TN: A recent state report shows most of Tennessee's uninsured residents hold jobs, but their employers are small businesses that can't provide health insurance at an affordable price. Worst, most state-directed solutions to the problem appear unfeasible at present. Families earning less than $30,000 annually - represented 61 % of uninsured in this state. Of that group, 84 % are employed at businesses with two to 10 employees. These workers, the survey showed, can't afford insurance. The lack of insurance is a clear and growing problem hurting individuals, communities and providers. The existing health insurance and health care delivery system can't meet the current and future needs of the uninsured. Tennessee has scaled back benefits and cut thousands from the rolls of TennCare, the state's Medicaid program for the uninsured and uninsurable.

NATL: Two Illinois legislators introduced a $21 BIL national health insurance plan for uninsured children modeled after Illinois' All Kids health insurance plan. US Sen. Durbin and US Rep. Emanuel said the bill offers states an additional 5 % federal subsidy over their current matching rate for kids above 200 % of the federal poverty level if they commit to offering all uninsured children in their state with access to SCHIP or Medicaid. The plan would be funded by eliminating two tax cuts that have not yet taken effect: the Personal Exemption Phaseout and the Pease provision. Both are expected to begin in 2006. Durbin and Emanuel said eliminating the tax cuts would generate about $30 billion in revenue between 2006 and 2010. "Of the 9 million uninsured children in this country, a majority come from families where at least one parent is working full time. These families are often ineligible for Medicaid and unable to afford private health insurance. It is time for Congress to act" said Durbin. [But at the cost of eliminating further tax cuts for the wealthiest 5% of Americans !! an outrageous idea !!]

FL: More uninsured patients coming into Florida emergency rooms may worsen overcrowding, adversely affecting quality of care and leading more emergency rooms to close their doors. The 83 physician groups responding provided substantial uncompensated emergency care, ranging from 26 to 79 % with an average of nearly 47%. Uncompensated services mean the hospital or doctor received no payment from either the patient or from a public or private insurer. The study also showed emergency physician groups providing the highest levels of free care tended to practice in urban hospitals serving large populations of Medicaid and uninsured patients. The problem is the number of uninsured patients in Florida and nationwide is growing even as discounts negotiated by private insurance plans and government programs squeeze reimbursement for health services. Thus, the researchers suggested, an emergency physician group's ability to shift costs from uninsured to insured patients to offset declining revenue is increasingly limited. Also, unlike hospitals, emergency physician groups do not offer other non-emergency services that could help subsidize unfunded emergency care.

NATL: Not all the drama is on stage for performing artists who need health-care coverage. For many with on-again, off-again show-biz jobs, theirs is a trying cycle of looking for roles that will deliver the compensation and benefits most Americans enjoy without interruption. But given the nature of what they do for a living, many performing artists find themselves among the 44 million of the nation's uninsured -- and desperately trying to find a way out [counting only those uninsured every day between Jan 1 and Dec 31 and not counting even those uninsured from Feb 2 2003 for 20 months until Oct 2 2004, for example]. Union membership helps some; not being in a union helps none. It's a problem that won't be going away anytime soon, Lawson says. "As far as I'm concerned, the national crisis remains health coverage for everyone," she says.

OH: University Hospital is developing a plan to prepare for a reduction or loss in the $34 million in public money it gets each year to care for the uninsured. The Hamilton County Commissioners are reviewing a proposal that would reduce the amount University receives each year by 43%. University Hospital operates 20 on-site clinics that cater to uninsured patients and pays $2.4 million for University physicians to staff community clinics. "If these centers go out of business, then who will hold the bag?" Redington said. He predicts that all area emergency rooms, especially at University, would see a minimum of 50,000 more patient visits a year. That could mean trouble for a city that is seeing more hospitals go on diversion, meaning they temporarily won't accept new patients because there are not enough beds or staff in the ER.

MN: Minnesota was the nation's healthiest state in 2005, its third straight year topping the list. Just 8.9% of the state's population is uninsured -- best in the nation. Nine percent of the state's children are uninsured. Minnesota had the fewest premature deaths with 5,728 per 100,000 people and the best infant mortality rate at 4.8 per 1,000 live births and the best rate of cardiovascular deaths at 248.2 per 100,000 people. As for dedicated "red-states" with solid GOP family values, Mississippi was the lowest-ranked state on the list, followed by Louisiana (49) and Tennessee (48).

MD: The Fair Share Health Care Act was approved by the 2005 General Assembly session and vetoed by Gov. Robert Ehrlich. The act is known as the "Wal-Mart" bill because Wal-Mart is the only business in Maryland affected the legislation. I am the proud sponsor of that bill, which requires large employers, who have more than 10,000 employees, to spend at least 8% of their payroll for employee health care. The legislation specifies that large private employers who spend less than 8% of payroll be required to pay the state the difference between what they currently spend and the 8% payroll difference. Payments to the state would become part of a special fund to help expand the number of people eligible for Medicaid. While Wal-Mart reaps multi-billion dollar profits, the Maryland taxpayers take care of a significant portion of Wal-Mart employees' health care. That's neither fair nor affordable.

CA: Sutter Health's new CEO has a plan for where the company wants to go, and plenty of distractions to take it sideways. Fry runs a 26-hospital system with $6.2 BIL in annual revenue that's become, fairly or not, the poster child for high hospital prices. Sutter faces a class action in Sacramento County Superior Court that alleges Sutter overbills poor people and the uninsured. In other california health news, a protracted legal fight between the California Nurses Association and the governor over the state's strict nurse-staffing law fizzled in November when Schwarzenegger quietly dropped his attempt to relax the rules. The first nurse-to-patient ratio law in the nation remains in place.

