HEALTH Insurance

Barone: A Democrat Reaches Across the Aisle on Medicare

2011-12-19T04:47:00.000-08:00

It's highly unusual in a presidential debate for two Republican candidates -- the two leading in current national polls -- to heap praise on a liberal Democratic senator.

But in the Fox News debate in Sioux City, Iowa, Thursday night, both Newt Gingrich and Mitt Romney had very good words to say for Oregon's Democratic Sen. Ron Wyden.

The subject was the Medicare reform plan put forward in a Wall Street Journal opinion article that morning by Wyden and House Budget Committee Chairman Paul Ryan.

"Today is a big day for the country," Romney said. It was "an enormous achievement" for Ryan and Wyden, people on opposite sides of the aisle, to come together.

Gingrich, harshly criticized last May for calling Ryan's earlier Medicare plan "right-wing social engineering," went out of his way to say that Romney had produced "a very good plan" for Medicare and that it was "brave" for Wyden to join Ryan in their bipartisan plan.

Politicians' praise is sometimes bestowed overlavishly, but in this case it was well merited. Ryan-Wyden represents a major step forward in public policy and gives hope that the Medicare entitlement can be rendered sustainable.

The Ryan-Wyden proposal provides for continuation of the current Medicare program for those now over age 55. For those younger, it would introduce in 2022 a "premium-support" system that would allow Medicare recipients to choose between the current program and a Medicare-approved private plan.

Those plans would be presented in competitive bidding and would have to be as comprehensive as traditional Medicare and would have to accept anyone who applied. There would be subsidies for low-income seniors.

Private insurers would thus have an incentive to design plans that would offer more generous benefits and lower costs than current Medicare. This kind of market competition has proved effective in the Medicare Part D prescription drug program enacted in 2003. Costs have been lower than government projections, and beneficiary satisfaction has been high.

Ryan-Wyden differs from the Medicare plan Ryan presented last spring by offering the option of keeping the current Medicare system. That is also a feature of the Medicare proposals of candidates Romney and Gingrich.

Wyden, with a solidly liberal voting record, may seem to be an unlikely partner in this enterprise. But he has consistently favored adding elements of market competition to our health care system.

He was one of the relatively few Democrats who provided necessary support for Part D in 2003. And in 2008, he and Republican Sen. Bob Bennett of Utah put forward a health care proposal based on eliminating the current tax preference for employer-provided health insurance.

That preference creates incentives to increase costs, and health policy experts of both left and right have argued for its elimination. But Barack Obama gave Wyden-Bennett the back of his hand and supported a plan that would centralize control in the federal government.

The Obama White House was quick to reject Ryan-Wyden, as well. While Obama has said on occasion that the current Medicare program is not sustainable in the long term, he is now firmly in campaign mode and uninterested in anything other than bashing Republicans for hurting seniors.

Ryan-Wyden makes this kind of cheap-shot politics more difficult. And it comes when a recent poll showed that only 29 percent of voters -- less than one in three -- support the Obamacare legislation. So it's no surprise that Obama prefers Mediscare tactics to defending his administration's largest legislative accomplishment.

The Republican candidates are united in their determination to repeal Obamacare, and repeal is a realistic possibility if Republicans should sweep the 2012 elections as they did in 2010. Ryan-Wyden also renders long-term Medicare reform a realistic possibility.

Ryan-Wyden helps to frame the health care issue in the presidential election as a choice between big government control and market competition. That does not help Obama.

Gallup reports that 64 percent of Americans regard big government, as opposed to big business or big labor, as "the biggest threat to the country in the future." That's just one point under the all-time high since Gallup began asking the question in 1965.

So it's not surprising that Romney and Gingrich saw fit to praise Wyden and that other Democrats are angry with him. But Wyden shows that at least one Democrat, even in campaign season, is more interested in good public policy than in politics.

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Michael Barone, senior political analyst for The Washington Examiner (www.washingtonexaminer.com), is a resident fellow at the American Enterprise Institute, a Fox News Channel contributor and a co-author of The Almanac of American Politics. COPYRIGHT 2011 THE WASHINGTON EXAMINER

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Get Medical Coverage for Family with Georgia Health Insurance Plan

2011-11-29T23:43:00.001-08:00

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The Price We Pay for Medical Care

2011-09-12T01:38:00.002-07:00

By REED ABELSON

Americans seem to be paying the price for the unrelenting rise in health care costs in this country, according to several studies being published on Thursday in Health Affairs, an academic journal.

The higher cost of coverage has taken a huge cut in the increase in income earned by the average family, says one study, and lower-income families are particularly hard hit, according to another. Meanwhile, the numbers of people who cannot afford insurance or do not have enough coverage have significantly increased, according to a third study.

In an analysis of just how much of a family’s paycheck is being gobbled up, analysts from Rand looked at how much of the average increase in a family’s gross annual income over the past decade has gone to pay for health care.

While the family saw an increase in income from $76,000 a year in 1999 to $99,000 a year in 2009, the researchers then deducted what they estimated would go to pay for insurance premiums, deductibles and co-payments and taxes to support Medicare and Medicaid. By the Rand calculation, if the cost of health care had been in line with overall inflation, the average family would have had nearly $5,400 in additional income a year that they could have spent.

The bottom line: Americans have less and less money to spend “on everything else” because they are forced to devote so much of their income to health care.

The authors conclude: “Given the perilous state of the US economy, the fiscal burdens imposed on ally payers by steadily rising health care costs can no longer be ignored.”

In a second study, researchers make the case that lower-income families are even more burdened by the high cost of medical care than those who are better off. Patricia Ketsche, a researcher from Georgia State University, and others calculated that low-income families pay more than 20 percent of family income toward health care, looking at both private spending and taxes, while other families who make more pay no more than 16 percent of their family income.

A third analysis looks at the unaffordability of health care by estimating how many people were without adequate coverage in 2010. The study, by the Commonwealth Fund, estimates some 29 million Americans were underinsured and about 52 million were or had been recently without coverage. Those 81 million adults compare to an estimated 75 million in 2007 and 61 million in 2003.

While the Commonwealth study suggests the federal health care law has the potential to significantly lower the number of people with insufficient or no coverage, the researchers also emphasize the need to reign in health care costs. “To ensure that premiums and care remain affordable, efforts to slow rising costs of care and reduce waste, duplication, and care of little value must intensify,” they say.

The September issue of Health Affairs is focused on health care costs, and the two studies that look at how American families are affected are available online for a week and afterwards by subscription. The Commonwealth Fund report will remain available on-line without a subscription.

No Job, No Insurance, No Health Care

2011-09-12T01:38:00.001-07:00

Workers who lose their jobs in the economic downturn typically suffer a double whammy: they lose not only their incomes but their employer-based health insurance as well. Millions are forced to forgo the medical care that they cannot pay for.

The depressing facts are laid out in the Commonwealth Fund’s latest biennial health insurance survey. An analysis of the data found that nine million working-age adults who lost their jobs between 2008 and 2010 became uninsured. Most of those could not find affordable coverage from insurance companies, and some were turned down when theyapplied.

Of that number, nearly three-quarters delayed needed care because of the cost. They were sick but did not visit a doctor, or chose not to fill a prescription, or skipped a recommended test, treatment or visit to a specialist.

Nearly three-quarters had problems paying medical bills when they did visit a doctor or a hospital. They used up their savings, struggled to pay medical debts over time, took out loans when they could, declared bankruptcy or ended up unable to pay for other basic necessities like food or housing.

Substantial help will not arrive until 2014, when the major provisions of the national health care reforms kick in. The reforms will provide subsidies to help millions of Americans buy insurance on new exchanges and will greatly expand Medicaid coverage for the poor.

In the interim, Congress should extend unemployment benefits to help the jobless pay for health care. It should also re-establish the subsidies provided by the 2009 stimulus package that helped laid-off workers stay on their former employers’ policies while looking for work.

New statement on best practice for critical illness insurance

2011-03-09T03:33:00.003-08:00

The Association of British Insurers (ABI) has issued a new statement regarding best practice for providers of critical illness insurance, which will have to be implemented by the end of next year at the latest.

The move by the industry body should mean greater clarity for people taking out critical illness cover, as it introduces changes that take into account previous issues regarding the insurance type, especially in terms of total permanent disability cover in critical illness policies .

Although total permanent disability cover is only involved in 3 per cent of all claims under critical illness, according to the ABI, it does present a much higher proportion of claims that have not been accepted in the past.

The statement therefore brings in a new set of standard definitions for total permanent disability cover, as well as replacing the old wording of the terminal illness definition, including changes to definitions for cancer and Parkinsons disease . In addition, the pre-existing conditions exclusion for policies involving children’s critical illness has been standardised.

Nick Kirwan, assistant director of health and protection at the ABI, said "The work on developing standard definitions for TPD and children’s cover will help ensure that critical illness policies are clear and pay out in line with customer expectations."

Save money on insurance premiums by quitting smoking

2011-03-09T03:33:00.001-08:00

This Wednesday 9 March is No Smoking Day and maybe the incentive some are looking for to stop smoking .

By stopping smoking it’s not the health that’s benefits but it can help finances . If an average packet of 20 cigarettes costs approx £6.85, those who smoke one packet a day could potentially save £2,500 a year.

It isn’t just the cost of the cigarettes where money can be saved. Savings can also be made on life and health insurance premiums, but only 12 months after quitting.

According to LifeSearch non-smokers can pay up to 50 per cent less in premiums. By getting in touch with your insurance company or a financial adviser, you could be making big savings.

However Matt Morris, senior policy adviser at LifeSearch advises, "It is important to make sure you have a new policy in place before cancelling the existing one, as a new policy could turn up some nasty surprises in underwriting and may even be declined if your health has changed."

U.S. Appeals Florida Health Care Ruling

2011-03-09T03:30:00.000-08:00

The Justice Department filed notice on Tuesday that it was appealing a decision by a federal judge in Florida who struck down the new health care law, saying it was unconstitutional for the federal government to require Americans to obtain health insurance. The judge, Roger Vinson of Federal District Court in Pensacola, voided the entire law after finding that the insurance requirement was “inextricably bound” to other provisions of the statute. The Justice Department said it was asking the United States Court of Appeals for the 11th Circuit, in Atlanta, to provide an “expedited review” of the decision.

Simplyhealth unveils health plan to support over 70s

2011-03-09T02:58:00.000-08:00

Affordability is crucial to maintaining the health and wellbeing of the nation's ageing population, according to the results of a recent survey carried out by health insurance provider Simplyhealth .

Almost 45 per cent of over 70s said that if access to healthy living was more affordable, it would help them keep fit and active. With 16 per cent of the UK's population aged 65 and over, its necessary for improvements to be made to the affordability of healthy living if Britain is to manage this growing demographic. Paying heed to this, Simplyhealth has introduced a new health plan, the Simply Cash Plan 70 Plus, for individuals aged 70 and over.

Clare Lee, spokesperson for Simplyhealth, said: "According to our research, 58 per cent of over 70s do attend regular health appointments. Yet, 26 per cent of those surveyed said that they needed extra encouragement to regularly attend routine health appointments. That's why we've launched Simplyhealth's new Simply Cash Plan 70 Plus, to help those over the age of 70 better budget for their everyday healthcare needs."

Repeal The Health Care Law? Not So Fast

2010-11-04T05:52:00.000-07:00

Republicans regained control of the House on Tuesday in part with a pledge to "repeal and replace" the new health law. But carrying out that campaign promise won't be as easy as making it was.

"Republicans cannot repeal Obamacare with President Obama wielding the veto pen," says Michael Cannon, director of health policy studies for the libertarian Cato Institute. "I mean that's not within a set of possible outcomes."

That's because as large as the new GOP majority will be come January, it's still not large enough to override a presidential veto. In addition, the Senate will still be controlled by the Democrats, who are unlikely to go along with the repeal effort.

But Cannon, who is no fan of the new law, says House Republicans are not without weapons to do battle with the measure. "They're going to do everything they can to try to cripple the law, throw sand in the gears and make it even more unpopular than it has been for the pass 18 months," he says.

One major way they can do that is by holding oversight hearings. Using subpoena power if necessary, Republicans could end up forcing Obama administration health officials to spend nearly as much time on Capitol Hill as they do in their offices actually trying to implement the law.

Cannon says a barrage of hearings and investigations by Republicans could help solidify public opinion against the measure. "The more they keep the law in the news and the more of a steady drumbeat of bad news they create about this law, the more likely it is that eventually someone with the power to overturn or repeal this law will do so," he says.

Threats Could Backfire

But all those hearings could also have the opposite effect — giving the administration a chance to make its case in favor of the law, a case that often got drowned out during the election campaign.

"The next round of this, while there will continue to be the broad sloganeering on both sides, will presumably get a little bit more into the detail," says Martin Corry, a health care lobbyist and former official at the Department of Health and Human Services during the Bush administration. "So if you're a family with a 22 year old still in college, you may not want to see that provision [that lets grown children stay on their parents' health plans] repealed."

Corry says other threats — such as trying to starve the new law by holding back its funding or preventing agencies from writing regulations needed to implement it — could also backfire.

That's because, he says, "many provisions in the law take effect, regulations or not, implementation dollars or not," so simply cutting off the money or the regulations could end up leaving those who must still comply with the law with even less certainty about what they should do.

Former Republican Sen. Dave Durenberger of Minnesota says he thinks the Democratic-led Senate could try to dampen the House repeal efforts by holding a series of hearings of its own. Among other things they could give health care groups a chance to tell Congress what things in the law they want to see fixed.

"And just putting that 'here are some things that could be improved' on the table, takes some of the wind out of the sail for repeal," Durenberger says.

At a news conference Wednesday, President Obama signaled he was open to some changes to the health law. He even suggested one of his own — repealing an unpopular provision increasing the number of 1099 forms small businesses must file with the IRS.

"It was designed to make sure that revenue was raised to help pay for some of the other provisions," the president said, "but if it ends up just being so much trouble that small businesses find it difficult to manage, that's something that we should take a look at."

Health Reform to Cover Most Young Adults by 2014

2010-10-10T01:58:00.000-07:00

More than 12 million of the nation's 15 million uninsured young adults ages 19 to 29 may be able to get health insurance in 2014 as a result of the healthcare reform law, according to a report released Friday by the Commonwealth Fund.

"By providing multiple insurance options for young adults at key life transition points, including graduation from high school and college, the law will significantly reduce both the short- and long-term gaps in health insurance that have historically plagued this age group at all income levels," wrote Sara Collins and Jennifer Nicholson, both of the Commonwealth Fund.

The number of uninsured young adults rose from 13.7 million in 2008 to 14.8 million in 2009. In addition, 5 million insured 20-somethings have very high out-of-pocket costs, leaving them effectively underinsured, the authors noted.

Take a look at reality of health care reform

2010-10-10T01:57:00.001-07:00

"A judgment is said to be true when it conforms to the external reality." - St. Thomas Aquinas

I loved the '90s supernatural drama "The X Files," with its ominous, blinking message - "The truth is out there." The "powers that be" seek to hide or distort the truth, that message whispered, but it won't stay cloaked forever.

The first round of Affordable Care Act (health reform) mandates, which took effect in September, reminded me of that message - that external realities exist, no matter how much wishful thinking or righteous indignation we throw at it.

Let's examine two sets of "external realities."

Consider first a young family without family health care coverage. According to the latest census findings, the majority of children live in households making $74,999 per year or less. Focus on the 0.7 percent who reside in households earning $35,000 to $49,999 and the 19.6 percent who live in households earning $50,000 to $74,999. These are typical middle-class households. Imagine for a moment that this family must either choose a sizable payroll deduction for family coverage or a premium for a "child-only" policy. There's the mortgage, taxes, utilities, car payments, car insurance, groceries, clothing, and a little recreation. Living paycheck to paycheck, would you choose to pay a premium for a healthy child who, at most, needs routine immunizations and the occasional office visit for colds? Or would you use that money for some other, seemingly more pressing, need? It is eminently understandable that such families would roll the dice and go without insurance. Before September, however, this was a risk with dire consequences should a child fall ill. Perhaps that risk served to pressure some families into taking the payroll deduction or buying a "child-only" policy.

Now imagine being an insurance company. By definition, insurance is an agreement that one party will assume a risk for a fee paid by the other. With life insurance, the buyer bets he will die, while the insurer, armed by the actuary, believes he will not. The few statistical aberrations are adequately paid for by the vast majority who make no claims. This majority forms a pool, which protects the solvency of the insurer and its continued ability to pay claims. With health insurance, the protective pool is formed by the healthy as a hedge against the claims of the sick. A pool composed entirely of the sick is called bankruptcy.

These two realities, of the family and of the insurer, crashed head on in September. As of Sept. 23, insurers are prohibited from denying coverage to children with pre-existing conditions. However, the mandate that everyone must purchase insurance doesn't kick in fully until 2016. If you are the young family, there is now absolutely no reason to worry about insurance. If your child stays healthy, as most children do, you can pocket the premium without guilt. Going without is no longer a gamble, because insurers have to cover your child if, God forbid, he or she should need an organ transplant or chemotherapy or some other treatment that costs in the hundreds of thousands of dollars.

Lagging U.S. life expectancy ranking blamed on health system

2010-10-10T01:56:00.000-07:00

The United States is falling sharply behind in worldwide rankings of life expectancy, and shortcomings in the U.S. health care system may be to blame, scientists say.

Researchers studying the issue concluded that obesity, smoking, traffic accidents and homicide can’t account for the drop—“leading us to believe that failings in the U.S. health care system, such as costly specialized and fragmented care, are likely playing a large role,” said Peter Muennig of Columbia University, lead author of the study.

In the research, which appears in the Oct. 7 online issue of the journal Health Affairs, Muennig and co-author Sherry Glied of Columbia cite the growing lack of health insurance among Americans as a possible culprit.

The study looked at health spending, behavioral risk factors like obesity and smoking, and survival rates for men and women ages 45 and 65 in the U.S. and 12 other industrialized nations.

While the U.S. has achieved gains in 15-year survival rates decade by decade from 1975 to 2005, the researchers found that other countries enjoyed even greater gains. So the U.S. slipped in the ranking, even as per capita health care spending rose at more than twice the rate of the other countries.

Around 1950, the United States ranked 5th for life expectancy at birth for women and 10th for men among developed countries, according to research cited by Muennig and Glied. The most recent figures, from the CIA World Factbook, rank the United States 22nd among those same countries.

Muennig and Glied found similar trends in the 13 countries that they studied, though they only examined 15-year survival rates for people at age 45 and 65.

When they compared risk factors, they found very little difference in smoking habits between the U.S. and the comparison countries—in fact, U.S. smoking rates declined more quickly than most other countries.

And while people are more likely to be obese in the U.S. than elsewhere, this was also the case in 1975, when the U.S. was less far behind in life expectancy, the investigators noted. Moreover, they said, the percentage of obese people actually grew faster in most of the other countries between 1975 and 2005.

Homicide and traffic deaths, meanwhile, have accounted for a stable share of U.S. deaths over time, and can’t explain the drop in life-expectancy ranking, the scientists said.

The most likely remaining explanation is flaws in the health care system, said Muennig and Glied, pointing to the role of unregulated fee-for-service payments and high reliance on specialty care amid skyrocketing costs.

Students 'should consider the value of their belongings' when searching for a house insurance quote

2010-09-18T01:41:00.001-07:00

Students searching for a house contents insurance policy to cover them when they are away from their parent's home could do well to evaluate how much their belongings are worth.

This is according to Graeme Trudgill, technical and corporate affairs executive at the British Insurance Brokers' Association (BIBA), who explained that consumers should account for designer clothes, their computer, printer and gadgets like iPads - as when combined their value could be very high.

"People have a lot of stuff and you have got to make sure that you just add it all up. It doesn't take long - you can do a quick check and your insurance broker can help talk you through it to make sure you have covered everything," he continued.

However, students - of which UCAS states there will be 470,789 attending new courses this year - may not have to shell out for their own individual policy, as some providers offer home-from-home deals where parents extend their policy to cover the youngsters' possessions while they study elsewhere.

Aetna gets OK to hike rates on individual health policies in California

2010-09-18T01:40:00.000-07:00

More than 1 million Californians will see their health insurance premiums rise Oct. 1 now that regulators have wrapped up their review of a plan by Aetna Inc. to raise rates an average of 19% for 65,000 individual policyholders.

Aetna was cleared Friday by the state Department of Insurance to proceed with its new plan. It was the last of four major insurers to be reviewed by the department, which has OKd double-digit rate increases by Anthem Blue Cross, Blue Shield of California and Health Net Inc. in the last month.

Regulators stepped up their scrutiny of the insurers after Anthem announced plans earlier this year to raise premiums by as much as 39%, triggering a backlash among policyholders, lawmakers and the White House. The insurer canceled the hikes and sought smaller increases that were allowed.

The insurance department has no authority to block rate hikes as long as they comply with California law, which requires insurers to devote at least 70 cents of every premium dollar to medical claims.

Aetna's plan met that threshold, the state concluded Friday. All of the hikes reviewed by the state take effect Oct. 1.

"The Department of Insurance in no way condones or supports these insurance rate increases on California policyholders, but the unfortunate reality is that legally insurers are entitled if their rate filings are found to be in line with state law," spokesman Ioannis Kazanis said.

Aetna welcomed the insurance department's decision and defended its rate increase as a necessary move to keep up with rising healthcare costs. The company said its maximum increase for a fraction of its members would be 30%.

"We are pleased that, after extensive and thorough review, the [department] has accepted the rates for Aetna's individual products in California," said Beth Anderson, president of Aetna's west region.

"Rate increases are never easy, but the growing market trends we are seeing in California — such as the increasing prices for hospital care, prescription drugs, doctor's visits and other healthcare services — directly impacts what our members pay."

Some Aetna policyholders voiced alarm at the coming increase, saying double-digit hikes each year could soon put insurance beyond their reach. Dave and Jo Nixon, for example, will see their annual cost rise 23%, to $17,676 from $14,340. The San Jose couple also have a $3,000 deductible.

"The trend is just crazy," said Dave Nixon, 56. "In two or three years, I'll be paying more for my health insurance than my rent."

Aetna and the other insurers had put their rate increases on hold since July while an outside consultant to the insurance department reviewed their paperwork.

Aetna announced last month that it was going forward with its Oct. 1 increases before the consultant had finished his review. The state would not give its consent until that work was finished.

Learning About Health-Care Reform

2010-08-14T20:55:00.000-07:00

With new health-care reform legislation being hotly debated nationwide, it’s not surprising that a meeting on the subject Friday at the Surry County Senior Center in Mount Airy drew a crowd.

“The new health-care reform is confusing to a lot of people, so if you feel confused, you’re not alone,” Annalisa Davis, the center coordinator, said at the start of a meeting attended by about 50 people, mostly retirees.

They came to hear Bill Wilson of the AARP in Raleigh discuss the various provisions of the bill and what it means not only for senior citizens, but younger families and individuals as well as employers.

“I have yet to see the perfect piece of legislation,” said Wilson, who has many years of experience in public-policy work in the N.C. General Assembly, and gave a similar presentation Friday afternoon in Pilot Mountain.

“And this does not break that mold,” he added of health-care reform. “This is a 2,000-plus-page bill.”

While its passage was controversial and continues to be resisted by many although it has become law, Wilson told the local gathering that some of the bill’s provisions represent an improvement over the present situation.

“But what people really want to know is ’how does this affect me?’”

Medicare Changes

Given the makeup of the audience, a major focus of Friday’s program was Medicare, the federal government program that provides health-care coverage to persons 65 and older and the disabled.

Wilson assured those gathered that guaranteed benefits offered under this program will be continued under the new health-reform legislation. It also is expected to add 10 years to Medicare’s financial solvency, ensuring its continued availability.

One positive way in which Medicare will be affected, Wilson said, is by expanding wellness and preventive care coverage, which will allow annual checkups — and tests and screenings, such as bone-density screenings — at no out-of-pocket costs.

“There are huge improvements in preventive care,” Wilson continued, which are aimed at reducing costs of medical treatment by catching major problems earlier. “That’s an important part of the new bill.”

Wilson also addressed another well-documented concern related to Medicare — the so-called “donut hole” seniors have fallen into which is associated with the Medicare Part D program that subsidizes the cost of prescription drugs.

The donut hole occurs when seniors exceed $2,700 in total drug expenses in a plan year, which then requires them to pay 100 percent of their prescription costs until $4,300 is spent out of pocket. The “hole,” which 3.4 million Americans fall into annually, can appear in a hurry when extremely expensive medications are involved.

Wilson said certain provisions in the new health-care legislation are aimed at lowering out-of-pocket costs for prescription medications, gradually leading to the planned closure of the donut hole by 2020. This will include rebates being offered to Medicare beneficiaries to help offset the drug costs.

“It is still complicated, but hopefully by 2020, we’re going to simplify this a little bit,” Wilson told the audience Friday.

The health-care-reform legislation also seeks to reduce Medicare costs through such measures as identifying fraudulent providers, eliminating overpayments and implementing a vendor-certification program.

Those who attended Friday’s program had plenty of follow-up questions for Wilson regarding Medicare.

Arvid Simmons of Mount Airy wondered what will happen with reimbursement rates for medical providers under the program; specifically if people enrolled in Medicare will have to make up the difference between what a doctor or hospital charges and what’s allocated.

According to Wilson, efforts to reduce the reimbursement rate by 22 percent — as a means of keeping costs of care down — have fallen by the wayside. “I don’t know of any provider who could take a 22-percent hit,” the speaker added.

A related question concerned the problems seniors are experiencing in some locations in finding doctors who no longer will accept Medicare patients because of the paperwork and financial issues involved.

“It’s a real problem for people moving into the state, especially urban areas,” Wilson said. While a physician in Raleigh or Winston-Salem might continue to see a longtime patient, new retirees to North Carolina are having trouble finding doctors willing to treat them through the Medicare program.

Effects On Individuals

Wilson also addressed the matter of how the recent legislation will impact the uninsured or those who buy their own coverage.

Beginning in 2014, the new health-care program will provide a one-stop shopping opportunity for them to obtain coverage through “state exchanges.”

These plans will offer a standard plan of comprehensive benefits, with four levels of coverage in all. There will be no discrimination based on pre-existing conditions, according to the AARP official.

Until 2014, temporary coverage can be obtained through “high-risk pools,” but these will still be expensive compared to most plans.

“This is a temporary program to help people who have trouble buying insurance, until we get to the state exchanges in 2014,” Wilson explained.

He also pointed out that the health-reform legislation will equalize the costs of coverage, which now can be higher based on someone’s gender, health status or the fact they are older adults. “Now if you’re a female, you’ll pay exactly the same premium as a male does,” Wilson told audience members.

The measure further eliminates coverage limits for medical care, which can soon be met if a catastrophic illness strikes someone. The main reason people lose their homes is because of high health-care expenses, Wilson said. “This will go a long way toward eliminating those bankruptcies and foreclosures,” he said of the new legislation.

Tax credits are in place to assist consumers in paying their premiums, to couples earning less than $58,280 and individuals with incomes lower than $43,320.

Also, the new plan expands eligibility for Medicaid coverage, which is available to low-income persons.

Families who are part of an employer-provided health plan can have their unmarried children covered under the same policy until they reach age 26. “That starts this year,” Wilson said.

“This will cover a lot of young people who think they are invincible,” he added, but don’t realize that they might be hurt in a car accident and need coverage.

Penalties Possible

Individuals are required to have basic medical coverage under the reform package, and will face penalties otherwise, according to Wilson.

Beginning in 2014, those who are eligible to buy insurance through a state exchange and don’t will be assessed a penalty of $695 per year or 2.5 percent of their taxable income, whichever is greater.

The penalties are designed to generate funds to offset some of the costs of those who remain uninsured and then require care.

Employer Impact

The guest speaker also discussed the new legislation’s effects on employers Friday. “This is a big sticking part in the bill,” he said.

Under its provisions, small businesses are exempt. “For any company with less than 50 employees, there’s no requirement that you provide health insurance coverage at all,” Wilson added.

However, tax credits are available to assist those businesses in paying for coverage for eligible employees.

Around 80 percent of American businesses employ fewer than 10 people.

About 2 percent of businesses across the country will be subject to some increase in costs under the recently passed bill.

Wilson responded Friday to rumors that employees will have to pay taxes on insurance provided through company plans. “Not true,” he said.

No Dental

In response to another question from an audience member, Wilson said dental coverage remains a “big gap” in terms of the overall health-care picture. “You’re out of luck,” he told the woman who inquired about that aspect.

While there is some coverage for dental services under Medicaid, that is not the case for Medicare, Wilson said.

“It’s one of the biggest problems we have right now in this state,” the speaker said of lack of dental-care coverage. “It just impacts your entire health,” Wilson added, explaining that tooth problems can affect a person’s nutrition, for example, and lead to other medical difficulties.

Those attending Friday’s presentation seemed to come away with a better understanding of the new legislation.

“I thought it was very good,” said Nancy Walker, who believes the program was interesting as well as informative.

“We are a small business owner,” explained Walker, a Mount Airy native who know lives in Rural Hall and co-owns an electrical firm. She said she came to Friday’s meeting concerned about how health-care reform will affect her personally and her business.

“What’s in this program that we don’t know about yet, us as a little guy?” she asked.

Affordable health insurance – What you should know

2010-08-14T20:54:00.000-07:00

There has been quite a few changes to the health-insurance industry in 2010, and there will be many more to come throughout the rest of the year. Many of the rules that currently control health insurance industries could well be changed.

It may be difficult to start looking for health insurance. Now the term “Affordable health insurance” may seem a contradiction in terms.as due to high premiums it’s not easy to believe that the coverage is actually worth the money.

The cost of health insurance coverage is small when you look at the cost of health care without the insurance.

The best way to find cheap health insurance is by checking the prices of a whole host of health insurance providers. Health insurance companies will charge you depending on many aspects such as if you are a smoker, your current weight and any existing health problems.

What you really need to know is how you can save money on health insurance. Taking the first offer that comes along will, most of the time, leave you paying more then you have to. You should also remember, just because one company has the lowest premium, this does not mean they are offering the best value for money.

Find out which physicians and hospitals are covered in your health insurance. Make sure your health care plan includes hospitals that are located nearby. Try not to be enticed by higher deductibles. Remember that a higher deductible could lower your possible monthly premium but it can also make you pay more for standard care.

