I though that you all might want to see exactly what is wrong with Laura.
Arthrogryposis, also known as Arthrogryposis Multiplex Congenita, is a rare congenital disorder that is characterized by multiple joint contractures and can include muscle weakness and fibrosis. It is a non-progressive disease. The disease derives its name from Greek, literally meaning 'curved or hooked joints'.
There are many known subgroups of AMC, with differing signs, symptoms, causes etc.[In some cases, few joints may be affected and may have a nearly full range of motion. In the most common type of arthrogryposis, hands, wrists, elbows, shoulders, hips, feet and knees are affected. In the most severe types, nearly every joint is involved, including the jaw and back.
Frequently, the contractures are accompanied by muscle weakness, which further limits movement. AMC is typically symmetrical and involves all four extremities with some variation seen
Some of the different types of AMC include:
Arthrogryposis multiplex due to muscular dystrophy
Arthrogryposis ectodermal dysplasia other anomalies, also known as Cote Adamopoulos Pantelakis syndrome, Trichooculodermovertebral syndrome, TODV syndrome and Alves syndrome.
Arthrogryposis epileptic seizures migrational brain disorder.
Arthrogryposis IUGR thoracic dystrophy,also known as Van Bervliet syndrom
Arthrogryposis like disorder, also known as Kuskokwim disease
Arthrogryposis-like hand anomaly and sensorineural deafness
Arthrogryposis multiplex congenita CNS calcification.
Arthrogryposis multiplex congenita distal (AMCD)[with a large number of synonyms such as Arthrogryposis multiplex congenita, distal, x-linked (AMCX1) and Arthrogryposis spinal muscular atrophy
Gordon Syndrome, also known as Distal Arthrogryposis, Type 2A
Arthrogryposis multiplex congenita, distal type 2B, also known as Freeman-Sheldon syndrome variant.
Arthrogryposis multiplex congenita neurogenic type (AMCN). This particular type of AMC has been linked to the AMCN gene on locus 5q35.Arthrogryposis multiplex congenita pulmonary hypoplasia, also with a large number of synonyms.
Arthrogryposis multiplex congenita whistling face, also known as Illum syndrome.
Arthrogryposis multiplex congenita, distal type 1 (AMCD1).[
Arthrogryposis ophthalmoplegia retinopathy, also known as Oculomelic amyoplasia
Arthrogryposis renal dysfunction cholestasis syndrome, also known as ARC Syndrom
Causes
The cause is unknown[], although several mechanisms have been suggested. This includes hyperthermia of the fetus, prenatal virus, fetal vascular compromise, septum of the uterus, decreased amniotic fluid, muscle and connective tissue developmental abnormalities. In general, the causes can be classified into extrinsic and intrinsic factors.
Extrinsic
There is insufficient room in the uterus for normal movement. For example, fetal crowding; the mother may lack a normal amount of amniotic fluid or have an abnormally shaped uterus.
Intrinsic
Musculoskeletal/Neuromuscular - Muscles do not develop properly (atrophy). In most cases, the specific cause for muscular atrophy cannot be identified. Suspected causes include muscle diseases (for example, congenital muscular dystrophies), maternal fever during pregnancy, and viruses, which may damage cells that transmit nerve impulses to the muscles.
Neurological - Central nervous system and spinal cord are malformed. In these cases, a wide range of other conditions usually accompanies arthrogryposis.
Connective Tissue - Tendons, bones, joints or joint linings may develop abnormally. For example, tendons may not be connected to the proper place in a joint
Research has shown that anything that prevents normal joint movement before birth can result in joint contractures. The joint itself may be normal. However, when a joint is not moved for a period of time, extra connective tissue tends to grow around it, fixing it in position. Lack of joint movement also means that tendons connecting to the joint are not stretched to their normal length; short tendons, in turn, make normal joint movement difficult. (This same kind of problem can develop after birth in joints that are immobilized for long periods of time in casts.)
The principal cause of AMC is believed to be decreased fetal movements (akinesia) caused by maternal or fetal abnormalities. It is associated with neurogenic and myopathic disorders. It is believed that the neuropathic form of AMC involves a deterioration in the anterior horn cell leading to muscle weakness and fibrosis.
In most cases, arthrogryposis is not a genetic condition and does not occur more than once in a family. In about 30% of the cases, a genetic cause can be identified. The risk of recurrence for these cases varies with the type of genetic disorder.There is a rare autosomal recessive form of the disease known to exist
Diagnosis
To date, no prenatal diagnostic tools are available to test for the condition. Diagnosis is only used to rule out other causes. This is done by undertaking muscle biopsies, blood tests and general clinical findings rule out other disorders and provides evidence for AMC.[5]
Treatment
While there is no reversal of this condition, individual quality of life can be greatly improved. As each person will respond differently, and will have different needs, a combination of therapies is beneficial. Physical therapy including stretching (may include casting, splinting of affected joints), strengthening, and mobility training are often provided to improve flexion and range of motion to increase mobility. Occupational therapy can include training in ADL and fine motor skills as well as addressing psychosocial and emotional implications of living with a disability. Since there is a variety of mobility impairments, individually tailored orthopaedic correction is often beneficial. Orthopedic surgery may be elected to correct severely affected joints and limbs and symptoms such as clubfoot, hernia repair and correction of unilateral hip dislocation, in cases where these surgeries improve quality of life.
[ Prognosis
Individuals with AMC are aided by vigorous therapy and in some cases surgical intervention. This varies to some degree, depending on the severity of mobility reduction.[] AMC is not a progressive disorder. Typically these individuals have normal cognition and speech and therefore the potential for productive, rewarding, and independent lives.