CA: Despite voluntary guidelines adopted by the hospital industry last year, many of California's front line health care providers are doing a poor job of communicating pricing information and charity care policies to patients. "Even if a hospital has adopted charity care guidelines, it didn't translate to front line staff." The broader implications of these gaps, she says, are that as more patients take on a greater portion of their medical costs, they may not seek care if they are worried about and lack an understanding about those expenses. Some shoppers also said they were asked for insurance code numbers in order to obtain a cost estimate while others were quoted different prices within the same hospital. Occasionally, personnel said it was against hospital policy to give out prices. "Voluntary guidelines don't work and that we need stronger consumer protections passed by the legislature. It's one thing for hospitals to have policies but if no one knows about them, it doesn't help patients."

MI: The Mid-South continues to lead as the least-healthy region with Mississippi coming in at No. 50. Louisiana, Tennessee, Arkansas and South Carolina rounded out the bottom of the ranking. Rankings are based on a wide range of factors, such as the rate of cardiovascular deaths, premature death, infant mortality, the level of uninsured and even high school graduation rates. All factors are proven to show a positive or negative effect on public health. Against that backdrop, the healthiest state in the nation is Minnesota, which has been at the top in 10 of the past 16 years.

NATL: Millions of employed Americans go uninsured each year because their companies do not offer health care benefits. But 47% of respondents in an informal Los Angeles Business survey said they do not feel the responsibility for health care lies with the employer, and that businesses should not be legally required to offer it. "Paying for health care isn't any more the responsibility of an employer than buying groceries for the employee," said one respondent. "The employer should pay the employee, and the employee should decide for himself how to use his money." Twenty percent said the federal government should step in to provide health care benefits. [Small business begins to catch on, maybe they would just like to be able to concentrate on their own business and be fully productive.]

NATL: Congress next year will consider ways to make health savings accounts more attractive. HSAs are tax-free accounts that individuals can use to pay medical costs. They must be combined with a high-deductible health insurance policy. More than 1 million people now are covered by HSA-eligible health plans and the number is expected to "skyrocket in 2006," says Serota, CEO of the Blue Cross and Blue Shield Association. The Blues plan to open a bank to serve customers with HSAs and other consumer-directed health plans. Legislation by Eric Cantor, R-Va., would allow employers to coordinate HSAs with flexible spending accounts and health reimbursement arrangements. Current HSA enrollees are more cost-conscious, but they also are more likely to avoid or delay needed care. [Also these plans are largely favored by younger healthier individuals, who are unlikely to have to pay the large deductibles. That leaves the less fortunate to fend for themselves at exorbitant premiums.]

NATL: There are no generally accepted guidelines on Nurse Practioner productivity in long-term care, nor are there any helpful survey data available. In 2001, researchers found that NPs in LTC facilities spent 35% of their working day providing direct patient care and 26% in indirect care activities, which included time interacting with nursing home staff, interacting with patients families, and speaking with physicians. That study found that NPs spent about 42 minutes on each patient each day, or about 14 min directly caring for each patient [1]. The difference between an NP who bills 16 visits per day vs 25 visits per day can mean over $100,000 a year to the employer.

NATL: Americans enrolled in so-called "Consumer-Driven Plans" (designed to make them more aware of health-care costs) are less satisfied and more likely to put off medical care. More than 70% of those enrolled in such plans said their plans made them consider costs when deciding to see a doctor or fill a prescription compared with fewer than 40% of those in traditional plans and 35% reported delaying or avoiding medical care. The findings provide evidence that high-deductible and consumer-driven plans may undermine the two basic purposes of health insurance: to reduce financial barriers to needed care and protect against high out-of-pocket cost burdens for patients. Nearly 3 times as many enrollees of consumer-directed plans spent 5% or more of their incomes on out-of pocket costs, as enrollees of traditional plans. [Remember delayed and avoided clinic visits translates to more aggravated conditions being treated and greater health care costs for late interventions.]

NATL: From both the direct cost and societal perspectives, the 7-vaccine childhood immunization schedule routinely used in the US provides substantial cost savings. From the direct cost and societal perspectives, the immunization schedule provided cost savings of $9.9 and $43.3 BIL, respectively. The direct costs without and with this schedule were $12.3 and $2.3 BIL, respectively, whereas the corresponding societal costs were $46.6 and $2.8 BIL. The dramatic decrease in the loss and suffering of patients, family, and friends although a direct result of the schedule was not quantified. [Asking what Universal Health Care would cost the nation is similar to asking what full vaccination of all children in our borders will cost. A different quality of life results for the whole nation many health problems can be averted or treated early, preventive health and healthy lifestyles could be more directly promoted. Should we talk about the costs or the enormous savings and value for the health care dollar?]

NATL: A measure to grant vaccine-makers protection from lawsuits, aimed at stimulating new responses to avian flu or bioterror attacks, could be added to a defense spending bill. Details of the proposal are still being negotiated, with some conservative Republicans considering a broad measure to cover vaccines, drugs or medical devices that could be used in a public health emergency, and others suggesting a much narrower focus only on potential avian flu vaccines. Florida Republican Rep. Dave Weldon, who usually sides with his fellow conservatives, strongly objected to including a sweeping liability provision -- with no compensation for injured people -- into a defense bill. He said medical personnel and other first responders to a health crisis would be reluctant to get vaccinated if there was a chance they could get hurt -- and not get compensated. "We could end up spending $7 BIL in a titanic failure," he said. "Broadly shielding manufacturers from responsibility for gross negligence, recklessness and other egregious behavior and leaving victims with no recourse, may cause more public harm than the pandemic disease itself" wrote some critics.

FL: Florida lawmakers will debate a sweeping reform package that would shift almost all of the state's Medicaid recipients to managed care programs by the end of the decade. Backers say the measure will improve quality and stem the growth of a $14 BIL program that now provides health care to 2.2 million Floridians. Of that total, 800,000 Medicaid recipients already fall under managed care plans Skeptics say the state is moving too quickly to adopt the first such statewide system in the United States. The proposal calls for setting up two pilot programs; one in largely urban Broward County and another in Jacksonville and surrounding rural counties. Recipients now receiving traditional Medicaid benefits would be given a choice of at least two managed care plans. "We do want to move to a market-based system but understand it is a controlled market system," said Alan Levine head of Florida's Health Care Administration. "The state is ultimately responsible to make sure that people get the care they need. We are not abdicating that." Considered one of Bush's top priorities for the remainder of his term, which expires next year, the governor's ambitious proposal may go too far, too quickly and do little to enhance benefits for recipients, critics say.

