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Wednesday, August 26, 2009

Elsevier Caught Again: Published Ghost Written, Industry Supporting Articles As Scientific Resesarch

Earlier this year, it was revealed that publishing giant Elsevier had allowed pharma king Merck to create a fake peer reviewed journal that hyped up certain Merck products, such that doctors would think that there was some serious science behind them. It later came out that Elsevier actually had a whole division which specialized in publishing such fake journals, made to appear real, and given the Elsevier stamp of approval (which hopefully is now becoming worthless). But, it appears things keep getting worse. Coral Hess notes yet another scandal, once again involving Elsevier's (now) fake stamp of approval. This time, it involved people hired by certain pharma companies ghostwriting scientific "review" articles that were supposed to give an overview of all the research on certain treatments, but... "emphasized the benefits and de-emphasized the risks" of those treatments. And people wonder why we're so skeptical about allowing pharma companies to dictate both our healthcare plans and our patent laws.

Conservatives Try To Pare Down Reform

From Center for American Progress

Conservatives have used the August recess to mount an organized opposition to President Obama's health care reform efforts. Even as 14,000 Americans lose their health insurance coverage every single day -- half a million will become uninsured while Congress is on vacation -- Republicans are insisting that Democrats pare down existing reform legislation. "We need to slow down and do a little less," Sen. Chuck Grassley (R-IA), the ranking member on the Senate Finance Committee and member of the "Gang of Six" tasked with producing bipartisan health care legislation, told a town hall gathering in Pocahontas, IA, on Monday. Similarly, during an appearance on CBS's Face the Nation, Sen. Kent Conrad (D-ND) predicted that the bill out of the Senate Finance Committee is "going to have to be significantly less than what we've heard talked about." Yesterday's revised deficit projections have given conservatives an additional argument for paring down existing legislation. Sen. Lamar Alexander (R-TN) issued a statement arguing that the higher projections were "a flashing red light for any health care proposal that doesn't reduce the cost of health care for Americans and their government," and Rep. Dave Camp (R-MI), the ranking Republican on the Ways and Means Committee, declared that "if the House Democrats' unaffordable $1 trillion health care bill wasn't dead before, it should be now."

SMALLER IS NOT BETTER: A smaller health reform package would do little to reduce health care costs and increase access to affordable health care. As National Institutes of Health bioethicist Ezekiel Emanuel points out, "[H]ealth care costs are the long-term driving force in federal and state budgets." Health care spending makes up "$1 out of every $6 in the economy, dwarfing automobiles and all other economic segments" and represents the "single most important factor influencing the Federal Government's long-term fiscal balance." Health care growth rates are "simply unsustainable and are why slowing the growth in health care costs is the single most important step we can take to put the Nation on firm fiscal footing." Scaling down legislation, however, "basically means gutting the benefits that would go to the working and middle class," the New Republic's Jonathan Cohn points out. "In other words," Cohn says, "it would help fulfill the fear many of these voters already have and that opponents of reform have tried hard to stoke: That reform doesn't have much to offer the typical middle-income American."

STEELE SCARES SENIORS: Despite the consequences of skyrocketing health care costs, Republicans continue to fearmonger about reform. On Monday, Republican National Committee (RNC) Chairman Michael Steele wrote an op-ed in the Washington Post saying that Obama "and congressional Democrats are planning to raid, not aid, Medicare by cutting $500 billion from the program to fund his health-care experiment." "These types of 'reforms' don't make sense for the future of an already troubled federal program or for the services it provides that millions of Americans count on," wrote Steele. To perpetuate the fear of Medicare cuts, the RNC released a "Seniors' Health Care Bill of Rights" declaring that Medicare should not be "cut." "We want to make sure that we are not cutting the Medicare program," said Steele on ABC's Good Morning America. But the $500 billion in cuts the Democrats are proposing would eliminate inefficiencies, reduce insurance company subsidies, unnecessary hospital readmissions, and lower payments that encourage overtreatment. None of the $500 billion is coming out of benefits. In fact, some of the cuts have been endorsed by the health industry and supported by Republicans -- including Steele. All of the latest Republican health care plans call for eliminating Medicare "waste, fraud and abuse," for instance, and a good number of Republicans voted for Medicare payment cuts as part of the Balanced Budget Act of 1997. Yesterday, Steele further undermined his own argument that Medicare is a sacrosanct program that must be protected by calling it "a very good example of what we should not have happen with all of our health care." Asked to respond to Rep. Anthony Weiner's (D-NY) argument that "if you like Medicare and you don't want to make any cuts to it, then you're basically defending a single payer system," Steele launched into an attack on the program, implying that it would be better if it were privatized.

REPUBLICANS REFUSE TO VOTE FOR REFORM: Senate Republicans who had previously indicated that they would be open to compromising on health care reform, are now suggesting they have closed the book on negotiations. Back in March, Grassley characterized himself as an honest negotiator, telling the Kaiser Family Foundation that "everything is on the table. ... You don't negotiate when everything is not on the table...everything's got to be on the table if you're negotiating in good faith." Since then, Grassley has adopted the rhetoric of the far right, routinely referring to health care reform as a government takeover, disingenuously misrepresenting reform legislation, and even going so far as to endorse the "death panels" myth. Yesterday, the Wall Street Journal reported that Grassley "vowed not to vote for an 'imperfect'" health care bill. "Now is the time to do this right or not do it," Grassley said. Similarly, Sen. Mike Enzi (R-WY), who is supposedly negotiating a health care bill in the Senate Finance Committee with Grassley and Sen. Max Baucus (D-MT), has indicated that he disagrees with "the entire approach the Finance Committee is taking.""We do need to have health care reform," Enzi said. "We do need to get it right. We need take the time to do it. I think the only way it will happen is we need to break it down into smaller parts than we have now and put it through one at a time."