Now the best tool you have available when you want to buy health insurance is to use the Internet. If you are ready to start looking for cheap health insurance, you can go online and get an online quote. Its important that you do proper research as many people are paying too much for their medical plan as some providers may charge for coverage which is unnecessary.

It's war on the wards of China's hospitals

2010-08-14T20:52:00.000-07:00

FORGET the calls by many Chinese patients for more honest, better-qualified doctors. What Shenyang's 27 public hospitals really need, officials have decided, is police officers.

And not just at the entrance, but as deputy administrators. The goal: to keep disgruntled patients and their relatives from attacking the doctors.

Officials in this north-eastern industrial city of nearly eight million people have a point. Chinese hospitals are dangerous places to work. In 2006, the last year the Health Ministry published statistics on hospital violence, attacks by patients or their relatives injured more than 5,500 medical workers.

"The police should have a permanent base here," said a neurosurgeon at Shengjing Hospital. "I always feel this element of danger."

In June alone, a doctor was stabbed to death in Shandong Province by the son of a patient who had died of liver cancer.

Three doctors were severely burned in Shanxi Province when a patient set fire to a hospital office. A paediatrician in Fujian Province was also injured after leaping out a fifth-floor window to escape angry relatives of a newborn who had died under his care.

Over the past year, families of deceased patients have forced doctors to don mourning clothes as a sign of atonement for poor care, and organised protests to bar hospital entrances. Four years ago, 2,000 people rioted at a hospital after reports that a three-year-old boy was refused treatment because his grandfather could not pay £50 in upfront fees. The child died.

Doctors and nurses say the strains in the relations between them and patients' relatives are often the result of unrealistic expectations by poor families who, having travelled far and exhausted their savings on care, expect medical miracles.

We're Headed Straight Off a Cliff If Health Care Passes

2010-03-20T21:36:00.000-07:00

Pork is the preferred legislative meat for members of Congress, but this weekend they opted for bologna as they tried to convince the public – and themselves – that their so-called “health care” or health insurance “reform” monstrosity will be good for us. At least Castor oil was supposed to work even though it tasted awful. This bill not only tastes bad, it will curdle the best health care system in the world, which could be made a lot better, but will be made much worse with many of the provisions in this legislation.

Democrats now readily admit that Medicare is full of waste, fraud and abuse, but they want us to believe they can run an even larger venture without throwing additional money away. Amazing!

President Obama again claimed in Saturday remarks to the House Democratic caucus that the bill will reduce the deficit by $1.3 trillion. He must know that isn’t true because the money “saved” from Medicare cuts will go to pay for new spending. Only in Washington can you save money and spend money at the same time.

Addressing critics of the bill, President Obama said no one is “going to pull the plug on grandma.” They won’t have to. Grandma will be denied treatment because she will be too much of a financial burden on government. It’s called rationing. Grandma had better start working out, eating lots of oatmeal and hope she doesn’t get sick. Why do you think the president kept mentioning sick children? It’s because children are the ones who will get the most – and best – treatment. Rahm Emanuel’s brother, Ezekiel, has said government has a right to decide how many health care dollars you are worth. And if children with a lifelong taxpaying potential are worth more than grandma who is taking more from the tax pot than she is contributing, that’s too bad for grandma.

The president also said the bill will save money by requiring only one test by the doctor “not five tests.” But what if the first test doesn’t reveal the nature of an illness? Suppose a cancer is hiding in one organ and the test is for cancer in another organ? A second (or fifth) test might reveal the location of the disease, but under Obamacare, a government bureaucrat will allow just one test. -- It’s a form of Russian roulette.

The president promised again “you can keep your doctor.” But what if the doctor quits because he or she can’t afford to accept reduced fees mandated by government to keep costs down, while paying ever-increasing premiums for malpractice insurance to protect the doctor from lawsuits, which, by the way, is another reason the doctor did so many tests.

Companies sometimes test-market new products in regions of the country to see how well they sell. Government-run health care has been test-marketed in Massachusetts and it is a disaster. The cost of the state’s insurance program has ballooned by 42 percent, or almost $600 million. According to an analysis by the Rand Corporation, “in the absence of policy change, health care spending in Massachusetts is projected to nearly double to $123 billion in 2020, increasing 8 percent faster than the state’s gross domestic product.”

The cost of insurance in Massachusetts is the highest in the nation. Double-digit rate increases are expected again this year. Yet, President Obama claimed Saturday that under the Democrats’ plan, rates will go down. How is this possible? If Massachusetts can’t run a cost-effective health program, how can the federal government? And by the way, the only reason Massachusetts has not gone broke (but is headed there) is because Washington has conducted large transfusions of cash because it has a vested interest in protecting the illusion of Massachusetts’ success.

The president said we should support the health insurance bill out of “a sense of neighborliness and community.” When I was growing up, that meant you, not government, helped your neighbor. Government was a last resort, not a first resource. Never has “I’m from the government and I’m here to help you” sounded more like an empty promise.

Remember when Democrats used to care about debt as a burden to our children and grandchildren? They claimed to care about debt when it was a “mere” $450 billion under George W. Bush. Now it’s headed toward the trillions. Where are the green eye-shade Democrats now? They’re spending us into debt as fast as the Treasury can print the money – or the Chinese will lend it to us. The interest on the national debt now exceeds the GDP of some countries.
Total U.S. debt has soared to an all-time high of 370 percent of yearly economic output. That far exceeds its peak of 300 percent during the Great Depression.

Jobs will be lost because of this bill. Already, Caterpiller Company is laying-off workers because it estimates the health care bill will cost the company $100 million.

Why should we believe the promises of politicians? While the president and Speaker Nancy Pelosi touted Medicare, what they forgot to mention was that the cost of that program (and the waste, fraud and abuse that is rampant in it) was supposed to be a fraction of today’s cost. In fact, it was sold on the basis of low cost.

There are no such things as cheap government programs. They become like the "Blob That Ate Tokyo," gobbling up everything in their path.

President Obama quoted Abraham Lincoln, who said he was “bound to be true” and suggested that he, too, was bound to be true. This legislation is so full of budget gimmicks, tricks and lies that the only thing true about is that it will make health care in America worse, not better.

Obama Urges Dems to Come Together for Health Care

2010-03-20T21:35:00.000-07:00

Victory within reach, President Barack Obama exhorted House Democrats on Saturday to stay true to their party's legacy and make history by bringing health insurance to millions of struggling families now left out. Leaders exuded confidence as they defused thorny problems in the countdown to a landmark vote.

Obama evoked Abraham Lincoln's moral compass and extolled Democratic achievements such as Social Security and Medicare — once controversial, now an essential part of the social fabric — on a day marked by a frenetic hunt for votes inside the Capitol and angry tea party demonstrations at the door. Some protesters hurled racial insults at black members of Congress.

"Is this the single most important step that we have taken on health care since Medicare?" Obama asked rank-and-file Democrats far from the chanting crowds. "Absolutely. Is this the most important piece of domestic legislation, in terms of giving a break to hard working, middle-class families out there since Medicare? Absolutely.

"It is in your hands," Obama said, bringing lawmakers to their feet. "It is time to pass health care reform for America and I am confident that you are going to do it tomorrow."

In a carefully orchestrated appeal to unity ahead of a career-defining vote, Obama and House leaders were joined by Senate Majority Leader Harry Reid, D-Nev., who brought a pledge from more than 50 of his Democratic colleagues to promptly finish the bill after the House votes Sunday. House Democrats have been wary of being left in the lurch by the famously unpredictable Senate.

A series of last-minute flare-ups threatened to slow the Democrats' march to passage, after more than a year of grueling effort.

The most intense focus was on a small group of Democrats concerned that abortion funding restrictions in the legislation don't go far enough. Determined to avoid votes on such a charged issue, Democratic leaders raised the possibility of addressing the concerns of abortion foes through an executive order from Obama. It would reaffirm existing federal law barring taxpayer funded abortions except in cases of rape, incest or to save the life of the mother.

Fear of absorbing health insurance costs hit San Diego’s youth

2010-01-29T20:17:00.000-08:00

Health care reform remains a hotly debated issue. It makes sense. The U.S. Census Bureau reported 46.3 million people had no health insurance in 2008.

Still, the debate has failed to highlight a key group: young people even though the health care package will affect them just as much. The issue is more so prominent in college town, San Diego.

In 2008, people age 18 to 24 had the highest rate of no health coverage at 28.6 percent, according to data compiled by the U.S. Census Bureau. The second highest uninsured group included people 25 to 34 years old at 26.5 percent. Thus, young people constitute more than half of all uninsured people in the U.S., according to the report.

If the proposed health care reform is passed, college students would be greatly impacted and in multiple ways.

First off, the millions of people who are uninsured, which includes college students, would have to obtain insurance, said San Diego State University political science professor Brian Adams.

In fact, he said this is one of the positive aspects of the legislation.

“Young people should probably get insurance anyway, because even if you’re healthy you can get into a car accident or you can have some catastrophic illness,” he said. “If you get into a car accident and you have $200,000 of health care debt, it can bury you for decades.”

SDSU journalism and media studies senior Natalie Scott is thankful to have health insurance through her parents’ plan while she is in school. She is concerned, however, about being covered once she graduates.

“I want to be covered even when I’m done with college and have my first real life job,” she said. “I won’t be getting paid too much so it is important to me that I get coverage and can afford it while I am working on my career.”

Other students, like Mary Zhong, have no health insurance. Her health care was terminated under her parents’ health plan when she recently turned 20. Zhong, who is a political science major, said she is “immensely” concerned about health care and hopes to purchase coverage through her part-time job.

“I recently studied abroad in Oxford University in England and was in awe of their universal health care system,” she said. “The U.S. is a highly industrialized nation, and yet I find it baffling that we are without some form of universal medical access. Everyone needs health care, and it should be easy to access.”

New Rules Promise Better Mental Health Coverage

2010-01-29T20:16:00.000-08:00

WASHINGTON — The Obama administration issued new rules on Friday that promise to improve insurance coverage of mental health care for more than 140 million people insured through their jobs.

In general, under the rules, employers and group health plans cannot provide less coverage for mental health care than for the treatment of physical conditions like cancer and heart disease.

Insurers cannot set higher co-payments and deductibles or stricter limits on treatment for mental illness and addiction disorders. Nor can they establish separate deductibles for mental health care and for the treatment of physical illnesses.

Such disparities are common in the insurance industry. By sweeping away such restrictions, doctors said, the rules will make it easier for people to obtain treatment for a wide range of conditions, including depression, autism, schizophrenia, eating disorders and alcohol and drug abuse.

For decades, many health plans have had limits on hospital inpatient days and outpatient visits for mental health treatments, but not for other types of care.

Kathleen Sebelius, the secretary of health and human services, said the rules guaranteed that people with debilitating mental disorders would not suffer “needless or arbitrary limits on their care.”

The rules, which take effect on July 1, carry out a 2008 law that was adopted with bipartisan support. They significantly expand the rights of people with mental illness, much of which goes untreated because of insurance restrictions.

Under the rules, insurers can still review claims for “medical necessity,” can still require prior approval of some services and can still charge consumers more for using doctors and hospitals that are not on a list of preferred providers.

But under the rules, insurers cannot use these techniques in a more restrictive way for mental health care than for other medical services.

The administration said the new requirements could increase premiums by four-tenths of 1 percent, or $25.6 billion over 10 years. Businesses with 50 or fewer employees are exempt.

The rules apply to group health insurance plans of the kind typically offered by employers. Federal health officials said the rules did not apply to the individual insurance market, where policies are sold directly to individuals and families. However, some states have laws that apply to the individual market.

Irvin L. Muszynski, a lawyer at the American Psychiatric Association, praised the government’s decision to require a single deductible for mental health and medical-surgical coverage.

“Patients with mental illness often have general medical conditions like diabetes or high blood pressure that require treatment at the same time,” so a combined deductible makes sense, Mr. Muszynski said.

The rules were developed by the Labor Department, the Department of Health and Human Services and the Internal Revenue Service, which share responsibility for their enforcement.

The government said the rules would benefit 111 million people in 446,400 group health plans offered by private employers, and 29 million people in 20,000 plans sponsored by state and local governments.

In the new rules, the government says a health plan would be violating the law if it “imposes an annual $250 deductible on all medical-surgical benefits and a separate annual $250 deductible on all mental health and substance-use disorder benefits.”

The rules say that an insurer may require “prior approval that a course of treatment is medically necessary.” But the insurer cannot enforce this requirement in different ways for medical benefits and mental health services. For patients who receive treatment without prior approval, the penalty must be the same.

A number of companies specialize in managing mental health benefits. The Obama administration said the techniques used by these companies would hold down the cost of complying with the new rules.

But, it said, the standards and techniques used to manage mental health benefits must be comparable to those for other medical care and cannot be applied more stringently.

In a preamble to the rules, the Obama administration said that patients had typically faced higher co-payments for visiting mental health professionals than for visiting primary care physicians.

The rules are likely to reduce this disparity, so more people will be treated by mental health professionals, the administration said. This, in turn, “could lead to more appropriate care and thus better health outcomes,” it said.

The law requiring parity in the coverage of mental and physical illnesses is named for its sponsors, former Senators Paul Wellstone, Democrat of Minnesota, and Pete V. Domenici, Republican of New Mexico.

What About Health Care Reform?

2010-01-29T20:10:00.000-08:00

President Obama mishandled the important topic of health care reform during his State of the Union speech on Wednesday night.

He spent little time discussing the issue, but when he did, he showed no sign of changing his method or learning from his opponents, insisting once again, "Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan." But where is the evidence of this? Both major bills before Congress include clauses which dictate exactly the kind of insurance you can have and what you can't.
And where is the incentive for doctors to keep accepting this insurance? More than 50% of practicing doctors already don't accept Medicaid, according to a 2005 survey, and the Medicare Payment Advisory Commission determined in 2008 that 28% of Medicare patients were unable to find primary care doctors. The yearly doctor dropout rate in private insurance exceeds 10% in many places, including New York.

President Obama went on to state that the health reforms would "reduce costs and premiums for millions of families and businesses," but how so? In Massachusetts, for example, insurance premiums went up when companies were compelled to cover pre-existing conditions and not drop anyone when they were sick. Noble ideals, but costly. And the rate of unnecessary ER admissions has remained steady at 15% even after universal health coverage passed in the bay state. "Patients will be denied the care they need" if health reform doesn't pass, the president reiterated last night, but there is no proof that increasing coverage expands access to health care. In Canada and Europe, the opposite is true.

The American public is no longer accepting the same tired platitudes, as evidenced by the Massachusetts election and the current climate around the country.

There are crucial problems not being addressed by health reform: First, there is a big shortage of doctors throughout the country, which will interfere with access to health care no matter your insurance coverage. The Association of American Medical Colleges estimates a shortage of 150,000 doctors by 2025.

Second, a one-size-fits-all HMO-style insurance is expensive and easily overused. It lacks the built-in disincentive for overuse of cheaper, higher-deductible insurance. Extending low-deductible insurance (a central principle of all the health reform bills) will lead to higher premiums, especially without portability to promote competition.

Third, even if you already have insurance it will be choked by government regulations and oversight under the new health insurance system, and it isn't likely to cover the high tech solutions you need. Lastly, doctors are already overwhelmed with too many patients. With no tort reform and decreasing reimbursements, they are likely to quit or at least quit taking insurance.

By not acknowledging America's concerns about health reform Wednesday night, the president appeared inflexible and incapable of real compromise. And by not spending much time on a topic that was front and center just a few weeks ago, he looked more like a politician than a leader.

Marc Siegel, MD

Unions Rally to Oppose a Tax on Health Insurance

2010-01-10T04:11:00.001-08:00

When millions of blue-collar workers were leaning toward John McCain during the 2008 campaign, labor unions moved many of them into Barack Obama’s column by repeatedly hammering one theme: Mr. McCain wanted to tax their health benefits.

But now labor leaders are fuming that President Obama has endorsed a tax on high-priced, employer-sponsored health insurance policies as a way to help cover the cost of health care reform. And as Senate and House leaders seek to negotiate a final health care bill, unions are pushing mightily to have that tax dropped from the legislation. Or at the very least, they want the price threshold raised so that the tax would affect fewer workers.

Labor leaders say the tax would hit not only wealthy executives with expensive health benefits, but also many rank-and-file union members who have often settled for lower wage increases in exchange for more generous health benefits.

The tax would affect individual insurance policies with annual premiums above $8,500 and family policies above $23,000, which by one union survey would affect one in four union members.

The House bill does not contain such an excise tax, and many House Democrats oppose adding it to the combined House-Senate legislation. But the tax is a critical revenue component in the Senate’s bill. If the bill does too little to cover its costs, it might be defeated. Many economists support the tax, saying it will help hold down costs.

With labor groups warning that the tax will infuriate a key part of the Democratic base — union members — President Obama has agreed to meet with several top labor leaders on Monday to address their concerns and try to defuse their anger. The group includes the presidents of the A.F.L.-C.I.O., Teamsters and the steelworkers’ and service employees’ unions.

But whether the tax is negotiable remains unclear. Not only has Mr. Obama specifically endorsed the idea, but the White House and Senate leaders see the tax as pivotal in paying for the health care overhaul and addressing runaway health care costs.

Many Democrats and union officials fear that if both sides dig in on the issue, it could create a rift between the White House and labor — with some union leaders hinting they might lobby aggressively against the entire health care bill if it contains such a tax.

Union leaders have repeatedly warned the White House about the strong rank-and-file dismay, which could hurt the Democrats in Congressional elections this fall, especially in battleground states like Ohio, Pennsylvania and Wisconsin.

Ron Gay, an AT&T repairman in Youngstown, Ohio, who spent much of the summer of 2008 urging co-workers to vote for Mr. Obama, said, “If this passes in its current form, a lot of working people are going to feel let down and betrayed by our legislators and president.”

The Congressional Budget Office estimates that 19 percent of workers — or about 30 million employees — would be affected by the tax in 2016. Economists say most of them would be nonunion, although it is organized labor that has the lobbying clout to take a stand.

In recent days, labor’s strategy has become clear. Unions are urging their members to flood their representatives with e-mail messages and phone calls in the hope that the House will stand fast and reject the tax. The A.F.L.-C.I.O., a federation of nine million union members, has declared next Wednesday “National Call-In Day” asking workers to call their lawmakers to urge them not to tax health benefits. The International Brotherhood of Teamsters is urging members to tell their representatives that “such a tax is simply a massive middle-class tax hike that this nation’s working families should not be forced to endure.”

Many Democrats fear that enacting the tax will hurt their re-election chances.

“This would really have a negative impact on the Democratic base,” said Representative Joe Courtney, Democrat of Connecticut, who has enlisted 190 House Democrats to sign a letter opposing the tax. “As far as the message goes, it’s a real toughie to defend.”

While union leaders would prefer killing the tax, some say privately that they could live with it if the threshold is lifted to $27,000, say, or $30,000. They argue that many insurance policies above $23,000 are typical of the coverage in high-cost areas like New York or Boston, or policies that cover small businesses or employers with older workers.

According to a union survey, one in four members would be hit by a $23,000 threshold, but only one in 14 if the threshold were raised to $27,000.

White House officials, however, voice concern that raising the threshold that much would lose $50 billion of the $149 billion in revenue that the tax is expected to generate over 10 years.

Health overhaul bill facing court challenges

2010-01-10T04:10:00.001-08:00

It now appears that some form of a health care bill will be passed unilaterally by congressional Democrats. But the fat lady has yet to warm up. Key provisions in the bill could be unconstitutional and need to be challenged. It could be a close constitutional call, as there are arguments on both sides.

Those who framed and ratified the Constitution intended to create a system of enumerated powers where all powers not specifically delegated to the federal government remained with state and local governments, and the people. Defenders of the individual mandate, requiring all Americans to have health insurance, cite the taxing power of the 16th Amendment and the commerce clause as the enumerated powers for this mandate.

In 1994, the Congressional Budget Office (CBO) opined: “The mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action. The government has never required people to buy any good or service as a condition of lawful residence in the United States.” But the CBO is a budget office, not a legal office issuing a historical statement about policy.

Individuals not carrying health insurance will be fined and possibly subjected to other penalties by the Internal Revenue Service. However, Congress has been careful not to call this a “fine,” but rather a “tax,” permissible under the 16th Amendment that authorized the federal income tax (“the Congress shall have power to lay and collect taxes on incomes, from whatever source derived”).

Such a tax would be discriminatory against individuals without health insurance, but defenders would counter that a graduated, discriminatory income tax schedule has been in effect since 1913, with those in higher-income tax brackets paying more taxes at a higher percentage rate. Hence, the 14th Amendment's equal protection clause may or may not be applicable to the individual mandate.

The 5th Amendment's takings clause may also be operative in that the government is, in a very real sense through the individual mandate, taking the individual's private property, in the form of his or her income, to buy insurance.

The commerce clause was initially intended by the framers to free up interstate commerce, specifically trade among the 13 Colonies, which had erected trade barriers. Following the New Deal and the Supreme Court-packing scandal, federal courts frequently defined the commerce clause as permitting regulations governing all commercial activity, far beyond the scope of interstate trade.

However, several recent decisions have revived some limits on the clause, such as United States v. Lopez. In this 1995 case, the Supreme Court held the commerce clause does not authorize a federal law banning guns in local school zones.

Critics of the Senate health care bill have also argued that the bill violates the equal protection clause by legislating unequal treatment among the states. Several “sweetheart” deals were arranged to secure passage of the bill — for example, the so-called “Cornhusker Kickback” in which the state of Nebraska was given a permanent waiver for any expanded state Medicaid costs mandated by the bill. Poor states will subsidize this discriminatory bailout.

But defenders of the bailouts will counter that state earmarks have been business as usual for decades by both Democrats and Republicans.

Even if Congress passes a health care bill on the grounds that it passes constitutional muster under the equal protection clause, the takings clause and the commerce clause, Congress does not have the final say: The courts do. We learned this from Marbury v. Madison, where the Supreme Court ruled an act of Congress unconstitutional. The courts today could indeed rule portions of the health care bill in violation of the 14th and 5th Amendments and/or the commerce clause.

The bill must be challenged in court. Forcing Americans to buy a certain private-sector product is an overdose of big government that may be toxic to the plain meaning and intent of the Constitution.

LI religious leaders offer support for Obama reforms

2009-08-19T21:14:00.000-07:00

A variety of Long Island religious leaders expressed support for President Barack Obama's national health care reform efforts Wednesday, though some were cautious about the plan and disappointed.

"Changes are needed," the Rev. Albert Hahn, pastor of the Smithtown United Methodist Church, said. "Health care costs need to be managed better, and a lot of Americans are in need of this kind of care and can't afford it."

Rabbi Anchelle Perl, the head of Congregation Beth Sholom Chabad in Mineola, was more cautious about the plan. "Health care reform needs to be done in a balanced way, along a middle ground, so you don't destroy the present infrastructure," he said. "This is a capitalist society."

Following Obama's two telephone conference calls Wednesdayto several religious groups to discuss his health care plan, local religious leaders offered their take on the health plan.

Bishop William Murphy, the head of the Diocese of Rockville Centre, could not be reached for comment. But in a letter he sent to all of Congress last month on behalf of the United States Conference of Catholic Bishops, Murphy said the bishops support "comprehensive health care reform that leads to health care for all, including the weakest and most vulnerable."

Murphy's letter also opposed not treating immigrants or using public funds for abortions. Murphy says abortion goes against church teachings.

Obama's preferences for a health care bill don't include public funding for abortions or health care for illegal immigrants.

Bishop Robert Harris of Grace Cathedral in Uniondale, who said he often is in contact with people with no health insurance, said he is "a little disappointed that the president is scaling back his original proposal." His reference was to the Obama administration signal recently that it may drop the controversial "public option" component from its proposed overhaul of the health care system.

"These are the conservatives who are against this, not the people who voted for Barack Obama," Harris said.

Slow Road to Government Care

2009-08-19T21:11:00.000-07:00

There are hints that the Obama administration and Democratic congressional leadership might be willing to negotiate on the inclusion of a government health insurer as part of health-care reform. The most likely alternative proposal, which has been discussed by the Senate Finance Committee, is to establish some system of consumer cooperatives or "co-ops."

While details are sketchy, the basic idea is to subsidize the creation of nonprofit health insurers on a state or regional basis. These supposedly would be run independent of the government and compete with traditional private health-insurance plans.

These government-authorized co-ops would serve no useful purpose. And they would risk the same adverse consequences as a public plan.

Democrats' health insurance proposals already require private insurers to accept all applicants with no pre-existing condition exclusions, at premium rates that do not reflect health status and vary only within a narrow range based on age. These changes guarantee people access to health insurance at rates that would not price the ill or near-elderly out of the market—without creating government-authorized co-ops.

Democrats' proposals expand eligibility for Medicaid and provide significant premium subsidies to buyers with incomes up to 300% or even 400% of the poverty level. These provisions would make insurance substantially more affordable for people with low-to-moderate income—without creating government-authorized co-ops.

Government-authorized co-ops also are not necessary to provide consumers with nonprofit alternatives. Nonprofit mutual insurance companies, most notably many Blue Cross and Blue Shield plans, already offer health insurance in many states. They are dominant players in some states.

Absent taxpayer subsidies or special rules, co-ops would not have any inherent advantage over private health insurers in establishing provider networks, negotiating with providers, and monitoring health-care utilization and fraud. Proposed co-ops instead would require billions of dollars of "start-up" subsidies.

More important, the creation of government-authorized co-ops would entail significant risk of ongoing subsidies by taxpayers (if not by private health-insurance buyers), of substantial private insurance crowd-out, and of eventual conversion to a government-run plan. Like a proposed public plan, government-authorized co-ops would be backed implicitly if not explicitly by taxpayers.

They would not have to hold the amounts of capital that private health insurers hold to back their promises. Government-authorized co-ops would almost certainly not have to pay income or premium taxes that private for-profit and nonprofit insurers must pay.

Although co-ops might initially be required to negotiate their own reimbursement rates with hospitals and doctors, substantial pressure would arise over time for centralized negotiations, with eventual benchmarking off Medicare reimbursement rates.

Compared with a public plan, government-authorized co-ops could simply be a slower road to government health care. The potential benefits are nil; the potential costs are large.

Health insurance stocks dip lower than market

2009-08-19T21:08:00.000-07:00

INDIANAPOLIS — Managed care stocks dipped slightly lower than the overall market Wednesday, after insurers received more bad publicity with letters from Congress asking for executive compensation details and other financial information.

Several stocks fell around 1 percent while the broader Standard & Poor's 500 index climbed slightly. Wednesday's performance followed a managed care rally on Monday, after statements from the Obama administration downplayed the possibility of a government-backed public health plan that many investors fear would provide unfair competition to private health insurers.

The stocks have gone through several volatile periods since the health care reform overhaul debate started taking shape earlier this year.

Dozens of insurers received requests for information that included records relating to compensation of highly paid employees, documents relating to companies' premium income and claims payments, and information on expenses stemming from any event held outside company facilities in the past 2 1/2 years.

The requests were made in letters signed by Rep. Henry Waxman, D-Calif., who guided a portion of health care legislation through the House Energy and Commerce Committee last month as chairman, and Rep. Bart Stupak, D-Mich.

Of the largest publicly traded health insurers, only Louisville, Ky.-based Humana Inc. has said it plans to cooperate fully. Others have only said they received the letters.

Stifel Nicolaus analyst Thomas Carroll said the request implies that health insurers are doing something wrong.

"It's further demonizing of the health insurance industry, and it's pushing the stocks back down today a little bit," he said.

Robert Zirkelbach, a spokesman for the trade group America's Health Insurance Plans, dismissed the request as a "fishing expedition." His group and several health insurers have been active contributors to the health care debate.

For instance, Minnetonka, Minn.-based UnitedHealth Group Inc. has suggested ways the government can save more than $500 billion in Medicare spending over 10 years.

America's Health Insurance Plans favors bipartisan reform and has said universal coverage and stronger regulations can protect consumers and make a public plan or co-ops unnecessary.

The industry also has weathered attacks on its profits, and Obama has frequently said a public plan was needed to keep health insurers honest.

This latest information request creates more "headline risk," according to Carroll.

"The managed care industry certainly is not looking good at all from an image perspective, but I don't know that it ever has," he said.

Senators Closer To Health Package

2009-08-05T22:01:00.000-07:00

Senate negotiators are inching toward bipartisan agreement on a health-care plan that seeks middle ground on some of the thorniest issues facing Congress, offering the fragile outlines of a legislative consensus even as the political battle over reform intensifies outside Washington.

The emerging Finance Committee bill would shave about $100 billion off the projected trillion-dollar cost of the legislation over the next decade and eventually provide coverage to 94 percent of Americans, according to participants in the talks. It would expand Medicaid, crack down on insurers, abandon the government insurance option that President Obama is seeking and, for the first time, tax health-care benefits under the most generous plans. Backers say the bill would also offer the only concrete plan before Congress for reining in the skyrocketing cost of federal health programs over the long term.

Three Democrats and three Republicans from the Senate Finance Committee will brief Obama on Thursday about the progress of their sometimes arduous talks, which are now set to extend through the August recess. The negotiators are holding the details close as they continue to debate key issues, and it could be a challenge for them to meet the Sept. 15 deadline set by the committee's chairman, Max Baucus (D-Mont.), for a deal.

Even if the partnership does not result in legislation, Democratic leaders are already contemplating ways to preserve much of what it produces as they look to unite their party and pick up Republican votes when the health-care debate moves to the Senate floor in the fall. The Finance Committee coalition is seeking compromise on some of the most complex issues facing Congress, including how to compel employers to continue providing insurance to their workers; how to more fairly distribute government subsidies for coverage; and who and how many should be allowed to remain uninsured.

Lawmakers said insurance companies are likely to pass the cost of such a tax to policyholders, raising the price of those plans. That would create a strong incentive for employers to stop offering them, thus driving down overall health-care costs. With employers paying less for insurance, tax analysts predict, they would pay workers more in wages, increasing income tax collections by as much as $180 billion over the next decade.

The Finance Committee proposal is also likely to contain a number of much smaller tax provisions, including a $2,000 cap on flexible savings accounts -- which are currently unlimited -- and a plan to improve tax compliance by requiring businesses to tell the Internal Revenue Service when they pay corporations for services.

