Sacramento Bee June 25 2009
BY CARLA K. JOHNSON Associated Press

CHICAGO - When it comes to health care spending, an ounce of prevention is seldom worth a pound of cure.

Take Mrs. Jones, a hypothetical 55-year-old obese woman at risk for diabetes. It costs $900 a year to hire a personal lifestyle coach to help her lose weight and prevent diabetes. Suppose that the coaching works for Jones, and she is spared diabetes and all its resulting health bills.

But research shows that for every person like Jones, six other people just like her get nothing out of such a program. They either don't lose weight or get diabetes anyway or wouldn't have developed it in the first place. The yearly cost of the prevention program for those six people: $5,400. That's probably more than Jones' health bills from diabetes would have amounted to.

There goes your pound of cure. The truth is, shockingly few prevention efforts actually save the health care system moneyoverall, despite claims bythe president and some in Congress.

Discussing daily aspirin use with people at risk of heart disease does save money. So do vaccinations for children. When doctors talk to smokers and offer medication to help them quit, that, too, saves money. But those are the exceptions.

Prevention is a good deal, some experts say, if you can buy one year of perfect health for less than $50,000.

Back to Jones. Helping 100 people like her would cost $270,000 over three years, but also would prevent 15 new cases of diabetes, avoid the need for blood pressure or cholesterol-lowering pills in 11 people, avoid $65,500 in medical spending for all 100 people and prevent 162 missed days of work due to sickness.

Dr. Ronald Ackermann at Indiana University School of Medicine in Indianapolis said recent studies suggest that offering the diabetes prevention program to groups of 10 people - instead of one-on-one coaching - can lead to similar benefits and cost as, little as $15 per month.

The YMCA is offering just such a group program. Retired accountant Paul Mullen, 66, of Indianapolis, has lost IS pounds since May and brought his blood sugar down because of lifestyle changes he learned. He pays $115 for the yearlong program, on top of his Y membership fee.

Michael Maciosek of HealthPartners Research Foundation in Minneapolis found that of 25 highly recommended prevention strategies, 15 cost less than $35,000 per year of perfect health gained.

Those are definitely bargains if you're using the arbitrary cutoff of $50,000 per healthy year to decide what's a good investment in health spending. And some economists say Americans would be willing to spend even more than that, say $100,000 per perfect health year.

No one really knows how much of the U.S. health care dollar goes toward prevention. The most commonly cited number - 3 cents of every health care dollar - is based on 20-year-old data.

An updated number - nearly 9 cents of every health care dollar - represents about $194 billion, said George Miller, who led the research for theAltarum Institute, a nonprofit consulting group.

Legislation pushed by Senate Democrats mentions prevention repeatedly. The Senate panel heading up health reform also calls for more research on prevention, creates a ne"^, interagency council to coordinate a national health promotion strategy and permits insurers to give incentives for health promotion and disease prevention.

President Barack Obama as recently as April said investing in prevention "will save huge amounts of money in the long term."

And it has become almost an article of faith among Republicans, Democrats and business leaders that prevention reduces health care costs.

But the Congressional Budget Office last week issued a statement on health care overhaul that dismissed the notion that prevention saves money. Prevention "would have clearer positive effects on health than on the federal budget," the CRO said.

From the DIrector: The word's history is full with the failures of Societies to prevent or prepare for individual or public disaster. Despite warnings  humans repeatedly fail to react when first warned. Physicians in practice should certainly agree.

From Greg Scandlen News Letter #181  6/4/09

Curiously, the United States has one of the lowest rates of out-of-pocket spending of all the OECD countries - 13% of total spending in 2005. Only France (7%), Luxembourg (7%), and the Netherlands (8%) have less. Even Canada relies on OOP spending more than the U.S. at 15%. The OECD average is 20%. The OECD average for all non-governmental spending is 26%. That means there is not a single country in the industrialized world that really has a "single payer."  They are all a mixture of public and private spending.

GMScan@comcast.com

 Parental Consent Act of 2009.

The Parental Consent Act of 2009 would deny federal funds to be used to establish or implement any universal or mandatory mental health, psychiatric, or socio-emotional screening program. It also bars federal funds to be paid to any local education agency that uses the refusal of a parent or legal guardian to provide express, written, voluntary, informed consent to mental health screening for his or her child as a basis of a charge of child abuse, child neglect, medical neglect or education neglect.