[edit] Epidemiology
AMC is relatively rare occurring in 1 out of every 3,000 live births.[5][8] Amyoplasia, characterized by fatty and fibrous tissue replacement of the limb muscles, is the most common form, at 43% of reported cases.[46] The majority of individuals thrive, with a minority strongly affected by respiratory muscle involvement.
] Affected people
Marty Sheedy Creator of the Project Scissor Gait Foundation, motivational speaker, and a resource for future medical students.
Luca Patuelli,"Lazy Legz Luca" a break dancer with AMC in Legs and Spine http://www.lazylegz.com
Ward Foley An Author living with AMC whose latest book is called "Thank my Lucky Scars" http://wardfoley.com/
Celestine Tate Harrington, a quadriplegic street musician who performed at the Atlantic City Boardwalk and author of the 1996 book, "Some Crawl and Never Walk."
Josh Twelves, an actor and comedian based out of Utah characterised by his "sit down comedy".
Greg Burns (artist), an artist in Oklahoma City who makes pen-and-ink drawings using a pen in his hand, and colors them with watercolors using a brush in his mouth.
Asta Philpot, an American born man living in England, who was the protagonist of a BBC documentary about prostitution as a mean of offering the chance sexual experiences to people with disabilities.
Lee Pearson, a 9 time gold medal winner at the Paralympic games in dressage
Katrina Porter, an Australian Paralympic swimmer, who recently won gold in the 2008 Paralympic Games in Beijing
Saturday, January 31, 2009
Friday, January 30, 2009
THE TROUBLE WITH HEALTH CARE
As many people do, I think the health care system in this country has serious problems. There are a number of potential solutions to this problem. We could move either to a free market system or to a single-payer plan, i.e., a government health care system. Our current system is neither of these systems, but rather a restricted market.
I consider our current health care system to be a restricted market. By this I mean that the insurance industry is a group of profit-seeking firms, but consumers do not have free choice to switch between the market alternatives. Many of the people who defend the current system claim that a free market is best. However our current system is not a free market. Many of the problems in our current health care system are a result of the restrictions in this market. Consumers cannot register their discontent with their insurance plans because it is difficult to switch plans. Because of this difficulty, plans can fail to provide quick resolution of claims, good information, or consistent policy because customers are tied in to their current plans through their employers and through the difficulty of switching plans.
Considering our current system of a restricted market, one of the simplest solutions to this problem would be to have a free market for health insurance, so that people could “vote with their feet.” Making our system a free market would require forbidding insurance companies to give discounts to employers, making it easier for the employers to buy insurance than for their employees to do so. Health insurance should thus count as a tax deductible expense, even for people who take the standard deduction. It should also be illegal for insurance companies to discriminate based on a pre-existing condition when a person is switching plans (unless the condition is not covered by the original plan). Employers should not be allowed to force employees to accept “their” plan. They should be able to set price based on age, sex, weight (as compared to height), smoking, and other “controllable” risk factors.
The government should require everyone to have insurance, and should give vouchers for the purchase of health insurance, good for a certain amount of money, which would be phased out with income. The government could also have a default plan into which people would be enrolled if they did not make any other choice. (National health insurance, however, seems to be politically unacceptable in this country, although it would probably be even better than any of the above solutions, although a very good free market system might be better than government health care.)
A remaining question is how to handle people who try to cheat the system by switching plans when they become sick. It would be reasonable to allow plans not to cover preexisting conditions when the previous plan did not cover the condition, at least in a sysem where the state provided vouchers for a basic amount of health insurance and a default plan if the people did nothing. Such a default plan should choose to cover various treatments based on cost-benefit analyses of those treatments. Based on these analyses, it might determine that it would only pay up to a certain amount for a given treatment.
I consider our current health care system to be a restricted market. By this I mean that the insurance industry is a group of profit-seeking firms, but consumers do not have free choice to switch between the market alternatives. Many of the people who defend the current system claim that a free market is best. However our current system is not a free market. Many of the problems in our current health care system are a result of the restrictions in this market. Consumers cannot register their discontent with their insurance plans because it is difficult to switch plans. Because of this difficulty, plans can fail to provide quick resolution of claims, good information, or consistent policy because customers are tied in to their current plans through their employers and through the difficulty of switching plans.
Considering our current system of a restricted market, one of the simplest solutions to this problem would be to have a free market for health insurance, so that people could “vote with their feet.” Making our system a free market would require forbidding insurance companies to give discounts to employers, making it easier for the employers to buy insurance than for their employees to do so. Health insurance should thus count as a tax deductible expense, even for people who take the standard deduction. It should also be illegal for insurance companies to discriminate based on a pre-existing condition when a person is switching plans (unless the condition is not covered by the original plan). Employers should not be allowed to force employees to accept “their” plan. They should be able to set price based on age, sex, weight (as compared to height), smoking, and other “controllable” risk factors.
The government should require everyone to have insurance, and should give vouchers for the purchase of health insurance, good for a certain amount of money, which would be phased out with income. The government could also have a default plan into which people would be enrolled if they did not make any other choice. (National health insurance, however, seems to be politically unacceptable in this country, although it would probably be even better than any of the above solutions, although a very good free market system might be better than government health care.)
A remaining question is how to handle people who try to cheat the system by switching plans when they become sick. It would be reasonable to allow plans not to cover preexisting conditions when the previous plan did not cover the condition, at least in a sysem where the state provided vouchers for a basic amount of health insurance and a default plan if the people did nothing. Such a default plan should choose to cover various treatments based on cost-benefit analyses of those treatments. Based on these analyses, it might determine that it would only pay up to a certain amount for a given treatment.
Thursday, January 29, 2009
With our economy in crisis, President Barack Obama newly sworn in and health reform hearings under way this week in the Legislature, only one thing is certain about U.S. health care: We cannot afford the status quo.