US Industries Hurt Most by Soaring Health Costs

August 04, 2009 by Rick Newman, U.S. News and World Report.

It started as a dull throb in the economy, with the pain growing sharper. Now there's finally a diagnosis: Runaway healthcare costs are directly harming businesses and their employees. As just about everybody knows, the cost of healthcare is rising much faster than wages, profits, and most other things in the economy. Healthcare spending accounted for about 11 percent of GDP in 1987; today it's more than 16 percent, and by 2017 it's very likely to be almost 20 percent. We spend more than $2 trillion a year on healthcare—roughly the same amount we spend on housing—and the cost is rising about five times faster than wages or overall inflation. Exorbitant cost is the main reason 47 million Americans have no health insurance—and why President Obama's ambitious plan to expand coverage and overhaul the entire system is in jeopardy.

Somebody has to absorb those painful price hikes every year, and since companies provide the insurance for about 60 percent of Americans, they're the first to get the bill. Some economists believe that businesses simply shift the cost of health insurance to workers, by offering lower wages to compensate for the costly benefit, and to their customers, by charging higher prices to cover the costs of healthcare.

A new study, however, shows that some industries have become chronically hamstrung by rising healthcare costs, with lower growth and employment than they'd have if costs were lower—or somebody else paid them. Researchers Neeraj Sood, Arkadipta Ghosh, and José J. Escarce of the Rand Corp. analyzed the performance of 38 industries from 1987 to 2005 and found that sectors where a high proportion of workers have company-provided health insurance—such as manufacturing, utilities, communications, education, and finance—showed the lowest growth over the 19-year period. Industries where fewer workers get company-paid health insurance—such as agriculture, hotels, entertainment, retail, and construction—grew more.

Since some industries naturally grow faster than others, the researchers isolated other factors that could explain the discrepancy. They also compared U.S. industries with their counterparts in Canada—where the government, not business, pays for healthcare—to see if the entire industry was suppressed because of global trends or just the American slice. Their conclusion: Rising healthcare costs in the United States have directly curtailed growth and employment. And the industries with the most generous benefits tend to be penalized for it. "Industries which provide healthcare to a large fraction of workers didn't grow as fast as industries offering health insurance to a small fraction of workers," says Sood.

The Rand study may be the first to document the impact of rising healthcare costs on business performance, but it reinforces lots of anecdotal evidence. Starbucks CEO Howard Schultz has complained that his company spends more on worker benefits than on coffee. General Motors has claimed that healthcare expenses add $1,500 to the cost of making a car. Only 59 percent of small firms offer health insurance to their employees, down from 68 percent in 2000. Many business owners say they limit hiring or try to get by with part-timers because the costs of full-time benefits are too high. The prospect that Obama's reforms could actually raise costs on many businesses, to help cover the uninsured, has undermined support for his plan.

Rand quantifies the effect this way: At 2005 GDP levels, every 10 percent increase in "excess" healthcare costs—the amount by which growth in healthcare costs exceeds GDP growth—would cost the economy 120,800 jobs and $28 billion in lost revenues. The researchers caution against extrapolating their data to estimate total jobs lost throughout the whole economy to excessive healthcare costs. But they did some other nifty calculations, showing how employment and output would change in 15 industries if healthcare costs do indeed rise to 20 percent of GDP by 2017, as many economists expect unless there's dramatic reform. (These figures aren't part of the study; Neeraj Sood of Rand provided them to me upon request. Data is from 2004 and 2005, the latest available.)

One startling outcome of the Rand projections is that every one of the 15 industries they analyzed stands to suffer lost jobs and output if healthcare expenses keep rising. Agriculture and forestry, where just 19 percent of workers have company-paid insurance, would shrink the least. Utilities, which cover 83 percent of their workers, would shrink the most. Here's how 15 major industries would fare if healthcare costs swell to 20 percent of GDP by 2017:

Industry Pctg. of employees with company-provided insurance Projected change in employment by 2017 Projected change in output by 2017
Agriculture, forestry, and fishing 19% -7% -7%
Accommodation 20% -7% -7%
Entertainment, recreation and other services 33% -12% -12%
Construction 36% -13% -13%
Retail trade 39% -14% -14%
Real estate 39% -14% -14%
Legal services 54% -19% -19%
Transportation and warehousing 58% -21% -21%
Wholesale trade 60% -21% -21%
Communications 61% -22% -22%
Educational services 61% -22% -22%
Finance and insurance 65% -23% -23%
Manufacturing 67% -24% -24%
Mining, oil and gas extraction 74% -26% -26%
Utilities 83% -30% -30%

One industry, of course, stands to gain plenty of jobs: healthcare. And benefit costs shouldn't be too much of a constraint, since the healthcare industry has one of the lowest rates of insurance coverage. Before long, it seems, everybody in America will either be a caregiver or a patient.

We are not producing anything in this country becasue it costs too much. Corporate sponsored health care is a major part of the problem.

The GOP's Top Chef Starves a Beast and Poisons a Debate

By Steven Pearlstein, Washington Post, Wednesday, August 26, 2009

Michael Steele, chairman of the Republican National Committee, this week revealed a secret Republican plan that would end up eliminating all federal farm subsidies; closing down Yellowstone and Yosemite national parks; selling off the interstate highway system; and canceling Head Start, subsidized school lunches and the entire college loan program.