"We've got options on the table that will pay for this fully," said Sen. Kent Conrad (D-N.D.), one of the negotiators. "It's a matter of choosing which pieces and how much of each piece is selected."

The excise tax is one of five provisions designed to slow the soaring trajectory of federal health spending, which is on track to bankrupt the country by the middle of the century absent significant reform, according to the Congressional Budget Office. Spurred by the CBO director's startling assertion last month that measures drafted by other committees would not bend the "cost curve," negotiators on the finance panel are also studying a plan to fine insurance companies that do not pay providers electronically, a plan to reduce payments to providers to force them to increase efficiency and a plan to study the comparative effectiveness of various medical treatments.

Finance Committee negotiators also want to set a target for savings through those reforms. If the target is not met, they would create a panel, called the Medicare Preservation Commission, that would recommend ways to obtain additional savings.

Baucus said preliminary estimates from the CBO, the nonpartisan arbiter of the cost of legislation, show that an early version of the plan would not only pay for itself but would begin to reduce projected budget deficits by 2019.

Health care debate: How many actually uninsured?

2009-08-05T21:58:00.000-07:00

By ERICA WERNER (AP)

WASHINGTON — It's a central goal of the president's plan: Extending health care coverage to the millions of Americans who lack it. Question is, just how many million are uninsured?

The answer could make a huge difference in the billions of dollars it will cost to remake the national system.

Barack Obama frequently cites last year's Census Bureau number of 46 million people with no health insurance. But some experts argue that figure is off by tens of millions — in one direction or the other.

The recession's continuing toll on jobs, a tendency to undercount people on Medicaid and other factors make it hard to come up with an exact number. And the most widely accepted range — 40 million to 50 million — includes some 10 million non-citizens, a detail that's generally overlooked when Obama and others talk about "uninsured Americans."

The lack of certainty about such big numbers is one more question mark for Obama and members of Congress as they try to craft a plan that would cover most of the uninsured. Obama says his goal is to cover 97 percent to 98 percent of Americans, a target that would be reached by plans taking shape in the Senate — if you don't count illegal immigrants. A bill crafted by House Democrats comes in closer to 94 percent.

All the plans would exclude illegal immigrants, who account for as much as 17 percent of the uninsured, according to the Pew Hispanic Center.

"I want to cover everybody," Obama said at a news conference last month. "Now, the truth is that unless you have a what's called a single-payer system in which everybody is automatically covered, then you're probably not going to reach every single individual."

Some people don't want health insurance or just don't bother to get it, but most people who don't have it can't afford it, Obama said.

"So I think that the basic idea should be that in this country, if you want health care, you should be able to get affordable health care," he said.

New Census Bureau figures expected next month could scramble the equation, adding billions in costs if the numbers come in higher than expected, or reducing costs if the numbers are lower.

There could be serious implications "if we all of a sudden found that instead of 45 million uninsured there are 35 million," said Michael O'Grady, a senior fellow at the University of Chicago's health policy and evaluation department and a former assistant secretary at the Department of Health and Human Services.

A lower figure could cut two ways: making Congress' job cheaper, but also making the country's health care woes seem less pressing.

Even if there are fewer uninsured than now estimated, health experts emphasize that it's still a lot of people, and being uninsured has consequences. The Institute of Medicine has found that uninsured people are more likely to succumb to illness and suffer premature death.

Still, some overhaul foes are accusing the media of overreporting the number of uninsured in order to frighten the public and "bolster calls for universal government-run insurance coverage," as a report by the conservative media watchdog Media Research Center's Business and Media Institute put it.

The 46 million number (actually 45.7 million) cited by Obama and others comes from the Census Bureau's annual Current Population Survey for 2007. It's the consensus figure, but some researchers believe the CPS overstates the number of uninsured people, partly by undercounting how many people are on Medicaid, the federal-state program for the poor.

Another government survey, the Medical Expenditure Panel Survey done by the Department of Health and Human Services, says that about 40 million people were uninsured for all of 2007, and about 70 million were uninsured for part of the year.

All those numbers are out-of-date. Taking into account the effects of the recession, with widespread job losses cutting into employer-provided health care — more than 5 million jobs have been lost since last August — researchers at the Urban Institute and elsewhere estimate that the present-day number of uninsured is closer to 50 million. That's the number used by the Congressional Budget Office.

The Census Bureau is releasing its Current Population Survey for 2008 on Sept. 10. Then, later in September, for the first time, it's releasing health coverage information collected by the American Community Survey, which has a much larger sample size than the CPS. Some researchers are expecting that number to be more precise.

Immigrants may lose state health insurance

2009-07-14T23:43:00.000-07:00

Thousands of legal immigrants — including hundreds on the Cape — could be cut from state health insurance rolls, making a dent in the commonwealth's vaunted health reform program.

Up to 30,000 immigrants who've held a green card for less than five years were sent letters July 1 saying their coverage under the Commonwealth Care program might be eliminated as of the end of the month. State officials and health care advocates say the ongoing fiscal crisis means the state doesn't have enough money to cover all its programs.

Related Stories
Health bill could cut costs to businesses Commonwealth Care is a government-subsidized health insurance plan that pays for medical and dental care. Participants pay premiums based on a sliding-scale fee, with the poorest paying no fee.

"They're going to lose their health insurance. They didn't see it coming," said Camila De Oliveira of the Community Action Committee of the Cape and Islands. The organization has enrolled thousands of legal immigrants in the state's new insurance programs that came about as a result of the health reform act of 2006.

Receiving Commonwealth Care benefits allowed many immigrants to go to the doctor for the first time in years, and quite a few found they needed treatment for conditions such as diabetes and cancer, De Oliveira said. "Now their treatment is going to be stopped."

She estimated there are at least 2,000 legal immigrants on the Cape who will be affected, including people from Brazil, Haiti and Jamaica.

Most individuals dropped from Commonwealth Care would be shifted to something called the Health Safety Net and would end up getting their care from already busy community health centers or emergency rooms, said Brian Rosman, research director of an organization called Health Care For All.

"It's definitely a step backward from the progress we've been making," he said.

The closest pharmacy serving Health Safety Net customers is in New Bedford, De Oliveira said.

State legislators have said they need to cut the $130 million in Commonwealth Care benefits for this group of "aliens with special status" because of the budget crisis, Rosman said. The federal government provides no reimbursement for these recent, legal — but non-citizen — residents. Gov. Patrick has come up with a compromise plan of restoring $70 million in benefits that "would at least keep them in the kind of primary care that would keep them healthy," Rosman said.

The compromise is in the state Legislature's hands now, said Richard Powers of the Commonwealth Connector, a quasi-state agency that helps enroll people in insurance plans under health care reform. He said if the compromise funding is approved for September, there will be a gap of at least a month when the immigrants don't have any type of Commonwealth Care coverage and probably will have to be covered by something like the Health Safety Net, which replaces what was formerly known as the free care pool.

"We don't know if it's even going to be approved at all," Powers said. He said Commonwealth Care clients are entitled to 30 days' final notice before their coverage can be pulled.

Samantha Dallaire, aide for state Sen. Therese Murray, said the Senate can't act on the compromise funding until the House takes it up. All revenue bills start in the House, she said. "If they vote it down, it's dead."

How Not to Fix Health Care

2009-07-10T01:05:00.000-07:00

FOR THOSE WHO seek health reform that is effective, bipartisan and fiscally sound, the past few days have been unsettling.

First, Senate Majority Leader Harry M. Reid (D-Nev.) told Senate Finance Committee Chairman Max Baucus (D-Mont.) that his panel's plan to limit the tax-free treatment of employer-provided health insurance would not pass muster; too many Democrats would object. The ability of employers to offer unlimited health insurance to workers tax-free drives up health costs by promoting over-consumption; it benefits the well-off at the expense of lower-paid workers who are less apt to have insurance and, if they do, receive less value from the tax-free treatment of benefits. President Obama made a mistake during the campaign when he attacked John McCain for proposing to get rid of the exclusion. He is making an even bigger mistake by letting campaign positions be the enemy of good public policy.

Second, Democrats continued their insistence on a public option -- a government-run insurance plan to compete with private insurers -- as essential to effective health reform. Mr. Obama issued what amounted to a public rebuke of his chief of staff, Rahm Emanuel, for the apparently heretical act of suggesting openness to an alternative: having a "trigger" mechanism under which a public plan would be established if the private insurance market fails to provide enough competition. The president, from Moscow, restated his support for a public plan, though, thankfully, he continued to avoid drawing a line in the sand. As we have said before, it would be tragic if this issue were to drag down health reform or make it impossible to secure Republican votes. Restructuring the health-care system is risky enough that Democrats would be wise not to try to accomplish it entirely on their own.

Third, a new gimmick has been designed to pretend that health reform is fully paid for. The Senate Committee on Health, Education, Labor and Pensions adopted a measure, endorsed by the Obama administration, to have the government provide long-term care insurance in which workers would be automatically enrolled unless they opt out. Premiums would flow into the system beginning in 2011, but benefits would not begin to be paid out until five years later; consequently, over the 10-year budget window through which the Congressional Budget Office assesses legislation, the program would bring in $58 billion, according to CBO estimates. Thankfully, the committee also agreed to an amendment, offered by Sen. Judd Gregg (R-N.H.), to require that premiums be set at an actuarially sound level -- not so low that the program would end up further draining the federal treasury. Still, the money that flows in during the 10-year budget window will flow back out again. These are not "savings" that can be honestly counted on the balance sheet of reform.

Many With Insurance Still Bankrupted by Health Crises

2009-07-01T01:48:00.000-07:00

Health insurance is supposed to offer protection — both medically and financially. But as it turns out, an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured.

And so, even as Washington tries to cover the tens of millions of Americans without medical insurance, many health policy experts say simply giving everyone an insurance card will not be enough to fix what is wrong with the system.

Too many other people already have coverage so meager that a medical crisis means financial calamity.

One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital.

He and his wife, Claire, filed for bankruptcy last December, as his unpaid medical bills approached $200,000.

In the House and Senate, lawmakers are grappling with the details of legislation that would set minimum standards for insurance coverage and place caps on out-of-pocket expenses. And fear of the high price tag could prompt lawmakers to settle for less than comprehensive coverage for some Americans.

But patient advocates argue it is crucial for the final legislation to guarantee a base level of coverage, if people like Mr. Yurdin are to be protected from financial ruin. They also call for a new layer of federal rules to correct the current state-by-state regulatory patchwork that allows some insurance companies to sell relatively worthless policies.

“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”

3 Open Enrollment Tips

2009-06-25T08:40:00.000-07:00

WITH ALL THAT'S going on in the market, it would be nice to think you could leave your health care on autopilot — but you'd be wrong. This October, as usual, 158 million American workers will have to make seemingly small but ultimately crucial decisions, as corporate America shifts more of its $537 billion health care burden onto workers. "People need to be more thoughtful about their choice than in the past several years," says Jay Savan, a principal with the professional-services firm Towers Perrin — especially if they don't want to get stuck with hefty bills. Some tips on being choosy:

Watch for hidden costs
Read the fine print: One trend Savan expects to see grow is surcharges — sometimes as high as $150 each month — for employees who opt to cover a spouse or child who could get benefits elsewhere. And the consultancy Mercer Health & Benefits estimates that 25 percent of large employers will offer prescription-drug plans that make employees pay a portion of drug costs instead of a simple copay. That'll sting if you're on, say, a $14,000 cancer drug.

Snag incentives
Being healthy can be good for a lot more than your waistline. In 2007 almost one in four large companies offered workers incentives for healthy behavior, a trend experts say will mushroom in 2009. Alexander Domaszewicz, a principal at Mercer, says he's seen perks such as lower deductibles and even a month of benefits for healthy decisions like losing weight. Don't lie, though: "That's like stealing from the company," Domaszewicz says, and can be a fireable offense.

Don't fear health-savings accounts
With caps on out-of-pocket costs and coverage for most preventive screenings, these plans can be a good deal, especially for the very sick or for very healthy consumers looking to sock away pretax funds. Balance the huge amount you'll save in premium costs against your exposure, Savan says. Many insurers' Web sites can help evaluate various plans.

Health care costs taking growing bite out of farm incomes

2009-06-25T08:35:00.000-07:00

Too many farmers don't have enough -- if any -- health insurance simply because it costs too much. And, for those without adequate insurance, health care costs are taking a growing bite out of their wallets.

As a result, one group says it's Congress' job to "develop alternatives to a private market that is unwilling or unable to provide affordable protection to the self-employed and small business owners."

The Boston-based health care watchdog group The Access Project on Wednesday released a report entitled Who is Uninsured? that shows a growing number of farmers and ranchers are having trouble making ends meet while keeping adequate health insurance coverage. It's causing either excessive debt or delays in seeking care, which can exacerbate medical conditions.

Ten percent of farmers don't have health insurance, and on average, the uninsured are spending 10% of their income on health care costs. While the prior number is slightly lower than the percentage of those uninsured in the U.S. population in general, growing expenses are making it tougher for farmers to get by without insurance.

"Those most reliant on income derived from the family farm or ranch are least likely to be able to afford private health insurance" says Carol Pryor, lead author of the report and Policy Director at The Access Project. "This threatens both their health and their livelihoods."

The report that's based on a survey of farmers and ranchers in Iowa, Minnesota, Missouri, Montana, Nebraska, North Dakota and South Dakota, also found:

Farmers and ranchers delayed care more than twice as frequently as those with insurance;
40% of uninsured use savings or take out loans to pay for health care costs;
34% of the uninsured spend 10% or more of their income on health care;
32% say health care costs "contributed to financial problems;
32% accrued medical debt.

Because of the trend these numbers show, Center for Rural Affairs director of rural research and analysis at the Center for Rural Affairs in Lyons, Nebraska Jon Bailey says plans to reform the health care system nationally must take into account the needs of rural businesses and communities.

"Health reform that continues to rely solely on the private insurance market and attempts to strengthen employer-provided insurance, no matter how regulated or reformed, will be irrelevant to a large number of rural people," Bailey says in an Access Project report. "If you want farmers to continue growing the food for our families, and if you want rural communities to thrive, then availability of affordable and quality health insurance must be effectively addressed."

Partisan Ire Surfaces as Senators Start Work on Health Bill

2009-06-18T01:07:00.000-07:00

WASHINGTON — Partisan anger flared Wednesday as senators began the public drafting of legislation to remake the health care system. By day’s end, lawmakers had settled in for a long, hard slog that may not fit with President Obama’s goal of signing a bill within four months.

“This is about as historic as it gets for all of us,” Senator Christopher J. Dodd, Democrat of Connecticut, said as he opened a day-long session of the Committee on Health, Education, Labor and Pensions.

Another Senate committee, dogged by questions about the cost and complexity of the legislation, postponed its session, scheduled for next Tuesday, until after July 4. Democrats said they needed the delay by the Finance Committee to work on reducing the cost of the bill, intended to provide insurance to millions of people with no coverage.

Mr. Dodd presided over the health committee in the absence of its chairman, Senator Edward M. Kennedy, Democrat of Massachusetts, who is battling brain cancer.

Senator Dodd said he hoped the committee would finish its work and approve a bill by June 26. But he told his colleagues, “My intent is not to jam anything, force anything on people.”

Within 15 minutes after the session started Wednesday, Republicans began to protest. Senator John McCain, Republican of Arizona, said it was ridiculous to take up such a large bill without a complete cost estimate.

He and other Republicans demanded more details of the legislation and more time to digest it.

Senator Orrin G. Hatch, Republican of Utah, said Democrats had made some grave errors.

“You advance legislation by focusing on areas of compromise, not strife,” Mr. Hatch said. “Now unfortunately we are beginning a partisan exercise on perhaps the most important legislation of our lives. I am personally somewhat, well, actually, very disappointed, because I wanted a thoughtful bipartisan compromise that could have become a lasting legacy for my dear friend, Ted Kennedy.”

President Obama is pressing Congress to speed work on the measures, which embody his top legislative priorities, reining in health costs and covering the uninsured. Mr. Obama wants to sign a bill by October, but senators of both parties said it was more important to get the policy right.

The bill before the health committee, drafted by Mr. Kennedy and Mr. Dodd, would require people to carry insurance, with federal subsidies for those who could not afford it, and would require most employers to help pay for coverage of their employees.

The bill would impose stringent new federal regulations on insurers and make far-reaching changes in the health care industry, which accounts for one-sixth of the economy.

Senator Michael B. Enzi of Wyoming, the senior Republican on the health committee, said the panel was moving “too fast to do an adequate job.”

Mr. Dodd said, “I appreciate the frustrations being expressed,” but plowed ahead. “We have a moral imperative to act,” he said.

Mr. Enzi said the bill had been drafted “with no input from Republicans,” and he asserted, “The bill costs too much, covers too few and will cause 10 million Americans to lose the insurance they currently enjoy.”

A preliminary estimate by the Congressional Budget Office said the bill would cost $1 trillion over 10 years but leave many uninsured. The office said an early version of the Finance Committee bill would cost $1.6 trillion.

Senate Democrats conceded that the unexpectedly high estimates had forced them to regroup, and acknowledged that they were still divided over how to pay for the legislation.

But Robert Gibbs, the White House press secretary, said he did not see any setback. “The president, I think, has laid out a timeline to get this done this year, and thinks that we’re on course to do it,” he said.

Senator Judd Gregg, Republican of New Hampshire, said he was on the committee when it considered President Bill Clinton’s plan for universal coverage in 1993-4. “It’s sort of déjà vu all over again for me,” he said.

Mr. Gregg said the Kennedy bill looked as if it had been written by Rube Goldberg, Karl Marx and Ira C. Magaziner, Mr. Clinton’s health care coordinator. Mr. Gregg criticized a provision that would establish a Medical Advisory Council to recommend minimum benefits for insurance policies.

“This is the elite of the elite deciding how everybody else will get health care,” Mr. Gregg said.

Senator Barbara A. Mikulski, Democrat of Maryland, fired back. “Our current system is a combination of Adam Smith, Darth Vader and the ‘Invasion of the Body Snatchers,’ ” she said. “So I like our plan the better.”

Ms. Mikulski said the Republicans’ complaints reminded her of objections to the creation of Medicare in 1965.

“The arguments against Medicare are the same arguments we are hearing now — government control, centralized bureaucracy,” she said. But, she noted, Medicare is hugely popular.

Senator Bernard Sanders, independent of Vermont, said, “The fight for comprehensive, universal health care is the civil rights struggle of the moment.”

And he issued this warning: “To all the lobbyists, all the big-money interests who give us campaign contributions and lobby so successfully with those 30-second ads on TV, I say your time has come and gone.”

Mr. Obama and many other Democrats have called for a new public health insurance plan, to compete with private insurers.

Senator Sherrod Brown, Democrat of Ohio, said such competition would “hold down premiums, discipline the market and keep the private insurances industry on its toes.”

But Mr. Hatch said, “Medicare and Medicaid are already on a path to fiscal insolvency; creating a brand-new government program makes no sense.”

Health insurance for men: what are the best options?

2009-06-18T01:04:00.000-07:00

Should men be taking a closer look at health insurance, following news this week that they are more likely than women to get many common types of cancer?

More worrying still, this research showed that men are far more likely to die of certain cancers, compared to women with the same condition.

Although the report, from the National Cancer Intelligence Network, found "no biological reason" why this should be so, it is thought men's unhealthier lifestyles and their reluctance to get symptoms checked by a doctor at an early stage are largely to blame.

Of course, spending hundreds of pounds a year on health insurance won't stop you getting cancer – or any other disease for that matter. But it will ensure that you are in a better position to deal with the financial consequences of serious illness; and taking a more active interest in your health may mean that early signs are detected sooner.

The question remains though, what type of health insurance is best?

There are a number of different types of policy. The best known is probably private medical insurance (PMI), which basically pays for private consultations and treatments, allowing policyholders to bypass NHS queues. Some employers will offer this insurance to staff, and it can also be bought individually. The main drawback is that it can prove expensive for comprehensive cover – particularly as you get older.

Cheaper, and far more widely bought, is critical illness insurance, which is often sold to those taking out a mortgage along with basic life insurance. Rather than pay directly for private treatment, this insurance is designed to pay out a tax-free cash sum on the diagnosis of certain life-threatening diseases. The idea is that this money will enable policyholders to pay off the mortgage, reduce their working hours or take extended leave while they recuperate.

Most critical illness policies cover about 30 conditions, and all should cover cancer, heart disease and stroke. But within these broad definitions there are numerous exclusions. Certain types of breast, prostate and skin cancers, for example, which are not considered "life-threatening" are routinely excluded on most policies.

Another option is an income-protection policy. Rather than cover specific ailments, this pays out a regular income to those who are unable to work through ill health. Provided a doctor has signed you off sick, these policies should pay up, regardless of the nature or severity of the illness. As well as covering cancer and heart disease, these policies help those with back problems, stress or depression.

The final option is a "cash plan". These schemes are relatively cheap, but the benefits are more limited. However, those who contribute to one of these plans can claim a contribution to regular medical bills, such as dental charges, opticians fees, physiotherapy and so forth.

So what should you buy, given most of us don't have the inclination or the financial wherewithal to pay for them all?

Alan Lakey, a financial adviser specialising in protection policies, says: "Both men and women should ask themselves what would happen to their income if they had a long-term health problem or illness. Those who work for an employer like the police or the NHS may have more generous staff benefits that would pay long-term sick pay at a reasonable rate. But most people won't have this luxury to fall back on. If this is the case, then income protection should be your first port of call."

He said critical illness could be useful, but it does not offer the same flexibility. He added that some customers may want to opt for private medical treatment, but this in most cases is unlikely to be their main priority – particularly given the cost.

Matt Morris of Lifesearch, a firm of advisers, agrees: "Anyone with dependants or debts who relies on their salary to live should ensure that they have adequate income protection in place as a first priority. Ideally, everyone would have an income protection, critical illness and a basic life insurance policy – usually in that order of importance."

Further information on each of these main products is given in the linked stories below, so men and women can decide what policy would give them the protection they need.

Critical illness
Income protection
Private medical insurance

The great uninsured--decreasing the surplus population

2009-06-18T01:02:00.000-07:00

Strange times we live in. We are now evaluating if we really need to do something about health care--the very sustenance of existence. We are not talking about who should get a tax break but who should be cared for so they may survive their time on our planet. The stakes don't get much higher than that for the millions of the great uninsured.

I spoke with a woman who told me she had just lost her home in Florida. She is a realtor and has a nice home in the Chicago land area. Maybe in her fifties. We chatted about real estate and selling my two flat and somehow we started talking about doctors. That's when she dropped the bomb and said she was uninsured and that she couldn't afford to get sick.

She said she couldn't afford health insurance and worse no one would insure her because she has pre existing conditions. This is not a poor person. This is not someone who doesn't pay taxes and has a mortgage. She simply cannot get insurance. Depending on where you come down in this debate you may say it is this woman's own fault. She should have been working for a company instead of a straight commission job. She should make more so she can afford health care.
The truth is everyone could become this woman.

The argument against Universal Health Care is that it will knock down the quality of our health care. But to the millions of uninsured in this country, some health care is better than no health care. I suppose it comes down to your view of America. If we are a country that takes care of it's people then you believe that health care is a right. But if your view is that it is every man and woman for himself and take the more Darwinian approach of survival of the fittest--then we should stop all the pretense and just say good luck to people like this woman.
There are a lot of people finding themselves in the unemployment line now. Some will never be rehired and will lose their benefits. Some will get old outside the corporate safety net without health insurance. So if we decide to tell all these people they are own, then like Scrooge, we should also tell that if they are going to die, then they should do it, and decrease the surplus population.

Laid off, what about health insurance

2009-06-10T02:23:00.000-07:00

Laid off? What about health insurance. Typically, you have three options – COBRA, purchasing on own, and going without. Going without is a really bad idea, and if it can be avoided then do so. COBRA is another option, and with the American Recovery and Reinvestment Act (ARRA) of 2009 the government may pay for 65% of your premiums. The final option is purchasing directly.

How you choose between the three options depends upon age, health, family size, available assets, eligibility under ARRA, and state you live in. The younger you are the more tempting it may be to go without coverage. The problem is that health issues are often a “surprise”. More importantly, if you experience a health issue when you are not covered it will most likely be difficult to get coverage later.

For example, a person in their 20’s opts not to get insurance. (Health insurance for a 20 something is comparatively cheap, so I can’t imagine why anyone would do this.) While they are not covered this person finds out that they have diabetes. It will be difficult to then go out and look for health insurance because you now have a pre-existing condition. Usually, this ends up being an issue always. If you were covered before the diagnosis, then it would not inhibit you from changing plans. However, once diagnosed it is advisable to never be without coverage.

COBRA is mandated by federal law. Basically, it allows the employee to purchase similar (or the same) coverage they had during employment. Often it is very expensive. However, under the ARRA you may qualify to have 65% of the premiums paid. Therefore, you would only be responsible for 35% out of pocket. As an example I will use a COBRA premium of $1,000. If you are a family that is pretty close to what your cost could be. You would only have to pay $350 per month for continuation of coverage. That is a pretty good deal, and worth every penny.

Government subsidized COBRA does not apply to everyone. (I have included a link on the bottom for more information.) There are restrictions on who will receive assistance and it lasts for 9 months. So if you are unemployed longer than 9 months you may have to consider other options. Usually, it is the choice of purchasing on own or continuing COBRA. (COBRA is usually available for 18 months, government subsidy only for 9 of those.)

As I have said, COBRA may be $1,000 per month for a family. It could also be higher. Typically these plans have low, if any, deductibles. So it may be worth looking at purchasing insurance individually. You could purchase a higher deductible policy and deposit the difference until you have the deductible set aside. (I give a $ example on my blog.)

Here are some bullet points to consider when choosing between COBRA and individual purchase:

Are you eligible under ARRA
Is the 65% co-pay taxable in your state
Not taxable for Federal Income
Varies by state – Oregon likely to be taxable; Washington & California not taxable
What is the cost of purchasing directly?
This may be tax deductible
Given the money that you have, what is going to work best for you?

Kennedy health plan includes long-term care

2009-06-10T02:21:00.000-07:00

WASHINGTON (AP) — Americans would be able to buy long-term care insurance from the government for $65 a month under a provision tucked into sweeping health care legislation that senators will begin considering next week.

The 651-page bill, released Tuesday by Sen. Edward M. Kennedy, D-Mass., would revamp the way health insurance works. Insurance companies would face a slew of new government rules, dealing with everything from guaranteed coverage for people with health problems to possible limitations on profits. Taxpayers, employers and individuals would share in the cost of expanding coverage to nearly 50 million uninsured Americans.

Release of the bill by Health, Education, Labor and Pensions Committee Democrats came as lawmakers at both ends of the Capitol accelerated their drive to enact health care legislation. House Democratic leaders also outlined a proposal, but offered only limited details.

Both plans omitted specifics on how to cover the costs, which could exceed $1 trillion over 10 years. Given the uncertainty as well as the political sensitivity over raising taxes or cutting Medicare, Senate Republicans prodded Democrats to fill in the blanks before the scheduled beginning of committee work next week.

A first-ever tax on employer-provided health benefits figures prominently among financing options under consideration in Congress, but President Barack Obama campaigned against that last year and its inclusion would require him to reverse course. Obama has proposed $634 billion in tax increases and spending cuts as a down payment on the plan and is soon expected to outline an additional $300 billion in Medicare and Medicaid cuts.

Kennedy's long-term care plan is designed to help disabled people pay for support services that would allow them to remain in their own homes and avoid moving into nursing homes. People would enroll in the program during their working years and begin paying premiums. To collect benefits, a person would have had to pay premiums for at least five years.

The benefit would be modest — not less than $50 a day — but it could be used to cover a wide range of services.

Prospects for the long-term care provision are uncertain, but Kennedy's advocacy may sway other lawmakers. For Kennedy, who is being treated for brain cancer, health care legislation would be the crowning achievement of a long and productive career.

At their core, the partial draft bill released by Senate Democrats and an outline circulated by senior House Democrats were largely identical.

Individuals would be able to purchase insurance through a new federally regulated national exchange, and private companies would be barred from denying coverage or charging higher premiums because of pre-existing conditions. Those who are satisfied with their current coverage could keep it.

Both bills would require individuals to purchase insurance if they could afford it. Waivers would be available in hardship cases. The Senate measure provides for an unspecified penalty for anyone refusing to obey the so-called mandate, and House Democrats are considering a similar approach.

In both the House and Senate, Democrats want to provide subsidies to families with incomes well into the middle class. One option under the Senate plan would phase out subsidies at about $110,000 for a family of four.

House Democrats also are said to be considering a wide-ranging change for Medicaid that would provide a uniform benefit across all 50 states and increase payments to providers. Medicaid is a joint state-federal program of health coverage for the poor.

The Senate plan would allow children to stay on the parents' insurance until age 26.

On a particularly contentious point, the emerging House plan would give people the option of buying insurance provided by the federal government.

Democrats on the Senate committee embraced a similar provision last week but omitted it from Tuesday's draft in what Sen. Chris Dodd, D-Conn., said was a gesture to Republicans who oppose it.

Sen. Mike Enzi, R-Wyo., the top Republican on the committee, responded derisively. He said Democrats did so "because they know we're not going to like what they've written and they don't want us to have any time to comment."

Senate Republicans on two committees most involved with health care urged Democrats not to move ahead without detailed cost information. "Paying for health reform in a responsible and sustainable way may be the most single difficult element of our efforts," they wrote.

But after months of preliminary effort, Democrats made clear they intend to move ahead on their own timetable, one that calls for passage of legislation in the House and Senate by early August. A final compromise would wait for September or later in the fall, according to a schedule the party's leadership established weeks ago.

"This is the year we have to do it," said Rep. Henry Waxman, the California Democrat who chairs the House Energy and Commerce Committee. Waxman was one of several senior Democrats who outlined proposed legislation to the party's rank and file during the day.

Numerous senior Democrats now aging and ailing have worked their entire careers on health care, but no one is more identified with the issue than Kennedy, first elected to the Senate in 1964. In a poignant announcement Tuesday, Dodd said Kennedy, diagnosed a year ago with a brain tumor, will be unable to attend the working sessions of the health committee he chairs beginning next week.

Health insured prepare for new costs

2009-06-04T23:59:00.001-07:00

US Health insurance analysts are preparing to assess health care costs.