The silver lining in this crisis is that it offers us the opportunity to build a high-quality, sustainable health system -- one founded on the premise that every person should be able to get the health care they need, rather than viewing health care as a consumer product that we can buy or forgo.
Patients get sicker, and cost more, when care is delayed. Take, for example, Joey, an uninsured 3-year-old whose mother couldn't afford asthma medications. As a result, Joey wound up in the emergency room with a serious asthma flare costing 10 to 15 times more than the medicine that would have prevented it. Or David, a retired store manager who, despite his Medicare coverage, was unable to find a doctor to treat complications of stepping on a thumbtack with a foot rendered numb from years of diabetes, because he lacked a Medicare supplemental policy. After searching for weeks in vain, he finally came to the hospital, his foot now afflicted with gangrene and in need of an emergency amputation. Timely care would have saved his foot at a tiny fraction of the cost.
As a society, we pay dearly, in human terms and in cold dollars, when people lack access to care. Now, with such giants as Microsoft, Starbucks, Boeing and Washington Mutual announcing job layoffs, more people will lose their health benefits. And, like Joey and David, when they get sick or injured, many will get care only when their situation becomes an emergency. Those high expenses are passed on to all of us in the form of skyrocketing health costs.
In an effort to develop options, the Legislature commissioned an economic analysis of five state health reform proposals. The analysis, prepared by Mathematica Policy Research, will be presented at hearings this week. In these tumultuous times, it may be tempting for lawmakers to favor the plan that costs the least in the short run, or to take no action. But that won't make people's unmet health needs go away.
As physicians, we believe the only way to create a durable system -- one that is equitable and affordable, allowing everyone to get the care they need -- is to design it around human rights principles that make protection of health paramount.
Using that approach, Northwest Health Law Advocates has just released a human rights evaluation of the five proposals that complements Mathematica's primarily economic analysis (available at nohla.org). NoHLA found that some reform proposals -- those that would cover all state residents -- are better than others but all need to pay more attention to human rights values.
And that is what Washingtonians want. In eight health care caucuses around the state in 2008, more than 1,000 people emphasized the need for universal coverage, affordability and access for all, reflecting those values.
Fortunately, the ethical choice is also the economically prudent choice. There is a false perception that we must choose between lower cost and broader access.
But creating a health system for all is the only sustainable solution over the long haul. It is the only way to prevent the sad stories and poor health outcomes physicians see every day. The quick fixes will just widen disparities and reduce access, which will drive up costs in the long run. Investing in comprehensive coverage, so the Joeys and Davids of our country get timely, appropriate care rather than requiring expensive treatment, will save money and improve health.
The best measure of who we are as a people is how we behave in times of crisis. As state and federal lawmakers consider options for reform, they should treat health care not as just another consumer product, but as a basic human right, like clean air and water.
Benjamin Danielson, M.D., is medical director of the Odessa Brown Children's Clinic and teaches at the University of Washington. Hugh Foy, M.D., is a Seattle physician, surgeon and educator.
The silver lining in this crisis is that it offers us the opportunity to build a high-quality, sustainable health system -- one founded on the premise that every person should be able to get the health care they need, rather than viewing health care as a consumer product that we can buy or forgo.
Patients get sicker, and cost more, when care is delayed. Take, for example, Joey, an uninsured 3-year-old whose mother couldn't afford asthma medications. As a result, Joey wound up in the emergency room with a serious asthma flare costing 10 to 15 times more than the medicine that would have prevented it. Or David, a retired store manager who, despite his Medicare coverage, was unable to find a doctor to treat complications of stepping on a thumbtack with a foot rendered numb from years of diabetes, because he lacked a Medicare supplemental policy. After searching for weeks in vain, he finally came to the hospital, his foot now afflicted with gangrene and in need of an emergency amputation. Timely care would have saved his foot at a tiny fraction of the cost.
As a society, we pay dearly, in human terms and in cold dollars, when people lack access to care. Now, with such giants as Microsoft, Starbucks, Boeing and Washington Mutual announcing job layoffs, more people will lose their health benefits. And, like Joey and David, when they get sick or injured, many will get care only when their situation becomes an emergency. Those high expenses are passed on to all of us in the form of skyrocketing health costs.
In an effort to develop options, the Legislature commissioned an economic analysis of five state health reform proposals. The analysis, prepared by Mathematica Policy Research, will be presented at hearings this week. In these tumultuous times, it may be tempting for lawmakers to favor the plan that costs the least in the short run, or to take no action. But that won't make people's unmet health needs go away.
As physicians, we believe the only way to create a durable system -- one that is equitable and affordable, allowing everyone to get the care they need -- is to design it around human rights principles that make protection of health paramount.
Using that approach, Northwest Health Law Advocates has just released a human rights evaluation of the five proposals that complements Mathematica's primarily economic analysis (available at nohla.org). NoHLA found that some reform proposals -- those that would cover all state residents -- are better than others but all need to pay more attention to human rights values.
And that is what Washingtonians want. In eight health care caucuses around the state in 2008, more than 1,000 people emphasized the need for universal coverage, affordability and access for all, reflecting those values.
Fortunately, the ethical choice is also the economically prudent choice. There is a false perception that we must choose between lower cost and broader access.
But creating a health system for all is the only sustainable solution over the long haul. It is the only way to prevent the sad stories and poor health outcomes physicians see every day. The quick fixes will just widen disparities and reduce access, which will drive up costs in the long run. Investing in comprehensive coverage, so the Joeys and Davids of our country get timely, appropriate care rather than requiring expensive treatment, will save money and improve health.