The plan came to light as a result of an op-ed piece this week in The Washington Post in which the party chairman committed the GOP to spending an ever-increasing share of the federal budget, and the national income, on Medicare. When combined with other Republican promises -- to balance the budget, protect defense spending and never, ever raise anyone's taxes -- the inescapable inference is that the government would run out of money for every other domestic program sometime around 2035.

Steele's stunning announcement brings the conservative strategy of "starving the beast" to a new level. Under the guise of protecting the elderly, Republicans hope to realize their dream of eliminating half a dozen Cabinet agencies, firing tens of thousands of government workers and ending government regulation as we know it.

Steele's op-ed was the latest salvo in his party's campaign to defeat President Obama's health-care reform effort at all costs and build public support for a Republican alternative that remains, to this day, a closely held secret. The new Seniors' Health Care Bill of Rights, however, hints at the outlines of the GOP domestic strategy.

Steele promised that under the Republican health plan, runaway Medicare spending would continue unabated. Not only would that mean no cuts in benefits, but it would ensure that reimbursement rates to doctors, hospitals and drugmakers would continue to rise faster than inflation, regardless of how much they earn or how unnecessary or wasteful the services they provide. Any effort to contain future spending growth, Republicans now believe, is nothing more than a "raid" on Medicare, the government-run health plan that Republicans were against before they were for it.

The country's top Republican official also vowed to cut off all federal funding for research to determine what are the most effective treatments for heart disease, cancer, diabetes and even that new scourge, restless leg syndrome. Left unclear was whether he prefers to have such research done by the pharmaceutical and medical-device industries, but one suspects that is the case.

On the issue of end-of-life care, Steele was uncompromising: In a Republican world, no government funds could be used to pay doctors to provide information about living wills, hospices or palliative care, whether seniors and their families ask for it or not.

"Government programs that seem benign at first can become anything but," Steele explained in articulating the new philosophy. Once back in power, look for Republicans to apply the same approach to issues such as flu vaccinations, disaster relief and air traffic control.

According to Steele, Republicans will also seek to outlaw "any effort to ration health care based on age." You don't have to be a lawyer like Steele to understand that would effectively make it a federal crime for any hospital to refuse a heart transplant to a 95-year-old, or for any doctor to refuse to prescribe Viagra to a sexually precocious seventh-grader. Although Steele did not indicate what the penalty would be, he did not rule out the death penalty.

Indeed, Republicans seem determined to preserve the uniquely American system under which health care is rationed today -- on the basis of employment status and ability to pay. According to the respected Institute of Medicine, this market-based approach to rationing has held the number of untimely deaths each year to a mere 18,000 uninsured souls. Thanks to Medicare, all of those victims are younger than 65, but apparently that is the kind of age-based rationing that real Republicans can embrace.

After reading his broadside, one is left wondering exactly what health reform plan Steele thought he was attacking. At one point, Steele claims that Democrats would prevent Americans from keeping their doctors or an insurance plan they like. Later, he warns that government will soon be setting caps on how many heart surgeries could be performed in the United States each year. Where is he getting this stuff? Has the chairman of the Republican Party somehow gotten hold of a top-secret plan for a government takeover of the health-care system that GOP operatives snatched during a break-in at Democratic National Committee headquarters?

If all that sounds spurious and unsubstantiated, it is. And like many of the overstated claims in this column, its purpose is to highlight the lies, distortions and political scare tactics that Steele and other Republicans have used to poison the national debate over health reform.
Have you no shame, sir? Have you no shame?

Steven Pearlstein can be reached at

GOP is the Enemy of Medicare

During the health care fight this summer, the GOP has been warning seniors, in ominous tones, of the danger that Democrats might cut Medicare--conveniently forgetting that this has been the Republican party's official position for more than a generation. Thankfully, their words have been immortalized.

A 1961 American Medical Association recording of then-actor Ronald Reagan warned that "one of the traditional methods of imposing statism or socialism on a people has been by way of medicine."

Four years later, Congress would enact Medicare. At the time a Congressman named Bob Dole would vote against it. Thirty years later, as Senate Majority Leader, he bragged "I was there, fighting the fight, voting against Medicare . . . because we knew it wouldn't work."

That same year the Republicans, led by House Speaker Newt Gingrich, would shut down the government when President Bill Clinton refused to sign a Balanced Budget Bill that called for cuts to Medicare.

Then in 2006, rising Republican star Michael Steele would advocate cutting Medicare:

In 2007, Gingrich would double down:

In 2008, Republican presidential candidate John McCain campaigned on a platform of cutting $1.3 trillion from Medicare and Medicaid over 10 years.

Last month, leading Republican Roy Blunt said "government should have never have gotten in the health care business":

Yesterday, though, RNC chairman Michael Steele rose to defend America's flagship single-payer system from any cuts--without a trace of irony--insisting "we need to protect Medicare and not cut it in the name of 'health-insurance reform."

But perhaps Steele and other Republicans are beginning to realize how out of step his defense was with over 40 years of Republican dogma. Because today he said "this single-payer program known as Medicare is a very good example of what we should not have happen with all of our health care."

Tuesday, August 25, 2009

You can't see the media double standard much more clearly than this

In case you sometimes wonder whether the accusations of progressives are true that the mainstream media are, in fact, anti-liberal and coddling of right-wingers, read this by Media Matters editor Eric Boehler. No question he's dead-right about the grossly different treatment of the "angry" Howard Dean and back-page reporting of hundreds of thousand of anti-war protesters a few years ago, compared to the respectful 24-hour treatment of Fox-generated (and to some extent, organized) anti-Obama mobs expressing their grass-roots "concerns."