AAPS is against American children being screened, stigmatized, categorized, and forcibly treated by people who are working for the government. Not only is the whole idea of universal or government sponsored “ mental health screening” unconstitutional; it is dangerous for many reasons including these:  

• It usurps parental authority and subjects children to government social engineering
• Mental health screening criteria are vague and subjective.
• It will lead to an expansion of coercive drugging of children against their parents’s judgment.

Thank you,
Michael D. Ostrolenk, MD

For more information:
Association of American Physicians and Surgeons, Inc
www.aapsonline.org.
A Voice for Private Physicians Since 1943

From the Director: 
In her book "Who KIlled HEALTH CARE?,  Doctor Regina Herzlinger, Professor of Business Administration describes rhe four major players in the health care arena.

They are what I call the Big Four: The Government, the Health Insurers, the Hospitals and the Medical Profession. Each are subject to their own set of Rules, Regulations,and Laws that govern their behavior.

Currently, in the USA, the "BIg Four" appear to be pulling in different directions.as they each seek to fulfill their promise and obligation to the public, or their stock holders and enrolled members'.

Our Presidents promise of a comprehensive reform programs to be ready by July 31,will assuredly be delayed by lawsuits and regulatory requirements governing change as well as a public demand for further explanation concerning its costs and how they will be met .

The world's libraries contain massive amounts of information concerning other nations efforts to reform their health care systems and why they failed. Who has read it?. 

Let's not forget: "Health care reform is a process, not an event."

For more information on Doctor Regina Herzlinger's remarks see  "Who Killed Health Care?" publ. McGraw-Hill, 2007

,  .   

From the Greg Scandlen Medical Newsletter #178-- May 1.2009

"ER Use Growing
The Boston Globe also reports that the use of hospital emergency rooms is soaring in Massachusetts. It says, "the cost of caring for ER patients has soared 17 percent over two years, despite efforts to direct patients with non-urgent problems to primary care doctors instead, according to new state data." Nearly half of the 2.5 million ER visits in 2007 "didn't require immediate treatment, or could have been treated in a doctors' office," according to the article".

"The article by Loz Kowalczyk goes on to say, "Several physicians and policy makers said the state information, along with other new data from Harvard researchers, suggests that emergency room crowding and rising costs will not be solved by providing people with health insurance alone, despite optimistic talk by politicians who advocated for the law."

"Despite optimistic talk by politicians" could be the theme song for the next four years".

SOURCE:
Boston Globe

For further information: greg@chcchoices.org

"It's Not the Uninsured
By the way, it is worth noting, as the Wall Street Journal has, that rising use of the emergency room is NOT coming from the uninsured, but from "those whose incomes put them at more than four times the poverty level, and who typically get their care at a doctor's office." While use of ERs grew by 26% from 1996 and 2004, "the percentage of uninsured ER patients remained flat, at roughly 15%."

"The story concludes, "this has important implications for the national health-reform push. If you give everyone insurance, there are going to be more people trying to get in to see primary-care doctors - and, perhaps, heading to the emergency room when they can't get an appointment."

SOURCE:
Wall Street Journal

FROM THE DIRECTOR--- May 21 2009
SOME PERSONAL OBSERVATIONS AND OPINIONS

Some of the CANADIAN PROVINCES now allow the sale of private health insurance to supplement the tax supported Single-Ppayer Health Care System.

The United Kingdom [UK] is urging people to buy private healthcare insurance policies in order to shorten the waiting lines/time  for National Health Service [NHS] Doctor visits.
Now, a trained specialist will be allowed to give seven years to government service, then practice privately for the rest of his life.

Sweden: citizens complain of the higher income taxes that make it difficult/ impossible to afford the cost of supplemental private health insurance, resulting in a longer wait for government provided necessary care.

Switzerland: a recent Doctor's work strike occurred when the government ordered a reduction in reimbursements for physician services. This was done without the usual discussions/negotiations 

Russia: the younger adult population appeared to be content with the freedom to choose a private physician as well as the freedom to engage in private enterprise.

Society moves slowly when changes are being made in vital social services. Health care reform is a process not an event

By Sarah McIntosh--Health Care News, Vol. 10,No.5 , May '09

"The Oregon Health Services Commission has drawn up a formal procedure for rationing health care services available to recipients of taxpayer-subsidized coverage."