The American Health Insurance Plan group is about to kick off a three-day conference in San Diego, to discuss the turmoil which has been occurring in the health industry.

More than 2,000 commercial insurers, employers, medical groups and hospital officials will be attending the conference to discuss the consumption of different health plans.

The conference has been called in response to the Obama administration's push to overhaul the health care system.

Most Americans who are covered by employer-provided health insurance, are now seeing increases in their share of health care costs.

At the same time, the cost of health plans is also rising, which some employers are refusing to pick up.

Health Insurance Plans Comparison

2009-06-04T23:57:00.001-07:00

When it comes to finding affordable health coverage, it pays to do a health insurance plans comparison. After all, you want to make the most informed decision possible; one that will leave you feeling certain that you have made the right coverage choice for you and your dependents. Comparing and contrasting plans allows you to take a closer look at the details, pros and cons of each medical plan, so that you will know what to expect from the coverage once you make your decision.

Look at it this way; you are unlikely to purchase a new car without first comparing it to other makes and models to determine if it has exactly what you need or if another vehicle better suits your needs and preferences. So why would medical coverage be any different? It is an important decision that is worthy of your research, time and consideration.

How to compare and contrast medical health insurance plans

While it may not be incredibly exciting, conducting a health insurance plans comparison is easier than you may think. First, you will want to line up the different types of plans available to you. In most cases, you are going to be choosing between the following types of insurance plans:

* Preferred Provider Organizations or PPOs-designed to provide comprehensive medical coverage through a variety of different doctors and specialists as well as hospitals and clinics without the need for referrals. You can even go outside of the PPO network for care, but your out-of-pocket costs will be higher.

* Health Maintenance Organizations or HMOs-are quite commonly considered the most affordable health care coverage. They also provide comprehensive coverage, but it is important to stay within the network and with a particular primary care physician who refers the patient if any other specialist services are needed.

* Health Savings Accounts or HSA accounts-offer high-deductible coverage, so you may have to pay more up-front for medical care and premiums are lower. However, the HAS accounts also include a tax-free medical savings account to help cover your out-of-pocket costs.

* Fee for Service or FFS plans-provide an even more affordable option, but typically do not provide comprehensive coverage and things like preventative care. You pay for all medical appointments and services and then the FFS plan will reimburse you a certain, pre-determined percentage of your cost.

Lining up these types of accounts side by side, you will then want to make a list of the medical services you have received in the past two years as well as predict the services you may be utilizing in the coming year. Also, take into consideration your budget. Are you able to pay higher premiums in an effort to save on out-of-pocket medical costs, or does it make more sense to go with lower premiums and risk the possibility of having to pay more out-of-pocket if an unexpected illness or injury occurs? Would you have the funds to cover these kinds of unexpected costs?

Really looking closely at your unique medical needs as you conduct your health insurance plans comparison is the best way to choose the plan that is right for you. As you arm yourself with the information you need to make an informed choice, you can know that you have taken responsibility for the medical and financial health both of yourself and your family members.

Brits opt for private insurance deals

2009-06-04T23:55:00.001-07:00

Worried Britons are seeking out private health insurance.The number of Britons taking out private insurance deals has risen over the past 12 months, despite the continued economic downturn.

New research from the Association of British Insurers (ABI) has found that over 6.2 million people were covered by private medical insurance (PMI) in 2008.

An additional 1.1 million consumers had arrangements in place with the Healthcare Trust, taking the total number of people covered by private insurance deals to over 7.3 million.

This marks a 2.7% increase on 2007's figures, with the ABI welcoming the results.

Director general Nick Starling explained that corporate PMI makes sense for both employees and companies.

He said: "PMI is good for companies and the economy because it enables employees to get back to work after illness or injury as quickly as possible."

Research from BUPA released in response to the ABI figures revealed that the top reason for taking out PMI is to gain access to clean hospitals.

Insured Cover Health Costs of Uninsured

2009-06-04T23:51:00.000-07:00

A "hidden health tax" has families paying $1,017 more in health insurance premiums in 2009; according to Families USA, a healthcare advocacy group. Individuals pay an additional $368, the group says.

According to Reuters, a report released Thursday by Families USA said that healthcare providers charge those with private insurance more to cover the cost of care for those without it, and insurers, in turn, raise premiums to pass along the cost. In 2008, people without insurance got about $116 billion worth of healthcare and paid for about 37 percent of the cost.

While government programs and charities paid 26 percent, $42.7 billion was left on the shoulders of the privately insured, the report found.

Despite Recession, Personalized Health Care Remains in Demand

2009-05-11T04:16:00.000-07:00

Thanks to patients who still value their health in hard times, the recession has barely slowed the growth of concierge medical practices, which charge hefty membership fees for highly personalized care and around-the-clock access.

From Seattle, where the movement began in 1996, to South Florida, where its largest concern is now based, physicians with boutique practices say they are losing far fewer patients for financial reasons than they had expected. While some new practices are not filling as quickly as they might, they continue to attract a steady flow of patients willing to pay thousands of dollars for the privilege.

The practices typically charge at least $1,500 a year, with the most elite services asking $25,000 or more per family. The fees cover a thorough physical exam and enable physicians to limit the number of patients they see so they can provide premier service.

Doctors give patients their cellphone numbers and schedule leisurely same-day appointments with no waiting. Some make house calls, though patients still need health insurance to pay for hospitalizations and specialists.

Most of the 20 physicians and executives interviewed said that a small number of patients had decided not to re-enroll in recent months, citing lost jobs or devalued portfolios. They tend to be like Susan Schwartzman, a book publicist from Yonkers who said she had given up her concierge doctor because of declining income, but only after first canceling her gym membership and swearing off restaurants.

For the most part, however, boutique practices have shown resiliency. Doctors said the recession seemed to have reaffirmed the importance of health care to their patients. With jobs scarce and stress at a peak, many may see a link between continued health and continued employment. And with savings depleted, they recognize that assiduous preventive care may help them avoid costly chronic conditions and hospitalizations.

As the economy crumbled last fall, Dr. Cynthia L. Williams of Torrance worried about the unfortunate timing when she sent letters in November informing her 2,200 patients that she would be converting to a $2,000-a-year concierge practice. Nonetheless, she said, she had signed up 315 patients and was adding one a week. “On my busiest day I’m seeing 14 patients, but on a lot it’s eight,” she said. “In the old practice, I was booked about one patient every 12 minutes, about 25 to 30 a day. I love it, and I think my patients love it.”

Many of the doctors boasted of their ability to keep patients out of emergency rooms by intervening by phone for conditions like diverticulitis or an abnormal heart rhythm. They said their deep knowledge of their patients helped them detect subtle changes and danger signs.

“A close personal relationship with a physician is not something that’s easy to find anymore,” said Dr. David L. Elliott, an MDVIP physician in Phoenix. “People find it valuable.”

Health care groups pledging to create $2 trillion in savings

2009-05-11T04:13:00.000-07:00

WASHINGTON – Volunteering to "do our part" to tackle runaway health costs, leading groups in the health-care industry have offered to squeeze $2 trillion in savings from projected rate increases over the next decade, White House officials said Sunday.

Hospitals, insurance companies, drug makers and doctors planned to tell President Barack Obama at a meeting today that they'll voluntarily slow their rate increases in coming years in a move that government economists say would create breathing room to help provide health insurance to an estimated 50 million Americans who now go without it.

With this move, Obama picks up key private-sector allies that fought former President Bill Clinton's effort to overhaul health care.

Although the offer from the industry groups doesn't resolve thorny details of a new health-care system, it does offer the prospect of freeing a large chunk of money to help pay for coverage. And it puts the private-sector groups in a good position to influence the bill Congress is writing.

The groups aim to achieve the proposed savings by using new efficiencies to trim the rise in health-care costs by 1.5 percent a year, the officials said. That would carry huge implications for the national economy and the federal budget, both of which are significantly affected by health-care expenses.

"I don't think there can be a more significant step to help struggling families and the federal budget," a senior administration official said in a conference call with reporters. The official spoke on condition of anonymity because the offer remains tentative.

The White House projects that the savings after five years under the proposal would mean about $2,500 a year in lower health-care bills for a family of four, the official said. Within 10 years, the savings would "virtually eliminate" the nation's budget deficit.

WHO'S MAKING THE PLEDGE?
The trade groups making the pledge represent a broad spectrum of health-care interests:

•The American Medical Association

•The Pharmaceutical Research and Manufacturers of America, representing drug companies

•America's Health Insurance Plans, which represents insurers

•Service Employees International Union

•American Hospital Association

•Advanced Medical Technology Association, which represents device makers

Generation Y to Get Web 2.0 Prepaid Health Insurance via PayPal

2009-04-23T03:05:00.000-07:00

Health funds worldwide need to attract younger members in order to help keep their health insurance premiums affordable. Prepaid Health Insurance via PayPal may be part of the solution according to GMHBA, an Australian not-for-profit health fund.

"The new site is promising to help young people cut through the clutter by providing hospital and extras health insurance cover online for just $9.90 a week via PayPal. It features numerous Web 2.0 style innovations that should resonate with the attention poor video centric Generation Y. The site is also carbon offset. Visitors will discover virtual avatars, Skype, Twitter, health Widgets and live video. An Apple iPhone can also be won to highlight the fact the site is also iPhone friendly" said Jonathan Crabtree, Online Manager, Strategy & Innovation for GMHBA Health Insurance.

"Importantly, we're looking for feedback and will continue to innovate to ensure the service we can offer is helpful and efficient. A paging service is available 24/7 for those people wanting to ask a question or two before they buy online. In any event, our prepaid health insurance is backed by a 60 day money back value guarantee. If people find better value elsewhere within 60 days and haven't made a claim, they can cancel their policy and we'll give them their money back," Mr Crabtree said.

"The hospital and extras package costs so little because you'd be a private patient in a public hospital with a $500 maximum annual excess and this cover does NOT pay benefits for: eye surgery, gastric banding, joint replacement, renal dialysis, obstetrics and IVF and related services," Mr Crabtree said.

Layoffs Equate to Loss of Health Insurance

2009-04-23T03:03:00.000-07:00

Losing a job is tough. If you are lucky, you will get a severance package that includes some pay and health insurance. But, what happens when that runs out? COBRA, the health insurance option offered to people who lose their health benefits, is expensive. And, it’s hard to make those payments when you’re on unemployment.

Lynn Brumby knows this first hand. She always had health insurance. “From the day I was born, until I was 53, I had insurance,“ said Brumby. That is, until she lost her job as a marketing counselor at Appalachian Christian Village.

“I knew i needed it because I had just been diagnosed with diabetes,“ said Brumby. She got the paperwork for COBRA, but realized she could not afford it, or expensive visits to the emergency room, on unemployment.

“I was at my wits end, I didn’t know what to do, I thought what am I going to do, I’m sick, where am I going to go,“ said Brumby. As unemployment rates continue to rise, the number of people in Brumby’s shoes grows larger.

“With the loss of insurance, a lot of people are not sure where to turn to for their health care,“ said Susan Reed, the Clinic Director at the Johnson City Downtown Clinic. In Johnson City, many of them are turning to the Downtown Clinic.

“I think they saved my life,“ said Brumby. “No one is denied care because of inability to pay, no one is turned away because of finances,“ said Reed. “We have seen an increase in the recently laid off, recently lost their jobs, which equates to I’ve recently lost my insurance,“ said Reed.

The clinic recently got $161,000 in federal stimulus money. Specifically, the money will be used to educate people who have recently lost their jobs about what the clinic can do to help them. “That’s going to enable us to maintain our level of staffing, it’s going to enable us to increase the amount of services that we’re providing,“ said Reed. To find out more click play above.

Health insurance and medical bills

2009-04-22T02:46:00.000-07:00

Health insurance is there to cover your medical bills and services you receive while visiting a hospital, doctor or having an x-ray, lab test, surgery, etc. Before the services are reimbursed to those providers of care, they all start out as medical bills. Some of us see the medical bills (due to lack of insurance coverage) all the time while others of us don’t really see the medical bill from the doctor visit because the doctor’s office staff submitted the (medical bill) services to the insurance company directly and the service is paid.

What happens when the bill doesn’t get paid by the insurance company or just gets submitted to you directly? Are you aware of what you are reading on the hospital bill?

Would you believe me if I told you that over 80% of the people in the United States do not know what they are looking at when it comes to reviewing their medical bill? Such an unbalanced statistic has given hospitals, facilities and doctor billing offices an enormous edge to get paid now (by you) and deal with the insurance company later or not at all.

Learn to read your medical bill so you or your family members don’t get taken advantage of by hospital and doctor billing offices paying something too soon or at all.

Club helps people who don’t have health insurance

2009-03-30T07:23:00.000-07:00

NBC
Published: March 24, 2009

If you lose your job, there are two alternatives when it comes to your health insurance.

One option is to pay for the COBRA plan offered by many companies.

Some companies can charged you as much as $400 a month.

The second option: Go without it, and hope that you do not get sick because it could end up costing you thousands upon thousands of dollars.

Now a new program is helping people without health insurance get some coverage.

It is called the No Insurance Club and for some, it is just what the doctor ordered.

Take Ralph Demicco for example.

He suffers from Type 2 diabetes, and by going without a doctor or getting the medications he needs, it could become a life or death situation.

“These are conscious patients they know they can’t buy insurance outside on their own but a program like this covers their maintenance side,“ said James Stanley, a doctor at the Briarcliff Medical Associates.

For one person to join the No Insurance Club, it cost $480 for the year.

After you sign the contract, you get 12 doctor visits a year that include services like physicals, blood work and flu shots.

For a family, no matter the size, it will cost you $680 for the year.

It includes everything that an individual plan does, but ups the number of doctor visits to 16.

“We’re trying to fill that gap where they can still come to us for that amount it’s a pretty good deal,“ said Stanley.

Once thing about the club unlike other insurance companies, you must see the same doctor for each and every visit and you can only see him no matter what.

Secondly, you can get your prescription drugs for $4.

The only thing is they have to be the generic version.

If you need to get a name brand, you will have to pay out of pocket.

If you use up all of your visits for the year before the end of the year, then you can renew your contract at the original price.

The No Insurance Club does not cover visits to the emergency room or hospital stays.

It also does not cover specialists.

To see if there are participating club physicians in your area, go to to their

Swelling ranks of US jobless yearn for health insurance

2009-02-21T20:45:00.000-08:00

FORT WAYNE, Indiana (AFP) — For many among the growing ranks of unemployed workers in the United States, the scariest part of losing their job is losing their health insurance.

Even before the current economic crisis, 45 million Americans were uninsured. That number is expected to rise to 54 million by 2019 if changes aren't made to the system, according to the director of the non-partisan Congressional Budget Office.

One of the swelling ranks, Amy Newlin, has been getting by on her savings and unemployment benefits after she and her husband lost their jobs last fall.

But while they can cut back on dinners out, new clothes or other inessentials, the costs of treating her diabetes, high blood pressure and thyroid difficulties have risen dramatically.

"I need insulin strips to test my blood, and medicine for my high blood pressure," Newlin told AFP.

"My insulin is 80 dollars a bottle without insurance and the strips are expensive, too. It's not easy to keep up."

The Indiana woman was one of dozens who attended a meeting Thursday for uninsured people to register for government-funded health care.

Health officials held the clinic in the basement of an elementary school to deal with a surging number of applicants as a flood of layoffs forced scores of area residents off their employer-provided plans and into the peril of being uninsured in America.

Newlin arrived prepared with a folder jammed with old pay stubs, her birth certificate and all the other necessary documents to ensure she would be signed up.

But even if she qualifies, it will be some time before she's insured and any serious illness or accident could still bankrupt her family.

Health care has long been a contentious issue in American social and political life.

High costs, the exclusion of patients with pre-existing conditions and bureaucratic snafus plague the private system, which is unattainable for a growing number of Americans.

The federal government manages two health care systems: Medicaid -- for the poor -- and Medicare -- for the elderly. They currently amount to 5 percent of America's gross domestic product.

But the costs will more than double to 12 percent by 2050, under the Congressional Budget Office's current estimates.

Indiana launched a plan at the start of 2008 to cover some -- the working poor, single parents, the moderately disabled -- who are not protected by Medicaid.

Residents aren't eligible until they've gone six months uninsured, and there's a small pay-in for participants, helping to hold down costs.

President Barack Obama made health care reform a central plank in his populist platform when he ran for the White House.

And the massive stimulus package he signed Tuesday included plans to help cover the cost of temporary coverage for scores of displaced workers and possibly extend Medicaid coverage to other uninsured Americans who would not normally be eligible.

Yet comprehensive reform has been hampered by the distraction and cost of the current economic crisis, along with the loss of Obama's first pick for health secretary, Tom Daschle, who withdrew from consideration amid questions about his tax history.

Washington's political wrangling is a far way from those gathered in the colorful basement cafeteria of Indiana's Fairfield Elementary School.

Newlin, for one, doesn't hold out much hope for the government to solve anything soon.

"I don't even know if they know where half that money is going," she said of the stimulus.

Jerome and Brenda Lewis, a couple in their mid-50s, have been without insurance since October when she lost her job -- and their coverage.

They are hopeful Obama will bring change and are thankful for the work of people who organized the clinic, but turn to a greater power for balance in these unsteady times.

"Right now, by the grace of God, everything is all right for us. We keep praying that everything will be all right," Jerome Lewis said.

Hundreds turn out for job fair

2009-02-14T01:15:00.000-08:00

By Brandon Fincher
02-14-2009

LINCOLN – Companies who were looking to hire certainly had no shortage of candidates who arrived at the old Lincoln gymnasium on Friday to participate in the Lincoln Job Fair.
Deborah Thornton, research analyst for the Talladega County Economic Development Authority, said, as expected, the turnout by job seekers and employers was large.

“So far it’s been great. We have 30 plus employers registered. I would say we probably have 200 to 300 employees who have already signed in who are now looking for jobs at the various employers’ tables,” Thornton said around 30 minutes after the doors opened.

People from all walks of life were in attendance including Reginald and Tonia Kelley, both of Oxford, who were job seeking as husband and wife.

Reginald Kelley said, “I’m getting ready to retire from the military, and I’ve been to job fairs before. In fact, I’ve participated in some job fairs, and the setup here is nice.”

Tonia Kelley added, “It’s pretty informative. We just recently relocated here, and it’s given us an idea of what’s in the area job wise.”

The Kelleys were far from the only job seekers in attendance, though. Danny Mitchell, of Cropwell, was also on the job hunt.

“I’ve just got my mind open. I’ve never been to one of these before,” Mitchell said. “So far it’s so good.”

Employers either passed out information or accepted job applications.

One of those was the Alabama Department of Corrections which was looking for correctional officers. Cynthia Nelson, with the ADOC, said she was looking for applicants that could pass the physical testing, background check and who were ready to come in and work in the state’s prison system.

Nelson said, “There are a lot of opportunities for advancement once they come in as a correctional officer trainee and after they’ve gone through the academy and established permanent status.

“Whenever we give our promotional exam or sergeant’s exam, they can take that and advance up. Once they’ve been in that classification, and if they desire to move up, they can take the next promotion.”

Nelson said the turnout was great, and there were many people who stopped by the ADOC booth who were interested in the job and picked up information to research.

“We have great benefits, and it is a career,” Nelson said.

The job fair was sponsored by the Talladega County Improvement Foundation, the Greater Talladega/Lincoln Area Chamber of Commerce, the Childersburg Area Chamber of Commerce, the Sylacauga Chamber of Commerce and the Talladega County Economic Development Authority.

Thornton said she had received calls from job seekers as far away as Cleburne, Randolph and Chambers counties who inquired about the job fair.

“We started in January with a job fair in Sylacauga. We were trying to do them every 90 days, but the needs were so critical we decided to bump it up and do it sooner,” Thornton said. “We have another job fair scheduled for April 10 in Childersburg.”

Thornton said the sponsors had devised a list and contacted companies from Talladega, Calhoun and St. Clair counties to see if they would like to participate.

She said the job fair benefited from volunteers who manned the sign-in table and restaurants and grocery stores such as Domino’s Pizza, Carter’s Barbecue, R and B Barbecue, Jack’s, Wal-Mart in Talladega and Pell City, and Super Foods in Lincoln who provided food to feed the employers.

Thornton said she also was thankful for service group who provided information and assistance at the job fair. They were Alabama Department of Public Health’s ALL Kids Insurance, Cheaha Regional Head Start, the Coosa River Baptist Association, and FIRST Family Service Center.

Job seekers were just thankful for the opportunity to have a chance for a job.

“When you have an opportunity to participate in a job fair, you’re always looking for something, a new job or a better job. It gives you a good feel for what’s out there,” Reginald Kelley said.

Doctor and Patient Building a Healthy Community, One Child at a Time

2009-01-24T00:23:00.000-08:00

By PAULINE W. CHEN, M.D.
Published: January 22, 2009

Like many other Americans this past Tuesday, I was moved by President Obama’s inspiring call to duty.

"Now, there are some who question the scale of our ambitions, who suggest that our system cannot tolerate too many big plans,” he said during his inaugural address. “Their memories are short, for they have forgotten what this country has already done, what free men and women can achieve when imagination is joined to common purpose and necessity to courage.”

One of the "big plans" of the Obama administration will be to revamp the nation’s health care system. But are these ambitions big enough to help the country’s smallest patients?

It has been hard over the last year not to feel that health care coverage for our neediest young people could have benefited from a “big plan.”

In May, the Commonwealth Fund, a nonprofit health policy research group, published a report that detailed striking health care disparities between states. The report found, for example, that three-quarters of children have regular medical and dental preventive care in Massachusetts, but less than half of the children in Idaho do. Whereas only 55 per 100,000 children are hospitalized for asthma in Vermont, South Carolina has a staggering hospitalization rate of 314 per 100,000.

More recently, the Kaiser Family Foundation summarized the role of Medicaid, the federal program that aids the poor, and the State Children’s Health Insurance Program. Roughly 30 percent of the nation’s children depend on these programs, but another 11 percent remain uninsured.

That’s 8.9 million American children who have no health insurance.

Last year, there was a big plan to try to change those numbers. But two bipartisan attempts in Congress to expand children’s health coverage withered after presidential vetoes.

This year, it appears that a revised and more comprehensive version of the State Children’s Health Insurance Program will likely pass, supported by the new president. After the House passed the bill last week, Mr. Obama said in a statement, “This coverage is critical, it is fully paid for and I hope that the Senate acts with the same sense of urgency so that it can be one of the first measures I sign into law when I am President.”

I am thrilled by the prospect of better health care coverage for children. At the same time, however, I understand the concerns of critics who ask if we are just throwing more money at the larger problem: our broken health care system.

As the President said on Tuesday:

“The question we ask today is not whether our government is too big or too small, but whether it works.... Where the answer is yes, we intend to move forward. Where the answer is no, programs will end.”

In at least one part of the country, North Carolina, the answer has been yes.

Since 1991, primary care physicians, administrators and state legislators there have worked to create and support a state Medicaid program called Community Care of North Carolina. The program has not only offered high-quality, patient-centered care for the state’s neediest children and adults, but has also saved millions of dollars in health care costs.

Based in part on the idea that each patient should have a “medical home,” the Community Care program assigns each Medicaid patient to one of 14 community health networks. Each network in turn is organized and operated by physicians, nurses, hospitals, health departments and departments of social services.

Patients receive primary care and preventive health measures coordinated by the various professionals in their network, and physicians and others receive fees for their services. In addition, each network receives $3 per patient per month to help implement additional programs like after-hours office care, nurses on call and community-based care coordinators for patients with complex issues, including children with cerebral palsy or cystic fibrosis.

North Carolina, in conjunction with independent consulting groups, has documented the savings for state taxpayers with this innovative program. In asthma management alone, Community Care of North Carolina saved an estimated $3.5 million dollars over three years. With diabetes care, the program saved an additional $2.1 million dollars over the same time period.

The most striking difference, however, between Community Care of North Carolina and other state Medicaid programs is the complete absence of insurance companies. Most states partner with an insurance company to deliver care to Medicaid patients; any residual profits go to the insurance company. But in North Carolina, state Medicaid administrators and health care providers manage the program exclusively and then funnel profits directly back into patient care.

I recently spoke to Dr. David Tayloe, the president of the American Academy of Pediatrics and a practicing pediatrician in North Carolina. Dr. Tayloe has been actively involved with Community Care of North Carolina since its inception.

“We have been able to have an effective collaboration between state government and physicians,” Dr. Tayloe said to me over the phone in a deep baritone voice that accentuated his rich Southern accent. “We basically have a not-for-profit administrative program for Medicaid, and the real winners are the children and the families.”

I asked if there might be something different about North Carolina compared to other states, something that made it possible to run a program like Community Care.

“If you look at the fundamentals of the program,” Dr. Tayloe replied, “they could be adopted by other states. There’s nothing holding a state back from saying ‘We want community-based care.’ Any state Medicaid program that commits the dollars to it can do it.”

“We’ve done it for 17 years,” he added, “and we’ve saved a lot of money for the state. No one in our general assembly even thinks about going to another system of care anymore.”

I asked Dr. Tayloe what had inspired him to become so actively involved with his state’s Medicaid program. He paused to think, then talked about his father, who had practiced pediatrics in North Carolina for over 40 years, and about his own lifelong desire to care for any child that walked into his practice.

“With the shortage of primary care physicians in the U.S., we are at risk of allowing our system of health care to deteriorate such that our most needy and deserving children do not have access to good pediatricians,” he added via e-mail the next morning. “This is what Community Care of North Carolina is all about — paying for a system that assures patients access to the best in primary care — a real medical home.”

He continued, “I envision a medical system in which the poorest at-risk children have access to the best and the brightest we have in medicine — on the front lines in our communities.”

Dr. Tayloe’s work and his words, even via e-mail, reminded me of the President’s message I had heard on Tuesday:

“We have duties to ourselves, our nation and the world, duties that we do not grudgingly accept but rather seize gladly.”

Click here to join the discussion on the Well blog, “In Health, Still Leaving Children Behind.”

VIDEO interview with Venezuelan gold mining union leader Manuel Montiel -- total 15' 54" in two parts!

2009-01-19T03:54:00.000-08:00

Venezuelan gold mining union leader Manuel Montiel speaks to VHeadline Venezuela News about the amalgamation/unification of several trade unions towards a greater empowerment and efficiency in labor relations following what is described as disastrous relationships with USA (Idaho-based) Hecla Mining which was bought out last year by the Russian-owned Agapov Group's Rusoro Mining.

Montiel: Well, my name is Manuel Montiel, I'm the General Secretary of the union here in the Agapov Group company. We've reached an agreement ... signing a collective contract ... that benefits over 200 workers in the company. They've complied with almost all the
clauses ... 90% of the contract ... yearly bonus and other bonuses ... we're now on the savings plan ... a saving plan where each worker will have an account in the bank ... we have a housing plan which will start in January, we'll start building houses for the workers, we've reached many agreements (with Rusoro).

We're thankful for the investment that they have brought to Venezuela, this Russian investment, Rusoro Mining ... we're very happy as far as we've always reached many agreements to get our objectives ... the workers' objectives to defend the workers ... they're complying with us now, the (Christmas) presents to the children of the workers ... they've made a very good party for the children. We've accomplished our goals ... we'll start now (from January 5) receiving production bonuses ... we've got the company's compromise to pay a production bonus for the workers.

We're safeguarding our future with this underground mine ... this investment that Rusoro Mining is making here in Venezuela on the La Emilia field ... we're going to have a future ... we've been allowed to work this mine for 20 years ... it's a future for our families, our houses, our children.

We now have a health insurance policy which covers hospitalization, surgery and ante-natal medical assistance for our families and parents, which we didn't have before ... with this investment, we've achieved many benefits.

We welcome Russian investment here in Venezuela. We also represent Corporacion Ochentamil' workers ... also of the Agapov Group ... where we got many goals so far, like air conditioned buses for transportation, which we didn't have ... now we've got them.

Carson: As an union leader, how do you feel about transnational companies involved in Venezuela?

Montiel: As an union leader, I repeat, we welcome any investment as long as it comes with good objectives as was the case with this company, Rusoro Mining, which always stands at the workers' side ... what we've asked they have given to us, always for the benefit of our families and our children.

Carson: But before Rusoro's arrival, how were the conditions here?

Montiel: There was a Canadian company before in the other mine, Camorra ... in comparison it was not good.

Carson: Which one?

Montiel: Hecla, here close by.

Carson: Ah, Hecla. OK. That's USAmerican, not Canadian.

Montiel: Yes, that one, now it's in Rusoro's hands, too, and we're ... all the unions are getting together now to have a common voice within all of Rusoro's companies, we'll have an unification of unions.

Carson: Are there accusations of diverse human rights violations against Hecla?

Montiel: Yes, now the relations with Hecla ... now that it has been bought by the state company... they're going to bring in a project for a collective agreement to unify (and get) the same benefits that we've achieved.

Carson: But what have the problems with MIBAM (Ministry of Basic Industry and Mining) been?

Montiel: Yes, they've always (had) problems with environmental permits, explosives permits, the MIBAM has been tough from the government side, they've been tough in attacking transnational companies.

Carson: Did MIBAM offer money to miners for mining reconversion?

Montiel: What happens is, the company has been complying, MIBAM ... but it happens that new lists appear where there are people who are not miners ... and they are squeezing in, trying to take advantage of this moment when the state (with the transnational companies) are giving (funds) for the mining reconversion to mitigate illegal mining. To do that, we will include 250 new workers who will be incorporated into the company ... 250 direct workers to end illegal mining ... they'll become hired workers with benefits, with a proper, a dignified wage, with collaterals like the "cesta-ticket" to bring a good bonus for their children, that's what we have in this company from now on.

Carson: I'd like to know what were the problems with licenses' procedures for other companies. Why do you think they had those problems?

Montiel: That's a problem we have here from the part of the government. Last year we had a problem in which MIBAM and the environmental ministry froze the permits, I don't know why. We stayed home for six months, the company didn't have means to support us, they complied with paying a bonus because the government was blocking, didn't want to grant permits so we could start mining.

Carson: But why were those permits denied?

Montiel: There was a problem ... but I think that now, with God's help, everything's speeded up because the government is now in partnership with Rusoro Mining ... they have an agreement and they have to comply with it.

