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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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