SURGEON GENERALS WARNING!!!

Feb. 9 (Bloomberg) -- Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy.

Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.

Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”

Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.

New Penalties

Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)

What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.

The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192). The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system.

Elderly Hardest Hit

Daschle says health-care reform “will not be pain free.” Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.

Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (464).

The Federal Council is modeled after a U.K. board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.

In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision.

Hidden Provisions

If the Obama administration’s economic stimulus bill passes the Senate in its current form, seniors in the U.S. will face similar rationing. Defenders of the system say that individuals benefit in younger years and sacrifice later.

The stimulus bill will affect every part of health care, from medical and nursing education, to how patients are treated and how much hospitals get paid. The bill allocates more funding for this bureaucracy than for the Army, Navy, Marines, and Air Force combined (90-92, 174-177, 181).

Hiding health legislation in a stimulus bill is intentional. Daschle supported the Clinton administration’s health-care overhaul in 1994, and attributed its failure to debate and delay. A year ago, Daschle wrote that the next president should act quickly before critics mount an opposition. “If that means attaching a health-care plan to the federal budget, so be it,” he said. “The issue is too important to be stalled by Senate protocol.”

More Scrutiny Needed

On Friday, President Obama called it “inexcusable and irresponsible” for senators to delay passing the stimulus bill. In truth, this bill needs more scrutiny.

The health-care industry is the largest employer in the U.S. It produces almost 17 percent of the nation’s gross domestic product. Yet the bill treats health care the way European governments do: as a cost problem instead of a growth industry. Imagine limiting growth and innovation in the electronics or auto industry during this downturn. This stimulus is dangerous to your health and the economy.

The French Lesson in Healthcare

The French Lesson In Health Care
The nation's system isn't quite as superb as Sicko maintains, but it's pretty good

Michael Moore's documentary Sicko trumpets France as one of the most effective providers of universal health care. His conclusions and fist-in-your-gut approach may drive some Americans up the wall. But whatever you think of Moore, the French system—a complex mix of private and public financing—offers valuable lessons for would-be health-care reformers in the U.S.
In Sicko, Moore lumps France in with the socialized systems of Britain, Canada, and Cuba. In fact, the French system is similar enough to the U.S. model that reforms based on France's experience might work in America. The French can choose their doctors and see any specialist they want. Doctors in France, many of whom are self- employed, are free to prescribe any care they deem medically necessary. "The French approach suggests it is possible to solve the problem of financing universal coverage...[without] reorganizing the entire system," says Victor G. Rodwin, professor of health policy and management at New York University.

France also demonstrates that you can deliver stellar results with this mix of public and private financing. In a recent World Health Organization health-care ranking, France came in first, while the U.S. scored 37th, slightly better than Cuba and one notch above Slovenia. France's infant death rate is 3.9 per 1,000 live births, compared with 7 in the U.S., and average life expectancy is 79.4 years, two years more than in the U.S. The country has far more hospital beds and doctors per capita than America, and far lower rates of death from diabetes and heart disease. The difference in deaths from respiratory disease, an often preventable form of mortality, is particularly striking: 31.2 per 100,000 people in France, vs. 61.5 per 100,000 in the U.S.

That's not to say the French have solved all health-care riddles. Like every other nation, France is wrestling with runaway health-care inflation. That has led to some hefty tax hikes, and France is now considering U.S.-style health-maintenance organization tactics to rein in costs. Still, some 65% of French citizens express satisfaction with their system, compared with 40% of U.S. residents. And France spends just 10.7% of its gross domestic product on health care, while the U.S. lays out 16%, more than any other nation.

To grasp how the French system works, think about Medicare for the elderly in the U.S., then expand that to encompass the entire population. French medicine is based on a widely held value that the healthy should pay for care of the sick. Everyone has access to the same basic coverage through national insurance funds, to which every employer and employee contributes. The government picks up the tab for the unemployed who cannot gain coverage through a family member.