Carson: But what with the other companies?

Montiel: The other companies too, now the environmental permits for PMG, for La Increible, all those permits should be granted, should be speeded up because, as the President Hugo Chavez says that there's a partnership with Russia, we hope that it actually gets like he says.

Carson: But there were many problems with other companies, like Gold Reserve, Crystallex ... what do you know about that?

Montiel: Well, the information that I have about Crystallex is that it is a Canadian company that had that (problem) and didn't want to start the projects because of (ungranted) environmental permits ... but now I think I heard the MIBAM minister (saying) that a Russian company will come to work on the Crystallex fields, now, under the surveillance of the government the permits are produced faster. The place where we need to speed up permits is the area where there's the largest quantity of gold mineral, which is the one where Crystallex was. So, for the growth of the municipality and the Bolivar state, we need those permits soon.

Carson: But, isn't it a legal problem to take those contracts from Crystallex and grant them to Rusoro?

Montiel: No, I don't think so, they had plenty of time, they (Crystallex) were in the Stock Exchange, they were in fact waiting for the shares to increase their market value and never worried to get the permits legally. And meanwhile the illegal miners were working ... they had small pumps ... and there were problems with Crystallex because they were on private land and the private concessions must be respected.

Carson: And what about those others at Las Brisas?

Montiel: Brisas del Cuyuni is the same problem, they have a problem because it's divided by a river, a river flows through it, so they wanted to channel the river somewhere else ... then the government (denied the permits) because of the environmental problem. But I think that the problem at Las Brisas is about to be solved.

Carson: But the union supports Rusoro actions and not the others?

Montiel: Yes, we are now going with Crystallex, we are unifying all the unions, as I was telling you, all the secretaries from the unions are going to join to achieve an unification. Crystallex, Caolin, Hecla, Minera Nacional, PMG, we're going to sit together with Rusoro Mining's management. We want to sit with the directors, who are in Venezuela, to talk about some issues for the benefit of this municipality.

Carson: Why the problems with Hecla, were they not paying, what happened?

Montiel: The problems with Hecla were mainly due to some people there, some "gringos" that were there that used to treat the workers very bad, so the government had to intervene. There was mistreatment by the management, all gringos, mistreatment by the National Guard, that forced people to undress to frisk them like if they were prisoners, thereby violating the workers' human rights.

Carson: What about the future?

Montiel: Now (the future) looks normalized, it's calmer with the National Guard, they're helpful. We know that every company has its own internal security, we have to respect safety and security parameters and they have to respect our parameters as workers, we are clear about the areas were we're not allowed, we cannot get there and that's it, it's a matter of company standards in safety and security.

Carson: So, you know about the problems at Las Brisas and Las Cristinas. What do you think is the solution?

Montiel: Well, the solution is that there should be an unification where they should grant us the permits that we require, grant the permits so these companies can open their doors so there's employment, for the growth of the municipality, more collaboration with indigenous communities, collaboration with the community, the roads, the streets, build schools, because we need that the mining projects grow so that the municipality can grow. As there's more production we'll grow and stop being a small municipality.

Carson: I spoke with Andre Agapov and he tells me that he's not against Crystallex getting permits and agree to work with the government on a 50-50 basis.

Montiel: Yes, they should do that too, it's better for the workers for them to go 50-50 so the payment and the permits for explosives, the environmental permits and the drilling permits are speeded up.

Carson: This means that the union is part of the management. They're not apart.

Montiel: No, the majority of the workers ... the union is made up by the workers, not by management. We're workers that have fought to get the benefits we have achieved.

(Other voice): ... he means that union workers participate in decision making.

Montiel: Yes, they've always taken us into account. If they're going to invest this or that number of millions, we sit with thw management and we tell them about our problems and they tell us about theirs and the situation with the economy.

Carson: You mean that the problems for the future can be avoided if it can be achieved that the workers cooperate with management staff, no problems, no conflicts.

Montiel: Yes, there'll always be problems, but what we hope is that they comply with our demands so we can comply with theirs ... meet targets that we have agreed on, starting January 5 ... we have established goals, to unify, to get the production bonus when we start working in the mine ... this past year the investment was slow due to the stock market, but for the rest...

Carson: Will it be an unified union of all the small unions?

Montiel: We are ... the group has many companies, we've always concentrated but now in January, we'll unify, we'll sit with the group's directors to explain the situation of all the unions and, God willing. we'll see one single union for all of the group's companies, where we'll represent all the companies in this area. I'm in charge of the Southern sector, Corporación Ochentamil, Lamin ... at El Callao there's another union, they, with us ... they've achieved their objectives.

Carson: Do you keep in touch with them?

Montiel: We've had a good relation, they've achieved their objectives, salary increase and ... everything increases with the salary.

Carson: Thank you for the interview.

Montiel: Thanks to you, and we welcome foreign investment whenever it comes, and always count on us Venezuelans to be here supporting you to progress.

transcript and translation by
Franco Munini, a member of Tlaxcala

Venezuela is facing the most difficult period of its history with honest reporters crippled by sectarianism on top of rampant corruption within the administration and beyond, aided and abetted by criminal forces in the US and Spanish governments which cannot accept the sovereignty of the Venezuelan people to decide over their own future.

Community health care forum to be hosted by Olson

2008-12-26T03:33:00.000-08:00

Olson has authored several health care bills in the Minnesota Legislature, including one to promote a small business pool for health insurance, but Tuesday’s forum will focus on national plans, not state plans.

The Obama transition team is asking for health care community discussions to be held between Dec. 15 and Dec. 31. The transition team will prepare a report from the discussions for Obama.

In the mean time, the forum “was specifically organized in response to a request that President-elect Obama made for community input meetings,” says Olson, DFL-Bemidji.

State Sen. Mary Olson would hold a community forum Tuesday in Bemidji, as part of a nationwide effort by President-elect Barack Obama to gain input on health care.

Health Care By and For the People

2008-12-20T06:10:00.000-08:00

by Sarah van Gelder

The Obama transition team is asking you to help create a new health care policy. Really. Host a meeting, invite friends and associates, look at the Obama team's proposal, and let the transition team know what you decide. If you are among a lucky few, Senator Tom Daschle, Secretary-designate for Health and Human Services, may show up at your meeting.

This may be more important than it sounds. The key dividing lines over how to fix our country's broken health care system are becoming clear. It may take the same sort of grassroots involvement that got Obama elected president to keep the private insurance industry from hijacking the process as they have during previous reform efforts.

Here's one of the key decision points. The Obama plan calls for giving everyone the option of signing up for a public or private insurance plan. But according to The New York Times, the private insurance industry is lining up against that option. It's no small matter. According to a report released Wednesday by health policy analyst Jacob Hacker, having a public option could make the difference between a system that covers everyone and controls costs, and one that will continue to leave millions out while costs soar.

As Americans are painfully aware, our health care system is broken. 45 million Americans or more are without health care coverage. Half of all bankruptcies are caused, at least in part, by unaffordable health care bills. We're spending more—16 percent of U.S. GDP (gross domestic product) to cover 85 percent of our population, while Canada and France each spend less than 10 percent of GDP to cover everyone.

The harm to our economy of our backward health care system is especially evident today, as all three U.S. auto makers suffer from the competitive disadvantage of covering health care costs that their overseas competitors can leave to more effective government-run insurance programs.

Americans voted for change this November. But what system makes sense?

According to the research we did at YES! for our special coverage of health care reform, government involvement is critical. A majority of Americans agree—two out of three believe the government should provide national health care coverage, even if it would mean higher taxes. Other wealthy countries have adopted various methods, but a system like Canada's is one of the most efficient at providing good coverage for everyone while keeping a lid on costs. Under this system, the government is the insurer, but patients choose their doctors from private, public, or non-profit health care providers.

Having a public system is the way to cut bureaucracy and cost. But government involvement is where things get controversial. The private insurance industry opposes such a move. And some say that the switch to national insurance is too big a leap for Americans. People will be afraid to give up the coverage they know for an unknown system.

So the Hacker proposal, which was adopted in part by Barack Obama, may be the perfect compromise. Keep your private insurance if you want. But if you aren't covered, or if your premiums are too high, or your deductions and exclusions are too onerous, you can opt for the public insurance system. You would still choose your doctor. Subsidies would insure the plan is affordable to all. At the lowest income levels, it would be free.

Including a public system in our range of options is what it will take to control costs, and thus make sure everyone is included, according to Hacker. The private insurance industry has made a lot of money by excluding things that are expensive, shifting costs on to individuals and families by, for example, excluding pre-existing conditions, and working to write coverage only for those who are less likely to need health care. They have a big incentive to figure out how to exclude a treatment or test and little incentive to invest in our long-term health, since people tend to shift insurance companies over time. Their business, after all, is not keeping us healthy. It’s generating profits for shareholders.

Medicare has kept costs under control more effectively than either private insurance companies, or pools of private insurers, like those who contract with the federal government to provide health insurance to federal employees. According to Hacker's report, Medicare spending per enrollee increased only 4.6 percent per year from 1997 to 2006, while the cost of private insurance increased 7.3 percent each year during the same time period.

Innovations in the public sector have helped contain costs, and there are substantial additional savings to be had from better use of information technology, care coordination strategies, and databases of practices and outcomes, according to Hacker. And public health insurance agencies are in a better position to negotiate for reasonable prices from private health care providers.

The nonpartisan Lewin Group estimates that Hacker's plan would save the U.S. economy $1 trillion over 10 years, while covering 99.6 percent of Americans.

The Massachusetts system, enacted in 2006, is a stark example of what happens when there is no public option. Everyone in the state is supposed to be covered, but their choices are limited to private plans. Premiums have been rising 8 to 12 percent per year, which means the system will soon be out of reach of individual families, employers, and the state government.

A public option assures that there is a benchmark against which private companies must compete. Without such a benchmark, private companies have no incentive to contain costs or improve services.

It's hard to argue with giving people a choice.

But the health care industry is arguing. The New York Times says medical associations are encouraging their members to attend the health care discussion groups being organized by the Obama transition team around the U.S. Past efforts to reform the health care system stalled in the face of powerful health industry lobbyists with huge campaign war chests. Will the industry be as adept at dominating the health care policy discussion when it's happening in living rooms and coffee shops around the country?

Here's how President-elect Obama put it at his December 11 press conference:

Year after year, our leaders offer up detailed health care plans with great fanfare and promise only to see them fail, derailed by Washington politics and influence peddling.

If Obama is able to bring together ordinary Americans, who so clearly are desperate for change, and if they get as engaged in health care reform as they were in the bottom-up presidential campaign, perhaps this time we'll get the change we need. Maybe people power will overcome corporate power, and we'll finally be able to join the rest of the developed world who enjoy health care security.

So far, more than 4,000 meetings are scheduled around the U.S. Here's where you can sign up to lead a session. All the information you need is online, including the moderator's guide and instructions for reporting the results back to the transition team.

Note: If you are part of such a discussion, please let YES! know. We'd love to read your report and post a selection. Send us an email at editors [at] yesmagazine.org. Put the phrase "health care discussion" in the subject line.

Their Hollywood lifestyle turned to hatred and divorce... but 25 years later, a debilitating illness inspired an even deeper bondBy Glenys Roberts

2008-12-12T20:32:00.000-08:00

Last updated at 12:44 AM on 13th December 2008

Our story began in the Sixties. His best friends were Michael Caine and Peter Sellers, Roger Moore and Princess Margaret. We holidayed in the South of France and weekended with the Queen’s photographer cousin, Lord Lichfield.

But it wasn’t Doug Hayward’s glamorous lifestyle that seduced me — I had just spent four years in Hollywood where I had seen a lot of high life. We bonded over an idealistic belief in the classless society.

Doug had proved it was possible for anyone to come from anywhere and make the most of their life. Brought up in a working-class home near Heathrow Airport, he went on to start a world-famous tailoring business. We married in 1970, had a daughter, Polly — and then everything went wrong. Perhaps it was the hectic pace of life, perhaps his obsessive work ethic. Or was it my determination not to be a stay-at-home wife?
Our divorce was bitter. We ended up in the High Court, and our daughter was made a ward of court. Though we continued living opposite each other and neither of us remarried, we barely exchanged a civil word for 25 years.

Then one day in 2004 he smiled at me in the street. ‘Has he buried the hatchet?’ I asked my — our — daughter.

‘Don’t be silly, Mother,’ she said. ‘He is becoming so dotty he thinks you’re someone else.’
Doug was diagnosed with dementiaWithin a couple of months my talented former husband had mysteriously blacked out and was taken to Accident & Emergency. Five specialist hospitals later there was a diagnosis. Doug — who had been so dynamic, so witty, so charming, so gentlemanly — had several sorts of dementia. He was not yet 70.
This ghastly disease is no respecter of persons. It strikes wherever it likes and each family has to deal with it as best they can. Doug had no close relatives other than my daughter, so I decided to support her early on by helping with his care.

But what had been a practical decision at the outset had a completely unexpected outcome. Dementia is often said to rob its victims of all personality. I didn’t find that. In many ways, my ex was still the same old Doug I had admired and fallen in love with.

When I first visited him in hospital, I had no idea what sort of a welcome I would get.

‘Do you know who I am?’ I asked him. ‘Yes,’ he said. ‘You are my former mother-in-law — but none of that matters any more.’ He could not find the right word for our relationship, but he wanted it to continue.

His illness often made him confuse his words, but with a little imagination it was easy to understand what he meant.

‘Can I get you on the “wild one”?’ he would say. He meant the mobile. ‘Where is the Moon?’ That’s what he called the house key because it caught the glint of the streetlight at night.
His vocabulary was quite charming, but there were many aspects of his illness that were not. The problems started as soon as he came back from hospital to the flat where he had lived alone since our divorce.

Already he was failing the MMSE — Mini Mental State Exam — which assesses capability based on the answers to questions such as ‘Who is the Prime Minister?’. Part of it was wilful failure — as a schoolboy Doug hated exams — but it didn’t change the facts.
He tried to light the bedclothes rather than the gas fireLeft to himself, he tried to light the bedclothes rather than the gas fire, and put food straight onto the burners on the kitchen stove without bothering with a pan. He scarcely knew his address any more, and couldn’t work out how to open the front door.

Yet he was determinedly independent and did not want to acknowledge any of this. Only recently he had been driving his car all over the country and as far as he was concerned he was going to continue. That meant we had to confiscate his car keys.
He hated this assault on his personal freedom and lost no opportunity to blame Polly and I. His aggression particularly upset our daughter.

She wanted to remember him as the supremely energetic father he had been, the life and soul of the party, the man who always had an amusing tale to tell, who knew the words to all the early Broadway and Hollywood songs by heart. To her, it seemed as if all the attractive parts of his personality had been excised, leaving him on a constant collision course with anyone who wanted to help him.

He couldn’t even take care of the new dog that had replaced his beloved Burt, a Jack Russell of some repute, who’d had his own Doug Hayward tailored jacket and obituary in the national press.
Doug felt he'd lost all quality of lifeBurt had been the runt of the litter, content even as a puppy to sit at home because he was allergic to trees and grass, thus perfect for an ailing owner. Jack, the newcomer, was an enormous, bounding thing who never sat still. He had to be rehoused and Doug concluded that was the end to any remaining quality of life.

He was so depressed that we did not have the heart to tell him he was never going to get better. He must have suspected it himself, so perhaps there was no point.

Some doctors, as well as most friends, seemed to take the view that he would be better off dead, but I couldn’t agree.

I tried to cheer him up by telling him doctors would one day discover a cure for Alzheimer’s and that I wanted him to be around to benefit when the breakthrough was made. We genuinely hoped it would come in time. But what was to happen to Doug in the meantime?

The choice was stark: he went into care or we funded 24-hour carers to look after him in the flat he loved, above the Mayfair tailoring business he’d created. He begged my daughter never to send him away, and so we decided he should live at home as long as possible — and, ironically, because of his frugal upbringing, we managed this.
In his heyday, Doug dined out on stories of his penny-pinching, which in his witty way he made seem utterly charming — an inevitable consequence of his working-class background.
We went as far as California for help - but found nothingIt meant he had saved what he earned for just such a rainy day, and my daughter, who had power of attorney, was determined to use his money for his benefit. His one extravagance had been top-of-the-range health insurance, so he could have the best medical advice the instant he needed it.

Not that anyone had the faintest idea what was the best way forward. Doug went as far as California and Barbados to try to find a cure while he was still able, but he found nothing.

Fortunately, we knew a brilliant Catholic geriatrician who shared my view that where there’s life there’s hope. Dr Keet’s answer to every problem was: ‘Keep your nerve and play it by ear.’

He was willing to come out at all hours, at a moment’s notice, to switch Doug’s medication and mastermind a cocktail of calming drugs alongside health supplements, including acknowledged brain food such as royal jelly and fish oil.

Doug was given Aricept, about the only drug that improves the memory of Alzheimer’s patients. The NHS refuses to provide it until a patient reaches the later stages of the disease. What a tragedy it is that they do not make the drugs we used routinely available to all dementia patients.

The NHS may do many good things, but it is difficult to understand why the diseases of the old are so underfunded when every drunk or drug addict who ends up in A&E on a Friday night is guaranteed sympathetic treatment.

Unlike drink and drugs, old age is not a lifestyle choice. Certainly, no one would choose to end their days as vulnerable as a newborn child — incapable of comprehension, of articulating their basic needs or controlling their bodily functions.

Doug couldn't tell us the problem, but he was terrifiedSo how do you find a reliable companion for someone in this state? At the start, we tried to save agency commission by answering adverts ourselves, only to find that private individuals are entitled to little information about prospective employees because of data protection.

In the end, we turned to a leading agency, on the basis they would never let us down. It was expensive, and although they found us several very good carers, there were some who were unsuitable — including one who seemed to be ill-treating my ex.
Doug couldn’t tell us what was wrong, but was plainly terrified of the man. Eventually, we found two wonderfully loyal carers who had worked for families we knew. We were fortunate, too, that Doug’s many friends were so helpful. They invited him to watch football on TV, especially when his team, Chelsea, was playing. They joined him at his gym, run by Annabel’s owner, Mark Birley.

Most lunch-times they took him to one of the many restaurants near his Mayfair shop. Doug usually rose to the occasion when he was in company, though his attention span was shortening.

He didn’t say much on those outings, but ate his favourite pasta and could even have a glass of wine. He liked to drop into his shop, too, and his eye for a well-cut jacket and his uncanny intuition were as sharp as ever.

Sometimes I took him to the cinema. We saw his friend Clint Eastwood’s Million Dollar Baby together. Doug, an avid movie fan, was still able to follow the most obscure plot and deliver an opinionated verdict.
We might as well still have been marriedSometimes we took him out in the car. He would sit next to me convinced he knew the way, ordering me to ‘Turn right, turn left’ and accusing me of being completely useless. We might as well still have been married.

Sometimes I took him for a walk in the park. Usually he loathed exercise, but once he struck out further and further only to bolt for home without warning, heading for the traffic. Doug, who had been a skilled footballer in his day, was still a strong runner. I only just managed to catch up and distract him in time. But our boldest idea was to take Doug, who loved the sun, back to the South of France where he and I had spent one of our first holidays together on Peter Sellers’ yacht.

Two years ago, my daughter found a house for rent near Nice where all Doug’s actor friends had holiday homes. We asked him whether he wanted to go — you did not tell my former husband what to do, even though he was ill. He said ‘Yes’ without hesitation, adding rather forlornly: ‘Do you think I can?’

That made us doubly keen — and determined nothing should go wrong. We planned the outing with military precision, invited a rota of my daughter’s friends to keep an eye out for him, and booked his doctor and the carer on our flight, just in case.

We reckoned without the August 2006 terrorist alert and all the added airline security procedures. In those first weeks you were not even allowed to take a lipstick on board, still less any liquid.

Doug, shaking with nerves, but still his old, proud self, refused to use a wheelchair, and stood in a queued for security for two hours without even being allowed a drink. When we finally got on the plane, he was in a foul mood. He hated the airline food, hated his seat, hated me for sitting next to him.
The holiday was a spectacular success
Then there was the first of many magical moments. We were just about to cross the coast of France at Antibes. Ahead lay the Mediterranean bathed in August sun. ‘Look out of the window,’ I said.

He looked grumpily down and then turned to me with a look of sheer childlike delight on his face: ‘I know where we are,’ he said. ‘He goes right out there and turns left and then he lands in Nice.’ He meant the pilot, and Doug was right.

The holiday was a spectacular success. He loved the bedroom my daughter had chosen for him because it was exactly like his room at home. He loved the garden, and for the first time in his life took an interest in flowers — which he asked to have planted in the garden of his English country house. We took him to lunch parties at the
beach and to all the old haunts.

Of course, there were nerve-racking moments. There was the time, five minutes after we arrived at the house, when he locked himself in the loo and we couldn’t get him out for an hour and a half.

There were the many times he tried to dive into the shallow end of the swimming pool and hated us for stopping him. Then there was the day he finally walked down the steps into the water with my daughter, launched himself into the pool and swam two lengths. Everyone burst into tears. We had never thought we would see him do that again.
When we returned to Britain, we planted the flowers he wanted in the garden of his country home near Henley, but Doug never saw them. He gave up spending weekends there because he saw frightening hallucinations lurking in the shadows.

Brought together by his illness
There was no use trying to dispute these visions — they were real people to him, and so we talked to them, as he did. On one occasion, our carer even laid the dinner table for the three make-believe women who seemed to keep him constant company.

Brought together by his illness, we spent the last four Christmases as a family for the first time since the Seventies. In the old days we used to spend them with Joan Collins.

At our first reunion, the cast list was the carer, the doctor, Polly and 12 firemen from the local fire station. They were there to cope with a fridge that had exploded after Doug — who had lost his sense of smell — failed to notice it had been leaking highly flammable ammonia.

And for the first time ever, I had managed to persuade Doug to come to the supermarket with me. He had never been a New Man. If there was no one to make a cup of tea for him, he threatened to leave home. In the old days, he had always overseen the festivities, on the principle that I would never get it right, and so he gladly rifled the supermarket shelves of poinsettias and mince pies, and was in a great mood.
We kept up the outings almost to the end. He sat in a seat of honour when Michael Parkinson was taping one of his last shows featuring Michael Caine and Tony Bennett. ‘None of us would know each other without Doug,’ Parky said. ‘He introduced us and we are all wearing his suits.’

I don’t think Doug cried, but I did. By then, he could rarely find the right words, despite knowing exactly what he wanted to say. Sometimes he even talked about his business. ‘Oh, I can’t say it,’ he would flounder in despair. Then I would voice what I thought were his sentiments. When I got it wrong, he was ferocious, but when I got it right, his relief was obvious.
Coming to terms with his disease
It even seemed to me that he came to terms with his disease after he bonded with a Nigerian part-time carer who told him: ‘We say in our village you must love every stage of life because even old age and illness has its compensations.’ You never know where help is going to come from.
This time last year, my daughter got married and Doug was in church with all the other guests. Then, on New Year’s Eve, which would have been our 38th wedding anniversary, I asked him out to a champagne dinner. Doug only ever did what he wanted, so when he accepted enthusiastically, it showed how far our relationship had come. In February, he started failing and finally had to go into care.

We decorated his room exactly like the one at home, and then I went away for a short Easter break confident he did not know anyone any more and had no idea of his whereabouts. Wrong. When I came back he was sitting in his chair with a tartan rug from his shop over his knees. ‘Where have you been, then?’ he said. It wasn’t so much an accusation as an acknowledgement.

He died three weeks later. But I could not have anticipated what happened next. ‘You take his ashes, Mum,’ my daughter said. ‘He’d like that.’

I put them on the piano he gave me in the old days. Then our musical tastes had differed wildly — he liked Thirties ballads, I liked Janis Joplin. This time I played him Rodgers and Hart’s 1935 love song with its wonderful refrain: ‘I know it’s over and yet... it’s easy to remember, but so hard to forget.’

3-year-old Payton Thornton finds hope in experimental stem cell transplant for rare skin disorder

2008-12-07T05:16:00.000-08:00

By Brett Buckner
Staff Writer
12-07-2008

WHITE PLAINS — Payton Thornton wants what every 3-year-old boy wants — to play tee-ball and wear flip-flops in the summer, to have a puppy like the one in Old Yeller and be able to wrestle with his big brother.

But because of a disease with a big name, Payton is denied those things.

It's called epidermolysis bullosa, or EB. It affects about 20 out of 1 million births, but the most severe form, recessive dystrophic EB, which is the kind Payton was born with, occurs about twice in 1 million births.

Payton's parents, Joy and Reid Thornton, don't pay attention to statistics.

"The numbers don't matter," Reid says, as Payton balances like a gymnast between his knees. "Payton's tough, tougher than most grown-ups I know."

Children born with EB are missing collagen VII, a protein that helps layers of skin stick together. Friction — from a hug to a fall — can cause blisters the size of water balloons. His toes are "mittened," fused together and the same thing could happen to his fingers.

The lining of his stomach is fragile as butterfly wings. Simply eating an Oreo cookie could rip his esophagus. Payton gets extra nutrition through his "special bellybutton" — a port in his stomach connected to a feeding tube.

"That's where my milk goes," he says, tapping on his stomach. "But I can't really taste it."

If nothing is done to help his skin heal, he will likely develop an aggressive form of skin cancer. Children with Payton's form of EB rarely live to see their 20th birthday.

And yet Payton doesn't do without much.

A few weeks ago, his grandfather bought him a green, kid-sized four-wheeler. Though it's slower than the red one his older brother, Parker, rides, it "goes fast enough," Payton says. And he'll prove it … in the living room.

"It goes like this," Payton says, stretching out his bandaged arms and gripping the imaginary handlebars with tiny pink fingers. "VRRRrrrrrroooommmmm!!!"

Watching him race across the linoleum making motorcycle noises, it's hard to feel sorry for Payton.

But there are just as many bad days — days of four-hour baths to clean bleeding sores and of 18-gauge needles used to pop his blisters, there are the medications he takes to fight infection and the gentle hands in latex gloves that change his bandages.

Though pain is all he's ever known, hope is a lesson Payton is starting to learn … perhaps sooner than anyone imagined.

Time to wait
It was well after midnight in early November 2007, when Joy read the story about a 2-year-old with EB named Nate Liao.

On Oct. 19, 2007, doctors at the University of Minnesota transplanted bone marrow and umbilical cord blood, both rich in stem cells, from his healthy brother through a catheter in Nate's chest and into his bloodstream.

Within months, the boy's body was producing collagen VII. His scabs and blisters started to heal. The bandages came off, and he was eating regular food.

The procedure was performed by Dr. John Wagner, head of the pediatric Blood and Bone Marrow Transplantation Program and director of the Stem Cell Institute at the University of Minnesota.

Joy wanted her son to have the same transplant. So she began a yearlong siege of letters, e-mails and phone calls to Wagner's office. Last month, the family flew to the University of Minnesota where Payton was evaluated by the transplant team and accepted into the experimental program.

"When just looking at his body surface, Payton's case is obviously severe and worse than most I've seen," Wagner says via cell phone on his way to a convention in San Francisco. "But his overall health is good and strong."

For three days, the family toured the hospital and the bone marrow transplant wing. They saw the germ-free rooms where Payton will spend upward of six months because of the chemotherapy that will leave his body "profoundly immune suppressed," Wagner says.

But every room has a TV and a Wii game system, which impressed Payton almost as much as his first airplane ride.

Joy was overwhelmed to finally meet the doctor she'd read about and watched on Good Morning America talking about this miraculous new procedure to help kids with EB.

"It was amazing, just to hear someone talking about a cure," she says. "When we talked to doctors before, no one ever gave us any real hope. Dr. Wagner changed all that."

For as much optimism as this treatment has created, it's important to remain cautious, says Geri Kelly-Mancuso, a nurse educator for the Dystrophic Epidermolysis Bullosa Research Association of America (DEBRA).

"I'm very leery of the word 'cure'," she says from her Cincinnati office. "If … there's a lot of ifs involved. If the procedure works for a specific subtype of EB with a specific mutation, it may not work for everyone with EB. But the good news comes in that the research is being done.

"Good news is rare for a disorder that disfigures and destroys so many lives."

During their visit, Payton underwent four biopsies to establish a baseline for his specific form of EB and to help find a cord blood donor.

But finding a donor wasn't going to be the hard part. The real fight was going to come from the insurance company, which was unlikely to cover such an experimental procedure. Wagner prepared the Thornton's for a lengthy process that he expected to last months if not years.

The transplant alone will cost $500,000.

"I knew, somehow, it would work itself out," Reid says. "We've been through too much to let money hold us back."

Three weeks later, on the day before Thanksgiving, Joy came home from dropping Parker off at school. As soon as she opened the door, the phone started ringing. On the other end was Karen Foster, transplant coordinator from Blue Cross/Blue Shield with incredible news.

Against all odds, they had been approved. Blue Cross/Blue Shield agreed to cover Payton's transplant.

"I was so excited and relieved," Joy says. "We were all speechless. Nobody saw it coming, and now it's all happening so fast."

Many more obstacles lay ahead, but finding an unrelated cord blood match for Payton won't be one. That will be "very quick," Wagner says, adding that it could take only a few weeks. But he doesn't want to rush.

"Could we go immediately to transplant with Payton? Yes, we could," he says. "We know we have good donors. We also know that Payton's in good condition — he's young and isn't malnourished as so many children with EB are. So I think we should delay for now; see what can be learned from the others who can't wait.

"Payton has time."

Wagner is quick to add that if for some reason Payton's health suddenly deteriorates, the transplant team is prepared.

"We're ready to go at any time," he says.

But this will never be a risk-free procedure. Wagner is honest about the real dangers lurking behind what so many are hailing as a miracle.

"There will be deaths," he says. "But the only reason parents see this as a real choice is because the disease itself is so bad. These kids can't have a normal life or a normal life expectancy.

"We know it can work. It just takes time … and funding."

That's the reality Joy and Reid continue to face. Before the actual transplant, Payton will have to make several trips back to Minnesota for more tests — with airfare alone costing upward of $2,000, which Joy and Reid have to pay "out of pocket" — not to mention the six or more months he'll have to live in isolation following chemo treatment.

But those are worries for another day. For now, they'll all go on living as normal a life as possible, which won't be a problem — at least for Payton.