The best measure of who we are as a people is how we behave in times of crisis. As state and federal lawmakers consider options for reform, they should treat health care not as just another consumer product, but as a basic human right, like clean air and water.
Benjamin Danielson, M.D., is medical director of the Odessa Brown Children's Clinic and teaches at the University of Washington. Hugh Foy, M.D., is a Seattle physician, surgeon and educator.
With health reform high on the agenda of the incoming Congress and President, a new analysis of legislative proposals—including the plans of President-elect Barack Obama and Senate Finance Committee Chairman Max Baucus (D-MT)—shows that several proposals already put forth could substantially reduce the number of uninsured Americans, and would either reduce health care spending or add only modestly to annual health care expenditures. The proposals demonstrate that it is possible to cover everyone with little or no additional total health spending, but to do so means requiring that everyone have coverage, and achieving administrative savings and purchasing efficiencies by building on public programs and group purchase of private insurance—either through employers or insurance exchangesThe analysis, by Sara Collins and colleagues at The Commonwealth Fund, finds that the proposals outlined by President-elect Obama and Senator Baucus could cover almost all Americans; however, analysts say that to guarantee near universal coverage, mixed private-public proposals like these would need to require that all Americans obtain coverage. The new report provides coverage and cost estimates for 2010 prepared by the Lewin Group, assuming full implementation of health care plans by then. Lewin projects that by 2010, absent the implementation of any large-scale reform, nearly 49 million Americans will be uninsured.
"Many of these proposals offer ways to significantly expand health care coverage and also improve the quality of benefits and the efficiency with which they are provided," said Sara R. Collins, Assistant Vice President for the Program on the Future of Health Insurance at The Commonwealth Fund and lead author of the report. "Though most proposals which cover more people come with a higher federal budget price tag, they can achieve significant administrative and health system savings. Universal coverage will need to be accompanied by health system reforms aimed at improving overall health system performance."
Several Plans Could Result in Lower Total National Health Spending or Modest Increases
According to the report, proposals that expand coverage significantly would add to the federal budget but, if designed appropriately, could reduce total health spending. Total health spending declines when a plan builds in ways to reduce administrative costs or efficiencies from greater purchasing power and thereby offsets new use of services by the uninsured. Federal spending increases, however, when the government assumes responsibility for part of the current health spending of households, state and local government, and employers.
Representative Pete Stark's (D-CA) AmeriCare proposal offers the greatest potential to ensure health insurance coverage for all, by broadening access to Medicare. At $188.5 billion in federal dollars in 2010, his plan has the highest federal budget price tag, but it would reduce national health care spending by $58.1 billion in 2010—by covering more people through Medicare, a program with significantly lower administrative costs than private insurance, according to researchers.
The Building Blocks proposal—a framework for universal coverage developed by Cathy Schoen and colleagues at The Commonwealth Fund which mirrors most elements of President-elect Obama and Senator Baucus' plans—would add an estimated $17.8 billion in health care expenditures in 2010, about 1 percent of current health care costs, which totaled $2.2 trillion in 2007, according to the latest figures available from CMS. Lewin based its assessment on the Building Blocks proposal because plans by President-elect Obama and Senator Baucus lack key details—such as the amount of premium subsidies for low-income families—which are needed for analysis. The report estimates that Building Blocks would cost the federal government a net $103.9 billion in 2010. New initiatives to improve quality and efficiency in the health system, such as reforming the way providers are paid, have the potential to offset both health system and federal costs.
The Building Blocks plan would cover 44.9 million people by expanding the nation's current employer and public insurance system. This is a less disruptive approach that builds on what is currently working in the U.S. health system, according to the report authors. Senator Baucus' proposal is similar in that it includes a requirement that all individuals purchase health insurance when it is deemed affordable. President-elect Obama's plan does not include such a requirement. Massachusetts is currently implementing a similar plan with an individual requirement to have coverage.
Tax Codes Affected in Some Proposals
Some plans build in measures to finance improved coverage through new tax revenues or spending reductions. Senator Ron Wyden's (D-OR) Healthy Americans Act would expand health insurance to an estimated 46 million uninsured people. Senator Wyden proposes to expand coverage by replacing the income tax exclusion for employer benefits with an income tax deduction and premium subsidies. People would gain access to insurance through regional insurance exchanges offering private insurance plans, or through an employer. This plan would add $1.21 trillion to federal spending in 2010, but is the only plan to specify sufficient new revenues and spending offsets ($1.25 trillion) to achieve net federal budget savings (of nearly $40 billion). Revenue increases and spending offsets included in the plan, such as new income tax revenues from substituting employee cash compensation for employer premium contributions, family premium contributions, employer payments, and the elimination of Medicaid and the Federal Employees Health Benefits Program (FEHBP), more than offset the incremental federal budget outlays.
While Senator Mike Enzi's (R-WY) Ten Steps to Transform Health Care in America Act and Senator Richard Burr's (R-NC) Every American Insured Health Act both aim to expand coverage by replacing the employer benefit tax exclusion with new standard income tax deductions and tax credits, their proposals don't go as far as others in covering the uninsured. Senator Enzi's plan would cover an estimated 26.9 million people and Senator Burr's plan would cover 22.3 million. Senator Enzi's plan includes an auto-enrollment process for uninsured people but does not impose a requirement that all obtain coverage. Senator Burr's plan also lacks such a requirement. Both proposals also rely on the individual insurance market which is more costly in general than group insurance. This means that the Enzi and Burr proposals cover fewer people compared to other plans and create higher health spending.
