right end," said Richard Hastings, CEO of Saint Luke's Health System. "Our health care system starts at the sickness end, and we really ought to start at the wellness end," Hastings said. That would necessitate a payer system that rewards doctors for keeping patients well, Hastings said. Wellness care would start with mothers and babies because that's where health starts, he said, and it would follow children to school in the form of physical and nutritional education. [Good ideas, but they don't benefit private insurers with rapid customer turnover.]

NY: New York's "Fair Share for Health Care" legislation, if enacted, will increase costs to businesses by $9.2 BIL and eliminate 100,000 jobs in its first year, according to the Employment Policies Institute. At the same time, the legislation would ignore about 83 % of uninsured New Yorkers, the institute's analysis showed. The institute is a non-profit research organization in Washington, D.C. "The high cost, lost jobs, and overall ineffectiveness of employer mandates should lead lawmakers to abandon the notion that the current health-care crisis can be addressed through employer mandates," said Mike Flynn, institute director of legislative affairs. "Real solutions must tackle the problem of skyrocketing health care costs overall and not just pass the buck on to businesses." The legislation would tax employers with more than 100 workers the equivalent of $3 an hour per worker unless they provide coverage worth that much.

The debate on how to cover the uninsured and at the same time contain costs has been mainly ideological so far, but needs to shift toward finding "a practical, realistic approach," the president-elect of the American Hospital Association, R Umbdenstock said. The AHA has long supported universal coverage. He doesn't think it would be too expensive for the United States, as long as care was provided more efficiently than it is now. "Our belief is that people by and large already receive care, but unfortunately not at the right place and the right time," Umbdenstock, who is also the AHA's chief operating officer, said in an interview. "So a lot of the cost is already in the system."

Legislators are closer than ever to creating a state health insurance program, but even proponents of the legislation doubt a universal insurance program will make it into law this year. Instead, the most likely program to pass the legislature this session would expand insurance for children, but that plan would require considerable support from Gov. Arnold Schwarzenegger. The most sweeping legislation was proposed by State Sen. Sheila Kuehl, D-Santa Monica. Her bill, SB 840, would create a single-payer plan, administered by the state and run by an elected health insurance commissioner. The cost of such a program is not spelled out. A companion bill, SB 1784, would enact a tax on incomes over $200,000 and self-employment income from $7,000 to $200,000 to pay for universal insurance. Ms. Kuehl filed her bill last year.

A proposal to raise $430 MIL through a provider tax on hospitals has the state's medical centers feeling sick. Gov. Corzine in his proposed budget called for a monthly tax on hospitals at a rate of $1,400 per bed. Half of the $430 MIL raised would go to the state's general fund for a variety of programs. The other half would be used to increase the amount of matching funds the state receives from the federal government under the Medicaid program, which covers health-care costs of the poor. "We think it's ill-advised to tax hospitals to raise money for the budget," said Gary Young of Cooper Hospital in Camden. " Under Corzine's plans, the state and federal Medicaid funds would be redistributed to hospitals under a formula based on the volume of Medicaid patients a medical center treats. Corzine's budget also calls for keeping charity-care subsidies at 2002 levels and eliminating $65 MIL in hospital assistance grants awarded to help cover a portion of the shortfalls in free care provided by hospitals that was not covered by the subsidies.

OH: After having back surgery in India, Placitas resident Charles Kaiser isn't in pain any more, and neither is his wallet. But a few months ago, the prognosis wasn't so good for either. Kaiser was too young at 63 to qualify for Medicare, but could not afford to purchase insurance coverage on his own. When his back pain became nearly debilitating in 2005, he consulted doctors who told him that he would need surgery on both his upper and lower back in order to avoid paralysis. The price tag was a whopping $100,000, all of which he would have to pay out-of-pocket. The news was devastating. "I was appalled," he says. "The amount was just beyond comprehension." On the advice of friends, Kaiser began researching the possibility of traveling to India to have the procedure. At first, the idea seemed ludicrous. But when his comparison shopping yielded the price tag for the surgery, Kaiser was sold. In India, he was told, he could have the same $100,000 surgery prescribed for him in the United States for under $10,000. Kaiser is one of a relatively small, but growing number of Americans who are finding it economically advantageous to travel overseas for everything from orthopedic surgery to a heart bypass. The nation of India, already a major player in other US industries, has begun to aggressively market itself to foreigners identified as "medical tourists".