Make you mad? It should.

Like Your Health Insurance? Maybe You Shouldn't.

By Simon Johnson and James Kwak, Washington Post
Tuesday, August 11, 2009 12:35 AM

If we fail to reform our health care system this year, a major reason will be that a majority of Americans are satisfied with their health coverage and believe that reform could hurt them. According to a recent (unscientific) Consumer Reports survey, 64 percent of readers are satisfied with their plans -- down from 67 percent in 2007, but still a clear majority. A recent New York Times poll found that 59 percent of Americans do not think that health-care reform will benefit them personally; 69 percent are concerned that reform could harm the quality of their own care and 68 percent are concerned that it could limit their access to treatment.

This is deeply misleading, for two reasons. First, what does it mean to say that you are satisfied with your health insurance? Consider homeowner's insurance. Until you need it -- your house burns down -- you have no way of judging its quality. The same goes for health coverage; until you have a serious illness, the kind where your plan's limits and exclusions may kick in, how do you know if your health coverage is any good?

For one thing, as the House Energy and Commerce Committee uncovered, some insurers go out of their way to revoke coverage for people with serious health problems by looking for mistakes on their original applications. For another, you could be underinsured, like 29 percent of all people with health insurance, according to Consumer Reports. It is politically relevant that two-thirds of Americans seem to like their health coverage, but whether they should like it is another question.

The second problem is that the health coverage that most satisfied Americans have -- employer-based coverage -- is less secure than they think. In America today, we have three main health insurance systems. At one end we have Medicare and the Veterans Health Administration, which (although many anti-reform protesters don't realize it) are government-funded and government-run programs, and generally popular ones. At the other end we have the individual market, in which individuals buy insurance policies directly from health insurers. The individual market is completely broken; according to a recent Commonwealth Fund study, 73 percent of people who tried to buy individual coverage in the last three years did not end up buying a plan.

In the middle we have the employer-based system, which according to the U.S. Census Bureau covered 59 percent of the population in 2007. The employer-based system is good and bad. On the plus side, it solves the fundamental problem of the individual market. Again, think about homeowner's insurance. The insurance company figures out how much your house is worth, estimates the chances of it burning down, multiplies those numbers together, and charges you that much (plus a little to cover expenses and profit) in premiums. That is, the cost of a policy should be related to the expected costs of that policy to the insurer.

Now translate this to health insurance and you'll see why the individual market is broken. If you have a serious illness, like cancer, your expected annual costs could easily be $60,000. The insurer has to charge you at least $60,000 for coverage, or else it will lose money. You can't afford that, so you go without insurance. According to the Commonwealth Fund, 70 percent of people with health problems found it impossible or very difficult to find affordable coverage in the individual market. In short, a "market" for health insurance works only if you prevent insurers from doing what insurers naturally do -- discriminate among people according to how risky they are.

The employer-based system solves this problem. Employers can spread the cost of health insurance across their workforces, so that all employees are treated equally, regardless of their medical history. Furthermore, the tax rules governing employer-provided health care require that employers offer plans that treat all employees equally. The result is that if your employer provides health coverage, you can probably get it.

However, the employer-based system has two major weaknesses. First, and most obviously, it means keeping your health insurance is dependent on keeping your job. That means that your health is only insured to the extent that your job is insured -- and your job isn't insured. If you lose your job, or get a divorce from the spouse whose employer covers you, you have to find a new employer who offers a health plan, or you will be stuck in the individual market. Alternatively, if you get sick, you may be stuck in your job, no matter how much you may want or need to leave it.

Second, employers are dropping their health plans; the percentage of people covered through an employer has dropped from 64 percent in 2000 to 59 percent in 2007, and that decline is likely to accelerate. Why? Because, according to a Kaiser Family Foundation survey, the average annual premium for family coverage has already increased from $5,791 in 1999 to $12,680 in 2008 -- a 9 percent annual increase -- and a study published in Health Affairs forecasts that national health spending will grow at an average annual rate of 6.7 percent until 2017. Arithmetically, with each year that passes, it becomes harder for companies to keep their health plans without reducing benefits, reducing wages or increasing employee contributions to health plans.

The bottom line is that your current health plan may not be as good as you think it is, and there is a good chance that it will not be around when you need it.

Health-care reform comes in several different flavors these days, but the basic minimum is that it allows all people to buy health insurance regardless of medical history, and it provides subsidies to help poor and middle-income families buy health insurance. That means that if you get sick and lose your job, you will still be able to get health care. That is something that everyone should be in favor of -- because everyone can get sick and lose his or her job.

Scare tactics on Health Care Debate

Joe Scarboro on morning media asked for both sides of the health care issue to calm down, and stop exaggerating. No one on the left is making up stuff like this. Even when the shrub was at his worst, no one on the left compared him to Hitler, or suggested any kind of violence. All the really sick stuff is coming from republicans. There are a lot of liberals who would never think of bringing guns to town hall meetings because it is legal or think we can intimidate people. Here's the story.

Fox's "death book" lie
by Jed Lewison
Mon Aug 24, 2009 at 08:20:03 AM PDT

The deathers at Fox "News" have been caught with their pants down, once again.

This time -- led by Chris Wallace of Fox "News" Sunday -- Fox is alleging that President Obama is trying to prematurely end the lives of millions of veterans by forcing them to read a "death book" that urges them to "pull the plug" and commit "assisted suicide."

Not surprisingly, it turns out that Fox's attack is totally made up. Their so-called "death book" is actually an optional guidebook on drafting living wills that had been listed in a Veterans Health Administration (VHA) handbook by the Bush administration in 2007.