Several Proposals Seek Incremental Coverage Expansions
In addition to proposals seeking more widespread reforms, researchers examined incremental reform bills that seek to expand existing public insurance programs, bills which provide new options for small employers, and proposals to expand health savings accounts. Though incremental bills cover far fewer people, they would be targeted to vulnerable groups. The Lewin analysts estimate that Senator John Kerry's (D-MA) and Representative (D-CA) Waxman's Kids Come First Act of 2007 would cover 6 million out of 12 million uninsured children and young adults in 2010.
Proposals Also Seek to Improve Quality and Efficiency
Many of the proposals analyzed in this report include standards for ensuring high quality care. Plans of both President-elect Obama and Senator Baucus are explicit about the need to establish rules for private insurance markets and define new benefit standards to ensure access to timely care. Senator Baucus proposes to establish an Independent Health Coverage Council that would be appointed by the President and work to ensure that coverage is affordable, appropriate, and accessible. Senator Enzi's plan also promotes setting standards for rules governing private insurance markets.
"These health care proposals represent a tremendous amount of work by Congress over the last year to move us on the path to a high performance health system," said Commonwealth Fund President Karen Davis. "Our new leadership in Washington can now use this thinking as a foundation on which to build a viable health care reform plan which ensures affordable, high-quality care for all Americans."
This analysis compares 11 leading Congressional bills and proposals designed to expand health insurance coverage and is the first of a two-part series (see list of plans reviewed below). Part II of the series to be published in February 2009 will analyze and compare Congressional bills that seek to improve health care quality and efficiency.
"Many of these proposals offer ways to significantly expand health care coverage and also improve the quality of benefits and the efficiency with which they are provided," said Sara R. Collins, Assistant Vice President for the Program on the Future of Health Insurance at The Commonwealth Fund and lead author of the report. "Though most proposals which cover more people come with a higher federal budget price tag, they can achieve significant administrative and health system savings. Universal coverage will need to be accompanied by health system reforms aimed at improving overall health system performance."
Several Plans Could Result in Lower Total National Health Spending or Modest Increases
According to the report, proposals that expand coverage significantly would add to the federal budget but, if designed appropriately, could reduce total health spending. Total health spending declines when a plan builds in ways to reduce administrative costs or efficiencies from greater purchasing power and thereby offsets new use of services by the uninsured. Federal spending increases, however, when the government assumes responsibility for part of the current health spending of households, state and local government, and employers.
Representative Pete Stark's (D-CA) AmeriCare proposal offers the greatest potential to ensure health insurance coverage for all, by broadening access to Medicare. At $188.5 billion in federal dollars in 2010, his plan has the highest federal budget price tag, but it would reduce national health care spending by $58.1 billion in 2010—by covering more people through Medicare, a program with significantly lower administrative costs than private insurance, according to researchers.
The Building Blocks proposal—a framework for universal coverage developed by Cathy Schoen and colleagues at The Commonwealth Fund which mirrors most elements of President-elect Obama and Senator Baucus' plans—would add an estimated $17.8 billion in health care expenditures in 2010, about 1 percent of current health care costs, which totaled $2.2 trillion in 2007, according to the latest figures available from CMS. Lewin based its assessment on the Building Blocks proposal because plans by President-elect Obama and Senator Baucus lack key details—such as the amount of premium subsidies for low-income families—which are needed for analysis. The report estimates that Building Blocks would cost the federal government a net $103.9 billion in 2010. New initiatives to improve quality and efficiency in the health system, such as reforming the way providers are paid, have the potential to offset both health system and federal costs.
The Building Blocks plan would cover 44.9 million people by expanding the nation's current employer and public insurance system. This is a less disruptive approach that builds on what is currently working in the U.S. health system, according to the report authors. Senator Baucus' proposal is similar in that it includes a requirement that all individuals purchase health insurance when it is deemed affordable. President-elect Obama's plan does not include such a requirement. Massachusetts is currently implementing a similar plan with an individual requirement to have coverage.
Tax Codes Affected in Some Proposals
Some plans build in measures to finance improved coverage through new tax revenues or spending reductions. Senator Ron Wyden's (D-OR) Healthy Americans Act would expand health insurance to an estimated 46 million uninsured people. Senator Wyden proposes to expand coverage by replacing the income tax exclusion for employer benefits with an income tax deduction and premium subsidies. People would gain access to insurance through regional insurance exchanges offering private insurance plans, or through an employer. This plan would add $1.21 trillion to federal spending in 2010, but is the only plan to specify sufficient new revenues and spending offsets ($1.25 trillion) to achieve net federal budget savings (of nearly $40 billion). Revenue increases and spending offsets included in the plan, such as new income tax revenues from substituting employee cash compensation for employer premium contributions, family premium contributions, employer payments, and the elimination of Medicaid and the Federal Employees Health Benefits Program (FEHBP), more than offset the incremental federal budget outlays.
While Senator Mike Enzi's (R-WY) Ten Steps to Transform Health Care in America Act and Senator Richard Burr's (R-NC) Every American Insured Health Act both aim to expand coverage by replacing the employer benefit tax exclusion with new standard income tax deductions and tax credits, their proposals don't go as far as others in covering the uninsured. Senator Enzi's plan would cover an estimated 26.9 million people and Senator Burr's plan would cover 22.3 million. Senator Enzi's plan includes an auto-enrollment process for uninsured people but does not impose a requirement that all obtain coverage. Senator Burr's plan also lacks such a requirement. Both proposals also rely on the individual insurance market which is more costly in general than group insurance. This means that the Enzi and Burr proposals cover fewer people compared to other plans and create higher health spending.
Several Proposals Seek Incremental Coverage Expansions
In addition to proposals seeking more widespread reforms, researchers examined incremental reform bills that seek to expand existing public insurance programs, bills which provide new options for small employers, and proposals to expand health savings accounts. Though incremental bills cover far fewer people, they would be targeted to vulnerable groups. The Lewin analysts estimate that Senator John Kerry's (D-MA) and Representative (D-CA) Waxman's Kids Come First Act of 2007 would cover 6 million out of 12 million uninsured children and young adults in 2010.