SAFETY NET
But the french system is much more generous to its entire population than the U.S. is to its seniors. Unlike with Medicare, there are no deductibles, just modest co- payments that are dismissed for the chronically ill. Additionally, almost all French buy supplemental insurance, similar to Medigap, which reduces their out-of-pocket costs and covers extra expenses such as private hospital rooms, eyeglasses, and dental care.

In France, the sicker you get, the less you pay. Chronic diseases, such as diabetes, and critical surgeries, such as a coronary bypass, are reimbursed at 100%. Cancer patients are treated free of charge. Patients suffering from colon cancer, for instance, can receive Genentech Inc.'s (DNA ) Avastin without charge. In the U.S., a patient may pay $48,000 a year.

France particularly excels in prenatal and early childhood care. Since 1945 the country has built a widespread network of thousands of health-care facilities, called Protection Maternelle et Infantile (PMI), to ensure that every mother and child in the country receives basic preventive care. Children are evaluated by a team of private-practice pediatricians, nurses, midwives, psychologists, and social workers. When parents fail to bring their children in for regular checkups, social workers are dispatched to the family home. Mothers even receive a financial incentive for attending their pre- and post-natal visits.

A typical PMI can be found in Goutte d'Or, a poor neighborhood at the foot of Montmartre that has been home for the past 20 years to a swelling population of immigrants from Africa and Southeast Asia. On Rue Cavé, a tidy modern building is given over entirely to caring for expecting mothers, infants, and young children. The place usually is bustling with kids scrambling over toys, while mothers, often immigrants in colorful headdresses and with babies strapped to their backs, talk to their doctors as part of twice-monthly evaluations.

PMI and other such programs are starting to get attention in U.S. health-care circles. "If we really want to ensure that no child is left behind, then the PMI system is a good way to do it," says Daniel J. Pedersen, president of the Buffett Early Childhood Fund. "It's based on the practical idea that high-quality investments made at the start of a child's life will pay huge dividends to both the child and society in the future."

To make all this affordable, France reimburses its doctors at a far lower rate than U.S. physicians would accept. However, French doctors don't have to pay back their crushing student loans because medical school is paid for by the state, and malpractice insurance premiums are a tiny fraction of the $55,000 a year and up that many U.S. doctors pay. That $55,000 equals the average yearly net income for French doctors, a third of what their American counterparts earn. Then again, the French government pays two-thirds of the social security tax for most French physicians—a tax that's typically 40% of income.

Specialists who have spent at least four years practicing in a hospital are free to charge what they want, and some charge upwards of $675 for a single consultation. But American-style compensation is rare. "There is an unspoken and undefined limit to what you can charge," says Dr. Paul Benfredj, a gastroenterologist in Paris.

Many French doctors, in fact, earn more by increasing their patient load, or by prescribing more diagnostic tests and procedures—a technique, also popular in the U.S., that inflates health-care costs. So far France has been able to hold down the burden on patients through a combination of price controls and increased government spending, but the latter effort has led to higher taxes for both employers and workers. In 1990, 7% of health-care expenditures were financed out of general revenue taxes, and the rest came from mandatory payroll taxes. By 2003, the general revenue figure had grown to 40%, and it's still not enough. The French national insurance system has been running constant deficits since 1985 and has ballooned to $13.5 billion.

That's why France is gearing up to make changes. It already requires patients to register with a general practitioner before visiting a specialist, or else agree to a lesser reimbursement, much like many U.S. insurance plans. But France isn't likely to make major changes to a system most citizens say they like. Why would they? Says Shanny Peer, policy director at the independent French-American Foundation: "France gets better results for less money and everyone is covered."

Is this the answer???

Barack Obama and Joe Biden's Plan
On health care reform, the American people are too often offered two extremes - government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.

The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors and plans to implement the plan. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.

Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year.

If you don’t have health insurance, you will have a choice of new, affordable health insurance options.


Make Health Insurance Work for People and Businesses - Not Just Insurance and Drug Companies.

Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.
Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.
Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.
Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees health care.
Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
Ensure everyone who needs it will receive a tax credit for their premiums.
Reduce Costs and Save a Typical American Family up to $2,500 as reforms phase in:

Lower drug costs by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs and taking on drug companies that block cheaper generic medicines from the market
Require hospitals to collect and report health care cost and quality data
Reduce the costs of catastrophic illnesses for employers and their employees.
Reform the insurance market to increase competition by taking on anticompetitive activity that drives up prices without improving quality of care.
The Obama-Biden plan will promote public health. It will require coverage of preventive services, including cancer screenings, and increase state and local preparedness for terrorist attacks and natural disasters.

A Commitment to Fiscal Responsibility: Barack Obama will pay for his $50 - $65 billion health care reform effort by rolling back the Bush tax cuts for Americans earning more than $250,000 per year and retaining the estate tax at its 2009 level.

whats wrong with the system

Despite four heart attacks,Former Vice President Dick Cheney is alive and well and living at Number One Observatory Circle - a medical accomplishment that symbolizes the incredible progress of American medicine. Cardiac care has been revolutionized in recent years: Death by cardiovascular disease declined by two-thirds over the past five decades. Also, according to the American Heart Association, 88 % of heart attack survivors under 65 return to their job. Other medical fields have been similarly transformed: depression is treatable, childhood leukemia is curable, and polio is history.

Yet, American health care has never been more expensive. Between 2000 and 2005, health insurance premiums doubled. Employers fret about their eroding profitability and employees feel the pinch on their wallets. Though labor costs rose, average family income is down in the last half decade, largely because of rising health costs.

Many health care experts see rising health care costs as an inevitable and unavoidable consequence of advances in medical science. So the only choice, in their view, Americans have is between: paying more or embracing some type of rationing.

Professor Uwe Reinhardt of Princeton University sees health care swallowing up 28 % of GDP by 2030 (up from 16% now), but asks: What would we rather spend the money on? "SUVs" In contrast, Brookings Institute senior fellow Henry Aaron prescribes a bitter, if sugar-coated, pill: "Intelligent health care rationing - limiting the availability of care that costs society more to produce than it is worth to patients - is not a horror to be avoided. It's a regretfully necessary limit to sustain fair access to health care that is worth what it costs."

Both of these approaches treat health care spending as if it was sui generis. In most other sectors of the economy, costs fall with advancements in technology, not rise. But the advancement of medical science has, curiously, not followed the trend; progress has begotten greater expense. In fact, even a lack of progress in health care is often accompanied by rising cost. Jonathan Skinner and his colleagues at Dartmouth considered cardiac care from 1986 to 2002. Their conclusion: while costs have continued to rise, survival rates have stagnated since 1996.

Why then is health care so different from other sectors of the economy? Simply put, consumers don't pay for health care the way they pay for most other goods and services.

As I write in The Cure: How Capitalism Can Save American Health Care, American health care has been shaped by two days: October 26, 1943 and December 1, 1942.

On October 26, 1943, the IRS ruled that employers could continue to pay health insurance premiums in pre-tax dollars. As a response to wage and price controls, employers had begun to offer health benefits to attract better employees. The IRS ruling legitimized and encouraged the practice, giving rise to the dominance of employer-sponsored health insurance.

On December 1, 1942, Lord Beveridge issued his report on health care and pensions to the British Parliament, envisioning zero-dollar public health insurance. Lord Beveridge had enormous influence here, particular among Democrats; his thinking (and persuasiveness) helped lay the intellectual foundation for Medicare and Medicaid.

Fast forward 60 years, and the end result of these two days is that Americans - whether privately insured or publicly covered - tend to be over-insured, and thus less sensitive to prices. And so we come to a paradox: American health care is so expensive because it's so cheap. That is, with Americans paying just 14 cents out-of-pocket for every health dollar, they have little incentive to economize on health expenses. Americans have access to the most technologically sophisticated system in human history - yet pay pennies on the dollar out of their own pockets. The upshot? A health care system that is heavy in cost but not necessarily strong in satisfaction and uneven in quality.