Trust is determined by the interpersonal and technical competence of physicians. Contributing factors to distrust in physicians include a lack of interpersonal and technical competence, perceived quest for profit and expectations of racism and experimentation during routine provision of health care. Trust appears to facilitate care-seeking behavior and promotes patient honesty and adherence. Distrust inhibits care-seeking, can result in a change in physician and may lead to nonadherence. Discrimination by physicians and health care systems was identified as an important factor in contributing to health care disparities. An expectation of discrimination may also contribute to disparities.

CA: More than 14% of Americans lacked health insurance last year, a slightly lower percentage than in 2004, according to federal statistics [however the number of Americans with private insurance dropped, more were in government programs, see next article]. 41.2 million Americans, or 14.2% of the population, were uninsured when its survey was conducted. It said 51.3 million had been uninsured for at least part of the prior year. Nearly 30% of children and 11.5% of adults had some sort of public insurance such as the State Children's Health Insurance Program, Medicare or Medicaid.

PA: Researchers at Families USA found insurers participating in the Medicare drug benefit program raised overall prices 3.7% for the top 20 drugs used by the elderly since enrollment began. Separately, the AARP found prices for nearly 200 of all drugs most used by the elderly -- not just under Medicare -- rose 3.9% from January through March. The drug benefits program, which began in January, [more accurately called a "drug maker benefit program" ]allows insurers to offer Medicare beneficiaries drug coverage with government oversight but without need to negotiate any prices. Participants are locked into a plan until annual open enrollment, although plans are allowed to change prices any time. Many patients were automatically transferred into the program, but about 11 million signed up individually. For the typical older patient taking four prescriptions each day, medicines cost $238.28 more for those 12 months, compared with $189.72 more the previous year.

NATL: A former HealthSouth Corp. controller was sentenced to eight years in prison, by far the harshest penalty received by anyone connected to the massive accounting scandal that nearly brought down the rehabilitation hospital operator. Hannibal "Sonny" Crumpler last year was found guilty by a jury of conspiracy to commit securities fraud and of submitting false financial statements to auditors on behalf of HealthSouth. Crumpler had previously been ordered to forfeit $1.4 MIL in criminal proceeds he was deemed to have obtained in the $2.7 BIL accounting fraud. The long-time lieutenant of former chief executive and company founder Richard Scrushy was sentenced to five years in prison in December. Scrushy was acquitted of a long list of criminal charges by a Birmingham jury last June despite testimony from five former CFOs that he was aware of and directed the fraud. Judge Hopkins admitted that she did not consider Crumpler to be a major player in the massive fraud. Most of the 15 other former HealthSouth executives who had pleaded guilty to various fraud and other criminal charges received little or no jail time for their parts in the scheme.

NATL: Nurses backed by the biggest US health-care union filed four class-action lawsuits against some of the biggest US hospitals, including No. 1 chain HCA Inc., claiming they conspired to depress wages for nurses amid a national shortage. The suits seek back compensation and legal costs totaling "hundreds of millions of dollars" under federal antitrust laws. "We have HR employees calling their counterparts at competitor hospitals, asking for and receiving detailed and current information about the wages these hospitals are paying their nurses". "The hospitals have reached an understanding that they will use this information not to compete," Small said. Demand for full-time registered nurses exceeds supply by nearly 170,000 nurses this year, according to the American Hospital Association. That shortfall is expected to widen to more than 1 million by 2020, the trade group estimates. Wage increases for nurses have been insignificant during the decade-long shortage, experts said. Wages stagnated in 2003 and then fell 6.4% in 2004, leading to a decline in nurses working at hospitals. [Thus was manufactured the so-called "nursing shortage".]

