» Wednesday, December 28, 2011 I The Sacramento Bee A9

A good list for hospital shoppers - 405 chances
Sunday, January 15,2012 I The Sacramento Bee

From CMA ALERT issue2224--Jan 9, 2012

State budget shortfall to extend Medi-Cal cuts

When the California Legislature passed the 2011-12 State Budget in June, they assumed a sizable ($10 billion) increase in revenue based on projections of an improving economy. But early projections show the state will face a $12.8 billion deficit for the coming fiscal year.

To account for the uncertainty of tax revenue, the Legislature included a set of automatic “trigger” cuts that would be implemented if revenues fell short. The trigger cuts were divided into two tiers, depending on how far revenues fell short.

On December 13, California Governor Jerry Brown announced that, while revenues are higher than last year, they are not high as projected. He therefore pulled the budget trigger on the “Tier 1” cuts.

Of the scheduled reductions, the extension of the March 2011 cuts to Medi-Cal managed care plans – expected to yield a $15 million reduction to the Medi-Cal program – is the most likely to affect physicians.

When the 10 percent cut was passed, the Program of All-Inclusive Care for the Elderly (PACE), Senior Care Action Network (SCAN) and AIDS Healthcare Foundation were exempted. They are now included in the cut. Doctors working with those plans may see reductions.

The official list of trigger cuts also includes the following:

• $100 million to the University of California
• $100 million to the California State Universities
• $100 million to the Department of Developmental Services
• $110 million to the In-Home Supportive Services program, including $100 million in service hour cuts, and $10 million for local anti-fraud efforts
• $92 million to the Department of Corrections and Rehabilitation (CDCR)
• $72.1 million in increased county charges for youthful offenders sent to CDCR
• $30 million to the California Community Colleges backfilled with a $10 per unit fee increase
• $23 million to the Department of Education related to childcare funding
• $16 million to the California State Library related to library grants
• $15 million to the California Emergency Management Agency related to local vertical prosecution grants

All of the cuts listed above were effective January 1, 2012.

Contact: David Ford, (916) 551-2554 or dford@cmanet.org.

By Penny Starr

January 3, 2012 (CNSNews.com) – According to its latest annual report, the Planned Parenthood Federation of America (PPFA) received $487.4 million in tax dollars over a twelve-month period and performed 329,455 abortions.

Marjorie Dannenfelser, president of the Susan B. Anthony List, a pro-life organization that lobbies Congress to defund Planned Parenthood, called the organization an "abortion giant."

"With over a billion in net assets and a business model centered on abortion and government subsidies, it is time for Planned Parenthood to end its reliance on taxpayer dollars," Dannenfelser said in a statement. "Despite an unprecedented effort by statewide and federal leaders to defund them, a wave of former employees willing to testify against them, and uniform agreement amongst Republican presidential candidates that they should be defunded, Planned Parenthood continues full-steam ahead."

"They are unwilling to answer to the pro-life American majority that wants out of this business," Dannenfelser said.

As reported earlier by CNSNews.com, a spokesperson with Planned Parenthood told Bloomberg’s Businessweek last year that 90 percent of government funding the organization gets is from the federal government or from Medicaid.

¡¡LINDENHURST, N.Y. (CBSNewYork) An alarming rise in a potentially fatal bacterial infection known as whooping cough has prompted a warning from the Suffolk County Health Department.

It's a tell-tale sign winter is coming for children and their colds.

But what is going around this year is a potentially fatal bacterial cough known as pertussis or whooping cough, reports CBS .

It's a chronic cough, almost a barking sound, that can last more than three months, and it is spread easily through droplets.

"My wife is on a bus, educational bus, so she is with kids all the time every day. But she hasn't been sick yet," local resident Steven Piering said Tuesday.

WCBS 880 Long Island Bureau Chief Mike Xirinachs On The Story. The whooping cough outbreak started with 13 cases in Smithtown on Long Island in June. Since then it has spread to more than a dozen districts in Suffolk County.

The most recent case of whooping cough involves a student at 5th Avenue Elementary in Northport, where 11 cases have already been reported. On Tuesday night, parents told CBS's Hazel Sanchez they are growing concerned.

"That's kind of scary. I wonder what's going on, why this outbreak started. What's going on?" one resident asked.