In other countries, faced with similar problems, the solution has been simple enough: rationed care. Canadians, for example, are resigned to wait for practically any diagnostic test or surgical procedure. According to the government's own statistics, 1.2 million Canadians are actively looking for a family doctor but can't find one. Patients in Ontario can only dream of having the access to PET scans that is available to lab animals enrolled in research studies.

Will spiraling costs force America down the same path? The best alternative is to put people in the driver's seat through consumer-driven health care.

Consumer-driven health care is based on a simple premise: move health insurance back to a more traditional definition of insurance - that is, cover people for unlikely and catastrophic events. For smaller expenses, people should be empowered with health dollars, and thus given incentive to shop around.

In theory, this should result in lower cost care without sacrificing patient health. Back in the 1970s, the RAND think tank in California tracked two thousand families over eight years in a study that cost about a quarter of a billion dollars (adjusting for inflation) - one of the most expensive experiments in the history of social science. The study compared the health and the health-care spending of two groups: one with free health care, the other with some type of cost-sharing up to a point, after which catastrophic insurance kicked in (structurally similar to a Health Savings Account). The result? Those on the free plan cost 40 percent more but in the end were no healthier than those on the HSA-style plan. This suggests that people are able to make intelligent health-care choices when provided with a financial incentive to do so.

Consumer-driven health care is new to the marketplace but has made inroads. William Boyles, publisher of the Consumer Driven Market Report, estimates that by the beginning of 2007, 13.4 million people will be enrolled in some type of consumer-driven health plan, doubling the number of people enrolled from a year before. And the early data supports the theory. Consider:

In a Kaiser Family Foundation survey, some 71 percent of those in the new "consumer-directed health plans" said the policies prompted them to consider cost when seeking health care, versus 49 percent of those with more traditional employer-sponsored coverage.
After a year-long analysis of consumer-driven health care use by its members, Cigna reports that costs are lower by 16 percent yet patients don't seem to be cutting corners; the use of medications that support chronic conditions increased, for example, indicating that members were not foregoing needed care, a fear that many people have about shifting from the current system to a more consumer-driven one.
There is, unfortunately, a Catch-22. These plans aren't more popular because they aren't more popular. The Kaiser study found, for instance, that half of respondents would rather be in a more traditional plan. No wonder - with market penetration of consumer-driven plans being relatively low, the pressure on providers to offer greater transparency (think hospital prices) is limited, making it difficult for consumers to navigate the health care labyrinth - and making the plans less appealing. In other words, the consumers at the cutting edge of the consumer-driven revolution have to pay prices set by consumers who don't care about prices. This makes the transition to consumer-based health care more difficult.

In short, the concept of "shopping around" for health care makes for great rhetoric but runs up against a harsh reality: health care is the most consumer unfriendly sector in the economy. But that's starting to change, albeit slowly. Some companies have already rushed to fill in the information void. Aetna, eHealthInsurance, Definity Health, and others offer services that are making it a little easier for patients to find pricing and quality information.

Government policy can contribute to the trend toward consumer-driven health: First, governments should work to popularize consumer-driven health care. This can be accomplished simply and easily: states can offer state employees the ability to enroll in consumer-driven plans. At present, most don't, thereby limiting the number of potential enrollees. Second, both state and federal governments must eliminate barriers to competition in health care. Consider that because state regulations limit out-of-state insurance companies from offering coverage, a 30-year-old man will pay four times more for the same health insurance policy from the same company in New York as he would in Connecticut. To create a market for health care, we need more competition - not simply among insurance carriers, but among hospitals and other providers.

Ten years from now, if consumer-driven health care continues to grow, things will be different - and better. After all, in five-sixth of the general economy, we look to individual choice and competition to drive innovation and lower costs. That's what will also cure America's health care malaise.