NATL: For-profit nursing homes and hospitals on average provide an inferior quality of care compared with their nonprofit peers. Authors writing in the journal Health Affairs found that a systematic analysis of 162 studies of nonprofit versus for-profit health care providers supports the concept that a facility's ownership status makes a difference in outcomes and in the cost of health care. "The overall pattern found differences between nonprofits and for-profits regarding cost, quality and accessibility," said Gray, a principal author. For-profit ownership is climbing in most sectors of health, from hospitals to hospice care. For example, for-profit hospitals accounted for 11 % of all hospitals in the early 1990s and now account for 16 percent. HCA Inc. is the biggest US hospital chain, with about 180 hospitals and $24 billion in revenue, and is for- profit. [Follow the link at our website and read this article. It's the crux of US health crisis. Making profits, by charging more and providing lower quality care. That's why we pay twice per capita what other nations do. That and the excess administration of our coverage policies.]

NATL: The number of hospital patients with pressure sores, also called decubitus ulcers or bed sores, rose from 280,000 cases in 1993 to 455,000 cases in 2003 -a 63% increase. Pressure sores typically result from prolonged periods of uninterrupted pressure on the skin, soft tissue, muscle, and bone. Vulnerable patients include the elderly, stroke victims, patients with diabetes, those with dementia, and people who use wheelchairs or are bedridden. Patients aged 65 and older accounted for 72% of all hospitalizations during which pressure sores were noted. On average, patients admitted to hospitals for treatment of pressure sores stayed nearly 13 days, costing on average almost $38,000 each. Nearly 9 of every 10 hospital stays involving pressure ulcers were covered by government health programs 66% by Medicare and 23% by state Medicaid programs. [Bed sores are entirely preventable, but require regular preventive care.]

CA: The Service Employees International Union representing about 3,000 healthcare workers is threatening to strike at three Southern California hospitals owned by HCA Inc., the biggest US hospital chain, over staffing and forced overtime. The union says the hospitals are chronically understaffed and that staffing levels are dictated by company officials at HCA headquarters in Nashville, Tennessee, rather than by local administrators. The union wants caregivers to have equal votes on a safe-staffing committee with management, and a procedure for binding arbitration if the two sides deadlock over staffing. "Things considered normal in competitive industries should be considered abhorrent when translated into healthcare," said Dana Simon, a negotiator for the union.

NATL: The AMA called for moratoriums on consumer advertising promoting new drugs and medical devices until the products have shown they work and are safe. The AMA urged the US FDA to require manufacturers to wait for an unspecified period after a drug or device obtains regulatory approval before launching direct-to-consumer advertising in print, on television, or elsewhere. Physicians have complained about patients who demand inappropriate drugs after being persuaded by a drug company's advertisement. Drug makers have said the ads educate the public and only advise patients to ask their doctors.

NATL: The AMA voted to support a plan mandating all Americans to "obtain" health care coverage. The vote marks a major change for the AMA, which for more than 10 years refused to back any policy that would mandate coverage, preferring "voluntary" reforms. The action commits the AMA to mobilize its lobbyists to support legislation requiring individuals and families earning 500% of the federal poverty level to obtain both catastrophic and evidence-based preventive health care coverage "using the tax structure to achieve compliance." Families and individuals earning less than 500% of the federal poverty level would also be required to obtain coverage after "implementation of a system of refundable tax credits or other subsidies." Those other subsidies could include vouchers for the purchase of health insurance. With the exception of Alaska and Hawaii, the Federal poverty level for an individual is $9,800 and for a family of four it is $20,000. In other business, the AMA House approved a pair of resolutions aimed at providing physicians with easy access to information about ways to "opt out of Medicare".

NATL: Commonwealth announces ten "aiming high" goals: 1. Long, healthy, and productive lives. 2. The right care: Research shows that Americans receive recommended care just over half the time. 3. Coordinated care over time. 4. Safe care. 5. Patient-centered care. 6. Efficient, high-value care: We spend far more on healthcare than any other country, but we don't get better results. 7. Universal participation: We're the only industrialized nation without universal coverage. 8. Affordable care: High costs and inadequate coverage undermine our financial security. 9. Equitable care: There are widespread disparities related to income, race, or ethnicity. 10. System innovation and capacity to improve: We can do better. We have the dedicated professionals, technology, research, and ingenuity to improve. [We're glad to see Commonwealth coming around to Project EINO's principles after decades espousing and funding everything out on the periphery. We would still put numbers 6, 7, 8 and 9 first. Too bad we didn't even have 5% of their annual budget for a couple of years, we might have fulfilled these goals already.]