INTL: Many of us spend a lot of time analyzing how to expand health coverage. But even the well-insured in this country might not be able to get the care they need, when they need it. Compare this with the primary care system in Denmark, which blends capitation and fee-for-service payment. Each physician has an enrolled patient population of about 1500 people and can handle same-day appointments and walk-ins. When the office closes, an "off-hours service" kicks in, staffed by doctors who handle questions by phone, informed by computerized health registries, electronic prescribing, and off-hours clinics. Patients as informed and engaged partners -- including shared decision making and assistance with self-care. Coordination of care -- including systems to prevent errors.Patient-centered care surveys. And perhaps most important, professional recognition and appropriate financing of primary care. [Yes, in Denmark recognition of primary patient-centered care - AND FOR WHOLE NATION!!]

NATL: For-profit health plans provide poorer quality care for Medicare beneficiaries than non-profit plans. An analysis covered 231 health plans enrolling 283,249 beneficiaries looked at plans' scores for four HEDIS measures: breast cancer screening, diabetic eye examination, prescription of beta-blockers after myocardial infarction, and follow-up after hospitalization. For-profit plans scored lower than non-profits for all four measures: 67.5% versus 74.8% for breast cancer screening; 43.7% versus 57.7% for diabetic eye exams; 63.1% versus 75.2% for beta-blockers after MI; and 42.1% versus 60.4 for post-mental illness hospitalization follow-up. There are a number of possible explanations for the lower quality seen with for-profits, Dr. Schneider noted. For example, for-profit health plans may not be implementing the types of quality management efforts common in non-profit plans. They also may be contracting with lower-quality providers. It is too soon to call for a ban on for-profit health plans caring for Medicare beneficiaries, Dr. Schneider observed. [Maybe quality monitoring and value for our health care dollars, ought to be the cornerstone of a new US health system?]

CO: As three Denver hospitals pull up stakes and move to the suburbs, their new customer base will be more affluent and more likely to be covered by private insurance. Questions remain about who will care for the city's poor and uninsured and whether the city's safety-net hospital, Denver Health Medical Center, can bear a bigger load. "Hospitals are moving to places that actually have less need," said Amy Beres, an analyst for SEIU Local 105, which formed Colorado for Health Care. "We need to be looking at how to serve that unmet need," Beres said, "rather than just moving to places where hospitals can make more profit." "There truly are many indigent and uninsured people in the suburbs," she said. "The suburbs are not immune from the increase in charity care." The hospitals are moving to the wealthiest of Denver's suburbs, which are also the least racially diverse and have the lowest poverty rates and people with government-sponsored health insurance.

CA: In San Francisco, charity care -- how and where the poor and uninsured are treated, and who pays for it -- has become one of the hottest of political hot potatoes. Sutter Health, the nonprofit system that operates the hugely profitable California Pacific Medical Center, is under fire from city, state and federal authorities who accuse it of providing too little charity care. Critics include San Francisco public health officials, who earlier this year slammed Sutter for receiving nearly $54 MIL in tax breaks for 2003 -- but providing just $2.4 MIL in charity care. Sutter is also included in a probe by the US Senate Finance Committee of 10 hospital systems. "It's my duty to make sure charitable donations actually help those in need and that they are earning their generous tax breaks" said Sen. Grassley Sutter hopes to deflect some of the political heat onto Kaiser Permanente, the Bay Area's largest health system. Kaiser sees relatively few uninsured and Medi-Cal patients because the vast majority of its patients are Kaiser HMO enrollees. San Francisco's uninsured population continues to soar, from about 110,000 in 2003 to an estimated 160,000 today (45% in 2 years). Many of those people are full-time workers and their families.

NC: Thomasville Medical Center cited a boom in ER admissions to justify sinking millions of dollars into a new, bigger ER. Wake Forest University Baptist Medical Center also has plans on the drawing board for a new ER and Forsyth Medical Center opened a new ER last fall. Hospitals point to emergency rooms as linchpins in their community service mission. The ER is typically one of the most expensive places to receive care, and most Triad hospitals say they've seen an increase in the number of uninsured patients in the last few years, who often can't afford to pay all of their bills. Nonetheless, it turns out that hospital emergency departments are not necessarily big sources of red ink. In some cases they may even be profitable, and they drive business to the rest of the hospital.

NC: Fewer NC workers have health insurance through their jobs. "Prognosis Worsens for Workers' Health Care" found that the proportion of North Carolinians with job-based health insurance fell by 6.7 % between 2000 and 2004. In raw numbers, it means 559,000 fewer North Carolinians get health insurance in 2004 through their employer or their spouse's employer than in 2000. "This dramatic decline in job-based health insurance has contributed directly to the growth in the state's Medicaid caseload and the surge in the ranks of the uninsured" says Adam Searing, director of the NC Health Access Coalition. "Clearly we have a health-care crisis, not a Medicaid crisis." Nationally, the study found that 3.7 million fewer Americans had job-based health insurance in 2004 than in 2000. Middle class workers earning between $45,000 and $67,000 a year had the sharpest decline in job-based insurance, and fewer than six in 10 children were covered through employer-sponsored health plans in 2004.