"They get colds at home. They bring it on the bus. They bring it to school. They're bringing it home," a school bus driver told WCBS 880 Long Island Bureau Chief Mike Xirinachs.

And what's particularly concerning to health officials is this most recent outbreak has the highest number of cases reported since 2006 when there were 110 for the year. Now it's 216 cases of whooping cough for the year so far.

What's causing this sudden and sharp rise in whooping cough has yet to be determined, said Dr. Dennis Russo with the Suffolk County Health Department. He said it might be as simple as more doctors are detecting and diagnosing it, or it could be an increase in some parent's decision to forgo vaccinating their kids.

"We like to have everyone vaccinated and create a cocoon effect, so that everyone around them is vaccinated and the disease is milder," Dr. Russo said.

"I'm not too concerned because my son has the vaccine," added Maria Sangiorgi of Lindenhurst.

Health officials said early detection and antibiotic treatment are the keys to better health and preventing the spread of whooping cough.

The majority of the students who have been infected with whooping cough had been immunized, which health officials said may account for their milder illness.

Babies who are not yet fully immunized are the most at risk of death from the infection.

It began with a massive national system of health planning designed to do precisely the wrong thing — reduce services at a time of growing demand due to the advent of Medicare and Medicaid. This was predicated on a bumper sticker slogan, “A Built Bed is a Filled Bed,” that was certifiably wrong both in theory and in practice. Health planning failed and was soon repealed.

Then we moved on to all-payer hospital rate setting at the state level that was adopted by thirty states despite the lack of evidence that it could work in anything but the highest cost locations. These, too, were repealed in all but one state (Maryland) because the regulations were “incomprehensible” according to one supporter and failed to work.

But most states retained some form of Certificate of Need regulations, which even the Department of Justice and Federal Trade Commission said failed to contain costs and were seriously anti-competitive. But that is exactly why the American Hospital Association supported these laws — they did not want to risk having to compete against more efficient rivals.

Then large employers got behind “business coalitions on health” that were based on the idea that sharp-penciled business executives could make doctors practice medicine more efficiently. Ultimately these efforts simply added yet another level of bureaucracy to a system that was already for too bureaucratic and did little to solve the problems of efficiency or cost.

Then the “policy community” discovered the “problem” of uncompensated care. After endless fretting and worrying about this new crisis, nothing happened and the level of uncompensated care, which was always a trivial amount of money, did not change a whit. When first discovered uncompensated care accounted for 6% of hospital costs and 13 years later it was still only 6% of hospital costs.

But the discovery of Uncompensated Care led to another discovery — the uninsured. Now here was an issue that would keep the policy community well-employed for decades and be the rationale for an entire bevy of new programs and initiatives. Yet over the course of the next two decades the level of non-insurance barely changed, in spite of all those programs. When it was first measured in 1987 about 84% of the population was insured and 16% uninsured. Twenty years later it was still 84% and 16%.

Of course, to effectively discuss the problem of the uninsured, policy makers would have to know something about insurance. Unfortunately, they learned just enough of the terminology to be dangerous. They completely misunderstood the meaning of ideas such as “risk pooling” and “adverse selection.”

But they had all the information they thought they needed to tell insurance companies how to run their businesses. They began by endorsing “mandated benefits,” which substituted the judgment of politicians for the buyers and sellers of health insurance in deciding what should and should not be covered in a health insurance policy. Over time over 2,000 specific laws would be enacted by the states. These laws did a lot to raise the price of coverage and make insurance less affordable, but the politicians were never blamed for these added costs. Only insurance companies were blamed.

But mandates did not address the “great problem” of the uninsured, so some progressive states went further. They adopted universal health programs of one sort or another. These programs were adopted with great fanfare by politicians and hailed by publications like the New York Times as great breakthroughs. But one-by-one they all failed and were repealed. In some cases they were never actually implemented or in other cases were repealed only after much damage, but the only thing truly “universal” about them was failure.

Then the states set out to “reform” their insurance markets, and once again ended up not “reforming” them but destroying them. See our posts on the NAIC small group reforms and the more ambitious individual market reforms in New Jersey and other states.

We haven’t yet mentioned The Federal HMO Act or ERISA because these laws wouldn’t have much impact on the market until the mid-1990s, but we will be getting to them in future posts.