NATL: Newly released records show that Guidant Corp. drafted a letter last year to tell doctors about significant defects in the company's heart devices, but it was never sent. Heart patients apparently kept getting the devices, advanced defibrillators known as Contak Renewal and Contak Renewal 2, which Guidant said in the proposed letter had electrical flaws. The letter and other Guidant records released by a Texas state judge suggest that the legal and financial consequences from an inquiry into Guidant could be significant for it and Boston Scientific Corp., which bought Guidant in April. A call to Boston Scientific was not immediately returned.

NATL: Last year, the tab for US healthcare grew by almost 8%, to $1.6 trillion[1] but if we're spending so much, why is the quality of healthcare improving so slowly, up only 2.8% last year? It's not because we aren't investing enough -- over $95 billion was spent on medical research last year. It has more to do with our research priorities. Ninety-nine cents of every research dollar is spent on new drugs and medical devices. Only 1 penny is left over to fund the research that ensures the safe and effective delivery of medical care to our patients. Breakthroughs in robotics and genomics may make headlines, but making sure that currently available drugs are getting to the people who need them has a much more beneficial impact on population health.

CT: Connecticut joined a shareholder lawsuit accusing UnitedHealth Group Inc. of manipulating stock options to enrich CEO McGuire and other top officials. Richard Blumenthal, the state's attorney general, joined the lawsuit on behalf of Connecticut's $23 billion pension fund, which owns 381,000 UnitedHealth shares. The lawsuit accuses UnitedHealth board members of allowing the "backdating" of stock options. It said this manipulation allowed McGuire to improperly amass $1.2 BIL from stock options, and caused UnitedHealth to overstate earnings and issue false financial statements since at least 1997. "McGuire's greed was gargantuan," Blumenthal said. "Gaming stock options to inflate executive pay violates the law's letter, as well as its spirit."

NATL: WellPoint Inc., the nation's biggest health insurer, covering about one in 10 people in the US, fared the worst among its peers in a survey gauging how quickly HMOs process and pay claims to doctors. Indianapolis-based WellPoint, which covers 34 million in the US, was cited as "the most aggressive shifter of responsibility to physicians to secure payment from patients directly. The company also fared worst in an overall composite of measures, including likelihood to deny claims and length of time taken to pay claims. WellPoint spokesman Jim Kappel said the study lacked "statistical significance". The rankings turn the tables on payers by quantifying and reporting on how well health plans do their job.

NATL: First lady Laura Bush is leading the US delegation to this week's UN General Assembly Special Session on AIDS. The Bush administration has reached out to militant Islamic governments, including some it classifies as terrorist states, to try to ensure the 2006 declaration backs abstinence and fidelity as crucial tools against AIDS, Evertz said. The United States has pledged $15 billion to fight AIDS, more than any other country. But of the 20 % of the total earmarked for prevention, about half the funds are designated for "abstinence and be faithful" programs. Groups receiving money have to demonstrate they are opposed to prostitution, needle-exchange programs are frowned on, and sex education for young people is lacking. Meanwhile, GW Bush's lead negotiator at a 2001 global conference on AIDS came to a follow-up UN meeting as a private citizen to challenge the US leader's current focus on fidelity and abstinence to battle the deadly disease. The declaration adopted at the 2001 conference, setting out a global strategy against AIDS through 2015, "was a good document and spoke about the need for comprehensive HIV education," said Scott Evertz, President Bush's AIDS policy director at the time. "I honestly don't know why we now need to insert, through this process, language about abstinence and fidelity".