GA: A group of hospital executives from across the state is trying to find a way to divvy up the funds that compensate hospitals for caring for patients who cannot pay. The Indigent Care Trust Fund uses state and federal dollars to help reimburse hospitals for taking care of patients who are poor or uninsured. The committee of 20 hospital CEOs and other executives, met on Sept. 29. The committee's goal is to reach a solution by Dec. 31, but some acknowledged that may be difficult. Last year's funds of $419 million were held up in a protracted battle between three of the state's largest hospitals and the Georgia Department of Community Health. The protesting hospitals were angry about a new methodology used to calculate how much money goes to each hospital. The program has been used since 1990, but in 2004 the methodology for determining reimbursements to hospitals changed and some large hospitals were told they would get much less funding than usual. [All of these artificial, unnecessary problems and wasted money on figuring out how to deal with the uninsured in our current system of substandard, delayed and absent care. ]

FL: The US DHHS has agreed to allow Florida Medicaid beneficiaries to choose managed care plans for their health care needs. The program is designed to provide Medicaid beneficiaries who enroll in managed care plans access to improved quality health care services, while also allowing state officials to maintain a reasonable rate of program growth. Florida requested the program after determining that the Medicaid growth rate of 13% a year for the past six years was unsustainable. In 2005, Medicaid spending is expected to consume 25 % of the state's budget, or more than $15 billion. The demonstration program will begin in two counties, Broward and Duval, in July 2006, with statewide implementation to follow. The demonstration will run through June 30, 2011. A fund of $1 BIL a year will be established to help the state pay safety-net providers caring for the uninsured. [Opponents of state level UHC efforts have argued for years that federal laws would disallow any innovative UHC system at the state level. Obviously their crystal balls are flawed.]

NATL: Health care expenses for US companies will cost an average of more than $8,400 per employee. Employees will pay about $155 of that increase in 2006, a 10% rise from 2005 levels. Employees are paying 64% more for health care than they spent five years ago. In that same time frame, employer costs have risen 78% -- both far outpacing other inflation gauges. [Of course as for any benefit earned its the worker who forgoes salary to receive the benefit, paying for both shares]. The survey found that employers now appear to be looking beyond simply shifting more of the costs to employees as a means of controlling expenses.

NATL: Criminal investigators at the US FDA are probing how Guidant Corp. handled problems with its heart devices. The FDA has been looking into whether Guidant properly reported failures of some of its heart devices and manufacturing changes to correct the problems. The disclosure comes as a pending $25.4 billion takeover by Johnson & Johnson of Guidant nears completion. The FDA began an inquiry into Guidant in June after a report in The New York Times that the company had not told doctors for three years that one defibrillator had a potential electrical defect. Since mid-2002, when Guidant corrected the problem, that defibrillator - the Ventak Prizm 2 DR - short-circuited more than two dozen times.

NATL: HCA Inc., the nation's largest hospital operator, said it was reorganizing its operations to create a new Central Group comprised of 58 hospitals in nine US states. The company, which operates 190 hospitals and 92 surgical centers, said it wanted to organize into smaller operating entities.

NATL: The Bush administration formally announced its opposition to a bipartisan bill pending in the US Senate to provide health insurance to low-income survivors of Hurricane Katrina. US HHS Sec. Leavitt sent senators a letter detailing the administration's concerns with the measure, which would temporarily expand the Medicaid health program for the poor, with the federal government picking up some of the expenses normally shared by state governments. Leavitt says the department's own state-by-state agreements to waive certain Medicaid rules, are superior to the bill. The bill's sponsors, however, argued that Bush's waivers do not provide even the same temporary coverage granted to New Yorkers after the September 11, 2001 attacks. "Could you please explain to us why the Katrina evacuees do not deserve the same assistance provided the people of New York?" the senators asked. Sen. Trent Lott, R-Miss., who spoke in favor of the bill when it was unveiled 2 weeks ago, said he now agrees with his governor. "I don't want to put people on this program who will expect to stay on the program" he said.

NATL: Stepping onto turf that has largely been occupied by Republicans in the US Congress, two prominent Democrats unveiled a measure they said they hope can break the stalemate over how to address spiraling medical malpractice premiums. Sens. Hillary Rodham Clinton, and Barack Obama have introduced the "Medical Error Disclosure and Compensation Act," which would provide funding to doctors, hospitals, and health systems that put in place mechanisms to promptly disclose medical mistakes or other mishaps to patients, offer compensation if the health provider is at fault, and ensure that those mistakes are reported to experts who can analyze them and recommend system changes to avoid similar problems in the future. Such early disclosure systems, being pushed by a coalition of patient, provider, lawyer, and insurance groups called "Sorry Works" has already achieved what Obama called "amazing" results. "Patients sue less, get compensated more, malpractice premiums go down, and doctors learn from mistakes," he said.

NATL: Securities regulators have issued a formal order of investigation in a probe of trading in the shares of hospital operator HCA Inc. Authorities are looking into Frist's recent sale of shares in HCA -- co-founded by the Tennessee Republican's father and brother -- in transactions completed just days before HCA's stock price fell on a disappointing July 13 profit outlook. Frist -- a potential 2008 presidential candidate -- said on Monday he had no inside information about the coming profit forecast when he began taking steps in April that led to his HCA stock sale.

NATL: Recent guidelines from the US Department of Defense (DoD) contravene international principles of medical ethics by permitting physicians to facilitate and monitor abusive interrogation practices. When the DoD guidelines came out, they looked similar to the UN guidelines, so we took a closer look and the differences were strikingly significant and very disturbing, not just because they seem to undermine traditional and well established ethical principles. It seemed clear that the ethical guidelines were designed to accommodate the kinds of roles the military wanted health care professionals to play in interrogation rather than starting with what the right ethical stance was. The new DoD guidelines state that only health care personnel actively engaged in clinical treatment of detainees are prohibited from participating in the interrogation process. Otherwise, physicians are permitted to assist in interrogations as long as their activity is in accordance with "applicable law."for the Bush administration this includes lengthy sleep deprivation, long-term isolation, severe humiliation, imposition of fear and exploitation of phobias, methods widely recognized as torture.