Proposals Also Seek to Improve Quality and Efficiency
Many of the proposals analyzed in this report include standards for ensuring high quality care. Plans of both President-elect Obama and Senator Baucus are explicit about the need to establish rules for private insurance markets and define new benefit standards to ensure access to timely care. Senator Baucus proposes to establish an Independent Health Coverage Council that would be appointed by the President and work to ensure that coverage is affordable, appropriate, and accessible. Senator Enzi's plan also promotes setting standards for rules governing private insurance markets.
"These health care proposals represent a tremendous amount of work by Congress over the last year to move us on the path to a high performance health system," said Commonwealth Fund President Karen Davis. "Our new leadership in Washington can now use this thinking as a foundation on which to build a viable health care reform plan which ensures affordable, high-quality care for all Americans."
This analysis compares 11 leading Congressional bills and proposals designed to expand health insurance coverage and is the first of a two-part series (see list of plans reviewed below). Part II of the series to be published in February 2009 will analyze and compare Congressional bills that seek to improve health care quality and efficiency.
Wednesday, January 28, 2009
Mr president a word please
Dear Obama: A Letter About Health-Care Reform
Working to change the system that's already there is not enough. We need a complete overhaul of our health-care model
By Dr. Ralph de la Torre
Dear President Obama,
As a concerned medical professional, I am gratified that health-care reform will have such a high priority in your new Administration. It was especially pleasing to see that one of your very first Cabinet selections was Secretary of Health & Human Services.
You have spoken often about the flaws in the U.S. health-care system and the grave risks, in both human and fiscal terms, associated with not correcting them. As a current hospital CEO and former heart surgeon, I'd like to share my perspective on today's health-care problems and recommend a course of action.
According to your Web site, "the Obama-Biden plan&builds on the existing health-care system." With all due respect, I believe that simply adjusting our current model would be a mistake similar to the one the Clintons made when they tried unsuccessfully to reform health care early during that Administration. We can't simply tweak elements of the system while leaving the rest intact. It's time to overhaul the entire model.
To start fresh, we need to clarify the three basic concepts of every health-care discussion: access, cost, and quality. We need to answer the following questions:
• How should we define access? Should every U.S. citizen have a primary care physician? Should anyone on U.S. soil at any given moment be entitled to medical care? Should the elderly and the very poor continue to have access that others do not? Does "access" define all medical care without reservation?
• How much should health care cost in the U.S.? Is 20% of gross national product acceptable (the level we expect to reach by 2016, if the present system remains unchanged), or should we aim for less? How much of that cost should be borne by employers, and how much by the government? What should an American family reasonably pay for health care?
• Where should we set the parameters for quality? Do we want to shoulder the tremendous costs of medicine that meet the very highest standards? What should be the goals for infant mortality, cancer survival rates, and other such metrics?
Defining access, cost, and quality will set the baseline requirements the new system must satisfy. These conditions, rather than any vague goal such as "universal care" or "affordability," should be the starting points for reform. Without them, any plan will soon hit financial and demographic obstacles that will derail it completely.
Arriving at consensus on such basic yet critical questions will not be an easy feat. That's why I suggest you launch a kind of 90-day Manhattan Project as soon as possible. Invite 50 to 70 of our country's smartest thinkers—people willing to spend three months in Washington—to solve what is one of the biggest domestic problems facing the U.S. today. Avoid policy wonks and business consultants, simply because the economics of health care differ so radically from those of other industries. Station the National Guard at every entrance to the meeting room and instruct them to keep out all lobbyists.
Who should be on this "A-Team?" Obviously, you'll need to select representatives from the relevant groups: physicians and hospital administrators, insurers and drugmakers, as well as legislators and their constituents. But two-thirds of the conferees should be crossovers, such as doctors who left their practices to run hospitals or administrators who switched to insurance. That way, they'll speak each other's languages and be equipped to talk from both sides of the table. Fortunately, many highly regarded individuals fit those descriptions, including former Senate Majority Leader Bill Frist, who has gone back to practicing medicine.
The IT Factor
In addition to building consensus around the baseline questions, it is vital that we understand that information technology may ultimately be the most important element of health-care reform. While I applaud your five-year, $10 billion IT spending plan, I'm afraid it will barely scratch the surface of the nation's need for medical data sharing. My six-hospital chain alone is budgeting $73 million over the next three years to upgrade its medical-care technology.
People talk about the potential cost-savings of integrating medical IT so that hospital computers can communicate with one another, as well as with primary-care offices and with imaging labs across the country. But the real payoff from IT investment will be the birth of truly preventive medicine. Imagine an integrated system that lets us identify populations at high risk for conditions such as hypertension or diabetes and thus encourages intervention before patients get sick, instead of just before they need high-risk, expensive procedures like cardiac surgery or foot amputation. Effective data sharing will give researchers the tools to reach that level of analysis. We should no longer define prevention as lifetime treatment of chronic disease.
Predictably, the companies now competing in the medical data field will balk at cooperating to such a degree. And, finding answers to the basic baseline questions will no doubt result in strenuous argument. But, those are hurdles project members can clear. While the plan they produce won't please everyone (truthfully, it should completely please no one), the ultimate objective must be an agreement that transcends all vested interests. I firmly believe that, just as the greatest American minds could put people on the moon and invent the atomic bomb, they can also create a world-class, sustainable health-care system.