NATL: The World Health Organization will examine whether the international drug patent system prevents developing countries from obtaining needed medicines, vaccines and diagnostic tests. The 192 WHO members agreed at an annual meeting in Geneva to launch an intergovernmental group to look for gaps in medical research and development, and draw up a global strategy to ensure the health needs of poor people are met. The WHO said the group would integrate the findings of an April report which criticised the existing drug development, marketing and pricing system, saying it largely neglected the poor. "The current system that is based on patents and high drug prices as the way to finance research and development leaves huge health needs unmet, particularly in developing countries," she said. The push toward needs-driven health research "will ensure that patients' needs -- and not simply profits -- drive medical innovation," she added. [Obviously, promoting an un-American system.] FL: More South Floridians are expected to go without health insurance, according to the demographic trends expected over the next 25 years. That would put a greater strain on the region's health care providers to give uncompensated and charity care, whose cost is partially passed on to commercial insurance customers in the form of higher premiums. South Florida's uninsured population under 65 is more than 1 million, accounting for 23.2 % of that age group, according to a 2004 study. The foreign-born population was more than twice as likely to lack health insurance than those born in the United States. "If trends continue 15 more years, commercial insurance won't be sold widely to most of the population, and it will be impossible for businesses to afford those premiums".

TX: In 2004, Texas hospitals provided $9.2 BIL worth of uncompensated care, which includes bad debt expenses. That's compared with $3 BIL in uncompensated care in 1993. On a national level, uncompensated care increased to $60 BIL from $25 BIL during the same time frame. Mary Grealy, president of the Washington, D.C.-based Health Leadership Council, says everyone is paying.

PA: In 2005 more than 266,000 people were uninsured in southeastern PA -- eight out of ten are in working families. The state could soon be taking a step backwards in its commitment to help uninsured residents. The proposed 2006-07 budget includes major cuts to Medicaid that will harm the ability of hospitals to meet the needs of the uninsured as well as jeopardize the survival of some institutions, threatening access for whole communities. The proposed budget would reduce state and federal payments to southeastern PA hospitals by more than $128 MIL. The state will lose more in federal matching funds than it saves in state funds while cost-shifting the burden of paying for medically necessary services onto local communities, hospitals and businesses. Even now, the state is only paying 82 cents for each dollar of hospital care given. The Medicaid budget cuts make no sense, medically or economically.

NATL: Recent activity in our nation's capital however, could undo the gains in some states and could potentially inflict significant damage on the health insurance markets in New York and many other states. Small business health plan legislation (aka, the Enzi bill) purports to help small businesses better afford health insurance. It may lower costs for the young and the healthy, but it eliminates effective state regulation and will allow some health plans to strip away the very benefits that the uninsured so desperately need--well-child care, mammography screenings, and diabetes care--and sock businesses with older or sicker workers with huge premium increases.

CA: The percentage of eligible private-sector workers in CA who accepted insurance through their employers fell 4.5% in 2003, the most recent year for which data was available, to 82.2 % versus 86.7 % in 1998. This finding comes as average individual insurance premiums climbed 42.2 % in the state and 41.9 % in the the nation during the five-year period. The state follows a national trend that saw 80.3 % of employees accepting employer-sponsored insurance in 2003, versus 85.3 % in 1998. With 46 million uninsured workers in the country, said Morse, "This situation can't continue. We need to get all Americans covered with health insurance." [Even moreso considering the real number of uninsured Americans to be nearly twice that number in any given month of the year.]

NATL: When you're a one-man show in the business world, finding quality yet affordable health insurance can be a real challenge. Master artisan Thomas Pafk knows that all too well. For nearly two decades, he has enjoyed an enviable reputation for creating fine furniture. Not nearly as enjoyable, however, is the feeling that he's between a rock and a hard place when it comes to finding and financing a health plan. "Oh god, it's a nightmare. It's the worst thing," says the owner of Thomas Pafk Design. "I have had all different types of insurance. I've done it all, and it costs a fortune. They make it so hard for small businesses to get any kind of insurance at all. It's ridiculous." Many small-business owners see health insurance as so cost-prohibitive that they find themselves going for stretches of time without coverage. Indeed, industry studies show a growing number of uninsured workers in the small-business community.