"The commission listed 680 common medical procedures and treatments and ranked them in order of priority. Beginning in 2009, the commission will reimburse physicians only for procedures and treatments ranking in  503 of 680. 
   This means a Medicaid recipient in need of a procedure the commision decided to rank 504th would be ineligible for that procedure."

For more information:  mcintosh.sarah@gmail.com

May 15, 2009

Poll: Americans Want Obama to Keep Abortion Conscience Clause in Place
Washington, DC (LifeNews.com) -- A new national poll of Americans finds a strong majority want President Barack Obama to keep conscience protections in place for doctors and medical centers. The president is considering rescinding the protections the Bush administration adopted to enforce three federal conscience laws. The protections make it more clear and provide support for doctors or medical facilities that feel pressured to participate in abortions. The Polling Accompany conducted a poll from March 23-25 with 800 Americans adults and found 87 percent believe it is important to “make sure that healthcare professionals in America are not forced to participate in procedures and practices to which they have moral objections.” Support for this protection garnered considerable intensity as well, with 65% of respondents considering it very essential. The Polling Company survey also found 80 percent of people who backed Obama in the 2008 presidential elections support the conscience protections. Without mentioning Obama's name, another question told respondents that the federal government is considering rescinding the protections. Opposition to revocation of the conscience protection rule outpaced support by a margin of more than 2-to-1 (62% vs. 30%). Some 44 percent of adults were strongly opposed to removing the protections while just 17 percent strongly supported it. Full story at LifeNews.com

CANADA
Canada’s health care plan, called Medicare, is unique in that it didn’t encourage the private practice of medicine for those patients willing to pay for it. The problem was solved, according to the late Dr. Adam Linton, a former Canadian Professor Medicine who told his Los Angeles audience in 1991, "We do have private practice in Canada, it’s called the United States". Many Canadians carry American health insurance. The amount of money Canadians spend on health care in the U.S. is not accounted for in their percent of GNP spent for health.

Are proponents of a "single payer system" familiar with the work of Rachlis and Kushner, who studied Canada’s national health care system known as Medicare and said, "We’re running a several billion dollar operation with no idea of what we’re trying to achieve", or "The public is not stupid". . .according to Monique Begin, PC, ‘people are not quite as satisfied with Canada’s Medicare as the polls would seem to show".

GREAT BRITAIN
Health care delivery in England is undergoing great change. They’re trying our HMO system, proposed by Former Prime Minister Thatcher ten years ago, in an attempt to reduce the number of sick people (one million) waiting for care. Their HMO effort, though more costly than expected, is growing in popularity and has shortened the wait for care. The sale of private health insurance is flourishing as well, and some striking workers demand the provision of private insurance in a new contract.

It would have been helpful if The President’s Task Force had consulted with Dr. David Green, Director, Health Unit, The Institute of Economic Affairs of Great Britain and a long time student of our delivery system, who wrote, ". . . the role of government should not be o pursue equality, but rather to secure access for all to a civilized minimum of health care"; or to have sought the advice of Ray Whitney, a former British Health Minister, who learned that the demand for free health care always outruns a government’s ability to provide for it.

Then there is Max Gammon, a British GP of more than three decades, who told the U.S. Congressional Sub-committee on Health, "I submit that the only guarantee of safety for the public and the medical profession is the development . . . of a truly independent medical service in which medicine is, as it should be, a healing relationship between individuals rather than interaction between a population and a state".

GERMANY
During a discussion of German Health Care with Peter Rosenberg, Director of The Federal Ministry of Labor and Social Affairs, he notified his audience that the merger of East Germany, with a universal national health care program and West Germany with both government and private care would cause their cost of health care to rise.

When asked what percentage of their GNP is spent for long term care he admitted that those costs were carried in another budget and were not part of the 8% GNP figure mentioned earlier. Peter Loeffler, President of Blue Cross of California stated ". . . long term care represented 25% of our GNP." A twenty-five percent (25%) increase in the German GNP brings their total GNP to more than 10%. Ours at that time was 11.2%, and they hadn’t yet added the cost of caring for the newly arrived citizens from East Germany.