NATL: Many US health insurers provided better medical care to their patients in 2004, but more consumers are enrolling in types of plans that do not make such data public. NCQA based its rankings on the type of care patients received, especially for chronic diseases such as diabetes and hypertension, as well as patient satisfaction. In 2004, 68% of patients were treated for high cholesterol following a heart attack, compared with 65.1% the previous year. Breast cancer screening was one notable exception which dropped to 73.4% last year compared with 75.3% in 2003. HOWEVER plans which are recently becoming popular like PPO's or those with high deductibles, generally do not report such data, NCQA researchers said, so that information on quality overall is much less reliable. Medicare officials are making such reporting mandatory and are using the data as part of a new initiative to pay doctors based on how well they care for patients, not how often.

NATL: Drug company offers of coupons, free music downloads and other enticements for consumers to use specific medicines are under scrutiny by US regulators. The FDA is seeking public input on whether such inducements are appropriate ways to promote medicines. Public Citizen complained to senators about an ad on the Internet and broadcast on MTV music television that offered up to 10 free downloads of music to consumers who got a prescription for acne drug Differin and refilled it. "Bribing physicians has long been held to be illegal [although its widely carried out under thin veils of "market research" banquets and the like]. This advertisement essentially pays teenagers to convince adults to procure this drug for them, with the size of the payment in proportion to the amount of drug prescribed".

NATL: Charity Hospital in New Orleans, which captured the sympathy of the nation as it struggled to evacuate patients from the chaos and destruction brought by Hurricane Katrina, cannot be saved and will be closed. Charity and University Hospital, the only free hospital in the city, and its buildings were issued their 'death warrant' by Katrina and the cataclysmic floods it spawned. Even before the storms, these old facilities were on the ropes. Only three hospitals are now operating in New Orleans, all are not-for-profit hospitals in the immediate suburbs. To the well-intended observer the facilities don't look much worse than they did pre-Katrina, but through the lenses of consulting engineers, the buildings have unsafe air to breathe, pervasive mold and destroyed mechanical systems. [They probably looked like a hurricane had hit, before the hurricane hit.]

CA: Gov. Arnold Schwarzenegger vetoed a bill that would have required the state's health department to create a Web site to allow consumers to buy prescription drugs from pharmacies in Canada, the United Kingdom and Ireland. Echoing the Bush administration's view of drug imports, Arnie wrote in his veto statement that he had safety concerns. California Democratic Chairman Torres described the veto as "another brutal blow to California's seniors and others living on fixed incomes and those without health insurance." Washington state Gov. Gregoire earlier this year signed a bill to allow retail pharmacies in her state to import prescription drugs from wholesalers in Canada as well as Britain and Ireland. [The governor's main interest is to make the budget work, but apparently not if it means that medical needs would also be met.]

NATL: US lawmakers requested an investigation into the sudden resignation of FDA Commissioner Lester Crawford and whether it was related to potential conflicts of interest from financial holdings. Bush administration officials gave no explanation for the unexpected exit. Crawford served as the FDA's deputy commissioner and acting commissioner for more than three years prior to his July confirmation as permanent FDA chief. He endured several controversies, including a series of drug-safety concerns and repeated delays on Barr Pharmaceuticals Inc.'s bid to sell a "morning-after" contraceptive without a prescription [his resignation came the day after the FDA's decision not to all sale of the pill].

NATL: The US government should allow imports of generic versions of patented medicines such as Roche AG's Tamiflu to help the country prepare for a possible bird flu pandemic. Tamiflu currently is considered the first line of defense against the H5N1 avian flu virus that experts fear could spark a deadly, worldwide outbreak in people. Swiss firm Roche is under pressure to step up production to quickly fill orders from several countries that want to stockpile the drug. Indian drugmaker Cipla said Friday it can produce generic versions of Tamiflu to help meet demand. But the USA has vowed not to take advantage of world trade rules that would allow it to import generic medicines in the event of a health crisis. "There is no need to be constantly surprised and unprepared when such emergencies present themselves," said the pharmaceutical lobby group said in a letter to the US Trade Representative.

NATL: The US House of Representatives easily passed the "cheeseburger bill" that would block lawsuits blaming the food industry for making people fat. The "Personal Responsibility in Food Consumption Act" passed on a bipartisan 300 to 120 vote. The House approved a similar bill last year but it died in the Senate. The bill comes amid growing awareness of the public health implications of the US obesity problem. But supporters of the bill said obesity and overeating should be dealt with by doctors, exercise routines and personal responsibility. [We could save a bundle if we tripled our expenditures in public health education. It's nonsense to talk of personal responsibility while we cut back on public health funds, school health programs and basic science education.] Democratic critics said the bill was unnecessary, that courts were throwing out such lawsuits as the one filed by several teenagers against McDonald's Corp.

INTL: South Korea launched an ambitious project to make the country a global hub for stem-cell storage and research. Helped by generous government support and an absence of some of the red-tape and ethical debate that has hampered research in countries such as the US, South Korea is fast becoming a key center for stem-cell research. Some religious groups and politicians oppose embryonic stem-cell research, saying the destruction of an embryo to harvest the stem cells is akin to abortion. Many US scientists say their work in this area is being hurt by the Bush administration's reluctance to fully back the research. US federal funds for experiments using human embryonic stem cells are restricted.

NATL: Although there is intense interest in and optimism about pay-for-performance programs, there is little published research on pay-for-performance in health care. Compared with the Pacific Northwest physician groups, those in California had greater quality improvement after the pay-for-performance intervention only in cervical cancer screening (a 3.6% difference in improvement; P = .02). During the first year of the program, between July 2003 and April 2004, the plan awarded $3.4 million in bonus payments. Physician groups with baseline performance at or above the performance threshold for receipt of a bonus improved the least but received the greatest share of the bonus payments.

NATL: In a study of more than 250,000 women living in 35 metropolitan areas in the US, low income was associated with a decreased likelihood of being screened for breast cancer consistent with previous reports. Women with an annual household income of less than $15,000 were less likely to have undergone a mammogram than women with higher incomes. The percentage of women, 40 years of age or older, who reported a mammogram in the previous 2 years ranged from 68.4% for those with an income below $15,000 to 82.5% for those with an income of at least $50,000. Similarly, women lacking a high school education were less likely to be screened than their peers with more education. Unmarried women and those lacking health insurance also had lower screening rates.