TN: Cover Tennessee, a $300 MIL initiative and Gov. Phil Bredesen's baby, cleared the Senate and will now head to his desk for signing. It's part of a larger proposal to provide health insurance to more than 600,000 Tennesseans, including many who were cut from TennCare. Cover Tennessee would provide basic, major medical coverage to uninsured workers for $150 a month, shared equally by the individual, employer and state government. Coverage under the program will be available in early 2007. "I appreciate the thoughtful, bipartisan debate the General Assembly has applied to this proposal over the past two months, and I'm especially pleased we can now begin building out these programs to provide health coverage for working Tennesseans and small businesses" said Bredesen.

NATL: Before any meaningful proposals can be made to reduce the cost of medical care, we really need to know where every dollar paid into the system goes. If Americans are paying more per capita for medical care than the people in other countries and getting less for it, we need to identify the sinkholes into which that money is flowing. Yet I suspect very strongly that every segment of the medical care delivery system would resist revealing that information with their utmost political might, for I suspect that each segment has its own very special sinkholes that must be kept secret to avoid the wrath of the American people. So, perhaps reforming the system won't happen until the system brings itself down, which if my calculations are correct, won't take too many more years.

NATL: The role of the physician is changing. For many patients, we have to go beyond diagnosing and treating. We have to be cognizant of our patients' financial and insurance status. If we don't ask patients whether they can afford their medications and help them obtain affordable medications, then we could be wasting our time and theirs with ongoing office visits.

NATL: New statistics from the Healthcare Research and Quality underscore how rapidly rising healthcare costs are eating into the budgets of America's families. The percentage of Americans under age 65 whose family-level out-of-pocket spending for healthcare, including insurance, exceeds $2000 a year rose from 37.3% in 1996 to 43.1% in 2003 -- a 16% increase. These figures have been adjusted for inflation, and healthcare expenditures for 1996 are expressed in constant 2003 dollars. The ranks of those whose out-of-pocket spending for family healthcare exceeded $5000 a year grew even more -- rising by 57%.

NATL: Commonwealth's Karen Davis waxes effusively "Massachusetts lawmakers recently passed historic legislation that would require all Bay State citizens to have health insurance. It also improves affordability of coverage so that this ambitious goal might be met". She contends that any substantive effort to expand access to coverage is worthwhile, given the growing number of uninsured in this country and the large body of evidence showing the dangerous health implications of lacking coverage and that what Massachusetts has done holds potential lessons for every state. It's important to be realistic, said Davis. [Being realistic in this great democracy means applauding every PR stunt that funnels more public health care money into private, high-overhead coffers. Being realistic means not expecting any increase in access to care after the intitial parade dies down.]

NATL: A study to determine the proportion of older people with diabetes mellitus (DM) eligible for Medicare Part D drug who will exceed the initial $2,250 coverage limit found that, of the estimated 3.2 million elderly people with DM eligible in 2001, approximately 64% had medication expenditures in excess of $2,250 in 2006 adjusted dollars. The proportion exceeding the initial coverage limit varied by type of hypoglycemic drug used from 60% of those using traditional hypoglycemics to more than 75% of those using novel hypoglycemics. Patients with more comorbidities and poorer health status were at greater risk of exceeding the initial coverage limit. A large proportion of older adults with DM may exceed the initial coverage limit under the standard Medicare Part D drug benefit and incur significant out-of-pocket spending.

NATL: The US FDA's policy to withhold early-stage experimental drugs from terminally ill patient infringes their right to choose, a US appeals court said sending the case back to a lower court. The FDA requires developing drugs to undergo a wide battery of tests, ranging from preclinical testing in the laboratory to large, advanced trials with people. Drug companies say the process can take up to 10 years. Judge J Rogers, writing for the majority, said terminally ill patients should be allowed to decide whether to accept the risks of taking a medication that might help them live longer. "The key is the patient's right to make the decision about her life free from government interference," she wrote. The ruling overturns a 2004 dismissal by the US District Court for the District of Columbia, which will now have to review the case unless the FDA appeals.