JAPAN

Since the passage of the Geriatric Health Act in 1983, seniors who reach age 70 are guaranteed health coverage. The number of seniors in Japan now represents 20% of the population, up from 3.0% in 1965. (This marked increase is the result of a correction in the demographic aberration caused by the population loss in World War II, also true in Germany).

Dr. Ikegami explained, ". . . the hospital admission rate of those 65 years and over has increased from 0.9% in 1955 to 6.2% in 1987. More serious is the fact that people hospitalized are not always seriously ill. Hospitals profit from hanging on to these less "expensive to care for" patients. This is the result of budgetary constraints leads to waiting lines for hospital care

 

From Greg Scandlen- www.greg@chcchoices, CPR 171, 5/4/'09

The Kaiser Commission looks at the effect of the Massachusetts reforms on community health centers. The study finds that, while the reforms increased the number of people with coverage, it has also increased the demand on the primary care system in the state, and finds, "the experience in Massachusetts indicates that insurance does not guarantee access to care; a shortage of physicians has made it difficult for many to access primary care." This has increased the caseload of community health centers while actually increasing the proportion of the uninsured served by these facilities, from 22% to 36%.

The report provides several lessons for reformers. Most importantly that, "Insurance does not guarantee access, so insurance expansions need to be accompanied by investments in the health delivery infrastructure, particularly primary care capacity." It also finds:

• Insurance expansions can lead to a surge in the demand for primary health care, especially in medically underserved low-income communities.
• In addition to expanding insurance coverage, investments to expand the capacity of the primary care system that will care for the newly insured, as well as for those who remain uninsured will be important
• Even post-reform, there will be a continuing need for sources of care for the uninsured.

SOURCE:
Kaiser Family Foundation.
http://www.kff.org/healthreform/7878.cfm

From the Director: Similar situation found in Canada and United Kingdom.   see esrlier Bulletins on this website

From Greg Scandlen NewLetter #158 12/19/2008

The Docs Are Disappearing

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The L.A. Times ran an article by Lisa Girion about the difficulties of primary care physicians. The story focuses on Dr. Tanyech Walford's struggle to stay in business given the lousy pay and the high overhead. The article says, "Small general practices afford doctors autonomy to practice medicine as they see fit and can produce strong doctor-patient bonds. But these physicians have little or no clout to leverage better payments with insurers; they have no economy of scale, which makes overhead more burdensome."

The article cites another example, "Dr. Jerry Connell kept his family practice going in Santa Rosa for 29 years. But he closed it in October because his income had slipped to $50,000 a year, even though he had 2,600 patients." When he sold off his equipment, he could not find another doctor to buy it so it was sold to a veterinarian and a tattoo parlor.

But Dr. Walford tried valiantly to stay in business, "In September, she sent invoices to Medicare, Medi-Cal, private insurers and patients for $70,000. With negotiated discounts and government fee schedules, Walford, as a rule of thumb, expected to collect two-thirds of her billings, or about $45,000, that month. Instead, she got $14,000 -- less than her overhead."

Now she has moved to Maryland where she will join a 200-physician group affiliated with Johns Hopkins. The article doesn't say where her patients went.

SOURCE:
LA Times.

The New York Times published an op-ed by Dr. Pauline Chen who asks, "Where Have All the Doctors Gone?" She writes, "In the last several months there have been reports in medical journals about an impending shortage of primary care physicians. But a recent survey indicates that the primary care crisis may not be looming on the horizon; it may already be at our back door."

She cites the physician survey we reported on last week as indicating primary care physicians are already packing it up. She adds a caution to Mr. Obama, "Any attempt to make health care more accessible will be doomed to failure without an adequate number of primary care physicians and a strong primary care system. Mr. Obama and his team may find ways to give more Americans access to the waiting room, but what if there's no doctor on the other side of the door?"

SOURCE:
New York Times.

For more information : www.greg@chcchoices,org

A number of consulting firms, including Mercer, Aon, and PricewaterhouseCoopers, are reporting a slowing of health care cost increases around the nation.

The firms report costs have increased between 6 and 11 percent over the past year. That's less than last year's projections.

For example, Aon predicted costs would rise at least 12 percent in the 12 months following June 2007, which in itself represented a continued slowdown from the 16 percent increase Aon reported in 2002.

According to PricewaterhouseCoopers (PWC), the rate of increase in health care costs nationwide has fallen every year since 2003.