Outside their house, where the open farmland seems to stretch on forever, Payton revs the engine of his four-wheeler. But he can only ride as fast as the rope in his father's grip will allow.

Trotting behind, ready to pull the motorcycle to a stop if Payton starts going too fast, Reid tries hard to keep up. But Payton never bothers looking back. He just grins and blinks against the cold breeze blowing in his face.

"He's really just like any other little boy," Joy says, laughing as Reid tries not to slip in the mud. "And that's all we want for him to be."

Mind the gap - UK goes unprotected says Barclays

2008-12-01T02:57:00.000-08:00

Written by Barclays Bank
Monday, 01 December 2008

Despite the level of fear surrounding unemployment and debts in the current environment, research pubiished by Barclays Financial Planning shows a worrying trend of people not providing themselves and their families with a safety net.

Over half of people in the UK are worried about being able to maintain their outgoings within the next 12 months, pushing essential safety nets like income protection and critical illness cover to the bottom of their priorities. Results show, nearly half (47 per cent) of UK adults have no protection policies4 in place whatsoever to protect them and their families in the event of losing their income, health issues or even death.

The safety net gap:

· 52 per cent have no life insurance
· 75 per cent have no critical illness cover
· 78 per cent have no income protection cover

Those aged between 35 and 54 often have the most responsibilities in terms of dependants and outgoings, but showed a large gap in their protection cover, with 45 per cent having no life cover and 74 per cent with no income protection insurance.

Alison Tattersall, Head of Customer and Proposition at Barclays Financial Planning said: "When finances are tight it is often responsibilities like protection policies that fall to a lower priority, and of course these policies protect outcomes that people don't want to think about. But people must consider the financial consequences of what would happen if they were unable to work, or their dependants situation if they died, it would be far worse than any concerns they currently have over struggling to meet their outgoings.

"Our research indicates that a large number of people are without any protection at all, or that they don't realise they have any policies in force. Both are equally as worrying, especially the current climate."

When looking at what other safety nets people could be relying on, the research reveals that 60 per cent of people admit to having nothing saved, having less than one month's salary in the bank, or not knowing what they have in savings at all. Worryingly the report also reveals that nearly 40 per cent of people don't receive benefits such as sick pay, death in service or health insurance, or simply do not know if they would be entitled to them. Coupled with 81 per cent of people not knowing what they would receive in benefits from the state if they were too ill to work, it shows that many people haven't thought through their plan b.

Alison Tattersall continues: "This is a worrying trend. People need to know what their state and employee benefits are before they are able to plan their protection needs properly.

"Over half of people that do have protection policies said they did not take advice or did not know if they had taken advice when buying their cover, and over 70 per cent do not know or only have a rough idea what level of payout their policies would give them if a claim was made. This could clearly mean people end up without the right cover for their needs, which is often just as bad as having no protection at all. We urge people to seek professional advice and review the level of protection insurance they have to cover themselves or their family."

Medical Alert: All will feel the pain if hospitals lose substantial funding

2008-11-28T04:57:00.000-08:00

Posted by Post-Standard Editorial Board November 28, 2008 5:02AM

Gov. David Paterson has laudably taken on the difficult but necessary task of cutting a state budget that is billions of dollars out of balance. But the size of his proposed cuts in Medicaid payments to hospitals could end up doing more harm than good.

The governor wants to cut more than $500 million in Medicaid in the 2008-09 budget alone, with more cuts predicted for the following budget year. Those cuts would take their toll on hospitals.

As the CEOs of Crouse, Community General, St. Joseph's and University hospitals pointed out at a Post-Standard editorial board meeting last week, hospitals serve as the primary medical safety net in the region. They are bound by the law to provide care for whomever comes through their doors -- and the numbers continue to climb as people lose jobs and health insurance and the local elderly population increases.

Patient volume already has increased 22 percent between 2003 and 2007 at the four hospitals, and the hospitals are feeling the strain. If things get much worse, one CEO said, he could foresee patients waiting up to 15 hours for care in the emergency rooms.

Yet hospitals are left to figure out how to absorb the growing numbers of patients -- a problem that can be traced back to the nation's inadequate health care delivery system -- while dealing with million-dollar cuts in their budgets. The four Syracuse hospitals stand to lose nearly $17 million over the next two years under Paterson's proposed cuts.

Hospital executives say they have managed to get by -- they don't have a choice -- but can't continue to operate with fewer funds and more patients.

New Yorkers who have health insurance may mistakenly believe that inadequate Medicaid reimbursements only affect low-income patients. But as one CEO explained, hospitals don't have "insured beds" and "Medicaid beds." They don't have a system that allows people with health insurance to skip the line in the emergency room. If an ER is backed up because it cannot handle all of the incoming patients, or the hospital doesn't have enough beds, insured patients will be just as affected as those without insurance. People who don't think so need only visit an emergency room.

The governor said that when it came to budget cuts, nothing was off the table. But the governor has consistently left one revenue-raiser off the table: He won't consider a millionaire's tax that would be temporarily placed on those with higher incomes -- as was done successfully under Gov. Pataki in 2003. The Assembly has passed such a measure, but it was rejected by the Senate.

Wealthy people would feel a pinch from such a tax. If a disproportionate share of the burden falls on hospitals, every New Yorker will eventually feel the pain.

She did it for love

2008-11-10T18:59:00.000-08:00

Out of love for her then ailing husband, sales development manager Sheryl Fong gave him one of her kidneys four years ago.

Church pastor Kenneth Fong has since recovered.

The operation and hospitalisation fees for her alone cost more than $20,000. Because her insurance policy does not cover 'elective surgery', that had to be paid in cash.

Mrs Fong, 38, quit her sales manager job which paid her a comfortable salary of $7,000 a month so that she could take time to recuperate after the operation.

She remained jobless for four months before she found a new job as a sales development manager.

For six months after her operation, she had to go for monthly health check-ups at the hospital. Each check-up cost her more than $100, which she had to foot.

Today, she still has to go for annual blood and urine tests to ensure her single kidney is functioning well. The tests set her back by about $100 each time.

Despite the immense physical and financial sacrifices that she had made, Mrs Fong said that she has been more than compensated.

Mr Fong, 43, received a new lease of life and she got her life back, too. When he was ill, she used to have to nurse him day and night.

She finds it hard to imagine someone going through the same ordeal for a stranger.

'It will certainly help if the altruistic donor is reimbursed for surgery costs,' she said.

'It is not fair to the donor if after donating an organ, he still has to settle a huge debt for the surgery fees.'

She added: 'But the compensation should not be seen as a payment. There should be no price tag on the gift of life. It is priceless.'

Hughson couple's burden eases as husband gets a new job

2008-11-01T02:50:00.000-07:00

By Eve Hightower
ehightower@modbee.com

Along with 1.4 million other Californians, Jerry King was out of work, applying for every job he could and looking for a break when The Modesto Bee wrote about him in September.

King finally got that break three weeks ago, when his old boss at Beck Properties called with a job offer for King and his wife, Debra.

"It's like a big, big rock was taken off of me," said King, a former home warranty representative.

King had been looking for a job for 17 months before his old boss called. As the unemployment numbers rose, he turned in hundreds of applications.

At the same time, his wife was recovering from cancer. Then she discovered another lump in her breast. With no health insurance, they sold their house to pay for medication. Meanwhile, the special medical aid she was getting was coming to an end.

Though faced with all of that, King had only good things to say about his former employer when interviewed for the story about his job search two months ago.

"They kept me as long as they could," he said then.

That loyalty and King's reputation as a hard worker won Mario Guerra's attention when he read the article in The Bee.

"There's only so much we can do in this economy. We can't help everyone, but I knew I could help them," said

Guerra, King's boss. "Jerry has always done a good job for us. So when this job came up, I thought of him."

Now Jerry and Debra King manage and maintain 592 storage units and moving trucks for B&R Self Storage in Stockton, which is owned by Beck Properties. The couple's new job comes with full health care benefits and a rent-free apartment.

"We're well taken care of. They're doing everything to make us feel comfortable," King said with a smile. "The bottom line is: Don't give up."

Guerra is glad to have King back.

"We go through life and just run across people and keep going. That article reminded me what a good guy Jerry is. We're all out there trying our best to find success. That's OK, but right now we need to take care of each other," he said.

Companies don't want to lose good people, he said. But their choices are limited in a bad economy. To stay alive, some companies have to lay off even their best employees. That doesn't mean they'll forget them.

"There's always a chance you'll be hired back after all this," Guerra said.

Debra King said it couldn't have happened at a better time.

"We never thought we'd be in such a bad situation. And Jerry was trying so hard to find work," she said. "There were times we didn't even have food. We had nothing."

Those times are behind them now, but the Kings realize they still would be in their Hughson mobile home fretting about medical bills had Guerra forgotten about his former employee.

"We got real lucky. A lot of good people are still out there feeling bad about not finding work," Jerry King said. "We just finally got a break. We're all looking for a break."

Bee staff writer Eve Hightower can be reached at ehightower@modbee.com or 578-2382.

Voters want solutions as health insurance costs rise sharply

2008-10-13T18:08:00.000-07:00

By SUZANNE KING
Special to The Star

Working two jobs isn’t exactly the way Dave Coffman envisioned his retirement.

But that’s how it’s turning out.

“I’m working basically because of health care,” said Coffman, 62, a retired school principal who lives with his wife in Lee’s Summit.

Until they qualify for Medicare, they have to buy private coverage. For now, their insurance bills amount to around $1,000 a month — including long-term care insurance, dental insurance and a health plan that has a $2,500 deductible. If he weren’t working two part-time jobs, Coffman said, there would be no way he could afford it.

“I never once thought about health insurance before I retired,” Coffman said.

Now it’s never far from his mind.

Like many Americans, Coffman says that health care will be a top concern as he casts his ballot in November.

“I know that each of the parties has a (health care) plan, but definitely we need something to help provide insurance,” Coffman said.

Coffman doesn’t want to see socialized medicine, but he wants to see a government that forces health care providers to hold the line on costs and helps the people who can’t afford them pay their health care bills.

At a time when 45 million Americans lack health insurance, Coffman is hardly alone. Even people who are insured are paying more all the time. In the past four years, according to a report in the New England Journal of Medicine, insurance premiums have climbed 35 percent, to $4,400 for an individual policy and $12,000 for a family policy.

“When people say they’re worried about health care, they’re not worried about where they’re going to find a decent doctor or medical care — they’re worried about paying for it,” said John McDonald, senior state director for AARP Missouri.

Certainly health care is on the agenda of Democrat Barack Obama and Republican John McCain.

Both candidates want to see a system that provides more affordable coverage to more people. And both talk about the need to cut costs; to improve efficiencies, partly through the use of information technology; to promote preventive care; to reduce errors; and to rein in medical malpractice lawsuits.

But the candidates’ fundamental approaches are vastly different.

Under McCain’s plan, individuals, not employers, would carry the responsibility for choosing and paying for health care.

Obama wants to shore up the current employer-based system by mandating more coverage and providing more subsidies.

“It’s a choice between adjusting the financing mechanism or a system of mandates,” said Maggie Nelson, manager for federal government and industry relations with Cerner Corp., the North Kansas City-based health care information technology company.

The McCain plan

Experts agree that McCain’s proposal is the most radical.

The senator from Arizona proposes eliminating the current tax exemption for employer-paid health insurance premiums — meaning people with job-based coverage would pay income tax on the premiums their employers pay, which are tax-free today. In exchange, he would provide a $2,500 tax credit to individuals and a $5,000 tax credit to families to buy their own insurance.

McCain’s camp argues that the system would give consumers more control, allowing them to keep insurance as they move from job to job, for example, while at the same time making them more aware of the true cost of going to the doctor.

Patients to be given right to 'top up' NHS treatment by buying private drugs

2008-09-23T05:26:00.000-07:00

By Tamara Cohen

Patients will be allowed to top up their Health Service treatment with drugs bought privately in a U-turn by the government, it was reported last night.

Alan Johnson, the Health Secretary, is said to be poised to relax the ban on patients paying for life-extending treatments while receiving NHS care.

Until now ministers have refused to allow individuals to combine NHS and private treatments saying such a move would undermine the ethos of the Health Service.

But Mr Johnson has been under pressure to reform the system after experts ruled it to be unsustainable.

A source told The Times that ministers hope an independent review of the issue next month will help to make the case for change.

‘Whatever is recommended won’t satisfy everyone. There is no magic bullet that resolves this very difficult issue’, a senior figure told the newspaper.

A Department of Health spokesman last night played down the reports, saying ministers had launched a review in July looking into the issue.

‘The review will report back in October. Ministers are looking into this but no decisions have been made’, she said.

It is understood there will be reforms made to the system under which local NHS committees decide which patients are exceptional cases, and can receive drugs not yet approved by NICE.

Professor Mike Richards, the national cancer director, is conducting the review into ‘co-payment’.

Mr Johnson agreed to reconsider the issue in June after a series of reports about patients who were refused NHS care after buying drugs for cancers of the kidney, bowel, lung, breast and multiple myeloma.

There was a public outcry over the death in March of Linda O”Boyle, a grandmother who was denied free NHS treatment after buying a drug to treat her bowel cancer.

If top-ups are allowed, these are likely to be capped, and patients may also have to pay for any associated costs incurred by the NHS such as treatment for side effects.

Any changes would be accompanied by measures to speed up the approval process for new drugs and make them cheaper, the source added.

The National Institute for Health and Clinical Excellence assesses the cost-effectiveness of new medicines and recommends whether they should be provided by the NHS in England and Wales.

Where it has turned down a drug, or has yet to make a decision, patients can appeal to their local NHS primary care trust to be treated as an exceptional case.

Those who favour top-ups argue that a postcode lottery already exists where patients in some areas are granted treatments that could extend their lives while others are not.

Earlier this month, the King’s Fund, a health policy think tank called for patients to be allowed to pay for top-up drugs to stop the creation of a black market in cancer drugs.

Professor Karol Sikora, a leading cancer specialist who supports top-ups, said: “This situation cannot go on, it’s against natural justice.’

But some doctors, MPs and the Royal College of Nursing argue allowing wealthier patients to purchase better care will lead to a two-tier system based on ability to pay rather than clinical need.

Professor Richards said that he was in discussions with patient groups NHS staff, pharmaceutical companies and the insurance industry over which patients would be willing to pay for extra care.

Push on for insurers to share autism costs

2008-09-16T05:38:00.000-07:00

DOVER - Because of his severe autism, the cost of educating 5-year-old Jack Ursitti runs $100,000 a year. But unlike expenses with most medical conditions, the bills for treating him will be borne by Dover schools and the rural town's taxpayers - not his family's medical insurance.

Now, the nation's largest autism advocacy group, Autism Speaks, is planning a legislative push in 20 states, including Massachusetts, to require private insurance companies to pay a portion of the intensive, expensive educational treatments that many medical professionals say are a child's best chance to overcome, or just learn to cope with, profound and lifelong developmental and learning disabilities.

Similar laws have passed in the past several months in Arizona, Florida, Louisiana, and Pennsylvania requiring private insurers to pay toward a variety of therapies, including applied behavior analysis. That system, known as ABA, involves a weekly regimen of more than 30 hours of intense, often one-on-one, positive reinforcement techniques for teaching children how to speak, play, learn, and function in the world.

But private insurers are balking at the proposed requirement, especially coverage of the specialty ABA programs, which they say are relatively new and unproven, and not effective for all children. ABA teachers are not licensed in many states, and insurers contend that the therapy system is still too new to be regulated sufficiently.

Requiring insurers to pay for educating autistic children would "drive up costs for everyone," said Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, an industry group representing 12 health plans operating in the Commonwealth.

Health insurers should not be dragged into the educational arena, particularly to pay for ABA classes, she added. "In a sense, it's asking for a blank check for therapies that we'd want more evidence to prove are really effective," Buyse said.

But parents of autistic children are determined to get their youngsters into programs that offer even a glimmer of hope. They also want to shift society's perceptions of autism.

"If my son couldn't hear and needed a cochlear implant, we wouldn't be asking the school system to take responsibility," said Jack's mother, Judith, coordinator of the New England lobbying effort for Autism Speaks. "As a society, we have to acknowledge that autism crosses a line from an educational issue to a medical one. Jack was diagnosed by a neurologist, not a schoolteacher."

Richard DeRoo of Reading, a software engineer whose 11-year-old son, Evan, has autism, said parents are desperate for more financial help.

Since his diagnosis at age 3, Evan has needed extensive behavior, speech, physical, and occupational therapy, his father said. The family paid for some of that care out-of pocket at a cost of $25 to $50 per hour.

Legal Things for peace of mind

2008-09-03T05:24:00.001-07:00

Today the Zen Habits blog talks about five legal things for peace of mind and I want to talk about four of them.

First of all, get a will done. While you may not have to worry about it after you're passing do not put your family through having to figure out what to do with your stuff and money after you are gone.

My Uncle on my mother's side passed away only a few weeks before my father and the stress of dealing with my Uncle may have been something that pushed my father over the edge. My Uncle did not have a lot, a worthless piece of land near Kingman, Arizona which might have been worth something in a few years, a run down trailer and a $1000 car.

However, because he did not leave a will and he had no children, several members of the family fought over every little piece he had. It even came down to fighting over the genological records that my uncle had. In fact, several members of the family have not talked to each other since because of all the strife it created. Do a will!!

Next up is to have a living will. You never know what might happen and people need to know what to do. After my mother had a stroke a couple of years ago, I was left with making all the decisions about her health. She was suffering from Dementia so she could no longer make the decisions and never had a living will so once again the family started fighting. Everyone knew what was best and all seemed only to care about what was best for them, not for our mother. If she had made out a living will we would had known her wishes and carried them out.

Next up is to get the insurance you need so you do not have any worries if something happens. Even if you're renting your present office, home, or store make sure you are fully covered. Also, get Errors & Omissions insurance if you work in a business that is giving advice or doing services that people may be unhappy with the services no matter how hard you try and will try to sue.

Finally separate your business from your personal assets. Set up a corporation or a limited liability business entity to shield your personal assets incase of a fore mentioned lawsuit.

The most important thing is to get the proper legal advice in each of these areas so you do what is best for you.

Health Care’s New Entrepreneurs

2008-08-27T16:17:00.000-07:00

Innovators are bringing consumer-oriented medicine to market, with promising results.

For seriously ill patients, American health care is second to none. Our commitment to innovation is unmatched; our researchers have won more Nobel Prizes for medicine than all other countries’ combined; our biotech and pharmaceutical industries, thanks partly to lavish federal funding for basic science research, are the envy of the developed world. So lopsided is the field that thousands of European scientists have relocated to companies in the U.S., where they have a better chance of transforming cutting-edge research into lifesaving new medicines.

But American health care is also much more confusing, impersonal, and expensive than it needs to be. Conflicting opinions from doctors and insurers often strand patients with complex diseases in a medical maze. Many primary-care physicians, frustrated with red tape and puny reimbursements, limit the number of Medicare and Medicaid patients whom they see, or they drop out of the profession altogether. Adding insult to injury, employers and employees face seemingly endless cost increases, with health-insurance premiums rising much faster than inflation or income.

Thankfully, entrepreneurs are finding ways to bring innovative, consumer-oriented health care to market—simplifying medical decisions, reinvigorating primary care, and lowering health-care costs. From health insurance to DNA-driven medicine, American health care is experiencing a revolution from below that promises to improve quality, lower costs, and empower people to control their own health care.

Today, we shop for cut-rate hotels on Travelocity, bargain for airfares on Priceline, and seek reliable information on everything from computers to flat-screen TVs at CNET. The same information explosion is occurring in health care. Dozens of websites, such as WebMD, Revolution Health, and eHealthInsurance, now offer consumers up-to-the-minute information on medical conditions, drugs, and insurance options, as well as basic quality information on doctors and hospitals. Internet-savvy patients can walk into their doctors’ offices knowing more about the latest treatments than their physicians do.

Critics counter that health care is more complicated than hotels. Without someone to help manage complex information, they point out, patients may find themselves overwhelmed by options, fall prey to snake-oil salesmen, or fail to see that they have received incorrect diagnoses or poor treatment plans. But where critics see a problem, entrepreneurs see an opportunity. Companies are finding ways to make even the most complicated medical decisions simpler for patients.

Take the Boston-based firm Best Doctors, founded in 1989 by Harvard Medical School professors. Best Doctors uses peer evaluations of physicians—polling 50,000 doctors worldwide in 400 medical specialties—to identify leading medical experts and then makes them available to 10 million patients in 30 countries. Normally, insurance companies limit patients’ access to specialists by requiring prior authorization for referrals, limiting access to preferred networks, or asking patients to pay more out of pocket. Patients whose employers offer Best Doctors, on the other hand, can go directly to the firm without prior authorization whenever they have serious medical problems and need help making decisions.

One such patient is John de Beck, a California teacher diagnosed with prostate cancer. De Beck faced a dizzying array of options, from cutting-edge robotic surgery to more traditional surgical, hormone, and radiation treatments. Since his employer had contracted with Best Doctors, John immediately had access to a “handler” who got John’s permission to send his medical records—including original biopsy slides and CT scans—to a Best Doctors clinical team. The team wrote a synopsis of John’s case and sent it to a leading Harvard expert on prostate cancer. Within a few weeks, John and his doctor got a binder from the expert that examined and explained his treatment options and made a personal recommendation for him.

Over the next year, John consulted with Best Doctors every time he needed to make a key decision about his treatment—for example, getting another opinion from a University of Chicago expert about a new type of radiation treatment, proton therapy. The depth of the reviews—and the fact that they came from leading experts who had no stake in his case—proved invaluable. “I can’t imagine, with the income that I’ve got, to be able to even find . . . somebody to personally review my case and write a personal diagnosis,” de Beck says.

“We trust patients to self-select,” Best Doctors president Evan Falchuk explains. “When they feel uncertain about something, they have the most interest in making sure things go right.” Falchuk hopes that Best Doctors is part of a growing trend toward more consumerism in health care—even in single-payer systems like Canada’s. “Even government-run systems are suffering from the same cost trends we are,” he says. Consequently, they are searching for ways to share costs with people, “and as the financial burdens fall more on individuals, those individuals want control.”

Marcus Welby, M.D. last aired on ABC in 1976. Fast-forward 30 years or so, and think about the prime-time doctor dramas that have replaced it: ER, Grey’s Anatomy, House, Scrubs, and Nip/Tuck. The folksy primary-care doctor familiar to patients a generation ago has all but vanished from America’s primary cultural medium, television—and this reflects his real-life decline. Insurance reimbursements, and especially Medicare, may pay primary-care physicians only a small fraction of the actual costs of treating patients, especially after one takes into account rising demands on doctors’ time and dramatically increased administrative overhead. Consequently, many doctors are retiring or avoiding primary care. In reality, as on television, hospital emergency rooms and expensive specialists are replacing them.

Personal relationships between primary-care doctors and patients foster long-term health and keep health-care costs in check, so this is an unwelcome development. And it could hardly come at a worse time. The need for primary care will rise rapidly in the years ahead as tens of millions of aging baby boomers develop serious chronic ailments ranging from heart disease to diabetes to cancer. The nation’s over-65 population will double by 2030; the American Academy of Family Physicians, however, reports that from 1997 to 2005, the number of med-school graduates entering primary-care residencies dropped 50 percent.

Policymakers compound the problem by advocating universal insurance schemes that would inject millions more patients into the system without fixing any of its underlying problems. In July 2007, the Wall Street Journal reported that many Massachusetts residents were having trouble finding primary-care providers, even as the state embraced a universal insurance mandate that could thrust 550,000 previously uninsured residents into overcrowded doctors’ offices. The Massachusetts Medical Society found that for new patients, the average wait to see an internist was up 57 percent since the previous year, to more than seven weeks.

Primary-care doctors’ woes are severe in the rest of the country, too. “Most physicians out there are in networks, meaning that they accept insurance and are held to the reimbursement schedules currently available to them,” says Kevin Kelleher, a Virginia doctor. And insurance rewards procedures—tests and surgeries—much more handsomely than it does working with patients on the prevention and management of chronic disease. The result: as reimbursements have flatlined or even declined, the traditional family practice has evolved into a high-volume, prebooked business in which physicians have just a few minutes to spend with each patient. “Double booking has become extremely common in the last six or eight years,” Kelleher observes. “Doctors don’t have any quality time to spend with their patients. . . . They’re lucky if they can address a current pressing health issue, let alone discuss prevention.”

Instead of waiting for the system to change, some physicians are changing the system. In 2004, in Reston, Virginia, Kelleher and Mark Vasiliadis founded Executive Healthcare Services, where clients receive a full range of preventive, primary-care, and acute treatments for a flat monthly fee of $150 to $450, depending on the size of their families. There are no contracts; if EHS clients don’t feel that they’re getting value for their money, they can leave. Kelleher says that EHS’s patient-retention rate is about 98 percent.

This out-of-pocket payment model counters some of the system’s perverse incentives. “We can very frequently just discuss problems on the phone with patients, since 90 percent of the diagnosis traditionally comes from their history,” Kelleher points out. “If someone calls with elbow pain, I can spend 15 minutes on the phone with them. I don’t have a financial impetus to get them into my office.”

Comparatively high prices allow EHS to operate with just 300 patients or so, a stark contrast with the 2,500 patients whom the average primary-care doctor must serve in order to turn a profit after low insurance reimbursements. EHS’s enviable scale won’t work nationwide, Kelleher admits, but he thinks that components of his program could be modified to accommodate larger practices and lower prices. For instance, patients could bolster their current insurance reimbursements with a flat monthly fee—maybe as little as $20—and in exchange receive enhanced primary-care access (longer appointments, say) from doctors with somewhat smaller practices.

Further, filing claims with insurance companies is so time-consuming and expensive that doctors could lower prices—perhaps by 20 to 30 percent or more—simply by offering more basic services on a cash basis. Primary-care physicians in this type of system would likely see fewer patients every day but could offer them more time and attention. Some observers have derisively called this “concierge medicine.” But it would be more accurate to say that Kelleher and his colleagues have embraced a primary-care model that puts the doctor-patient relationship first—where it used to be.

This model seems to be gaining traction with frustrated patients and doctors. Last October, one West Virginia doctor made national news when the Wall Street Journal chronicled his prepaid primary-care plan. Vic Wood offers the 100 or so patients in his plan unlimited primary and urgent care, basic diagnostic tests, and many generic drugs for a monthly fee ranging from $83 for an individual to $125 for a family.

One patient is a private music teacher who, before joining Wood’s plan, had gone without health insurance for four years because his wife’s health insurance would have cost him $400 a month. Wood diagnosed him with high cholesterol and is treating him, with excellent results. A local business started offering Wood’s clinic as a benefit, switched to a major medical plan with a high deductible, and saw its monthly premiums drop by $4,000. The firm’s health insurer lowered its rates the following year, noting that workers “required less time in the hospital and used Dr. Wood’s clinic for nearly all of their primary care,” reported the Journal.

Wood’s clinic isn’t without its detractors, particularly among insurance companies that see prepaid physician plans as competition. But it hasn’t deterred him. “I’ll sign up one patient at a time if I have to,” Wood told the Journal. “I can’t see my practice surviving for the next 10 years without this model.”

Henry Ford didn’t invent the automobile. He just found a way to mass-produce it, allowing him to sell an affordable, reliable form of transportation to middle-class Americans. Can twenty-first-century entrepreneurs do the same for health care, which seems defined by expensive, labor-intensive services? In a word, yes—by “unbundling” inexpensive services from expensive settings like hospitals and by moving from a reactive medical model that treats already sick patients (very expensive) to a predictive, personalized model that monitors patients for disease predispositions and keeps them healthy (far cheaper).

Wal-Mart, for all the fire that labor activists direct at it, is quickly becoming the Henry Ford of health care. It took a bold stride into health-care markets in 2006, rolling out a Florida pilot program offering dozens of generic drugs at just $4 for a month’s supply. The program quickly spread to other states and added many new generics, including medicines for glaucoma, attention deficit disorder, fungal infections, and acne. As of May 2008, Wal-Mart estimates, the program has saved consumers over $1 billion in prescription drug costs. Competitors like Target and Kroger have rushed to match its offerings.

Another low-price, low-tech step toward shrinking health-care costs is the emergence of convenient-care clinics like RediClinic and MinuteClinic, which are housed in larger retail stores like Wal-Mart, Target, and CVS. The first convenient-care clinic, QuickMedx (later renamed MinuteClinic), opened in Minneapolis–Saint Paul in 2000 after its founder, Rick Krieger, couldn’t find a doctor on short notice to administer a strep-throat test to his son. Wasn’t there a better way, he wondered, to get fast, convenient care for simple illnesses? “We are not talking about diabetes, cancer, or heart disease,” he told Harvard Business School researchers in 2002. “We are talking about colds, throat and ear infections.”

The convenient-care clinics all use a similar model: offer a list of simple, low-cost health-care services for the consumer who can’t see his regular physician or doesn’t have one. The clinics keep prices down by offering care from a skilled nurse practitioner under the oversight of a licensed physician. Instead of skipping care or going to an emergency room, patients strapped for time or money can just head for a local store. As of November 2007, some 800 convenient-care clinics were operating across the U.S., up from 62 in 2006, with hundreds more planned.

Despite their popularity with consumers, the clinics have met with opposition from some state medical societies and groups within the American Medical Association that feel that the clinics fragment health care by preventing patients from developing long-term relationships with primary-care physicians. Web Golinkin, RediClinic’s chief executive officer, believes that these concerns are greatly exaggerated. “The reality is that care is already fragmented,” he says. Further, millions of Americans don’t have primary-care physicians or have trouble accessing them, and millions more lack insurance; convenient-care clinics may not address all these patients’ needs, but they can at least get them routine care and provide an entry point into the broader health-care system. “We see a lot of patients who are outside of our scope of practice,” Golinkin acknowledges, “but we refer them back to their primary-care physicians if they have one and help them find one if they don’t.” He objects to the idea that patients must seek an expensive consultation for every medical condition: “Spending $200 or $250 to treat a consumer’s strep throat is not a sustainable model.”

Convenient-care clinics show a lot of promise, but state regulations that prohibit them outright or make it difficult for them to operate effectively are holding them back. “Probably the biggest hurdles are regulations of physician oversight of nurse practitioners,” says Golinkin. Most states require such supervision, but some take the principle to an extreme by requiring doctors to be on site at the clinics or by severely limiting the number of nurses they can manage at one time. These regulations drive up clinic costs, making them unprofitable.