NATL: The Senate will debate a measure by Mike Enzi that would allow small businesses to pool together across state lines to purchase insurance. The idea, strongly backed by such groups as the National Federation of Independent Business, is to let them have the same clout in the marketplace as big corporations. Millions of people who work for small businesses are uninsured. But the Enzi bill exempts those health plans from many state rules and regulations. The AARP retirees group, the American Diabetes Association, and the American Cancer Society, among others, are pushing hard to stop the Enzi bill, saying it could erase 20 years of progress in health coverage by eroding benefits.

NATL: The US Medicare trust fund will be exhausted in a dozen years, two earlier than forecast last year, because of increasing health care costs. Democratic lawmakers responded "The report confirms that, despite White House scare tactics, Social Security remains sound for decades to come. The real threat to Social Security comes from Republicans, most of whom support and voted for privatizing Social Security," Senate Democratic Leader Harry Reid said in a statement". The trustees projected Social Security outlays to outstrip tax income in 2017, the same date as forecast last year. [The many years of surplus payments from hard-working Americans paychecks have disappeared into the ether.] Bush's new prescription drug benefit [really not a part of Medicare at all, but a subsidy to pharmaceuticals and insurers] will require substantial increases in both revenues and premium charges.

NATL: According to the Agency for Healthcare Research and Quality, 24.2% of poor Americans under age 65 -- 3.8 million persons -- reported being continuously uninsured for at least 4 years when surveyed in 2003. Poor Americans, those whose income is equal to or below the poverty line, represented 12.6% of the US population under age 65. Alternately, high-income Americans, who made up 37.6% of the under age 65 population, accounted for only 10% of those continuously uninsured from 2000 to 2003.

NATL: Wellcare Health Plans Inc. said first-quarter net income rose 54% on strong gains in Medicare and Medicaid membership as the company benefited from the government's prescription drug plan for the elderly. Net income at the Tampa, Florida-based company rose to $16.8 million, or 42 cents per share from the year-earlier period. For the second quarter, Wellcare expects an additional 14% increase.

NATL: HealthSouth Corp has reached an agreement with the US DOJ that removes the threat of an indictment for the accounting fraud committed against the company by members of its former management. The Birmingham, Alabama-based company has struggled to emerge from the shadow of scandal caused by a $2.7 BIL accounting fraud discovered in 2003.

NATL: Tenet Healthcare said it had agreed to pay $21 MIL in a civil settlement with a US Attorney to resolve long-running criminal charges of kickbacks to doctors, sending the hospital chain's shares higher. The deal comes after two federal juries deadlocked on criminal charges involving Tenet's Alvarado Hospital in San Diego. Last week, the US Medicare agency threatened to bar the hospital from government insurance programs. The San Diego case charged Tenet with illegally recruiting new physicians with lucrative payments and helping to set up their practices in exchange for patient referrals to the hospital. Tenet admitted no wrongdoing, but did say it was "distressed" by several instances of excessive payments the hospital made to doctors.

NATL: Health insurer UnitedHealth Group received a subpoena requesting documents from 1999 relating to the granting of stock options and a from the IRS for documents from 2003 relating to stock options and other compensation for executive officers. UnitedHealth said it may have to restate past earnings by as much as $286 MIL as it reviews stock option practices. The health insurer also said last week the US Securities and Exchange Commission is conducting an informal inquiry into its stock option granting practices. UnitedHealth has been under scrutiny for possible "back-dating" of options. Backdating occurs when a company sets the grant price for the stock option retroactively to maximize potential profit to the recipient. [Who is running the health care system in this country, Tony Soprano?]

NATL: Compared with trials funded by nonprofit organizations, industry-supported studies tend to result in favorable outcomes for new treatments. Surveys of randomized trials published between 1990 and 2000 showed that research funding affected reported outcomes. Proposals to ensure more reliable reporting included improved academic oversight and required registration and publication of all clinical trials. While 49% of not-for-profit trials, 56.5% of jointly funded trials favored newer treatments over 67% of industry-funded trials did. Similar patterns were observed for trials of drugs, devices