Here's more detail on the garbage being spewed by Fox:

1. Fox's alleged "death book" is actually a guidebook on preparing living wills

The thing Fox is calling a "death book" is actually a guidebook called "Your life, your choices" initially developed in 1997 to help veterans understand issues relating to advance directives and living wills should they ever experience a medical condition (such as a permanent coma) where they cannot communicate their treatment preferences. Although the guidebook can be downloaded, it carries a disclaimer noting that is currently being updated and revised for a 2010 release. (See this article for more information on the revisions.)

Despite Fox's claim that the guide encourages assisted suicide and euthanasia, it is solely focused on helping veterans determine what type of care they wish to receive if they should ever became incapable of making their wishes known. The guidebook specifically makes clear that it has nothing to do with assisted suicide, which is illegal.

2. Although Fox said VHA practitioners must give the guidebook to each of the 24 million vets they serve, there is no such requirement

According to a directive issued in 2007 under President Bush, the guidebook is merely an example of the type of document that VHA practitioners should give to patients who ask for help with living wills.

3. The Bush administration, not the Obama administration, included the guidebook in the VHA handbook.

In February 2007 the Bush administration's VA issued a directive listing the guidebook as an example of the type of documents VHA practitioners should give to patients who want help drafting living wills. In July 2009, the Obama administration issued a minor update to portions of that directive, but did not change language on the guidebook at all.

US Health Care System Economically Unviable

Our system isn't sustainable. It has to change whether conservative folks like it or not. 10% this year, 10% next year, and so on, how long can this go on. Even the drug companies and care providers should realize this cannot continue. The only folks this benefits are the insurance companies. Bu 2020 the US will be spending 20% of our GDP on health care, while the rest of the industrialized world is spending 1/3 that much. Health care costs could be considered our national overhead. If you are a business and your overhead is 3 times higher than your competitors, you are not going to be in business long. Here are the cost figures.

Employer-Provided Health Care Costs Expected To Rise 10.5% In Next 12 Months
TOM MURPHY | 08/25/09 08:34 AM |

INDIANAPOLIS — Costs for employer-provided health plans are expected to rise more than 10 percent within the next 12 months, a jump workers may feel in their paychecks or through changes to their insurance coverage.

An aging population, rising costs and growing patient demand for services are among the reasons for the higher costs cited in an Aon Consulting report released Tuesday.

Aon Consulting, a subsidiary of Chicago-based Aon Corp., surveyed about 60 health insurers around the country earlier this year. The study found that, on average, insurers expect to pay out 10.5 percent more in claims costs in the next year – slightly less than the 10.6 percent increase forecast last year.

The expected increase doesn't necessarily mean the premiums employees pay will grow at the same clip. Actual increases for each insurer or plan can vary by such factors as plan design, geography or the general health of the people covered.

Some employers also might swallow the higher costs because workers this year already have had to contend with salary freezes, reductions and layoffs, said Tom Lerche, Aon Consulting's health care practice leader.

"There's one school of thought that says, 'Our employees have borne enough, let's minimize or not pass any costs along to the employee,'" he said.

However, others may ask workers to pay more through increased deductibles or copayments. They could make changes to the plans they offer, such as eliminating a traditional plan and offering a consumer-directed, high-deductible plan instead.

Lerche said most employers will consider it "an absolute business imperative" to lower any cost increases to mid- to low-single digit percentages.

Companies also could deal with rising health care costs by limiting pay increases, said Joseph Antos, an economist with the Washington, D.C.-based American Enterprise Institute for Public Policy Research. He was not involved with the Aon study.

"Employer contributions are not gifts, they're part of total compensation," he said. "And if you end up having a more expensive health benefit that your employer pays most of, that means that your wages aren't going to up as fast as they would have."

The Aon survey also found that prescription drug costs are expected to rise 9.3 percent, a slight dip from the 9.4 percent trend forecast a year ago.

Lerche said a number of brand-name drugs have lost patent protection, which allows patients to buy less-expensive generics. Employers also have encouraged their workers to use generic drugs and cost-management programs.

The health care overhaul debate currently taking place in Washington, D.C., won't control this growth. The debate's outcome and the potential savings achieved through any overhaul are both big unknowns.

In any case, the impact from any reform push likely won't be felt for a couple years, notes Antos.

"None of it will affect workers next year," he said.

Aon conducts its survey twice a year to give clients a sense of cost increases they may face as they consider benefit plan renewals. Many employers conduct open enrollment in the fall for coverage that starts the next year.

The Price of One Legislator

On the buying of Bauchus, Montana News MIKE DENNISON says : We’re talking about the health insurance industry and the health industry, which is HMOs, hospitals, physicians, pharmaceutical companies—that’s probably where the bulk of his money has come from. The report that we prepared showed, out of about almost $15 million he’s raised in the last six years, both for his campaign and his leadership PAC, 23 percent of that came from insurance and health interests, and about 18 percent of that was from the health sector and a large amount from pharmaceutical—not the companies, but people who work for pharmaceutical companies and pharmaceutical PACs, about $830,000 just from that sector alone. The total amount was about $3.4 million, which we believe is probably more than any other member has received.

Highest priced legislators bought by Health Care Industry

To quantify buying of the Senate a bit further here's interesting comment just posted on Washington Post wesite. It's a bipartisan effort:

paphorter wrote:

Here are just a sample of payments to Senators, almost all are on the list except Bernie Sanders.