Other states strictly regulate who can own and operate the facilities. According to the California HealthCare Foundation, California laws “require ownership by local physicians who operate the health care facility”; as a result, the CHCF notes, “there are very few clinic operators or clinics in California,” though MinuteClinic is trying to gain a foothold there. And even in California, promising early evidence suggests that convenient-care clinics, despite their scarcity, are changing the economics of basic health care. In May 2007, the Los Angeles Times reported that the state’s largest physicians’ association, HealthCare Partners Medical Group (with more than 500,000 patients), started posting prices—at a substantial markdown—for many common procedures, in a direct concession to competitive pressure from convenient-care clinics.

The really exciting strategies for controlling health-care costs are genetic technologies that will identify the tiny differences in DNA that make some people susceptible to various diseases, from diabetes to Alzheimer’s. Myriad Genetics reports $100 million in revenue for a test that has told 150,000 female customers whether they carry the BRCA gene, which puts them at increased risk of developing breast or ovarian cancer. Another company, Navigenics, offers a $2,500 test called Health Compass that screens consumers for 20 conditions, including diabetes, prostate cancer, and obesity. “In five years, we will have a very large number of these gene tests,” Kari Stefansson, who leads the biotech firm deCode Genetics, told Forbes, “and they will be frequently used, at least by an educated portion of the population who will want to know.”

Over the next 10 to 15 years, moreover, technology will offer Americans customized health-care solutions tailored to their individual genetic profiles—individualized regimens of exercise, diet, and drugs to ward off diseases far earlier and more effectively than is possible today. One small company that exemplifies the trends in personalized medicine is Genomas, which is exploring pharmacogenomics, or how drugs interact with people’s genes to produce different reactions. Many patients taking common drugs—statins for high cholesterol, for instance, or antipsychotics for mental illness—have adverse reactions that lead them to switch medicines repeatedly or to stop taking them altogether. These actions can lead to more expensive health complications, like heart attacks. Some experts estimate that about 2 million serious adverse drug reactions may occur every year, producing 100,000 deaths and billions of dollars in excess health-care costs. Genomas’s technology, which it calls PhyzioType, may help physicians and insurers predict common side effects and realize huge savings. (One study has found that effective genetic testing for a single blood-thinning drug, warfarin, could help patients avoid “85,000 serious bleeding events and 17,000 strokes annually,” reducing costs by $1.1 billion.)

The field remains in its infancy. Some voice concerns about the quality of the science linking newly discovered genes with complex conditions like heart disease or diabetes, and worry that fly-by-night companies will just hand patients test results without any counseling about what they mean. These concerns are legitimate but not insurmountable—and it’s easy to see how powerful market applications will emerge. Patients with a family history of chronic ailments like diabetes, heart disease, and cancer, for example, might gladly pay extra for an insurance package that included genetic counseling and guidance on which drugs were likely to offer the best outcomes and the least risk of dangerous side effects.

To unleash the full promise of these new technologies and business models, policymakers should deregulate the market for medical products and services while liberating consumer demand. Congress should give individuals the same tax deduction for the purchase of health insurance that employers now have. Also, because each state currently requires any insurer doing business in that state to cover certain mandated services—driving up the cost of basic health insurance—we should create a national market for health insurance, perhaps through an optional federal charter (as now exists for banks) or through direct cross-border sales. This increase in individually owned insurance and real market competition would encourage companies to offer a broad mix of new health-care services and insurance products that cater to consumers’ real needs at prices they can afford. As the insurance environment became defined by individuals purchasing their own portable coverage, employers, unions, and hospitals would become trusted health-care intermediaries and help patients navigate the system.

In 2003, Congress enacted a moratorium on Medicare payments to physician-owned hospitals that has since expired, though opponents keep trying to resurrect it. It should stay dead, thus encouraging health professionals to explore new venues for patient care and create new bundles of health-care services. Doctors, convenient-care clinics, and specialty hospitals could then compete for customers in a wide variety of health-care settings. There isn’t one store for electronics, and there’s no reason that there should be one venue, or just a few, for health care.

Today, you don’t have to pick up a science-fiction novel to envision the future of health care. Convenient-care clinics already offer a wide range of basic health-care services at affordable prices; more services—perhaps including genetic testing—are sure to follow, with the results flowing back to a patient’s primary-care physician in an electronic health record that is reliable, secure, and easy to use. Doctors who are now overwhelmed and underpaid will opt out of insurance for most basic services in return for prepaid primary-care agreements that offer patients more convenience and better care at affordable prices. Waiting at a doctor’s office or an emergency room for basic care will decline, replaced by access to your primary-care physician through e-mail and even cell phone. Entrepreneurs will mine reams of information to help devise state-of-the-art patient-care regimens for complex diseases like cancer, helping patients in small Iowa towns get the quality of care currently available only at academic hospitals in Boston or New York. Patients will pay for many more basic services out of tax-exempt health savings accounts (HSAs), driving continuous competition and innovation. Finally, advances in genetics will enable doctors to match patients with treatment regimens that give them the best chance of avoiding unwanted side effects and maximizing good outcomes.

In short, from HSAs to DNA, we’ll be matching the right treatment to the right patient at the right price, and we’ll be restoring patients to the center of medical decisions—which is where they belong.

Paul Howard is the director of the Manhattan Institute’s Center for Medical Progress and the managing editor of its web-based journal, Medical Progress Today.

Bristol Compressors Opens Medical Clinic For Its Employees

2008-08-23T04:14:00.000-07:00

By Debra McCown
Reporter / Bristol Herald Courier
Published: August 23, 2008

BRISTOL, Va. – In a trend some say is the return of the company doctor, Bristol Compressors cut the ribbon Friday on an employee health clinic. The clinic will provide more convenient medical services to employees while saving them and the company money, said Holly Bays, manager of employee benefits for Bristol Compressors.

Bays said it will enable employees to develop a doctor-patient relationship so they won’t avoid the doctor when they need care. An added plus is that they won’t have to take vacation time to see a doctor.
“Our employees are very, very, very excited about this,” she said.

Bristol Compressors is the first company in the Tri-Cities region to open an on-site clinic like this one, said Chris Brown, chief executive officer of Integra Health Management, the Charlotte, N.C.-based company that will operate it.

But, he said, companies around the nation are doing the same.

Five years ago, fewer than 5 percent of companies with more than 1,000 employees had built or studied the idea of building a clinic, he said. Now, the figure is between 30 percent and 40 percent, he said.
“It just hasn’t taken off here in the Tri-Cities area yet, but we hope it will,” he said.

Representatives of other area employers, including large companies like Food City and Alpha Natural Resources, attended the ribbon-cutting and asked questions.

Michael Ferracci, CEO of Appalachian Cast Products, said company clinics are likely to become a trend in this area.

“It has to, because health care ... it’s out of sight” said Ferracci, whose company employs about 130 people.

Bays said the clinic at Bristol Compressors will allow employees and their covered dependents – a total of about 2,400 people – to use the clinic for a $10 co-payment and receive a month’s supply of certain generic prescriptions for a $5 co-pay.

She said the hope is that by providing easy access to routine and preventive care, the company will reduce costly emergency room and urgent care visits.

All employees have access to health insurance through the company, she said, but some do not enroll. All of the company’s 1,029 employees, who earn an average wage of about $15 an hour, will be able to use the clinic, she said.

Human Resources Director Rick Nunley said in an era of skyrocketing health care costs, businesses no longer have the luxury of paying health insurance claims alone. They must take a longer term approach by investing in employee “wellness” and preventive care, he said.

“If you can have plans in place to address the issues of diabetes, hypertension and heart disease today, then you get to reduce your costs tomorrow,” he said.

The clinic opening is an encouraging sign for company employees, who have faced a many uncertainty in recent years after a series of layoffs drastically cut the company’s work force.

The company, whose future was up in the air until it was bought by KPS Capital Partners last year, remains one of Bristol’s largest employers.

Engineering Systems Administrator Charlotte Stewart said the idea for the on-site clinic came with the company’s new management.

“I think it’s a new concept to this area that a lot of us are unfamiliar with and looking forward to making it work,” Stewart said.

Dennis Stiltner, an engineering lab employee, likes the idea, too.

“It’ll save money for them and keep us a job, and save money for us, too, so it’s good all the way around,” he said.

Tinkerbell, Peter Pan, Cinderella & Alladin arrested in Disney Worker action

2008-08-18T04:06:00.000-07:00

32 people including workers & some of the most notoriously sanitised & perfidiously evil warped stereotypes to have been implanted in the 20th century child's imagination were arrested in California on Friday "on a misdemeanor count of failure to obey a police officer and two traffic infractions." As we know Aladdin is a thief & it is no surprise LAPD finally cuffed him. But the others?

Ostensibly they had been taking part in continuing trade union action against Disneyland for contracted work, health benefits and so on - so forth.

There is no such thing as the average family, but if we believe that 2 hetrosexual adults with perfect teeth can spawn prepubescent replicas of themselves "one little son" and "one little daughter" than they pay $256 (= £137.29 or €174.21) for one day's admission.

Meanwhile the Disney corporation which shocked readers of Naomi Klein's "No Logo" for its excessive profits continue to rake in money. 2007/2008 Winter quarter profits were declared to hit a record high of $1.18 billion ( £632,840,000 or €802,996,000).

You would think one wish one a star which might come true is the hope that such a corporation could grant a contract. But the 2,300 approximate workers who are engaged in this struggle have worked since the end of January without contract. Disney also proposes permenantly denying health benefits to employees who work fewer than 30 hours or 5 days per week. The Trade Union representing the housekeepers, bellmen, bartenders, dishwashers, and cooks employed at the Disneyland, Grand Californian, and Paradise Pier hotels, says that free health insurance is really the only sweet thing about an otherwise bitter contract. Without a raise in the average hourly wage of $11.30 the Union says the workers of Disney will priced out of health potions & clean white teeth. They mightn't even afford diapers as the Americans call nappies for their spawn.

But beneath the dungeons of Disneyland California there is a lower level of acknowledged poverty. The minimum stage wage is set at $8.00 which allows a Disney worker to buy one healthy BigMac more per hour and pray the government of Schwarzenegger thinks to copy the UK and confiscate their fattened youth soon.

One In Five Young Men Screened For Prostate Cancer

2008-08-12T04:59:00.001-07:00

A new study has shown that one in five American men in their 40’s underwent a prostate-specific antigen test (PSA) during the last year.

Published in the Sept. 15 issue of Cancer, the research highlights the difference in screening rates between young black males versus young white males.

Senior investigator Dr. Judd W. Moul from Duke University in Durham, North Carolina said, "Our findings for black men are discouraging. We've been encouraging black men to get screened at age 40 or 45 for more than a decade, yet only one-third of these high-risk men reported being tested."

In the case of prostrate cancer the blood levels of a protein called prostrate-specific antigen (PSA) usually rises. Doctors recommend a PSA screening by the age of 50 years for men though in the case of African American men or those with a family history of the disease, the American Cancer Society recommends prostrate cancer screening by the age of 45 years. The recommended testing age by the association drops to 40 years for men with two or more first-degree relatives with prostate cancer.

The study based on a 2002 survey of U.S. men in the age group of 40 plus, suggests that young black men are 2.4 times more likely to undergo a PSA test as compared to the white male, as were younger Hispanic males.The chances of having a PSA test increased with factors such as obesity, having a higher household income of $ 35,000 or more, and higher education level as well as health insurance cover and a relationship with a physician.

The rates of PSA screening for the last year were 22.5 % of men aged 40 to 49 and 53.7 % of older men though doctors feel black men should have more screening done as they are at a greater risk for prostrate cancer. The current rate of one out of three black men being screened was not good.

The study authors wrote, "Our study is the first to specifically examine PSA screening in younger men, which provides an important assessment of quality of care, especially for high-risk groups. Further investigation will be required to understand the impact of new risk-stratification strategies, with particular focus on the policy implications of potentially large increases in health-care resource use."

Obama, McCain take to airwaves to duel over Iraq, energy crisis

2008-08-10T04:25:00.000-07:00

Barack Obama is vacationing in Hawaii, but he and Republican rival John McCain jockeyed yesterday on the airwaves.

Obama, giving the weekly Democratic radio address for the first time as party nominee, said that the past week gave "two stark examples of exactly what's wrong with Washington," a federal budget deficit that could reach nearly $500 billion last year, and a $79 billion surplus for the Iraqi government from windfall oil profits.

Obama said that McCain would continue President Bush's unfair tax policies by extending tax cuts for the wealthy, and would continue Bush's "open-ended commitment to the war in Iraq."

"Senator McCain talks about putting our country first, but he is running for a third term of the very same policies that have set our country back . . . I believe that we need to move in a new direction," Obama said.

McCain, in his own weekly radio address, again poked fun at Obama's reputation as a sterling orator - and suggests he lacks substance.

Noting that Obama burst onto the national stage at the 2004 Democratic convention and is expected to give "another celebrated performance" in Denver later this month, McCain said, "even the most stirring speeches are easily forgotten when they're short on content. Taking in my opponent's performances is a little like watching a big summer blockbuster, and an hour in, realizing that all the best scenes were in the trailer you saw last fall. In the way of running mates, Senator Obama should consider someone with a knack for brevity and directness, to balance the ticket."

McCain then faulted Obama for wanting to "forfeit" US military gains in Iraq, increase the size of government, and to raise taxes, but to not do enough to lessen the energy crisis.

"First there was his call for Americans to check their tires - which is common-sense advice, but hardly has the makings of a national energy strategy. If we can't drill our way out of the problem, it seems even more unlikely that we can inflate our way out of it."

"A serious energy plan involves a lot more yeses than nos," McCain argued, plugging his proposals for more offshore drilling, nuclear power, clean coal, and renewable sources.

FOON RHEE

Guaranteed healthcare is key plank for Democrats
PITTSBURGH - Democrats shaped a set of principles yesterday that commits the party to guaranteed healthcare for all, heading off a potentially divisive debate and edging the party closer to the position of Barack Obama's defeated rival, Hillary Rodham Clinton.

Obama, soon to be the Democratic nominee, has stopped short of proposing to mandate health coverage for all. He aims to achieve something close to universal coverage by making insurance more affordable and helping struggling families pay for it.

Advisers to Obama and Clinton both told the party's platform meeting they were happy with the compromise, adopted without opposition or without explanation as to how healthcare would be guaranteed.

In return for the guarantee, activists dropped a tougher platform amendment seeking a government-run, single-payer system and another amendment explicitly holding out Clinton's plan as the one to follow.

The party now declares itself "united behind a commitment that every American man, woman, and child be guaranteed to have affordable, comprehensive healthcare."

Under any system in play, most people would still put out money for health insurance as they do now, but they would get help when needed.

The 51-page platform draft showed the influence of Clinton's supporters not only in the extensive section on healthcare but in its assertions about the treatment of women. Some of her backers believed sexism dogged her campaign for the nomination.

An extensive section on women's rights is included and the votes she received in the primaries are described as "18 million cracks in the highest glass ceiling."

Democrats typically have a strong plank in favor of abortion rights; this year's version is stronger than usual. "The Democratic Party strongly and unequivocally supports Roe v. Wade and a woman's right to choose a safe and legal abortion, regardless of ability to pay, and we oppose any and all efforts to weaken or undermine that right," it says.

Gone is the phrase from the past that abortions should be safe, legal and "rare."

The party also pledges to ensure access to adoption programs, prenatal and postnatal care, and income aid programs for expectant mothers.

The party also:

Promises "practical and humane immigration reform in the first year of the administration."

Favors restoration of the ban on assault-type weapons and other "reasonable regulation" that recognizes the constitutional right to own and use firearms.

Favors helping religious groups provide social services as long as "public funds are not used to proselytize or discriminate."

Rep. Cooper pushing ‘Healthy Americans Act’

2008-07-29T05:08:00.000-07:00

By: Christine Buttorff, news correspondent

Rep. Jim Cooper (D-Nashville) wants to end employer-based health care insurance and replace it with a tax-credit to allow everyone to purchase their own private health insurance.

Cooper is one of the House sponsors of the ‘Healthy Americans Act,’ which was reintroduced in the House earlier this month.

Congress will not be taking any action on the proposal until at least next year under a new president, but while in Nashville on Monday, Cooper said it’s important to begin talking about the issue now. Health care spending accounts for about 16-percent of the gross domestic product, and is especially important to Nashville’s economy.

“Nashville probably has more to gain or lose than any other city in America because we’re a premier health care capital,” said Cooper. “Whether it’s HCA, or Saint Thomas, or Vanderbilt [University Medical Center] or other fine health care institutions and companies here we are much more health care oriented than most other places in the country.”

Under the bill, employers would give employees the money spent on health care premiums. Employees would then be required to buy health insurance with after-tax dollars.

Cooper said a $15,000 tax-credit for a family of four would also allow those whose employers don’t offer health insurance to buy it. Health insurance for a family of four is estimated to cost about $12,000 per year.

Under the bill, employers will still be able to offer prevention and wellness benefits, and withhold premiums from paychecks. However, many corporations have pushed back, saying that health benefits are one way they are able to recruit.

Cooper said that system has been abused meaning extra perks are added allowing some individuals, particularly high-paid executives, to deduct more money.

“There are some people who wouldn’t get their $50,000 break, but everyone would get at least $15,000,” explained Cooper. He added that if everyone is enrolled, risk would be pooled across the whole population, so insurance companies will be required to insure even those with serious, chronic conditions.

In addition to pooling risk, the bill is also estimated to save $1.48 trillion dollars in health care costs over the next eight years as insurance companies adapt to compete for individuals on the private health insurance market.

A 150-member group called the “National Coalition on Benefits,” (NCB), which includes major employers such as the BlueCross BlueShield Association and the FedEx Corporation, have expressed other concerns. In a letter this month to the bill’s Senate sponsors, the NCB said that the bill has the potential to inhibit the way employers offer standardized benefits across state lines.

The “Employee Retirement Income Security Act,” (ERISA) allows employers, according to the letter, “to offer uniform benefits to their employees, retirees and families without being subject to the confusing patchwork of mandates, restrictions and costly rules that vary from state to state.”

Cooper counters that some kind of national standard would be created to establish a basic health plan across states.

The bill would offer subsidies for those making up to 400-percent of the Federal Poverty Level ($21,200 for a family of four), and therefore get rid of Medicaid altogether.

Both of Tennessee’s Republican Senators, Lamar Alexander and Bob Corker are co-sponsors of the Senate bill, introduced by Sen. Ron Wyden (D-Ore.) and Sen. Bob Bennett (R-Utah).

Invitations were issued to 'women leaders' for Monday’s event. About 100 women and a few men attended.

Aid long delayed

2008-07-20T06:11:00.000-07:00

By Alan Johnson, Catherine Candisky and Jonathan Riskind

hat Gerald E. Cartee really needs is a new heart.

His is wearing out, but it won't be replaced. Instead, he's seeking $700 a month in Social Security disability benefits to help him get by during whatever time he has left.

What Cartee is going to get, however, is a "tickle" on Dec. 30. That's when Social Security Administration bureaucrats will update, not resolve, his case, filed in July 2005.

"It's frustrating. God, it's frustrating," Cartee said. "You don't get anything out of them if you write or talk to them. It's like you're just another number."

Cartee, 57, of Worthington, worked as a medical records clerk until he became seriously ill about three years ago. He was shocked when his doctor told him he had had at least two silent heart attacks; he also has congestive heart failure, vascular disease, cirrhosis of the liver and hepatitis C.

But, according to Social Security, Cartee is not disabled and can still work at his old job. He appealed the original determination and is waiting for a hearing before an administrative law judge.

Returning to work is impossible, Cartee said. He can't even walk one block to his mailbox without shortness of breath and chest pains. His partner, Michael, bought him a small scooter to help him get around.

Dr. Paul Nanda of Columbus, his physician, concluded in a June 17 report that Cartee has, "as we already knew, significant heart failure."

The problem holding back Cartee and thousands of other Ohioans is the huge Social Security disability backlog. The problem is old and appears likely to persist.

Only eight of the nation's 142 Social Security offices -- including one in Dayton -- have longer waits than Columbus.

More than 761,000 claims were pending nationally as of June 27, up from about 745,000 a year ago, according to the Social Security Administration. Once a benefit rejection is appealed, the average national wait for a decision is just what it was a year ago: 510 days.

In Columbus, as in some other cities with many cases and especially long waits, the agency has focused on providing more hearing judges. Two more are starting in the Columbus office this year, said the office of Sen. Sherrod Brown, D-Ohio.

The number of cases pending in the Columbus office declined to 9,310 at the end of June from 10,731 a year ago. The average waiting time dropped, too, to 728 days from 771.

But the wait, as calculated by the government, starts after a reconsideration appeal is rejected. In Cartee's case, the clock started running in November 2006 -- 16 months after he asked for help.

Congress and the White House have begun increasing funding for the agency in recent years. Brown is one of the lawmakers pushing for an even bigger boost to help erase the backlog.

Brown and Sen. George V. Voinovich, R-Ohio, are among lawmakers who want to add $240 million to the White House budget request. Too many people are waiting years to have their applications approved, some losing homes or custody of their children or even dying before benefits are awarded, said a letter sent last month by Brown, Voinovich and 50 other senators to the leaders of the Senate Appropriations Committee.

Jeff and Janis Mickey would readily agree. The Orient couple waited 5 1/2 years to get final word that Mrs. Mickey's disability application had been approved; that came just 11 days ago. They are still waiting for the first monthly check of about $1,700.

Mrs. Mickey, formerly a customer service manager with Marriott foods, suffered a massive heart attack in November 2001 and had triple-bypass surgery. Over 10 months, she had nine serious heart procedures. Her transplanted arteries clogged quickly; now she has five stents in them.

All along, however, Social Security officials continued to say that Mrs. Mickey could work in a "sedentary job."

During the long wait for a disability decision, the Mickeys plunged $80,000 into debt. They began selling things, including most of Mr. Mickey's pipe collection.

They would have lost their home and car had it not been for generous family members. Mr. Mickey's checking account has not been in the black for five years. He is constantly digging into his $1,000 overdraft protection, then paying it back to get even. But he never gets even.

The situation is complicated by Mr. Mickey's health problems. He is disabled because of a polymyositis, a rare serious muscle disease that forced him to leave his job as a banker 12 years ago. He sometimes is bedridden for up to six weeks.

Although they knew each other in high school in Jewett and even appeared as love interests in a play, The Importance of Being Ernest, they did not get together as a couple until 31 years and two broken marriages later.

Now they are united in a fight against government red tape.

"It's repulsive," Mr. Mickey said. "They make you feel like a bum. I'm disgusted by the system."

"It was demoralizing for me," Mrs. Mickey added. "I thought many times, 'It's never going to happen.' "

llness that brings pets to the vet

2008-07-18T16:43:00.000-07:00

by Joan Lowell Smith
Friday July 18, 2008, 6:27 PM

Ever wondered what prompts pet owners to make an appointment with the veterinarian? What better source for answers than the largest and oldest pet health insurance company in the country: Veterinary Pet Insurance in Brea, Calif., which provided a Top 10 list of reasons for owners to plop their pooches and kitties in the car for a trip to the vet.

CANINE
1.Ear infection
2. Skin allergy
3. Pyoderma/hot spots
4. Gastritis/vomiting
5. Enteritis/diarrhea
6. Urinary tract infection
7. Benign skin tumor
8. Eye inflammation
9. Osteoarthritis
10. Hypothyroidism

FELINE
1. Urinary tract infection
2. Gastritis/vomiting
3. Chronic renal failure
4. Enteritis/diarrhea
5. Diabetes mellitus
6. Skin allergy
7. Colitis/constipation
8. Ear infection
9. Respiratory infection
10. Hyperthyroidism

Carol McConnell, vice president and chief medical officer for VPI, acknowledged that pet owners may be surprised by what's not on the list. "Falling just short of the Top 10 are major injuries -- broken bones, poisoning, trauma from car accidents or animal attacks," she said.

McConnell added that hypothyroidism in dogs rose from No. 11 in 2006 to No. 10 last year, jumping sprains to No. 13, and then explained that hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormone, which is responsible for regulating metabolism. Dogs suffering from that malady appear lethargic and gain weight, despite a strict diet and exercise.

Feline enteritis leaped from No. 16 in 2006 to No. 4 in 2007. One-third of all common conditions are often related to or exacerbated by diet changes or "dietary indiscretions" -- a nice way of saying the owner is overfeeding or giving the wrong foods to kitty.

The good news is that the pet food recall has had a positive effect on dietary choices. "This past year," McConnell said, "our numbers indicate that pet owners took gastrointestinal and dietary difficulties more seriously."

Many claims are associated with age-related changes, such as osteoarthritis and renal (kidney) failure, but she said any of the Top 10 can occur at any age. As the economy squeezes consumer's discretionary income and many pet owners are recalculating budgets, VPI averaged claims state by state on non-routine veterinary care in 2007: California's $500 per pet topped the list. New Jersey's average was $437 and the lowest per pet non-routine medical expenses were Mississippi's at $207. For more data on VPI, call (800) USA-PETS or visit petinsurance.com.

Voynick's views

We checked with Brian Voynick, a veterinarian often quoted in this column. Owner of American Animal Hospital in Randolph and host for 11 years of "Pet Stop" on News 12 New Jersey, Voynick agrees with the lists.

"Sure," he said. "Those have been the reasons for the past 26 years I've been practicing, but it's not that complicated. Many of the items are related to the skin. For example, ears are an extension of the skin. Most patients we see have either skin problems or gastrointestinal problems."

"With cats, we're in the dark ages when it comes to proper nutrition," Voynick said. "We should be preventing most of those conditions. We've come a long way with dog diets, but we're pitifully deficient when it comes to cat nutrition." When he attends continuing education meetings, Voynick said the most crowded seminars are always those dealing with skin disease and GI problems.

He also explained hyperthyroidism in cats as "a benign tumor on the thyroid gland, which you can feel -- about the size of a pencil eraser -- accompanied by excessive appetite, weight loss and a racing heart that can hit 220 beats per minute."

At a conference in London a couple of years ago, a world-renowned endocrinologist named Mark Peterson tackled cat diets. "He showed us the perfect diet for a cat by displaying a giant cartoon of mice being poured from a cereal box," Voynick said. "Think of it. Mice are vegetarians, so the cat is getting veggies, too."

Contact Joan Lowell Smith at P.O. Box 302, Garwood,N.J. 07027 or e-mail her at jsmith@starledger.com.

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Wedding Examiner

2008-07-12T01:23:00.000-07:00

Once a lady with a huge rock on her finger was signing as a witness for a county civil ceremony I performed and asked how much the wedding cost. In Los Angeles County, a marriage license is $70 and the ceremony is $25, so for $95 you’re legally married and out the door. The lady sighed and confided, “Gee, I wish I’d known about you for my wedding. It’s been two years and we’re still paying it off.”

Thus we conveniently arrive at the second of the Five Ways To Screw Up Your Wedding:

Go Heavily Into Debt.

Nowadays couples frequently pay for their own weddings without the traditional boost from the folks, since they’re marrying a little older and sometimes the folks just don’t have it to spare. Supposedly the cost of the "average American wedding" keeps spiraling up and up, and this year (according to the Wedding Report Inc.) the average is currently just below $29,000.

But I’d be a bit skeptical of this statistic. What is meant by “average?” Is it a mean, a median, a true average? Just one $4 million celebrity wedding can lift hundreds of $25 civil county weddings into “average” territory, depending how you chew up and spit out the numbers.

And who was sampled to arrive at this “average”? The Wedding Report methodology page says it electronically surveys about 3700 participants--which would eliminate anyone who isn’t wired into a computer. That’s 3700 people surveyed out of over two million weddings in the U.S. last year--their estimate, based on a proprietary blend of data from state and county sources--so that’s a pretty small slice of the overall wedding cake. Maybe not so average, huh?

So perhaps $29K doesn’t accurately portray a true average of all American weddings, but rather just the average for the weddings of those on the right side of the Digital Divide who are spendy about their weddings. It seems we don’t have a number comparing Spendies to the other one million nine hundred and ninety-six thousand-odd couples who hitched up, so I don’t think we really know how economically “average” the Spendies are. My guess is, if they have computers and can drop almost thirty grand for one day’s show (or get enough consumer credit to do so) they’re doing a whole lot better than many a truly average American, especially in our days of foreclosure crisis and record lows in saving.

That won’t stop the Marital Industrial Complex from touting the number, however. Why would they do that, if it’s not a true measure of the average cost of American weddings? Because pushing this figure onto the public serves The Complex in two ways: first, it is a means to persuade prospective advertisers that they should come into the bridal market with a big splash, as the wedding water’s fine.

And the second objective? To make the NotSpendies and the Spendies-But-Not-With-$30G-To-Blow feel bad that they aren’t keeping up with all those other newly-minted Mrs. Joneses.

--------------------------------------------------------------------------------

It’s critical you understand Reason Two before you start planning your wedding, because it’s part of a marketing strategy called “aspirational marketing” and it is not your friend. There are many fine books you can consult on this, but to cook it down: aspirational marketing is about persuading you to murder your budget by convincing you that you DESERVE better than you can afford. In wedding terms, this means they don’t care if you’re working class, sick, struggling, heavily in the red, and unable to stay financially afloat in your living situation; the Marital Industrial Complex will tell you that you DESERVE to have all the trappings of royalty on your wedding day--or you should spend like your bride is a princess, in the case of diamond ads targeted at men--even if it ruins your life. They’re happy to make you want more than you need, they’ll direct you to where to buy it right now, and will even offer you credit (wedding loans!) to "help you out."

Don’t listen! It’s hard, because The Marital Industrial Complex is everywhere--magazines at the checkout stand, sponsored ad segments posing as reality television shows, postcards, websites, books, you name it. Their influence is huge and hard to avoid, and they make everything SO PRETTY!

Now before those of you who have a stash of wedding money get your consumer dander up, I’m not saying every wedding has to be modest. In fact, if you have scads of disposable income, by all means throw your thirty grand (and more!) into the economy and make yourselves and lots of wedding vendors very happy. I love working at lavish affairs and I enjoy their design sense and trendiness just as much as the next officiant. But I’m certainly not going to encourage people who are already in trouble to make a greater misery of their money situation so they can live up to a questionable “average.” If you can pay for your shindig without running up your credit cards or borrowing from friends or taking out an unsecured wedding loan on which you'll be making payments for years--maybe even longer than the marriage itself will last , and that’s a sad thought eh?--then by all means: SPEND. And enjoy your bounty with a clean conscience.