PWC projects the trend will not continue into 2009 because of several factors, including growth in the number of private hospitals and outpatient facilities, continued shift of Medicare and Medicaid costs onto those who purchase private health insurance, and larger enrollment in taxpayer-funded health insurance programs.

Mercer paints a slightly less-dire picture, pointing out employers are controlling costs through innovation. Thirty-eight percent of respondents to the firm's 2008 survey said their company would improve health management programs to control costs, and 19 percent said they would add consumer-directed plans.

"Disease management was first designed only for very large, self-insured employers," said Blaine Bos, worldwide partner and senior health and benefits consultant at Mercer. "But it has been expanded over the last decade to the point where most insurers add that to their fully insured products for everyone."

Only 10 percent of companies in the Mercer survey said they would reduce coverage.

"There is some confusion over what it means when coverage is reduced. Often reducing covered services is not a cost-shift to consumers," said Bos.

"A good example would be taking bariatric surgery and imposing rules on when and how someone can get  it," Bos continued. "Maybe in going forward a plan beneficiary would have to go through behavioral management for a time period before getting the surgery. This can be used to reduce waste and improve likely outcomes, making the surgery more likely to work."

James P. Gelfand Ogelfand(jgelfand@gmail. com) writes from Washington, DC.NTERNET INFO

From: Health care News, 1 December 2008

Democratic Leadership Postpones SCHIP Vote

Congressional leaders have decided to postpone a vote on legislation pertaining to the State Children's Health Insurance Program until 2009, when a new president will be in office and veto-proof majorities could be in place in both houses of Congress.

Attempts to expand the State Children's Health Insurance Program (SCHIP) by $35 billion were vetoed twice in the 110th Congress, both occurring in late 2007. President George W. Bush (R) called the legislation "a step toward government-run health care" at the time.

The third attempt at expanding the controversial program, which will be introduced, in January according to sources in the House of Representatives, will seek to use revenue from, higher tobacco taxes to fund expanded SCHIP eligibility.

"A very large battle over SCHIP expansions will likely be fought next said Devon Herrick, Ph.D., a senior fellow at the National Center for Policy Analysis. 'The reason this is a a step towards government-run health care is that 77 percent of children in families earning between 200 and 300 percent of the federal poverty level already have private coverage

"For families earning between 300 and 400 percent FPL, 89 percent already have private coverage.' Herrick continued, "Between 50 and 75 percent of past taxpayer-funded insurance expansions have crowded out private coverage, and the same will happen here if Congress succeeds in expanding SCHIP".

"This issue is really whether we want to fully fund a program intended for the needy or want to expand it to include couples who earn 300 percent above the poverty line." said Carl Tate, a former U.S. Department of Commerce official during the Bush administration.

Expanding SCHIP wouldn't reduce the number of uninsured children but would simply cause families to switch from private insurance to SCHIP. says Kalese Hammonds. a health care policy analyst at the Texas Public Policy Foundation.

"Every time we make more people eligible for government programs, we get one step closer to a government-run health care system." Hammonds said. "President Bush is right to resist expanding SCHIP. Studies show that expanding government programs does little to actually reduce the number of uninsured.

From The GREG SCANDLEN NEWS LETTER  #155
11/26/2008    greg@cncchoices.org

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Free Riders? Heartland policy advisor Bill Snyder had a nice op-ed published in the Wall Street Journal this week. He makes the point that the uninsured are not some homogenous mass of misfits and unfortunates. Rather they are often people who are responsible and pay their bills on time. He cites a California study that found half of the uninsured with incomes twice poverty received and paid for health care services in the last year. Eighty percent paid in full and another 10% were paying in installments. Nationally, the uninsured paid $30 billion for health care services directly out-of-pocket. He suggests that, "perhaps we should look for ways to encourage the millions of people who are currently eligible for existing government programs to enroll before we expand programs to include people that may not need assistance."

SOURCE:
Wall Street Journal.

.

 From the Rubber Room at the Wilson Think Tank:

Now that it's over and the pundits have had their say, I think I may have it figured out.

 Totalitarianism is inevitable. It is a product of human nature, original sin, a character flaw in mankind. Many have given it different names but it is the force that drives human history.