All of this was done in a mere twenty years. All of it failed, but only after creating much turmoil and doing real damage to the health care system, the economy, and the lives of families. It all adds up to the greatest experiment in social engineering of our lifetimes.

You may have noticed in this sorry saga that all of it was pushed by academics and politicians, and all of it was imposed upon hospitals, doctors, employers, and insurance companies. Who is missing? The patient/consumer/employee/taxpayer.

All of it was a clash between powerful elite interests who simply used concern for “the folks” as an excuse to gain power. Nobody in this story trusted the people to make their own decisions or control their own destinies.

The pretext of their activities was to control health care costs, improve health care quality, and ensure access to health care services. All of this effort failed to have any impact whatsoever on any of that. The nation would have been better served had none of this happened.

For more information: GMScan@comcast.net

From the Director: Also search "medically uninsured" in this section of the HCREI website for more information concerning this subject.

From the Drudge Report   11/26/2011

An Electronic Eye on Hospital Hand-Washing

Fixes looks at solutions to social problems and why they work.

Tags:

Hospitals, Infections, North Shore University Hospital, Surgery and Surgeons, video

Richard Lee for The New York Times    11/26/2011

A board in the surgical intensive care unit at North Shore University Hospital in Manhasset, N.Y., reminds people to sanitize their hands.    

Beeps and blinking lights are the constant chatter of a hospital intensive care unit, but at the I.C.U.’s in North Shore University Hospital in Manhasset, N.Y., the conversation has some unusual contributors.  Two L.E.D. displays adorn the wall across from each nurses’ station.  They show the hand hygiene rate achieved:  last Friday in the surgical I.C.U., the weekly rate was 85 percent and the current shift had a rate of 91 percent.  “Great Shift!!” the sign said.   At the medical I.C.U. next door, the weekly rate was 81 percent, and the current shift 82 percent.

That’s too low for a “Great Shift!!” message.  But by most standards, both I.C.U.’s are doing well.  Those L.E.D. displays are very demanding — health care workers must clean their hands within 10 seconds of entering and exiting a patient’s room, or it doesn’t count.   Three years ago, using the same criteria, the medical I.C.U.’s hand hygiene rate was appalling — it averaged 6.5 percent.   But a video monitoring system that provides instant feedback on success has raised rates of hand-washing or use of alcohol rubs to over 80 percent, and kept them there.

Hospitals do impossible things like heart surgery on a fetus, but they are apparently stymied by the task of getting health care workers to wash their hands. Most hospitals report compliance of around 40 percent — and that’s using a far more lax measure than North Shore uses.   I.C.U.’s, where health care workers are the most harried, usually have the lowest rates — between 30 and 40 percent.  But these are the places where patients are the sickest and most endangered by infection.

How do hospitals even know their rates?   Some hospitals track how much soap and alcohol gel gets used — a very rough measure.  The current standard of care is to send around the hospital equivalent of secret shoppers — staff members who secretly observe their colleagues and record whether they wash their hands.   This has serious drawbacks:  it is expensive and the results are distorted if health care workers figure out they’re being observed.   One reason the North Shore staff was so shocked by the 6.5 percent hand-washing rate the video cameras found was that measured by the secret shoppers, the rate was 60 percent.

Richard Lee for The New York Times

From the Director: Our system of health care needs fixing not replacement by a system that fails everywhere it's been tried.

Supreme Court to Pick Obamacare Lawsuits Next Month
The Supreme Court will take its very first look at the lawsuits challenging Obamacare next month when members of the high court meet on November 10 to decide which, if any of the multiple cases it will consider.

The Obamacare law has come under strong opposition from pro-life groups because it fails to include provisions that would prevent taxpayer financing of abortions and because it prompts concerns about rationing health care for elderly and disabled people. Leading pro-life groups ranging from National Right to Life and Americans United for Life to the nation’s Catholic bishops and the Family Research Council all opposed the bill because of their pro-life concerns.

Today, the SCOTUS blog broke the news about the Supreme Court taking its first look at the various legal challenges to the law.

“Five of the six pending petitions (the sixth is not ready yet) were distributed to the Justices’ chambers on Wednesday, for consideration at that private session,” it reported. “Although a grant of review is not assured, that is highly likely, since all sides agree that the Court should take on the controversy, and the constitutionality of a key provision of the new law has been decided differently by federal appeals courts.”