When the panel emerges with a plan, it must be followed immediately by a transition time line—perhaps six to seven years—during which an initial pilot program would expand in an orderly fashion, piece by piece. But it's imperative that this process begin right away. If we don't tackle health-care reform within weeks of Inauguration Day, the will for change that has built up so powerfully during your campaign will quickly evaporate. This is an opportunity our nation can ill afford to squander.
Working to change the system that's already there is not enough. We need a complete overhaul of our health-care model
By Dr. Ralph de la Torre
Dear President Obama,
As a concerned medical professional, I am gratified that health-care reform will have such a high priority in your new Administration. It was especially pleasing to see that one of your very first Cabinet selections was Secretary of Health & Human Services.
You have spoken often about the flaws in the U.S. health-care system and the grave risks, in both human and fiscal terms, associated with not correcting them. As a current hospital CEO and former heart surgeon, I'd like to share my perspective on today's health-care problems and recommend a course of action.
According to your Web site, "the Obama-Biden plan&builds on the existing health-care system." With all due respect, I believe that simply adjusting our current model would be a mistake similar to the one the Clintons made when they tried unsuccessfully to reform health care early during that Administration. We can't simply tweak elements of the system while leaving the rest intact. It's time to overhaul the entire model.
To start fresh, we need to clarify the three basic concepts of every health-care discussion: access, cost, and quality. We need to answer the following questions:
• How should we define access? Should every U.S. citizen have a primary care physician? Should anyone on U.S. soil at any given moment be entitled to medical care? Should the elderly and the very poor continue to have access that others do not? Does "access" define all medical care without reservation?
• How much should health care cost in the U.S.? Is 20% of gross national product acceptable (the level we expect to reach by 2016, if the present system remains unchanged), or should we aim for less? How much of that cost should be borne by employers, and how much by the government? What should an American family reasonably pay for health care?
• Where should we set the parameters for quality? Do we want to shoulder the tremendous costs of medicine that meet the very highest standards? What should be the goals for infant mortality, cancer survival rates, and other such metrics?
Defining access, cost, and quality will set the baseline requirements the new system must satisfy. These conditions, rather than any vague goal such as "universal care" or "affordability," should be the starting points for reform. Without them, any plan will soon hit financial and demographic obstacles that will derail it completely.
Arriving at consensus on such basic yet critical questions will not be an easy feat. That's why I suggest you launch a kind of 90-day Manhattan Project as soon as possible. Invite 50 to 70 of our country's smartest thinkers—people willing to spend three months in Washington—to solve what is one of the biggest domestic problems facing the U.S. today. Avoid policy wonks and business consultants, simply because the economics of health care differ so radically from those of other industries. Station the National Guard at every entrance to the meeting room and instruct them to keep out all lobbyists.
Who should be on this "A-Team?" Obviously, you'll need to select representatives from the relevant groups: physicians and hospital administrators, insurers and drugmakers, as well as legislators and their constituents. But two-thirds of the conferees should be crossovers, such as doctors who left their practices to run hospitals or administrators who switched to insurance. That way, they'll speak each other's languages and be equipped to talk from both sides of the table. Fortunately, many highly regarded individuals fit those descriptions, including former Senate Majority Leader Bill Frist, who has gone back to practicing medicine.
The IT Factor
In addition to building consensus around the baseline questions, it is vital that we understand that information technology may ultimately be the most important element of health-care reform. While I applaud your five-year, $10 billion IT spending plan, I'm afraid it will barely scratch the surface of the nation's need for medical data sharing. My six-hospital chain alone is budgeting $73 million over the next three years to upgrade its medical-care technology.
People talk about the potential cost-savings of integrating medical IT so that hospital computers can communicate with one another, as well as with primary-care offices and with imaging labs across the country. But the real payoff from IT investment will be the birth of truly preventive medicine. Imagine an integrated system that lets us identify populations at high risk for conditions such as hypertension or diabetes and thus encourages intervention before patients get sick, instead of just before they need high-risk, expensive procedures like cardiac surgery or foot amputation. Effective data sharing will give researchers the tools to reach that level of analysis. We should no longer define prevention as lifetime treatment of chronic disease.
Predictably, the companies now competing in the medical data field will balk at cooperating to such a degree. And, finding answers to the basic baseline questions will no doubt result in strenuous argument. But, those are hurdles project members can clear. While the plan they produce won't please everyone (truthfully, it should completely please no one), the ultimate objective must be an agreement that transcends all vested interests. I firmly believe that, just as the greatest American minds could put people on the moon and invent the atomic bomb, they can also create a world-class, sustainable health-care system.
When the panel emerges with a plan, it must be followed immediately by a transition time line—perhaps six to seven years—during which an initial pilot program would expand in an orderly fashion, piece by piece. But it's imperative that this process begin right away. If we don't tackle health-care reform within weeks of Inauguration Day, the will for change that has built up so powerfully during your campaign will quickly evaporate. This is an opportunity our nation can ill afford to squander.
Monday, January 26, 2009
Now what????
We seem to have stalled out. If anyone has any ideas on how I can raise the money to help her please let me know. I am becoming desperate!!!!
Wednesday, January 21, 2009
THANKS FOR YOUR SUPPORT
We are making some progress but we still have a very long way to go.
as of today we have raised $310.00 and I hope that you all can find it in your hearts to help this woman.
as of today we have raised $310.00 and I hope that you all can find it in your hearts to help this woman.
Monday, January 19, 2009
Laura fell again over the weekend and that hand of hers is really taking a beating. hopefully we can get her that wheelchair soon. We have gotten the ball rolling with donations and now we need only $24900.00 to reach our goal. If you are interested in contributing you can e-mail me at dhackett06@verizon.net. your help and prayers are greatly appreciated.