Funding -------Senator------Health Care Related contributions received

17,563,956 McCain,John AZ R
15,747,735 Kerry,John MA D
8,298,887 Specter,Arlen PA D
6,260,466 Baucus,Max MT D
6,053,840 McConnell,Mitch KY R
5,551,547 Harkin,Tom IA D
5,052,273 Lieberman,Joe CT I
5,014,639 Hatch,Orrin UT R
4,662,222 Brown,Sherrod OH D
4,515,337 Dodd,Chris CT D
4,334,201 Grassley,Chuck IA R
4,331,057 Burr,Richard NC R
4,213,855 Kyl,Jon AZ R
4,178,299 Cornyn,John TX R
4,109,512 Kennedy,Edward M MA D
4,037,004 Alexander,Lamar TN R
3,900,134 Ensign,John NV R
3,576,721 Cardin,Ben MD D
3,340,082 Rockefeller,Jay WV D
3,286,198 Conrad,Kent ND D
3,247,794 Coleman,Norm MN OLD R
3,245,066 Schumer,Charles NY D
3,159,183 Chambliss,Saxby GA R
3,050,694 Smith,Gordon OR R
2,880,528 Hutchison,Kay Bailey TX R
2,870,616 Durbin,Dick IL D
2,817,100 Lincoln,Blanche AR D
2,650,628 Voinovich,George OH R
2,634,653 Bunning,Jim KY R
2,565,701 Feinstein,Dianne CA D

Around this Earth, most modern countries are providing all of their people with some form of single payer HEALTHCARE, NON PROFIT TYPE. To do that, they spend an average of 10% of their GDP. The US spends 18% GDP on healthcare, $2.6 trillion,and for that only covers some 82% of it's people. And in all those other countries, no one goes bankrupt from healthcare bills.

But it seems, all of our politicians are bought and paid for, what else could prevent them from exercising common sense?

"Legislators For Sale"

Olbermann Harshly Criticizes Members Of Congress Over Health Care Reform:
Huffington Post First Posted: 08- 3-09 11:01 PM | Updated: 08- 4-09 06:45 AM

Keith Olbermann harshly criticized members of Congress in a "Special Comment" tonight for paying more attention to the needs of the health care industry, who donate large sums of money to their campaigns, than to their constituents, who would benefit greatly from health care reform. Olbermann titled the segment "legislators for sale."

From the transcript:

I could bring up all the other Democrats doing their masters' bidding in the House or the Senate, all the others who will get an extra thousand from somebody if they just postpone the vote another year, another month, another week, because right now without the competition of a government-funded insurance company, in one hour the health care industries can make so much money that they'd kill you for that extra hour of profit, I could call them all out by name.
But I think you get the point. We don't need to call the Democrats holding this up Blue Dogs. That one word "Dogs" is perfectly sufficient. But let me speak to them collectively, anyway.I warn you all. You were not elected to create a Democratic majority. You were elected to restore this country. You were not elected to serve the corporations and the trusts who the government has enabled for the last eight years.

You were elected to serve the people. And if you fail to pass or support this legislation, the full wrath of the progressive and the moderate movements in this country will come down on your heads. Explain yourselves not to me, but to them. They elected you, and in the blink of an eye, they will replace you.

If you will behave as if you are Republicans -- as if you are the prostitutes of our system --you will be judged as such. And you will lose not merely our respect. You will lose your jobs!

Every poll, every analysis, every vote, every region of this country supports health care reform, and the essential great leveling agent of a government-funded alternative to the unchecked duopoly of profiteering private insurance corporations. Cross us all at your peril.

Because, Congressman Ross, you are not the Representative from Blue Cross. And Mr. Baucus, you are not the Senator from Schering-Plough Global Health Care even if they have already given you $76,000 towards your re-election. And Ms. Lincoln, you are not the Senator from DaVita Dialysis.

Because, ladies and gentlemen, President Lincoln did not promise that this nation shall have a new death of freedom, and that government of the corporation, by the corporation, for the corporation, shall not perish from this earth.

5 Myths About Health Care Around the World

By T.R. Reid, Washington Post
Sunday, August 23, 2009

As Americans search for the cure to what ails our health-care system, we've overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they've found ways to cover everybody -- and still spend far less than we do.

I've traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

1. It's all socialized medicine out there.

Not so. Some countries, such as Britain, New Zealand and Cuba, do provide health care in government hospitals, with the government paying the bills. Others -- for instance, Canada and Taiwan -- rely on private-sector providers, paid for by government-run insurance. But many wealthy countries -- including Germany, the Netherlands, Japan and Switzerland -- provide universal coverage using private doctors, private hospitals and private insurance plans.

In some ways, health care is less "socialized" overseas than in the United States. Almost all Americans sign up for government insurance (Medicare) at age 65. In Germany, Switzerland and the Netherlands, seniors stick with private insurance plans for life. Meanwhile, the U.S. Department of Veterans Affairs is one of the planet's purest examples of government-run health care.

2. Overseas, care is rationed through limited choices or long lines.

Generally, no. Germans can sign up for any of the nation's 200 private health insurance plans -- a broader choice than any American has. If a German doesn't like her insurance company, she can switch to another, with no increase in premium. The Swiss, too, can choose any insurance plan in the country.

In France and Japan, you don't get a choice of insurance provider; you have to use the one designated for your company or your industry. But patients can go to any doctor, any hospital, any traditional healer. There are no U.S.-style limits such as "in-network" lists of doctors or "pre-authorization" for surgery. You pick any doctor, you get treatment -- and insurance has to pay.

Canadians have their choice of providers. In Austria and Germany, if a doctor diagnoses a person as "stressed," medical insurance pays for weekends at a health spa.

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations -- Germany, Britain, Austria -- outperform the United States on measures such as waiting times for appointments and for elective surgeries.