  Every human is motivated by an effort, risk and reward triangle. Whether emotionally or rationally, everyone is acting under those three factors. Reward differs for everyone. Everyone has a different view of risk. Different people are willing to invest vastly differing amounts of effort. Different forms of government are the result of the majority of the people being more concerned about one of these factors above the other two.

  Tyranny is the result too much risk. People are worried about their survival. They aren't worried about effort and reward  - just being around tomorrow. Socialism is also the product of risk. People don't believe the reward justifies their effort. They'd rather put in minimum effort for a small guaranteed reward. A democracy is low risk while minimizing effort. A republic is low risk with the emphasis on reward.

  None of these forms of government are permanent because their own success changes the effort-risk-reward equation. As a Republic acquires wealth, it becomes risk averse and degenerates to a democracy by distributing government control to the people. A democracy continues to generate wealth but attempts to spread it among the masses to reduce risk. This redistribution becomes socialism. Socialism consumes wealth because effort and reward become disconnected. When this system breaks down, risk become excessive. People face starvation and look for a tyrant to save them from themselves. In a tyranny, the concentration of power breaks the relationship of effort, risk and reward. The people have nothing and nothing to lose. The only outcome is a revolt  External forces can effect the time and direction of these changes but have never prevented them.

  "All the world's a stage, And all the men and women merely players." But who is the audience? Who writes the reviews we call history?

Brian Wilson, Radio Talk Show Host,Author
11/9/2008 

From the Medical Director HCREI:
Expanding on Brian Wilson's profound thought that Totalitarianism is inevitable, one could imagine, while  guided by the experience of major nations, what to expect will occur to our health care delivery system.

 Borrowing from my thoughts written on this matter in Chapter 9,  pages 64-65, of "Health Care Reform-Facts and Fiction", published 1998,  I offer them to HCREI visitors as I believe our health care system will unfold.

"Do I feel that managed care will be in place for several decades?  Yes, in some form. Whether it is under private or government control is as yet undetermined. Either way, Americans will have to manage with less care than they have had in the past. Privately administered, competitive managed care is the popular idea, at the moment.  It must be made to work or the health care of Americas will, by default, fall into the lap of the federal government.

Should that occur, what can we expect?

There would be complete takeover, by an existing federal agency with appropriate enlargement of its staff, or with the formation of a new Bureau. The State governments will function in an essential but subsidiary role. The physicians will regain control of the quality, not the cost, of health care since few non-professionals understand it. At the outset of our reform effort it was believed that cost control required quality control.  It is now recognized that cost control will not be achieved without reducing patient utilization of health care services. In other words through “rationing”.

Rationing will take several forms, the most common of which will be to place patients on waiting lists for the care they need. That could mean weeks in the earlier years, later months or longer. In a nation with universal, government regulated care, some patients never receive the care they need if funds are limited.  This can occur if a patient is considered too old or if their life expectancy does not justify the cost.  In the case of younger patients care or surgery would be unlikely for those with a hernia, varicose veins, hemorrhoids or a birth malformation.  Undesirable but not life threatening conditions.

Women would be expected to tolerate painful menstrual periods, loss of urine control because of child bearing or as a result of aging.   People seen walking on the streets with ace bandages for their varicose veins are a common site in European nations. Unseen, but be assured it is true, are men and women wearing diapers to catch leaking urine.

The federal government will allocate the money needed, to state agencies for final distribution. The actual delivery of care, at the community level, will be regulated by regional and local committees made up of consumers and providers, who will be guided by federal regulation and limited budgets.

This new health care system will attempt to avoid the errors committed in other nations. Hopefully, only the better aspects of existing systems will be adopted. Yet, if history is our guide, it’s not likely that a government-controlled system of health care will fare any better in the United States. Throughout the world, patients and the people who care for them have the same goals. They differ only in the language they speak, the color of their skin and the amount of money they have to spend.  All delivery systems, otherwise, are very much alike and, in time, develop the same problems as a result of consumer and provider abuse.

The outstanding similarities in all national systems are:

1)     Promptly delivered, non-emergency, quality care is available only outside of the system, in private offices or hospitals, for cash or its’ equivalent.

2)     In most nations, private health insurance coverage is available, thus recreating the two-tier system of health care the government promised to eliminate. One for the poor who cannot afford anything else and another for those Individuals who can pay the difference.l.