NATL: Errors in telephone communication can result in outcomes ranging from inconvenience and anxiety to serious compromises in patient safety, although 25% of interactions between physicians and patients take place on the telephone, little has been written about telephone communication and medical mishaps. Adverse outcomes resulting from communication errors in telephone medicine may range from inconvenience and anxiety to serious risks to patient safety. History-taking may be inadequate in more than half of phone calls, and management decisions may be inappropriate in more than one third.

NATL: A majority of US consumers surveyed support Internet-based health records if they can be secured to protect patient privacy, according to a study released on Tuesday. In a nationwide poll 72% of Americans favored electronic health records. The support was consistent among all ages, income levels, education and political affiliations. Most patients said such systems must prevent unauthorized access and allow individuals to decide who can view their information as well as when it can be shared. About 70% also said employers should not have access. Barriers include the cost, training requirements and competing standards that make it difficult for doctors in one office to view records from another. [How much easier such cost-saving measures would be to organize under a more unified and federally regulated UHC system!]

NATL: The deep economic crisis which that engulfed Argentina between 1999 and 2002 may have caused as many as 20,000 additional cardiac deaths, mostly because of the psychological impact of the crisis and the collapse of the health care system. This is the first study worldwide linking an increase in acute coronary syndromes with a social crisis. "We think that people felt so sad that they simply did not ask for medical attention. They remained at home,". Researchers found that in-hospital mortality also increased by 20% among the patients assisted during the crisis. Because of a fiscal crisis at the hospitals, coronary angioplasty procedures tended to be replaced by less-expensive bypass surgeries.

NATL: A second medical expert has resigned to protest the US FDA failure to allow over-the-counter sales of a "morning-after" contraceptive. [Although official reports denied that the first resignation was due to the failure to approve this pill, see above] Dr. Frank Davidoffhas stepped down from his position as a consultant to the FDA's Nonprescription Drugs Advisory Committee. Members of that panel and another committee of outside experts voted 23-4 in December 2003 to recommend non-prescription sales of the contraceptive, called Plan B. The FDA has rejected their own medical advice, as well as support from the agency's scientific staff. That delay "crossed the line for me," Davidoff said. "I can no longer associate myself with an organization that is capable of making such an important decision so flagrantly on the basis of political influence, rather than the scientific and clinical evidence."

NATL: Former US HHS Secretary for GW Bush Tommy Thompson told the Urban Health Care Conference of making his HHS employees go on diets and forcing them to go not just outside the building but across the street to take a smoking break. Thompson advocated putting a dollar-a-pack tax on cigarettes and requiring all states to cover the uninsured, with help from the feds in terms of tax-code subsidies. He touts having the federal government and insurers fund a "stop loss" reinsurance program that would take on all insurance risks over $75,000 relating to a health-plan member [a nifty plan to let the insurers preserve staggering profits and executive salaries by passing all real risks on to the public. Currently we pay twice per capita for health care what any other industrialized nation does, that doesn't bother anyone in congress, so why not shoot for three or four times the going rate?]

OR: For employer-insured individuals coping with mental illness or chemical addictions, the passage of mental health parity in Oregon will mean better financial support and fewer limits for care. "There is plenty of suffering going on without having all these limits on coverage," said Sonja Tanner, who learned about the shortfalls of her employer-based mental health coverage when her son was hospitalized at 9 years old for mental health distress related to Asperger's Syndrome. "We had therapists and counselors telling us what we needed, but we were denied access." But many insurance companies argue that the new state mandate, which requires fair and equal group health insurance parity for mental health and substance abuse disorders, will drive up medical costs for everyone, and benefit only a small cadre of high-needs individuals. [That used to be the definition of insurance, didn't it?]

CO: Consolidation among Denver hospitals and a recent $2.25 BIL building boom are chief drivers of rising health care costs. Ten years ago, Denver had 20 independent or small-system hospitals, but today three large systems own more than 75 % of the beds in the market. That consolidation has allowed systems to raise prices, driving up costs and hospital profit margins to four times the national average. Meanwhile, health insurance premiums in Denver increased 82 % from 2000 to 2004. "Denver's hospital systems are prospering while its health care system is hurting," states the report, commissioned by Colorado for Health Care.

INTL: Ontario workers are well-trained. That simple explanation was cited as a main reason why Toyota turned its back on hundreds of millions of dollars in subsidies offered from several American states in favour of building a second Ontario plant. Toyota confirmed months of speculation Thursday by announcing plans to build a 1,300-worker factory in the southwestern Ontario city. In addition to lower training costs, Canadian workers are also $4 to $5 cheaper to employ partly thanks to the taxpayer-funded health-care system in Canada, said federal Industry Minister David Emmerson. "Most people don't think of our health-care system as being a competitive advantage," he said. [Perhaps first US state with a real UHC system will see businesses rush in for savings and healthy work force.]

NATL: A survey of Katrina evacuees in shelters in the Houston area revealed that 14% report a family member, neighbor or friend killed by the storm or subsequent flooding. 52% report having no health insurance coverage at the time of the hurricane. Of those with coverage, 34% say it is through Medicaid and 16% through Medicare. 33% report experiencing health problems or injuries as a result of the hurricane and 78% of them are currently receiving care for their ailments. 41% report chronic health conditions such as heart disease, hypertension, diabetes and asthma. Of the 61% who did not evacuate before the storm, 38% said they were either physically unable to leave or had to care for someone who was physically unable to leave.