The high court is expected to announce the results of its preliminary look at the lawsuits by November 14, although it will not be rendering a decision. The announcement will merely indicate which of the lawsuit the Supreme Court will take. With some federal judges upholding the law and some striking it down in full or in part, the decision by the top court on which cases or cases it will take could point to the direction the court may go when it hands down a decision next summer. http://www.lifenews.com/2011/10/26/supreme-court-to-pick-obamacare-lawsuits-next-month/

From the Director;  Supreme Court Promises a Final Decision in June of 2012

WASHINGTON (AP) -- The Drug Enforcement Administration says people turned in more than 188.5 tons of unwanted or expired prescription medications in the agency's third National Prescription Drug Take-Back Day on Oct. 29.

The DEA initiative that began 13 months ago has resulted in almost 500 tons of medications being taken out of circulation, with assistance from state, local and tribal law enforcement partners as well as community groups.

For the most recent collection day, 5,327 sites were set up around the country.

DEA Administrator Michele Leonhart says the amount of drugs collected during the three Take-Back Days held so far speaks volumes about the need to develop a convenient way to rid homes of unwanted or expired prescription drugs, which could fall into the hands of abusers or pollute the environment.

© 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Learn more about our Privacy Policy and Terms of Use.

From the AAPS Newsletter 10/28/2011
Your Medical Privacy–
Another ObamaCare Casualty

CLICK HERE TO READ ARTICLE ONLINE AND COMMENT

by Elizabeth Lee Vliet, M.D.

"...It was a sad day recently when a married menopausal woman learned that her recent Pap test was positive for human papilloma virus (HPV). “How could this happen?” she asked. “I have not had sex with anyone but my husband since we married 30 years ago.”

Over the past year, her husband had several trips overseas for weeks at the time. She suspected the positive HPV indicated he had been unfaithful, but when she asked him, he said, “Oh, it can be latent for a long time.”

I showed her my records from 2008 and 2009: Paps were HPV negative. Her newly positive HPV likely means her husband had had sex with an infected person during his travels. She broke down weeping.

HPV is an increasingly prevalent sexually transmitted disease that can hit women of all ages and increases the risk of invasive cervical cancer—another reason she was upset about becoming HPV positive. She now faced hard decisions. As she left, I felt sad watching her suffer with the impact of this news on her marriage.

This kind of painful situation happens daily in doctors’ offices. Such personal and private pain should remain between the patient, physician, and family.

My patients are horrified at the idea that such personal health information could be released to a government database, open to anyone with access to the system. But your privacy is another casualty of the damage caused by Obamacare’s new rules and regulations governing health professionals.

The U.S. Department of Health and Human Services (HHS) recently released new federal regulation that requires private health insurance companies to give health records of every person they insure to the government.

Although government jargon in the HHS rules distracts from their real goal, the end result is clear: government bureaucrats would have access to the health records from all private insurance companies—including yours—whether you want them to or not.

Under the new rules, the Federal government will own and control your medical records, without your permission. The government will be your new “overlord” controlling your medical information on federal computers in a federal database. You will no longer be able to control who sees your medical information.

The most personal aspects of your life are slated to be sent to Washington by your private insurance carrier for all your medical visits. This provides individual medical data for the federally run Comparative Effectiveness Research coordinating panel of experts. This panel of government-appointed experts, copying the rationing approach in Britain, will decide what treatment is allowed for individuals, based on government criteria such as: 

• cost of treatment
• effectiveness as determined by government experts
• your “quality life years” remaining 

Beyond privacy issues, there is major concern about safety of your medical information when hackers can penetrate even highly secure federal agency computers such as the Pentagon, VA, and Department of Defense. Hackers stole millions of medical records from the Veterans Administration, and patients were at risk for identity theft.

David Blumenthal, M.D., the President’s former “health information czar,” admitted that “no infrastructure exists in most areas of the country for secure health information exchange among providers and between providers and consumers.”

Medical privacy? The Obama administration’s health czars seem more concerned about power and control over your medical care than protection of your private medical information.

In summary, the Obamacare “Patient Protection and Affordable Care Act” of 2010 and the “Stimulus Bill” of 2009 gave the federal government total control of very personal aspects of your life: 

• money that is currently in the private healthcare sector
• your private personal and family health information
• your access to timely medical care
• the types of treatment you will be allowed to have, based on your age and value to society..." 