3)     All but one of the major nations, the exception was Canada, made provisions for concurrent and comprehensive private health care for those who would pay for it.
Recently, A Canadian Provincial Supreme Court ruled that the sale of private health insurance would be allowed  in their Province.  Other Provinces have or are expected to do the same.

NB;:"Health Care Reform-and Facts and Fiction" publ. 1998, byVincent W Cangello MD.
See Contact Us section of this website.

Capitol Hill Briefing on Massachusetts

GOVERNMENT & MEDICINE

Mental health coverage to see boost as long-sought parity law is enacted The law does not apply to small employers or the individual insurance market. But it leaves stronger state parity laws intact. By Doug Trapp, AMNews staff. Oct. 27, 2008.

 Washington -- The $700 billion economic recovery bill signed into law on Oct. 3 was designed to improve the nation's economic health. But a provision in the law also should serve to improve the mental health of many by requiring parity between mental health benefits and physical health benefits.

The mental health parity law, more than a decade in the making, "is one of the most dramatic improvements in the health care available for people who have mental illness and substance use problems in my lifetime," said Jeremy A. Lazarus, MD, 65, a psychiatrist and speaker of the AMA House of Delegates.

Years in the making, requirements go into effect in January 2010 for most plans. Doctors who have had difficulty referring patients to psychiatrists and other mental health professionals should find significantly fewer obstacles, Dr. Lazarus said.

Physicians sometimes struggle with current coverage limitations in the mental health portions of insurance plans, said Nada Stotland, MD, MPH, president of the American Psychiatric Assn. Many plans, for example, require more prior authorizations or higher patient cost-sharing for mental health benefits than they do for medical or surgical benefits.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 became law on the back of the economic recovery act. The law bans most group health plans that offer mental health and substance abuse benefits from restricting them -- through higher cost-sharing or treatment limits -- more than they do medical or surgical benefits.

The never-ending story: Flu vaccine season goes year-round
The process of developing and distributing vaccine is long and complicated, but efforts to speed it up are paying off.

By Victoria Stagg Elliott, AMNews staff. Oct. 6, 2008.
[download pdf]

After several rocky seasons, this year's stock of influenza vaccine has been arriving on time, or even before physicians expected it. "This year was good news," said Stuart Sanders, MD, an internist and sports medicine physician in Demorest, Ga. "There was no problem getting our full shipment of flu vaccine."

His 1,350 doses arrived by the end of August, a far cry from previous years when supplies arrived late or not at all. Some 143 million to 146 million doses are expected before the season is done, and all five manufacturers have been shipping since early August.

"This is really quite a technical achievement that [manufacturers] are rising to this challenge and are on a faster timeline than in previous years," said Bruce Innis, MD, vice president for clinical research and development at GlaxoSmithKline.

   
This season, five companies are involved. Sanofi Pasteur expects to ship 50 million doses, and CSL Limited is supplying 6 million. Novartis, which purchased Chiron in 2006, will manufacture 40 million shots, and GSK plans to provide 35 million to 38 million. MedImmune will make 12 million doses of the intranasal version.

Science also is speeding the process. Manufacturers increasingly are using reverse genetics to hasten production of seed viruses. They also are working to develop cell culture production, which is expected to increase capacity and make supplies more predictable. Cell culture would be particularly useful to deal with a pandemic in which the virus also affects birds, since chickens produce the eggs required to make the vaccine.

This formula does not rely on cell- or egg-based production processes. Instead, vaccine antigens are produced more quickly by combining toll-like receptor-mediated immune enhancers and recombinant bacteria.

Former CEO to pay United investors $30 million

William McGuire, MD, further whittles down his holdings in a third settlement over stock options.

By Emily Berry, AMNews staff. Oct. 6, 2008.

Former UnitedHealth Group Chair and CEO William McGuire, MD, has agreed to forfeit another portion of the fortune he amassed during the 17 years he led the company, settling with investors in a lawsuit over alleged stock-option backdating.

Under the agreement, Dr. McGuire will pay $30 million to United investors in a class-action lawsuit led by a California pension fund and will surrender options to purchase 3.65 million shares of stock granted between 2003 and 2005. At mid-September's stock prices, those shares would be worth about $100 million. The case had been set for trial in September. 
"In effect, this was an example of runaway executive compensation," said Peter Mixon, general counsel for the California Public Employees' Retirement System (CalPERS).