NATL: Rising health care costs, not health coverage, is people’s chief health care concern. In a June, 2005 Kaiser Family Foundation survey, the top worry was having to pay more for your health care or health insurance (45 % said they were very worried), followed by not being able to pay medical costs when you are elderly (42 %), your income not keeping up with rising prices (40 %), not being able to afford the health care you think you need (34 %), losing your health insurance (30 %) and not being able to change jobs because you’re afraid of losing your health insurance (18 %) The public wants the government to play a leading role in providing health care for all. For example, in an October, 2003 Washington Post/ABC poll, by almost a two-to-one margin (62 % to 33 %), Americans said that they preferred a universal system that would provide coverage to everyone under a government program, as opposed to the current employer-based system. American overwhelmingly agree that access to health care should be a right. In 2000 just as in 1993, eight in ten agreed that health care should be provided equally to everyone, and over half agreed strongly or completely . In addition, in 2004, about three-quarters (76%) agreed strongly or somewhat that access health care should be a right. In August, 2003, Pew found Americans favoring, by 67-26, the US government guaranteeing health insurance for all citizens , even if that meant repealing most of recent tax cuts .

NATL: The percentage of businesses offering health insurance to their workers has declined steadily over the last five years as the cost of providing coverage continues to outpace inflation and wage growth. Three in five firms (60%) offered coverage to workers in 2005, down significantly from 69% in 2000 and 66% in 2003.  The annual premiums for family coverage reached $10,880 in 2005, eclipsing the gross earnings for a full-time minimum-wage worker ($10,712).  The average worker paid $2,713 toward premiums for family coverage in 2005 or 26% of the total health premium.

NATL: In the wake of Hurricane Katrina, lawmakers in Washington have shelved -- at least temporarily -- plans to reduce spending on the massive Medicaid health program by $10 billion. The cuts were to be part of broader budget deficit-reduction legislation due September 16. There is another reason for the delay besides the need to provide immediate relief to hurricane victims -- even some Republican lawmakers say it would be bad public relations to cut Medicaid when so many poor people were disproportionately -- and visibly on national television -- affected by the hurricane. "This is not the time to take on Medicaid or other entitlements for the poor," said Sen. Gordon Smith, R-Ore. Some Republicans, said that while the federal government may well end up spending more on Medicaid to help the hurricane victims, it is important to proceed with the budget legislation as well. Said House Budget Committee Chairman Jim Nussle, R-Iowa, "we're not cutting Medicaid. We're reforming government."

NATL: Many persistently high primary care users appear to be overserviced but underserved, with underlying problems not addressed by a medical approach. Some may benefit from psychosocial support, whereas others may be good candidates for disease management interventions. [Translation: even among the small group of patients who overutilize health care, these patients are probably not successfully accessing those heatlh care services they really need.]

NATL: Perceptions of entitlement to gifts from pharmaceutical companies and companies' involvement in sponsored educational events leave medical students at risk for unrecognized influence according to results of a survey of third-year medical students. The results showed that, on average, students received one gift or attended one sponsored activity per week. Roughly 70% believed that gifts would not influence their prescribing practices. The researchers suggest that school-wide policies limiting student contact with drug representatives would help generate skepticism regarding the purpose and consequences of gifts and company-sponsored educational events, as long as these policies "were made highly visible and discussed formally."

INTL: Per capita expenditure on prescription drugs in British Columbia more than doubled between 1996 and 2003. Results of a new study suggest that most of this growth in costs was due to high-priced, so-called "me-too" drugs, which are patent protected but basically very similar to drugs already on the market. 142 of 1147 newly patented drugs between 1990 and 2003 were "breakthrough" drugs, defined as "the first drug to treat effectively a particular illness or which provides a substantial improvement over existing drug products." The remaining 1005 new drugs (88%) were classified as me-too drugs. Me-too drugs accounted for 41% and 63% of costs in 1996 and 2003, respectively. The authors note that the average cost of treatment with me-too drugs was four times that of vintage generic drugs. They estimate that roughly one fourth of the total cost of prescription drugs would have been saved in 2003 if half of the me-too drugs were priced to compete with older alternatives.

NATL: In hopes of narrowing the gap between urban and rural healthcare, the USDA Rural Utilities Service has awarded nearly $10 million in new funding to a company Orange County, California, using teleconferencing and telemedicine technology to provide healthcare to patients in remote areas. Data from digital medical instrumentation, including electronic stethoscopes and electrocardiograms, are transmitted via a secure online network to off-site providers, and video conferencing allows physicians and nurses to perform medical examinations in real-time with patients in remote locations. Although telemedicine purports to reduce healthcare costs, particularly those related to transporting remote patients, a Cochrane review published in April 2005 concluded that to date, there is little evidence of clinical benefits. Studies published thus far had variable and inconclusive results for other outcomes such as psychological measures, and there was no analyzable data regarding cost-effectiveness.

NATL: Democrats in the US House and Senate are pushing legislation that would dramatically expand federal funding for the Medicaid health program for the poor, both to states that suffered damage from Hurricane Katrina last week, as well as states that are now hosting tens of thousands of evacuees. "A person who is evacuated from the Superdome in Louisiana to the Astrodome in Texas should be confident that the federal government will facilitate and ultimately guarantee payment for Louisiana refugees," said a letter to HHS Sec Leavitt from John Dingell, Mich., Sherrod Brown, and Henry Waxman, [Why not always take care of all impovershed Americans in need of health care? Why just temporary for some high profile disassters?] House and Senate Republicans, as well as President Bush, have said they will act to guarantee health coverage to those affected by the storm, but have so far not proposed any specifics.

NATL: New Orleans area hospitals, which struggled to operate just after Hurricane Katrina with little power and less security, now have a different problem, the government says -- they need patients to come back so they can stay in business. But with the city all but emptied by a mandatory evacuation order, those beds are mostly empty. "One of the concerns is if we don't bring back patients to support their activities, they may not be able to continue those activities," Adm. Craig Vanderwagen, the assistant surgeon general, said at a weekend briefing. [A point we have made for several years, that much of the US health care costs are fixed costs need to be kept up anyway for everyone's sake and that spending on those in the hospital at any given time should justifiably be at public expense - since any of us might need those services in the future.]