Elizabeth Lee Vliet, M.D. is a preventive and climacteric medicine specialist with medical practices in Tucson AZ and Dallas TX that take an integrated approach to evaluation and treatment of women and men with complex medical and hormonal problems. Dr. Vliet is also President of International Health Strategies, Ltd., whose mission is twofold: liberty and privacy in treatment options and preservation of the Oath of Hippocrates focus on the individual patient.

The findings, published in the Journal of the American Medical Association, are the latest in a series of carefully designed experiments that have found that vitamins and other dietary supplements are useless or possibly dangerous. On Monday, the Archives of Internal Medicine published a paper that concluded that older women might have a higher overall mortality rate if they take multivitamins, folic acid, iron, magnesium, copper or zinc.

"Just because ifs 'only a vitamin' or If s natural,' we assume it must be safe. But over and over again, we see thaf s not necessarily the case," said Howard Par-nes of the National Cancer Institute, which funded the prostate cancer study. "Not only isn't it the fountain of youth that some people said, it can be harmful."

About half of U.S. adults regularly take some kind of supplement, according to the latest federal data,

Americans spend more than $28 billion a year on vitamins, minerals and other substances that companies claim can reduce the risk for cancer, heart attacks, strokes, diabetes and Alzheimer's disease, among others, including about $340 million alone in 2010 for vitamin E, according to the Nutrition Business Journal.

Beta carotene might help slow a common form of blindness known as macu-lar degeneration. But virtually every other large, rigorous attempt to verify the benefits of a dietary supplement has failed, and in some cases produced evidence of harm.

The National Institutes of Health launched a $119 million project to study prostate cancer in 2001 after laboratory studies and some clinical data indicated that the anti-oxidant vitamin E and selenium might protect against prostate cancer, the second most common cancer among men.

The study followed more than 35,533 men ages 50 or older at 427 sites in the United States, Canada and Puerto Rico. The men were divided into four groups who took daily doses of 400 international units of vitamin E and 200 micro-grams of selenium; vitamin E and a placebo that looked like selenium; selenium and a placebo that looked like vitamin E; or two placebos.

An independent panel monitoring the experiment halted it in 2008 when it became clear there was no benefit and indications emerged the supplements might be increasing the risk for prostate cancer and diabetes.

From AAPS News Letter 10/4/2011

Premiums Up, Choices Down:
The First Wave of Obamacare
Click here to read article online and comment.

By: Elizabeth Lee Vliet, M.D.

Kaiser Family Foundation just released further bad news about the poorly named Patient Protection and Affordable Care Act ("Obamacare"). American families facing a bad economy, high unemployment, and crashing home values now get hit with another cost increase: higher health insurance premiums that are rising more every year.

Obama’s campaign focused on "hope and change," but I suspect these winds of "change" are ones that most Americans did not "hope" for, did not want, and would like to escape.Look at the bleak facts:

Hurricane Irene wreaked visible damage all along the Eastern seaboard this fall. The damage from Obamacare’s extensive new mandates and regulations is less visible, but no less damaging to individuals, families, businesses, and our overall economy. At least we had warning that Hurricane Irene was coming and could take steps to prepare and protect ourselves. But we were falsely promised that the hurricane named Obamacare would lower costs, improve access to health insurance, and "protect patients." Even in this earliest stage, with only a fraction of the mandates implemented, we are seeing massive damage.

Obamacare advocates like to blame the "greedy" insurance companies. But most of the blame for higher premiums is directly caused by the Obamacare first wave of mandates and regulations.

As of the fall of 2010, all insurance policies must:

Adding this coverage unavoidably means the policy will have to cost more.

Obamacare regulations already control practically every decision a private insurance company can make. It is only going to get worse as government "medicrats" micromanage every single aspect of insurance coverage.

When the government gets in the middle, it always costs more. Think hugely inflated prices for solar panels made by Solyndra. Think high-priced toilets when the Pentagon pays. Think $16 dollar muffins for government bureaucrats to eat at government conferences. The government is buying? Triple or quadruple the price!