However, for those of you who are on the fence about joining the Spendies, imagine what you would do if someone just plopped thirty grand in cash onto your lap TODAY and you didn't have a wedding to plan. Would you:

Pay off your credit cards? (aaah, what a good feeling that would be!)

Put a down payment on a home, or put it into the mortgage?

Put it into an education fund?

Maybe you could use a new car? Do you have health insurance? Do you need a chunk of savings to cover you in case you become ill or unemployed or want to travel or invest or ????

Or would you feel an overwhelming urge to blow it all--thirty thousand dollars, almost enough to buy a brand new 2008 mercedes c-class sedan--on a dress, dinner, and cake?

Think that over carefully before you decide to Uphold The Average.

--------------------------------------------------------------------------------

It’s held as a cultural fact that money woes are one of the chief causes of divorce. Whether that’s true or not, debt’s a huge cause of anxiety for many people, so do you really want to make it worse by going in almost thirty grand deeper?

One of my favorite money columnists (Michele Singletary over at the Washington Post) often answers questions like these; if thinking about money before your wedding makes you suddenly nauseated, you can sign up for her wonderful emails on personal finance, and they might help you get your act together. Read her columns about weddings and finances for newly-marrieds too, they're great. You can check her out here, and may your tummy finally find some peace.

Finally, ask yourself (and be honest): am I really going to be able to enjoy this extravagant day, knowing that nothing is actually paid for and interest is accruing even as I say “I do?” Or will I choke on that $1200 custom cake we just HAD to have? It might be better to put down the aspirational marketing magazine and plan something that won't break the bank, so you can think more about your loving spouse than say, a collection agency. Who would you rather have own you?

There are plenty of affordable ways to have a great wedding--we’ll go into some of those in future posts, and how to have Spendy big ones too!--but for now just remember: going into debt for Your Special Day will not only ruin your wedding, it’s likely to wreck a good long chunk of your life and credit rating and relationship. Mortgaging your future is no way to start a marriage.

And who wants to be average, anyway?

Elizabeth Oakes can be reached at weddingexaminer@gmail.com

Labour agreements build productive businesses

2008-07-02T06:06:00.000-07:00

HCM CITY — More than 70 per cent of HCM City’s 2,743 enterprises have signed collective labour agreements with their workers, according to statistics provided by the city’s Labour Federation.

Collective labour agreements specify things such as salaries and bonuses, health and safety, working hours and breaks, social insurance, and employees’ rights to strike.

The Government’s Labour Code states that a collective labour agreement must be signed by a trade union official and the head of a company or organisation. Negotiations between these two parties set down the rights of workers in the collective agreement.

This process often proves more effective in establishing workers’ rights than labour contract negotiations between individuals and their employer.

Each enterprise must set up its own trade union, which is in charge of protecting that enterprise’s workers’ rights.

Employer stake

"We signal a collective labour agreement with our workers because we are aware of its importance," Alexandre Lemoalle, chairman of Sanofi Aventis Viet Nam told Viet Nam Net. "Our employees work hard and contribute to the development of the company, so they deserve to be treated well."

The company’s agreement gives its employees family health insurance and up to 30 months paid absence in the event of an accident. The employees have also recently had their meal allowances increased.

Long-term relationships between our employees and the company are created by treating them well, said Lemoalle.

"Collective labour agreements establish workers’ rights and benefit enterprises," said Truong Lam Danh, vice chairman of HCM City’s Labour Federation. "They’re core for enterprises’ stability."

Workers only go on strike if their rights are violated or their needs are not met. Enterprises that sign and respect collective labour agreements are less likely to see worker discontent mushrooming into strike action.

Conflict between workers and their employers will still arise, however, if an enterprise fails to fulfil its obligations specified in a signed agreement, or if it will only agree to provide the minimum Labour Code requirements.

Collective agreements require a huge effort by trade union staff. The trade union has to convince an enterprise of the benefit of such agreements, said Danh.

As of the end of May, 330 collective strikes had broken out across the country this year, of which 118 were in HCM City.

To deal with the problem, the Labour General Federation’s chairman Dang Ngoc Tung has asked enterprise trade unions to push for the implementation of the Labour Code and union regulations. In particular, trade unions should focus on raising wages and developing insurance coverage.—VNS

It sounds like heresy but we've got to stop treating the NHS like a national religion

2008-06-30T16:43:00.000-07:00

Every healthcare system throughout the world is currently in the middle of a perfect storm.

The deepening crisis engulfing all health services has been caused by three crucial factors: ageing populations, mounting costs in advancing technology and treatment, and well-informed service users who are used to making sophisticated consumer choices.

Yet the problems are perhaps more acute in Britain than anywhere else in Western Europe, not least because our monolithic National Health Service is proving too inflexible, bureaucratic and outdated to meet the challenges of the new era.
Sixty years old this month, the NHS was designed for an entirely different age, when life expectancy was far lower, medicine was less complex and the British population, having emerged from six years of gruesome war, was much more subservient to state authority.

The Labour Government, while adopting an increasingly proprietorial air towards the NHS in the run-up to the 60th anniversary, has recognised the system is in dire need of reform.

The strategy adopted during the years of Tony Blair's rule was to throw vast mountains of cash at the system. Since Labour came to power, NHS spending has more than trebled, topping ?100billion annually.

But real change was not delivered, so the usual problems have persisted, particularly in the rationing of treatment, the differing standards throughout the country and the increasing costs of a top-heavy bureaucracy.

When Gordon Brown arrived in Downing Street last summer, he appointed a leading and very capable surgeon, Lord Darzi, as one of his health ministers and ordered him to conduct a fullscale review of the NHS.

The result is the document launched yesterday under the optimistic and slightly Soviet-sounding title High Quality Care For All.

But it would be wrong to be too cynical. Lord Darzi is a dedicated healthcare professional, not a calculating career politician, and there is much to admire in his document.

For a start, the idea of creating polyclinics in every town is an excellent one, vastly improving access to healthcare, especially for those who have busy working lives and cannot easily get to GPs surgeries during the day.

These new-style polyclinics have been given a bad press by the doctors' professional union, the British Medical Association. As a result of this negative campaign, they have been presented as a destructive alternative to the trusted GP.

Nothing could be further from the truth. Polyclinics are a complement to current services and, if run properly, they will expand the range of the treatments available, thereby reducing the pressure on hospitals and delivering care far closer to patient's homes.

Mind you, for all the benefits of polyclinics, it was this Government that shattered the tradition of GPs providing 24-hour cover through its disastrously botched negotiations of the last GP contract, which allowed doctors to reduce drastically their hours and yet receive more money.

In part, therefore, polyclinics are a solution to a problem created by ministers.

There are other aspects of the Darzi report to be welcomed. The proposed NHS constitution, which legally enshrines patients' rights, should act as a restraint on authorities trying to block certain types of treatment.

Lord Darzi's call for closer working between the various branches of the NHS is common sense, though too often ignored by empire-building bureaucrats who jealously guard their own territories.

Speeding up the procedures by which the National Institute of Clinical Excellence (NICE) decides whether to license a certain drug will also benefit thousands of patients.

But there is also a serious downside. As with so many statist plans, the expansion of bureaucracy becomes a substitute for real action.

Sadly, in failing to learn the recent lessons of history, Lord Darzi has allowed his plan to become littered with yet more extensions of the corporate state.

So we read that he wants a National Quality Board, a new Care Quality Commission, a new NHS Medical Education Service and a new Fit To Work service, as well as vast amount of new paperwork contained in the demands for 'quality accounts' - audits of how well patients are treated - as well as a host of other indicators, targets and box-ticking exercises.

Just as worryingly, there seems to be a fundamental contradiction at the heart of his document. On the one hand, he says he wants to end the ' postcode lottery'.

On the other, he argues that, to improve efficiency, better performing trusts and health centres should be rewarded with extra funding, while poor performers should be penalised.

But in practice, such an approach will only worsen the variation in the provision of treatment. In effect, patients will be hit twice over for living under an inadequate trust. The key is the lack of tangible incentives to drive efficiency.

So we need to admit - and this is almost heresy - that the NHS just can't do everything. We like to be sentimental about it as though it was a religion. It's simply a core service on which to build our own responsibility for health. Service users must make the transition into welcomed customers.

This brings us to the greatest weakness of Lord Darzi's scheme. For all Gordon Brown's talk yesterday of 'the bold vision' of the ten-year plan, in practice it is only perpetuating the failed structure of the NHS.

The fact is that the continuation of the state healthcare monopoly can never meet the needs of the British people in the 21st century.

This is partly because we have reached the limits of taxation on job-holders. Those in work would simply not put up with a further 5 or 10 per cent increase in their income tax to pay for the NHS.

But more importantly, the very existence of a massive bureaucratic monopoly breeds its own chronic inefficiencies, leading to widespread waste, mismanagement, low productivity and lack of pressure on suppliers and contractors.

In my own field of cancer treatment, for instance, many leading drugs are far more expensive in Britain than in continental Europe, for the sole reason that the absence of any commercial competition here means that the big companies can keep pushing up their prices, knowing that the Government will have to pay.

What we really need in healthcare is more competition, with the Government acting as the guarantor of a basic level of treatment for all patients. The NHS should be regarded as a private health insurance company, not a national religion.

Far from leading to injustices, the introduction of a proper market would actually lead to real reform, driving up standards and lowering costs, just as happens in most other Western countries.

A truly radical reform would be to give every individual a health insurance voucher, enabling them to choose to buy their treatment wherever they wanted. That would transform healthcare in this country far more than all the fine words of the NHS constitution.

• PROFESSOR Karol Sikora is a leading cancer specialist and former chief of the World Health Organisation Cancer Programme.

1,600 British early retirees lose their health cover in the Valencia region

2008-06-25T02:16:00.001-07:00

The Valencian Regional Health Service say they will no longer treat those British retired residents who have not reached pensioner age.
Spanish newspaper El País has picked up on the policy change from the regional health service in Valencia which means that thousands of pre-retirement foreign residents in the region will no longer be able to obtain free health care.

Until now the Valencian public health service had an open-door policy for the hundreds of pre-retirement British residents in the region who were thus attended to in the region under a category of ‘extensión o demada’.

The Generalitat regional government said that some 3,000 foreigners have been benefitting from the arrangement, 1,600 of them British residents, and that it explained a high number of operations for problems such as cataracts, angina or other heart problems. The costs of these treatments was being met by the regional health service in Valencia which has said ‘no more’.

Pensioners are not affected as the Valencia health service can claim back the cost of their treatment from the British Government, and tourists also have no problems as the E-111 card covers their needs in Spain for as long as a year.
However those who retire early to the Costa Blanca are not covered unless that retirement has been forced by an accident or illness.

Now such British early retirees are obliged to take out private health insurance. The change in practice in Valencia was supported by both the Partido Popular and the Socialists in a move to better control access to health resources.
The move could well be followed by other regional health services in Spain.

Knowlton joins insurance agency

2008-06-23T05:40:00.000-07:00

LEWISTON - Allstate Insurance Co. announces that agent Jon Knowlton is expanding an existing agency.

Knowlton has purchased former agent Gerry Dutil's book of business and is now meeting the insurance and financial needs of families in Androscoggin and surrounding counties. Knowlton worked for agent Patti Gagne as a sales producer, and brings solid industry experience with him. He holds his P&C, Life and Health and Series 6 & 63 securities licenses.

The Jon Knowlton Allstate Insurance Agency, located at 400 Sabattus St., is a full-service agency providing insurance and financial service assistance. The agency is open Monday through Friday, with evening and Saturday appointments available by calling 783-7555.

Mills on NDC failures in government: 'I was a bad judge'

2008-06-20T01:16:00.000-07:00

Kwabena Amankwah , 20/06/2008

The Presidential Candidate of the opposition National Democratic Congress, John Evans Atta Mills, Wednesday admitted that the mistakes he made while serving in the NDC Government as the Vice President were due to his poor sense of judgment of people.

"I was not a good judge of people when I was in Government,” the Law Professor stated when he took his turn on “The Evening Encounter with Presidential Candidates,” an interactive programme initiated by the Institute of Economic Affairs, under the auspices of the Ghana Political Parties Programme.

Prof Mills was responding to a question about the mistakes he made whiles in government.

When he was reminded of the fact that it would not be prudent to entrust the destinies of over 20 million Ghanaians into the hands of somebody with a flawed sense of judgment, the NDC flag bearer was, however, quick to assure, “I was a bad judge of people when I was in Government, but now I'm not.”

Even though the nation's economy was rendered almost comatose under his watch as the Chairman of the National Economic Management Team, in addition to allowing an American 'businesswoman,’ Juliet Cotton, to walk away with a huge amount of state- guaranteed loans secured for a rice project, Prof Mills insisted that he resorted to “prudent fiscal” measures in handling the economy, adding that he would apply the same measure if he ascended the nation’s presidency.

Prof Mills, who used much of his time to castigate the Kufuor administration, made a lot of promises which some analysts have described as "too lofty and overly ambitious," wondering how somebody who is seeking to rule the nation could make such promises without giving any indication of concrete measures to raise the needed funds to fulfill them.

He promised to provide potable water for all Ghanaians, insisting that "a caring government will not look on unconcerned while people suffer water shortages."

Others include solving the problem of slums being developed in the city; embarking on an irrigation project in the Accra Plains; expanding the school feeding programme to cover all basic schools; providing free uniforms for basic school pupils; expanding access to secondary education and working to progressively make it free; reviewing the National Health Insurance Scheme "to make it more national"; establishing a factory in the Western Region to produce fertilizer; fighting crime and corruption; and restoring the morale of the Police Service.

But, speaking on Joy FM’s Super Morning Show yesterday, Abu Sasraku Foster, a CPP guru, could not understand why Prof Mills could make such promises without providing practical measures to translate them into reality.

Views sampled among some of the electorate across the country indicate that they were not convinced about the sincerity of Prof Mill’s promises.

"This is a man who had the opportunity to serve the nation as the Vice President and also headed the National Economic Management Team. What legacy did he leave to convince us that he will be able to manage the affairs of the nation, if he is given the mandate?" Dennis Kwakwa, a youth opinion leader wondered.

Meanwhile, the Executive Director of the Danquah Institute, Asare "Gabby" Otchere- Darko, has urged the NDC flag bearer to "take Ghanaians serious if he wants to be taken serious."

Commenting on Prof Mills’ presentation on Joy FM’s Super Morning Show programme yesterday, the former Editor-in-Chief of The Statesman observed, "It was the typical run of Mills sort of thing - bash NPP small, praise the PNDC and NDC, give promises, to deceive himself that he can ride on them to power, without telling the people how to pay for the promises."

In the words of Mr Otchere-Darko, "it is not just enough to make such promises; we can all make promises, but you have to cost the promises and tell the people how practical they are if you want them to take you serious."

Spokesperson for the NDC flag bearer, Mahama Ayariga, however, insisted that Prof Mills was sincere about all the promises he made, and that bringing them into reality was not an impossibility.

The MP for Bawku Central yesterday told listeners of Joy FM’s Super Morning Show that a clear-cut plan to fulfill all the promises had been clearly spelt out, and had been indicated by Prof Mills in some of his previous presentations. Mr Ayariga however, failed to add anything concrete to the promises made by his party leader.

'Insurer forced annuity, but we still work'

2008-06-16T06:29:00.000-07:00

When dentists Nick and Polly Patsias turned 60 within a month of each other last summer, it wasn't only birthday cards that came tumbling through their letterbox - they also received letters from numerous insurance companies inviting them to turn their savings into a lifetime income through an annuity.

As owners of a thriving dental practice in Beckenham, Kent, the couple had no intention of retiring so they ignored the correspondence.
But one of the companies they had saved with - Abbey Life - took it upon itself to buy an annuity for them.

Abbey Life turned a pension of £57,000 in Polly's name into an annual income - payable once a year in arrears - of just over £3,300 without offering her tax-free cash or any financial protection.

A worthy tribute

2008-06-09T05:26:00.000-07:00

By L. PIERCE CARSON

Register Staff Writer

Big bottles of cult status wine, no-stone-left-unturned trips all over the world, lavish wine parties, automobiles filled with collectible wine and old-fashioned star power combined Saturday night to push Auction Napa Valley 2008 proceeds past the $10 million mark.
The second time this decade that the valley’s trendsetting charity wine event exceeded all expectations, proceeds for the 28th annual fundraiser totaled $10.3 million, just $200,000 short of the record set in 2005.

“It’s fabulous,” enthused Kathleen Heitz Myers, who co-chaired this year’s auction with her mother, Alice, and brother, David.
Noting that “people come here from all over the world” to bid on exceptional wine lots donated by the 300-member trade organization, Napa Valley Vintners, Myers said the outcome “validates what we do in the community. I can only offer praise for all the staff and volunteers do, and thank the bidders for their support. I’m thrilled.”

Jay Leno, host of “The Tonight Show,” returned to wine country to kick off this year’s dinner auction with trademark quips and observations of current events. He tackled everything from politics to out-of-control teen stars, from obesity to the Pope.
His remarks tickled the crowd’s fancy, including the queen of TV talk shows, Oprah Winfrey, who dined in the giant white tent on the Meadowood fairway with vintner and former Hollywood mogul Rich Frank and ABC-TV chief Steve McPherson, teaming up to offer one of the auction’s coveted lots — one that included a walk-on role on “Grey’s Anatomy” and an extraordinary wine trip to New Zealand. While Winfrey confessed “Napa Valley is my new favorite place,” she did not bid on any of the live auction’s 44 super lots.

The lot that raised the most money Saturday night was one that barely registered on the radar as the glamorous offerings were put on public display at an auction preview last Friday.

“Fund A Need” underwrites medical care offered by Community Health Clinic Ole, quietly explained one of the agency’s biggest boosters, vintner John Shafer. He told bidders that Clinic Ole — which serves farm workers and area residents with little or no health insurance — had taken care of 20,000 patients last year. He said Auction Napa Valley continues to fund Clinic Ole each year and hoped that bidders could find a little extra in their wallets to do the same.

As a sweetener, Chanel Fine Jewelry provided the top bidder in this lot with a diamond necklace valued at $40,000.

Bids were taken at levels of $1,000, $5,000, $10,000, $50,000 and so on, up to the high bid of $500,000 made by Woodside’s Joy Craft, who, as auctioneer Humphrey Butler clasped the diamond pendant around her neck, told reporters: “This is what I came to do tonight.”

With vintners Mary Miner and the Steffens family offering runner-up bids of $200,000 and $300,000, respectively, the Fund A Need lot brought in a total of $1.7 million for Clinic Ole.

Raising just under $1 million was the final lot, which celebrates the life of industry icon Robert Mondavi, who passed away a little over three weeks ago just shy of his 95th birthday.

Put together by vintners Garen and Shari Staglin, an event at Copia on June 28 will feature a panel of friends and family discussing the life, wines and contributions of Robert Mondavi, preceded by a reception where a majority of Napa Valley Vintners members will be pouring their wines. Five top-flight chefs from East and West Coast restaurants will prepare a celebratory dinner paired with 17 wines.

Prior to bids being taken, a moving video tribute to Mondavi was screened and his 94-year-old brother, Peter, offered both toast and tribute to Bob and Margrit Mondavi. Taken aback by the sustained applause from all in the tent, the younger Mondavi brother recalled his sibling’s “tremendous energy” and that he wanted “only the best for the wine industry.

“It’s hard to recall all the things that he did ... and he wasn’t only just for the Napa Valley. We’ll all miss him.”

The lot brought in a total of $950,000, with 95 people agreeing to pay $10,000 each for a place at the table.

It took a bit of coaxing from auctioneer Fritz Hatton for the event’s biggest wine lot to tie a record set during the dotcom boom. Previously, a successful dotcomer paid $500,000 for a six liter bottle of Screaming Eagle, a cult wine made from Oakville fruit. Although this year’s lot offered more wine — six liter bottles of Screaming Eagle from the inaugural 1992 vintage — David Li paid the same amount — half a million dollars — for it. The owner of a cyberspace company located in Shanghai, Li maintains Screaming Eagle is “the best wine in the world.”

The live auction brought in $8,598,000 this year, with the popular Friday afternoon barrel auction contributing $1,383,000. The newest adjunct of Auction Napa Valley, the e-auction, netted $371,203 from online bidding around the world.

Auction’s top lots

While the stock market took a nosedive at the end of last week, unemployment numbers were way up and the price of gasoline topped $4 a gallon, bidders weren’t shy about raising their bidding paddles. A number of this year’s offerings saw spirited bidding and final numbers that exceeded quiet predictions.

Once again, a lot that incorporated wine and Hollywood soundstages proved a popular attraction. Rich Frank, of Frank Family Vineyards, teamed up with ABC-TV president Steve McPherson to offer a walk-on part in the hit ABC series, “Grey’s Anatomy,” in addition to dinner for four with some of the cast members at Mozza, hosted by chefs Nancy Silverton and Mario Batali. Following the Hollywood events, Frank will whisk the quartet off to New Zealand on an Air New Zealand Business Premiere flight for a week of wine tasting and lavish tastings and dinner parties. Also included in the lot is a five-year vertical of etched magnums of Frank Family’s Winston Hill cabernet sauvignon and a case of 2005 Promise, Frank and McPherson’s new joint venture of small lot cabernet sauvignon.

Auction regulars Jody and Stratton Sclavos, of Saratoga, paid $480,000 for this lot. When Frank and McPherson first teamed up to make this type offer at the 25th auction in 2005, the Sclavoses were top bidders as well, paying $300,00 for wine, dinner with Teri Hatcher and a “Desperate Housewives” walk-on.

There was also plenty of interest in the lot offered by Harlan Estate, a ten-magnum vertical of its Bordeaux blend (1995-2004) in a special presentation case, along with a celebratory dinner for eight with vintner Bill Harlan. Auction regular John Thompson teamed up with Paul Wick, both residents of the Peninsula, for the high bid of $340,000.

St. Helena’s Hi Sang Lee picked up a pair of lots that also prompted a wealth of bids. First was Blackbird Vineyards invitation for four to experience the excitement of a Chanel fashion show in Paris and to stay in the upscale Hotel Plaza Athénée. While in Paris, the foursome will get a tour of the private apartment of Coco Chanel. Two double magnums of Blackbird’s proprietary blend were also included in the lot. Lee ponied up $300,000 for the Parisian experience.

He also spent $290,000 on the lot offered by Bryant Family Vineyard. It includes an eight magnum vertical of Bryant Family Vineyard cabernet from 1993 through 2000. On top of that, Lee and five friends will join vintner Don Bryant at a private dinner at his New York City residence, paired with Bryant wines.

In addition to picking up the Chanel necklace, Joy Craft wanted another jewel, five double magnums from Colgin Cellars 2005 harvest — IX Estate Red and Syrah, Tychson Hill Vineyard Cabernet Sauvignon, Cariad Red and Herb Lamb Vineyard Cabernet Sauvignon. She spent $260,000 for these gems.

Also among this year’s top 10 bids were:

The Chair’s Lot, offered by the Heitz family. It provided for exclusive use of the Point, a former Rockefeller Great Camp in the Adirondacks of New York, for eight couples. Heitz Wine Cellars is including roundtrip jet travel between Chicago and the Adirondacks, a dinner and wine tasting with Kathleen Heitz Myers at the luxury camp as well as a number of other meals during the four-day stay. The high bidder from Champaign, Ill., (who preferred to remain anonymous as permitted by auction officials) paid $240,000 for this excursion.

A dinner party with vintner Naoko Dalla Valle celebrating the return of Maya, a respected Bordeaux blend from Dalla Valle Vineyards, brought in a top bid of $200,000 from David Reis, of Rye, N.Y. The lot included Maya 2005 in one six-liter bottle and six 750 ml bottles.

Auction officials announced Saturday night that next year’s auction will be chaired by the Trefethen family, namely Janet and John and their children, Loren and Hailey.

Clinton refuses to bow out of presidential race

2008-06-04T06:48:00.000-07:00

By JIM KUHNHENN and BETH FOUHY

NEW YORK (AP) — Angling for a vice presidential nod, Hillary Rodham Clinton refused to bow out of the Democratic race Tuesday, hoping to maintain leverage as Barack Obama clinched the delegates needed to secure the party's nomination.

"A lot of people are asking, 'What does Hillary want?'" Clinton told supporters at a rally in New York. "I want what I have always fought for: I want the nearly 18 million people who voted for me to be respected and heard."

Clinton told the crowd she would consult in the coming days with advisers about the fate of her moribund candidacy. But her remarks came hours after she told congressional colleagues she would be open to joining Obama as his running mate.

Many of her top supporters spoke openly of Clinton's potential vice presidential prospects. Lanny Davis, a former White House special counsel under President Clinton, said he told the former first lady Tuesday that he was initiating a petition to press Obama to select her for the second spot on the ticket. He said Clinton did not encourage or discourage the step.

"If he doesn't have her, I think he can still win. With her on the ticket, he can't be beat," Davis said.

Clinton's national finance chairman, Hassan Nemazee, said he was also pushing an Obama-Clinton ticket, claiming that together they would be able to raise $200 million to $250 million for the general election.

Advisers indicated earlier Tuesday that the former first lady would publicly acknowledge in her speech that Obama had crossed the delegate threshold. But she changed her mind and refused to do so even after television networks and The Associated Press declared the Illinois senator had sealed the nomination.

Her advisers said they considered the delegate numbers to be unreliable, even as the AP estimated Obama had several more than the 2,118 needed to nominate. Earlier, Clinton acknowledged on a conference call with New York lawmakers that the delegate math was not there for her to overtake Obama, according to several participants on the call.

She said none of that publicly Tuesday but vowed the Democratic Party would unite in its effort to defeat Republican John McCain in November.

Clinton won South Dakota's primary Tuesday, while Obama won Montana's. The two contests rounded out a historic five-month primary battle that pitted the first major black candidate against the first serious woman contender.

The South Dakota victory, which was unexpected, gave Clinton an excuse to buy more time to consider options, her advisers said.

On the conference call with New York colleagues, Clinton, a New York senator, said she would be willing to become Obama's running mate if it would help Democrats win the White House.

Clinton's remarks came in response to a question from Democratic Rep. Nydia Velazquez, who said she believed the best way for Obama to win key voting blocs, including Hispanics, would be for him to choose Clinton as his running mate.

"I am open to it," Clinton replied, if it would help the party's prospects in November. Her direct quote was described by two lawmakers who spoke on condition of anonymity because they were not authorized to speak for Clinton.

"I deserve some time to get this right," she said, even as the other lawmakers forcefully argued for her to press Obama to choose her as his running mate.

Joseph Crowley, a Queens Democrat who participated in the call, said her answer "left open the possibility that she would do anything that she can to contribute toward a Democratic victory in November. There was no hedging on that. Whatever she can do to contribute, she was willing to do."

Another person on the call, Rep. Jose Serrano of New York City, said her answer was "just what I was hoping to hear. ... Of course she was interested in being president, but she's just as interested in making sure Democrats get elected in November."

Rep. Charles Rangel, a devoted booster of Clinton who helped pave the way for her successful Senate campaign, said he spoke to her Tuesday and got much the same answer.

"She's run a great campaign and even though she'll be a great senator, she has a lot of followers that obviously Obama doesn't have, and clearly the numbers are against her and so I think they bring all parts of the Democratic Party together and then some," Rangel said.

Aides to the Illinois senator said he and Clinton had not spoken about the prospects of her joining the ticket.

Most of Clinton's campaign staff will be let go and will be paid through June 15, said the officials, who spoke on condition of anonymity because they were not authorized to divulge her plans.

Universal health care, Clinton's signature issue as first lady in the 1990s, was a point of dispute between Obama and the New York senator during their nomination fight.

Clinton reiterated her commitment to that issue in her remarks Tuesday.

"It is a fight I will continue until every single American has health insurance. No exceptions and no excuses," she said.

Other names have been floated as possible running mates for Obama, including former rivals New Mexico Gov. Bill Richardson and former North Carolina Sen. John Edwards, and governors including Janet Napolitano of Arizona, Kathleen Sebelius of Kansas and Tim Kaine of Virginia. Also mentioned are foreign policy experts including former Georgia Sen. Sam Nunn, Connecticut Sen. Chris Dodd and Delaware Sen. Joe Biden, and other senators such as Missouri's Claire McCaskill and Virginia's Jim Webb.

Obama could also look outside the party to people such as anti-war Republican Sen. Chuck Hagel of Nebraska or independent New York Mayor Mike Bloomberg. Or he could look to one of his prominent supporters such as former Sen. Tom Daschle of South Dakota or try to bring on a Clinton supporter, such as Indiana's Sen. Evan Bayh or retired Gen. Wesley Clark.

Beth Fouhy reported from Washington. Associated Press Writer Devlin Barrett contributed to this report.

Health, chemicals ministries sort out pharma policy issues

2008-06-01T06:37:00.000-07:00

The controversial National Pharmaceutical Policy 2006 may finally see the light of the day with the Health Ministry and Chemicals and Fertilisers Ministry sorting out differences over some proposals in the policy. "The secretaries of Ministry of Health and Ministry of Chemical and Fertilisers, held a meeting a couple of weeks back in which concerns of Health Minister Anbumani Ramadoss were discussed and ironed out," a senior government official told a news agency.

With the issues sorted out, the Chemicals and Fertilisers Ministry would be approaching the Group of Ministers (GoM), which was formed to look into the policy again, the official said while adding that it would then be up to the GoM to decide on the future course of action.

The draft pharma policy was referred to the GoM headed by Agriculture Minister Sharad Pawar, after concerns were raised by the pharmaceutical industry over the issue of price control as proposed in the draft. Till now, four meetings of the GoM have taken place but it has not been able to find a solution.

In the fourth meeting held on 30th April, Health Ministry has objected to the some of the proposals made in the draft after which it was decided that secretaries from both ministries should sit and overcome hurdles for smooth passage of the policy. The Health Ministry had apparently objected to the provisions in the pharma policy pertaining to drug regulator and procurement of medicines for government hospitals and health insurance, which it felt would be duplicated.