The CalPERS agreement is the third settlement involving the former CEO regarding alleged improper stock option backdating.

Backdating, the practice of retroactively assigning the grant date to a day the stock was at a low value, allows for automatic profit when options are sold at a higher price. It is not illegal, but investors are supposed to be informed when a company backdates stock options.

United already had agreed to pay $895 million to the same plaintiffs and is awaiting final approval of that deal by a federal judge. Former United General Counsel David Lubben also settled, paying $500,000 to plaintiffs.

Dr. McGuire did not admit wrongdoing; nor has he done so in any previous settlement. In a December 2007 settlement with the Securities and Exchange Commission, Dr. McGuire agreed to pay the SEC a $7 million fine, return $11 million in what the SEC called "ill-gotten gains," plus $1.7 million in interest, while also returning stock options and cash to United.

PROFESSIONAL ISSUES

Time to get tough? States increasingly offer ways to opt out of vaccine mandates

Too many exemptions have been seen as a risk to public health. But a push to crack down might do more harm than good.

By Kevin B. O'Reilly, AMNews staff. Sept. 8, 2008.

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Measles are coming back. The Centers for Disease Control and Prevention reported that measles outbreaks have reached a peak not seen since 1996. By late August, 131 cases had been confirmed in 16 states.

Almost half of the cases occurred in children who had not been vaccinated because their parents claimed religious or personal exemptions to vaccine mandates.

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"This measles outbreak may be a warning shot," said Paul A. Offit, MD, chief of the infectious diseases division at the Children's Hospital of Philadelphia. "We now have communities that have a lack of herd immunity. That puts children at risk."

Other physicians and public health experts are echoing Dr. Offit's concern. They say states are making it too easy for parents to exempt their children from the vaccines required for school entry. As scientifically unfounded information about vaccine risks swirls around the Internet and among parents, experts say the exemption rate is bound to grow.

But others worry that toughening the opt-out process, or just talking about mandates, could lead to an even greater loss of public trust in the immunization system.

15 states allow a child to be exempt from vaccination if 1 parent signs a form.

National immunization rates are high, ranging from 85% to 93%, depending on the vaccine, the CDC said. But in states such as Minnesota and Colorado, the nonmedical opt-out rates exceed 5%. And research shows that the easier the exemption process, the more likely parents are to use it.

The 28 states that have religious-only exemptions saw their opt-out rates remain stable between 1991 and 2004, according to an Oct. 11, 2006, study in the Journal of the American Medical Association. But the 20 states that also allow personal-belief opt outs saw exemptions grow by 61%, to 2.54%, during the same period. Meanwhile, the 15 states with the easiest exemption process -- one parent's signature -- saw their rate jump 48%, to 2.51%, during that time.

These exemptions were not without consequences, according to the study. The religious-only opt-out states had rates of pertussis two times lower than did states that also granted personal-belief exemptions. The hassle-free exemption states had pertussis rates 90% higher than the states where opt outs are the hardest to obtain.

Exemptions: Too many, too easy?

Francesco "Chek" Beuf, MD, is a pediatrician in Boulder, Colo., where vaccination rates are on the decline. Only 62% of 2-year-olds in Boulder County received the pertussis vaccine in 2005, according to health officials, and there have been 510 pertussis cases since 1999.

A Dec. 27, 2000, JAMA study found that exempted children in Colorado -- where signing a form is all it takes for exemption -- were 22 times more likely to contract measles and about six times more likely to get pertussis.

Religious or philosophical exemptions from school-entry immunization mandates are allowed in all but 2 states.

Colorado's anything-goes exemption system "stinks," Dr. Beuf said. "It means that people don't feel social pressure to get their kids vaccinated. ... It's given too many people a blank check to just dither around the subject."

Dr. Beuf favors getting rid of the state's philosophical exemption altogether. A more modest Boulder County Medical Society resolution would limit the number of personal-belief exemptions allowed statewide each year, though it does not specify a cap. The resolution will be considered at the Colorado Medical Society meeting in September.

Other states make it tougher for parents who refuse vaccines. New York allows religious exemptions and authorizes school officials to question parents about their beliefs before letting children enter school unvaccinated.

From the Directror; Some action is necesary despite parent's concerns. Return of these diseases can be fatal to adults/parents. A compromise is essential since all concerns are valid.