Again thanks and God bless you
Again thanks and God bless you
Saturday, January 17, 2009
Tuesday, January 13, 2009
A Plea for Help
This is my first attempt at blogging so please bear with me. My name is Dave and my wifes name is Laura. we have 3 kids ages 8, 6 and 4. I never thought we would find ourselves in a position like this. I guess we are just another victim of the current economic downturn in America.
My wife has a birth defect known as arthrogryposis-multiplex-congenita. In simple terns it means that all of the major joints in her body are deformed. Some slightly out of allignment some are grossly deformed. One major symptom of this condition is that due to her poor sklelatel structure she easily looses balance and falls down (sometimes very hard).
We have been married for almost 10 years and here is our dilema.When we first married her condition was not that bad . she could walk (although with a pronounced limp) and could get through a normal day with only a moderate amount of difficulty. I had a very good job with good benefits including top notch insurance.
After we had our first child in 2000 her right hip started hurting. She began falling down a lot more frequently and finally she went to an orthapedist who told her that she would soon need to haver both her hips replaced. We put it off for a few years because we both wanted more children.The years went by and we had two more kids . The pain in her hips was by now unbearable and we decided it was time to do the surgery. So in 2005 she had the right one done and in 2006 she had the other replaced. Her hips were now feeling better but this did nothing to imrove her balance and she still falls on a regular basis . She has hit her head several times in the bathroom .
We took care of all the medical bills with the help of the insurance company as they arose. Mortgage was paid, car note was paid there were always groceries in the house and life was as good as we could expect with her condition.
In A[ril of 2007 I lost the job i had for the past 7 years due to layoff. I was out of work for about a month .I finally found a job but had to take a huge paycut (I went from making $65000.00 a year to $25000.00 a year).The insurance offered by new employer was far to expensive ($600.00 a month on a $2100.00 salary) I figured it was only temporary and something better would come along sooner or later.We paid the cobra for the insurance as long as we could we paid the mortgage and car notes as long as possible. but weeks turned into months and soon our savings were gone I cashed in my meager 401k and continued paying what I could. The months continued on and nothing better has come along on the employment front in January 2008 we could no longer afford to keep the insurance . In February she fell hard and Broke several bones in her hand although she went to the emergency room they said they could not treat her because there was no insurance and it was not considered a life threatening injury . They put her arm in a sling (not set no cast) and sent her home Her hand is still almost useless to this day. In June she fell again. This time she hurt her back and again she went to the emergency room after an x ray she was told that she herniated 2 discs in her back but again they could not help her they gave her some vicodin and sent her home. The months coninue to roll on and now we are having trouble paying the mortgage and the car. She has applied for disability but of course the government has denied her claim and the lawyer we spoke to said it may take years for the appeal.
We have spoken with several doctors wha say she needs surgery on her hand and her back the total amount needed for both operations is about $25000.00She also needs a motorized wheelchair so she can take care of the kids without cracking her head open we have priced those at about $3000.00. We are now forced to appeal to generosity of strangers any help you can give would be greatly appreciated
I will get you the information on where to send donations if I see anyone will help us.
please keep her in your prayers.
My wife has a birth defect known as arthrogryposis-multiplex-congenita. In simple terns it means that all of the major joints in her body are deformed. Some slightly out of allignment some are grossly deformed. One major symptom of this condition is that due to her poor sklelatel structure she easily looses balance and falls down (sometimes very hard).
We have been married for almost 10 years and here is our dilema.When we first married her condition was not that bad . she could walk (although with a pronounced limp) and could get through a normal day with only a moderate amount of difficulty. I had a very good job with good benefits including top notch insurance.
After we had our first child in 2000 her right hip started hurting. She began falling down a lot more frequently and finally she went to an orthapedist who told her that she would soon need to haver both her hips replaced. We put it off for a few years because we both wanted more children.The years went by and we had two more kids . The pain in her hips was by now unbearable and we decided it was time to do the surgery. So in 2005 she had the right one done and in 2006 she had the other replaced. Her hips were now feeling better but this did nothing to imrove her balance and she still falls on a regular basis . She has hit her head several times in the bathroom .
We took care of all the medical bills with the help of the insurance company as they arose. Mortgage was paid, car note was paid there were always groceries in the house and life was as good as we could expect with her condition.
In A[ril of 2007 I lost the job i had for the past 7 years due to layoff. I was out of work for about a month .I finally found a job but had to take a huge paycut (I went from making $65000.00 a year to $25000.00 a year).The insurance offered by new employer was far to expensive ($600.00 a month on a $2100.00 salary) I figured it was only temporary and something better would come along sooner or later.We paid the cobra for the insurance as long as we could we paid the mortgage and car notes as long as possible. but weeks turned into months and soon our savings were gone I cashed in my meager 401k and continued paying what I could. The months continued on and nothing better has come along on the employment front in January 2008 we could no longer afford to keep the insurance . In February she fell hard and Broke several bones in her hand although she went to the emergency room they said they could not treat her because there was no insurance and it was not considered a life threatening injury . They put her arm in a sling (not set no cast) and sent her home Her hand is still almost useless to this day. In June she fell again. This time she hurt her back and again she went to the emergency room after an x ray she was told that she herniated 2 discs in her back but again they could not help her they gave her some vicodin and sent her home. The months coninue to roll on and now we are having trouble paying the mortgage and the car. She has applied for disability but of course the government has denied her claim and the lawyer we spoke to said it may take years for the appeal.
We have spoken with several doctors wha say she needs surgery on her hand and her back the total amount needed for both operations is about $25000.00She also needs a motorized wheelchair so she can take care of the kids without cracking her head open we have priced those at about $3000.00. We are now forced to appeal to generosity of strangers any help you can give would be greatly appreciated
I will get you the information on where to send donations if I see anyone will help us.
please keep her in your prayers.
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