As health insurance premiums spiral up at this rate, more and more families will be forced away from the private policies and into Medicaid. This is not an "unintended consequence." The goal of this Administration, as Obama himself has said on tape, is to drive private insurers out of business when people are unable to afford the policies that are "Obamacare-compliant." The end result is the "public option" of fully socialized medicine that was the intent all along. Obamacare will destroy the private sector in medicine and make people dependent on the federal government, with the federal bureaucrats controlling every aspect of your medical care.

Real reform would put Americans—instead of the government or the insurance company—back in the driver’s seat as patients and savvy consumers. Americans need to take back their rights, including the right to choose how, when, where, and with whom to seek medical care and health insurance. Only then will we see premiums start to decrease.

Patient power. Not government power.
What a novel idea!

Researchers from the United States and Europe working in laboratories on the human immunodeficiency virus (HIV) found it is unable to damage the immune system if cholesterol is removed from the virus's membrane.

"It's like an army that has lost its weapons but still has flags, so another army can recognize it and attack it," said Adriano Boasso of Imperial College London, who led the study.

The team now plans to investigate how to use this way of inactivating the virus and possibly develop it into a vaccine.

Usually when a person becomes infected with HIV, the body's innate immune response puts up an immediate defense. But some researchers believe HIV causes the innate immune system to overreact. This weakens the immune system's next line of defense, known as the adaptive immune response.

For this study -- published on Monday in the journal Blood -- Boasso's team removed cholesterol from the membrane around the virus and found that this stopped HIV from triggering the innate immune response. This in turn led to a stronger adaptive response, orchestrated by a type of immune cells called T cells.

AIDS kills around 1.8 million people a year worldwide. An estimated 2.6 million people caught HIV in 2009, and 33.3 million people are living with the virus.

Major producers of current HIV drugs include Gilead Bristol Myers Squibb, Merck, Pfizer and GlaxoSmithKline.

Scientists from companies, non-profits and governments around the world have been trying for many years to make a vaccine against HIV but have so far had only limited success.

A 2009 study in Thailand involving 16,000 volunteers showed for the first time that a vaccine could prevent HIV infection in a small number of people, but since the efficacy was only around 30 percent researchers were forced back to the drawing board.

An American team working on an experimental HIV vaccine said in May that it helped monkeys with a form of the AIDS virus control the infection for more than a year, suggesting it may lead to a vaccine for people.

HIV is spread in many ways -- during sex, on needles shared by drug users, in breast milk and in blood -- so there is no single easy way to prevent infection. The virus also mutates quickly and can hide from the immune system, and attacks the very cells sent to battle it.

"HIV is very sneaky," Boasso said in a statement. "It evades the host's defenses by triggering overblown responses that damage the immune system. It's like revving your car in first gear for too long -- eventually the engine blows out.

He said this may be why developing a vaccine has proven so tricky. "Most vaccines prime the adaptive response to recognize the invader, but it's hard for this to work if the virus triggers other mechanisms that weaken the adaptive response."

HIV takes its membrane from the cell that it infects, the researchers explained in their study. This membrane contains cholesterol, which helps keep it fluid and enables it to interact with particular types of cell.

Normally, a subset of immune cells called plasmacytoid dendritic cells (pDCs) recognize HIV quickly and react by producing signaling molecules called interferons. These signals activate various processes which are initially helpful, but which damage the immune system if switched on for too long.

Working with scientists Johns Hopkins University, the University of Milan and Innsbruck University, Boasso's team found that if cholesterol is removed from HIV's envelope, it can no longer activate pDCs. As a result, T cells, which orchestrate the adaptive response, can fight the virus more effectively.

Pa. federal judge rules against insurance mandate

By Chris Mondics

INQUIRER STAFF WRITER

"...The Rising Flood of Spending

There are two ways to constrain expenditures: cost-sharing and rationing, including the stealth rationing of price controls. Medicare and Medicaid eschew the former, with predictable results (Am Spectator, July 2011). A new RAND study has shown that families who have a high deductible and a health savings account spend 30% less, in all areas: out-patient, in-patient, and prescription drugs. It also found that low-income and/or high-risk families are not disadvantaged by such plans, reports John Goodman (http://healthblog.ncpa.org 6/17/11).

According to Medicare actuary Richard Foster, the ACA will triple the rate of increase of health insurance costs, from about 3.5% per year to 14% by 2014 (Health Affairs, July 2011). Ralph Weber explains that this is by doubling down on a failed system of mandates, subsidies, and controls. More mud in the channel.