In Japan, waiting times are so short that most patients don't bother to make an appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule a consultation about my aching shoulder. "Why don't you just drop by?" the receptionist said. That same afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an operation. "When could we do it?" I asked. The doctor checked his computer and said, "Tomorrow would be pretty difficult. Perhaps some day next week?"

3. Foreign health-care systems are inefficient, bloated bureaucracies.

Much less so than here. It may seem to Americans that U.S.-style free enterprise -- private-sector, for-profit health insurance -- is naturally the most cost-effective way to pay for health care. But in fact, all the other payment systems are more efficient than ours.

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France's health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada's universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

4. Cost controls stifle innovation.

False. The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who's had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

5. Health insurance has to be cruel.

Not really. American health insurance companies routinely reject applicants with a "preexisting condition" -- precisely the people most likely to need the insurers' service. They employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer's "rescission department" digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this stuff to survive in a tough business.

Foreign health insurance companies, in contrast, must accept all applicants, and they can't cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital (or health spa), usually within tight time limits. The big Swiss insurer Groupe Mutuel promises to pay all claims within five days. "Our customers love it," the group's chief executive told me. The corollary is that everyone is mandated to buy insurance, to give the plans an adequate pool of rate-payers.

The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.

In many ways, foreign health-care models are not really "foreign" to America, because our crazy-quilt health-care system uses elements of all of them. For Native Americans or veterans, we're Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we're Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we're Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we're Burundi or Burma: In the world's poor nations, sick people pay out of pocket for medical care; those who can't pay stay sick or die.

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that America has "the finest health care" in the world. We don't. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals, world-class research -- the United States could be, and should be, the best in the world. To get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.

T.R. Reid, a former Washington Post reporter, is the author of "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," to be published Monday.


In addition private US health plans like Aetna, CIGNA, United Health Care have to support $10-20 million dollar salaries for their CEOs vs $150,000 for the head of Medicare and 20-30% administrate costs vs. 2% for Medicare.

What about Drug advertising and the promotion of new drugs? A US Today 2008 article says Prescription-drug advertising is big business. The pharmaceutical industry in 2006 spent $4.8 billion on consumer ads, according to IMS Health, a private firm that tracks sales and marketing. The industry spent $7.2 billion more marketing products to doctors. Government Accountability Office reported in 2006 a study of 64 drugs that found for every $1 spent on advertising, sales increased by a median of $2.20. This kind of advertising, which was banned in the USA until 1997, is banned in nearly all other Western countries.

Prescription drug spending is galloping up by around 17 percent a year and is the fastest-growing item in health care inflation. Rising drug prices are part of that growth. They are the highest in the world, because Congress has rejected the controls that other Western countries use to limit prices.

Health Care's Core Myth

A core myth in the misinformation about U.S. health care is that private insurers administrative costs are lower" when in fact that simply is not true:

A common justification for Medicare is that the public health insurance system has an overhead cost which is about 2% of claims, while the private sector has administrative costs between 20%-25% of claims. Source is from an insurance industry website:

Another excess of the private health insurance industry is CEO salaries. CEO annual salaries of private health insurance companies average over $10 million a year. The Head of Medicare’s salary was $150,000. The health of the country should not be in the hands of CEOs who get rich for non-performance and for denying coverage to be able line their own pockets at the public’s expense.

Sunday, August 23, 2009

How to break the impasse AND WIN

Instead of the legislative machinations being bandied about, Obama can win this by splitting the public option into a separate bill and having it passed out of a House committee immediately, and meanwhile getting the up vote, at least from all the Democrats and probably a few Republicans, on the less–volatile parts of the bill. Those remaining elements are namely (1) the end of the insurance company's right to deny or rescind coverage (before or after the claim) or discriminate with outrageous pricing based on pre-existing conditions; (2) the universal mandate; (3) the insurance “exchange” where insurers will have to compete on established parameters of coverage; and (4) assistance with premiums for people who can't afford them, such as a family with an income less than $88,000 as in the current House bill.

Even without the public option, those are serious changes that bring the U.S. close to at least some of the European systems that are significantly less costly than the current mish-mash of a system we have (if you can call it a system). (Several of the Continental European systems do rely to a great extent on private insurance.)

There will be huge cost-savings simply from insurance companies no longer deploying armies to dig for and do battle over pre-existing conditions, from doctors and hospitals knowing exactly when the patient shows up at the door that they will be paid in full, by whom and when, and probably to some extent by somewhat improved competitive environment through the exchanges.

But Obama cannot give up on the public option. First, he must acknowledge that when they understand the “public option” correctly – that it is a choice entirely in the hands of the individual between a public non-profit policy and private policies -- Americans overwhelmingly support being given that choice. Accordingly, he must put the burden of persuasion against this public option on the opponents: why in the world would they deny the American people something they want which will help control insurance costs? By promoting a separate bill on the public option, he can promote debate on that issue alone by allowing people to focus on what it really means, and in the process put even more pressure on the opponents to explain themselves. This they are unlikely to be able to do, since they are protecting the highest possible profits of the insurance companies -- reducing their incentive to improve efficiency -- and gigantic salaries in the tens of millions for their top executives.

The best chance of actually getting the valuable public option is to stop allowing opponents to hide behind all the ridiculous flak the rest of the bill is receiving. Cut it out but keep it alive (and well).