NATL: After four years of double-digit increases, premiums for employer-provided health insurance in the US rose only 9.2% in 2005, according to the annual survey released Wednesday by the Kaiser Family Foundation and Health Research and Educational Trust. The percentage of employers offering health insurance to their workers, however, continues to decline. This year 60% of employers are offering coverage, down by 13% since 2001 . Altman called the trend "a slow but perceptible deterioration of our employer-based (health insurance)] system." The increases in premiums help explain the decline. This year the average annual premium for a single employee is $4,024, while the average premium for family coverage is $10,880. That is more than the gross earnings of an individual working full-time at the minimum wage of $5.15 per hour, Altman noted.

NATL: Computerized medical records could save the United States more than $81 billion annually through greater efficiencies and reduced errors, according to a study appearing in Health Affairs. Proponents of electronic medical records and computerized drug prescriptions believe such systems promise great savings but some warn the technology will be difficult to implement and is unlikely to yield huge benefits any time soon. "But computers don't offer the panaceas that politicians hope for and computer firms are peddling," said Dr. David Himmelstein. [PNHP has cited the current US health care budget at $1.9 TRIL which would even make this optimistic one-time savings about 4%, or a fraction of our the budget's annual increase.]

NATL: US health officials granted tentative approval for a generic liquid version of the AIDS drug AZT, allowing it to be used overseas under a US program to fight HIV. The generic version of GlaxoSmithKline Plc's drug zidovudine or Retrovir, made by India-based drugmaker Aurobindo Pharma Ltd., is the latest in a string of approvals for the program. However, the generic drug will not be available in the United States because of patent protections. A five-year, $15 billion program launched by President George W. Bush in 2003 aims to pay for treatment for 2 million AIDS patients and provide care for 10 million others in 15 countries, mostly in Africa.

NATL: Months before the FDA issued a safety alert about problems with Guidant Corp. heart devices, a company report to the agency showed that some of those units were short-circuiting. But the agency did not make that data public at the time because it treats the information it receives in such reports as confidential. The company disclosed data showing that one of its widely used defibrillators, the Ventak Prizm 2 DR, was short-circuiting at the rate of about one a month, a rate that some doctors say was troubling. Dr. Daniel Schultz, director of FDA's Center for Devices and Radiological Health, said it would tie up too many resources to review hundreds of filings the FDA receives each year and determine which data could be routinely released.

NATL: Hospitals that perform a high number of cystectomies have significantly fewer patient complication and fatality rates than do those with a low volume of such procedures, according US researchers, who also found that staffing also affects patient outcomes. Mortality was significantly higher (more than 4-fold increased) in the low-volume hospitals (3.1%) than it was in the high-volume hospitals (0.7%). Moderate-volume hospitals had an intermediate incidence (2.9%). Hospitals with a high ratio of registered nurses to patients also had a lower mortality risk (odds ratio, 0.43). Mortality rates at lower-volume hospitals with high registered nurse-to-patient ratios are very similar to those at high volume hospitals.

INTL: France will cut its health insurance deficit to 8.3 billion euros ($10.23 billion) this year despite a shortfall in revenues due to weak economic growth. Despite large trade union protests, the government pushed through a series of cost-cutting health reforms last year, including a 1-euro charge for seeing a doctor and a rise in welfare levies. [This new french copayment from patients is $1.20 US. Wouldn't it be nice if we had effective protests about our copays 20x larger?]

NATL: The global pharmaceutical industry launched a new Web site giving details of clinical trials on new medicines in a bid to allay patient fears over drug safety. The move follows criticism that companies manipulate or suppress results of clinical studies in order to come up with favourable conclusions. The new portal (www.ifpma.org/clinicaltrials), links available online information about clinical trials worldwide. Drugmakers hope the project will head off legislation from governments in the wake of scandals over pain drug Vioxx and the use of antidepressants in adolescents. The issue came to a head last year with accusations by Eliot Spitzer that Glaxo fraudulently suppressed information about the use of its antidepressant Paxil, or Seroxat, in children.

NATL: Just days before Medicare officials in Washington unveil the private prescription drug plans that will be available to the program's 43 million elderly and disabled beneficiaries starting next January, both liberals and conservatives in Congress are calling for a delay in the controversial program. Conservatives in the US House Wednesday unveiled "Operation Offset," an effort to find budget cuts to help pay for relief needed to rebuild the states and cities decimated by Hurricane Katrina three weeks ago. Delaying the new Medicare benefit by a year is at the top of the list, primarily because it would save an estimated $30 billion over the next decade. Democrats are concerned the Medicare beneficiaries will be automatically assigned to a drug plan this fall. [Usually incremental health care reforms are rolled back after they are initially rolled out.]

NATL: US FDA warnings to drug companies over misleading advertisements have more than tripled in the last year. The agency sent 17 warning letters in the 12 months ending in August 2005 compared with an average of about four to five letters in previous years. The majority of the 17 letters, about 82 %, cited companies for not including information about side effects and other risks in promotional materials for patients or doctors. Many offending ads either left out certain serious risks, while others used very small font size to mention them at the bottom of the page. About half the letters also warned companies for making false claims about how well the drug worked, while about 40 % cited them for wrongly comparing the featured drug to a competitor.

NATL: Although financial support for biomedical research in the US has doubled over the last 10 years, Americans support even greater investment in health-related research by public and private funders. After adjustment for inflation, total funding rose from $47.8 billion in 1994 to $94.3 billion in 2003. Industry support (i.e. money derived from our pharmacy bills). from pharmaceutical, biotechnology and medical device firms accounted for 57% of funding. Pharmaceutical company spending on clinical trials has increased, but fewer new drugs are being brought to market. There were 35.5 per year between 1994 and 1997. This fell to 23.3 per year from 2001 to 2004. 78% of Americans believe it is "very important" to maintain world leadership in health-related research, with 67% stating that they are willing to pay one dollar more per week in taxes for additional medical research. However, "Americans are losing confidence in their health care system," with the majority of respondents saying they are dissatisfied with the quality of health care in this country.

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