Complaints that the U.S. spends a higher percentage of GDP on healthcare than any other country omit the fact that the percentage paid out of pocket (13%) is less here than almost anywhere else (Scandlen, healthblog.ncpa.org 6/13/11).
..."

"...States May Decline to Form Exchanges

At the annual meeting of the American Legislative Exchange Council (ALEC) in New Orleans Aug 4, the Health and Human Services Task Force passed a resolution recommending that state officials not participate in planning or establishing the state health insurance exchanges as provided for in the ACA, and that state legislatures urge Congress to defund planning grants. 

Representatives from the Goldwater Institute argued that exchanges were a “silver dagger in the heart of ObamaCare lawsuits.” Once hundreds of millions of dollars are spent implementing the law, courts will be increasingly reluctant to overturn it.

Federal planning grants are seductive, but they expire after 2014, and costs are then likely to escalate rapidly. All the rules must comport with federal rules, and plans must be approved by the Secretary of HHS. Any state control was called a “mirage.” When ACA’s price controls reward insurers for dumping the sick, states will be left with the responsibility.

In 28 states, legislation has been defeated or not proposed. 

Kansas returned a $31.5 million “innovator grant” for exchange infrastructure. Oklahoma was the first state to opt out...".

By JENNIFER HABERKORN | 8/3/11 11:28 PM EDT

The debt ceiling agreement could jeopardize millions of dollars, and perhaps billions, in initiatives from President Barack Obama’s health care reform law if the super committee can’t come up with required spending cuts.

Many of the pots of money in the law — one of the Democrats’ most prized pieces of legislation — could get trimmed by the debt deal’s sequestration, or triggered cuts. The funds for prevention programs and community health centers, grants to help states set up insurance exchanges and co-ops, and money to help states review insurance rates could be slashed across the board if the panel can’t find enough cuts this fall.

Funding for the temporary high-risk pools for pre-existing conditions could be sliced, too, as well as grants to improve maternal and child health. And as previously reported by POLITICO, the law’s cost-sharing subsidies — which are supposed to help low-income people pay their out-of-pocket expenses — could face the ax, too.

The prospect of reductions to the health law’s programs — which would undermine the law’s attempts to expand access and improve health quality — could provide an added incentive to Democrats to avoid the triggered cuts. The reductions will happen if the new committee can’t find at least $1.2 trillion in savings over the next 10 years.

"There are at least 15 provisions of the Obama health care law that will find themselves subject to this trigger if the committee is not able to come up with other cuts," said Sen. John Barrasso (R-Wyo.). "When I look at these, I think it gives a huge incentive to the Democrats to find cuts. What would be triggered if we can’t find other cuts would cut right into the Obama health care law."

Senate Republican leadership aides identified the potential funding cuts shortly after the law passed and are talking with the Congressional Budget Office to determine what parts of the law would be subject to sequestration.

The fact that the programs are vulnerable at all means Obama and congressional Democrats did not succeed in their attempts to shield the health reform law from the debt-deal trigger.

Obama had resisted efforts by congressional Republicans to make the law’s individual mandate a part of the trigger during earlier debt-limit negotiations. But while the final deal doesn’t directly target the health care law, the cuts to specific programs could still happen because of the way the law is written.

The debt ceiling law exempts several programs for the poor and those with low incomes, as defined by the 2010 Balanced Budget and Emergency Deficit Control Act, called PAYGO. That law exempts Medicaid, Social Security and the Children’s Health Insurance Program, among other programs.

But it doesn’t protect the health law’s provisions because the definitions became law a month before the health law was passed.

"If you’re not on the list, you wouldn’t be protected," said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

Thursday, 28 July 2011

　ANDREW HASSON

Anne Ball, 71, a retired business consultant: 'I have bilateral cataracts and under the original NHS criteria I was entitled to have at least one of mine treated - but then the West Sussex health authorities decided to change the threshold level to save money'

Hip replacements, cataract surgery and tonsil removal are among operations now being rationed in a bid to save the NHS money.

Two-thirds of health trusts in England are rationing treatments for "non-urgent" conditions as part of the drive to reduce costs in the NHS by £20bn over the next four years. One in three primary-care trusts (PCTs) has expanded the list of procedures it will restrict funding to in the past 12 months.

Examples of the rationing now being used include:Related articles