Tuesday, August 18, 2009


In defense of incrementalism on healthcare, Kevin Drum points out the decades-long long timeline required for the French system to get where it is. One very knowledgeable commenter to this entry – he identifies himself as “Bruce Webb,” who, if it is the same person as the person of that name who runs his own policy website, is someone who really understands and can articulate the issues in the Social Security “debate” -- explains why the “public option,” while important and worth continuing the fight for, is not theoretically necessary to avoid the doomsday price-collusion scenarios many on the left, including even Krugman, are predicting if the public option is not adopted now. Everyone with an interest in this particular issue – in making sure we are focusing on substance more than the symbolism of victory -- should understand what Section 116 of the House bill means.

Incrementalism and Triggers

Submitted by Bruce Webb (not verified) on August 18, 2009 - 12:38pm.

I don't think people are fully aware of the profit controls built into the House version of the bill particularly in Sec 116. And they are pretty easily enforced, you take one readily obtainable number of premiums collected, divide it by the amount of dollars actually spent on medical care, and you get your 'medical loss ratio'. If it falls below a percentage set by the Health Choices Commissioner companies have to rebate the difference. So to that extent the Obama people (who I suspect have actually read and understand the bill) are right and many of the doom-sayers are wrong, you don't need the PO to contain premium increases. Which is not to say that the Public Option is not critically important, without it you have the constant danger of agency capture and some future Commissioner bending over backwards to lower the acceptable medical loss ratio and so boost profits for the privates. That is the point where the PO provides a backstop in the form of comparable cost, if the Commissioner gets gamed by the privates the PO just grabs the customer based on premium savings as the privates price themselves out of the market. Ultimately the PO helps avoid Bush-style crony capitalism.

But over the short run the controls established in Secs 111-116 prevent most of the doomsday scenarios being pushed in the left blogosphere that have 50 million helpless Americans delivered into the maw of the insurance companies because of the mandate. So the world would not come to an end if we had a bill without a public mandate, and it might make it easier to get to single-payer by incrementally expanding Medicaid to higher percentages of the poverty level and Medicare to lower age cohorts.

The real reason we need the PO now is because Republicans are right, the House bill takes all the fun out of being a private health insurer. Instead of paying for your lobster and private jet by devising ever more elaborate ways to screw over people by denying them care, you actually have to supply value per dollar of premium. It is not that private companies won't be able to compete, it is just that investors will flee for greener pastures with better (meaning more predatory) margins. As private companies abandon markets (as they did as the HMO model faded) the PO provides a landing place.

But starting from the principle of universal access and a single risk pool is not a terrible place to be for the first couple of years.

It's also worth pointing out to the doomsayers who threaten to pick up their marbles and go home if the new system is not "single payer," that the French, German and Swiss systems, all of which are significantly less costly than ours and are generaly believed to work very well, depend heavily on private insurance. As with the essence of the Obama plan, the main elements are a universality mandate, regulation of policies (e.g., no denial or price discrimination for pre-existing conditions) and assistance for those who need it to get coverage.

I added the following comment to Drum's post:

Almost everyone continues to underestimate grossly the cost-control effect of universal insurance: of doctors and hospitals knowing when the patient shows up at the door that they will be paid, by whom and when, and of insurance companies no longer looking for pre-existing conditions. A massive part of the thing we cavalierly call "administrative waste" is the machinery needed to collect payment -- as evidenced by the reports of the Duke University Medical Center needing 800 billing administrators for an 800-bed hospital. The waste in digging for and fighting over alleged pre-existing conditions is a gigantic waste, too.

If we can split off the public option with an immediate bill passed by the Dingell-Waxman committee in order to get universal insurance without any effect from pre-existing conditions, we could then galvanize public opinion on the need not to let insurance companies have free pricing rein.

If the Democratic leadership can force a commitment from the Blue Dogs not to assist the Republicans in preventing a majority vote on the bill itself, there are enough votes to pass a bill with the public option. If we can get that -- and it will be a popular feature once it is in place and the majority of Americans finally understand what it is -- by all means we should. But I am in the "trust Obama" mode. We were all afraid he was getting too wimpy in the face of right-wing irrationality before the election, and we know how that turned out. We are seeing the best punches they can throw at it, and in the long-run, because they are so ridiculous, they will not stand up. Sarah Palin had 59% approval a year ago. Now she's down to the hardcore 37%. It does happen.

Monday, August 10, 2009

The "death panels"

The "Advance Care Planning Consultation," the section that right-wingers are claiming is a surreptitious plan for "death panels" that a senior will have to submit to every five years, is, in fact, a new provision to have Medicare cover (pay for) such a consultation if a Medicare beneficiary wishes to have one, but no more frequently for Medicare coverage than once every 5 years unless a life-threating condition has come to light.

I heard someone on the Ed Schultz Show call in and ominously point us to pages 425-30 of the Energy and Commerce bill. That's what's actually in those pages. It's amending Medicare to pay the doctor for consulting with you on a friggin' living will.

Now you know when you hear the friend you once thought to be a sensate human being utter this beyond-the-pale absurdity. How far can distortion be pushed? This is truly way, way outside any envelope of a minimum standard of rationality. That is what Republicanism has been reduced to. It's frightening.

Selling the "public option" better

The "public option" idea has not gained as much public traction as it should have, and once again, poor communication by supporters, including Obama, bear at least some of the blame. Opponents have had free rein to put out the idea that it will amount to a government takeover, but even excluding the crazies, insurance companies and their captive Senators have said with virtually no response, and with some plausibility, that a government-run plan – i.e., a plan that is funded in part by taxpayers -- will destroy competition. Who, after all, can compete with a plan where the spigot can be turned on anytime by a willing Congress and President?

What is meant by a "public option"? One critical aspect that nobody has pushed to the forefront, at least in the Energy and Commerce Committee bill (Dingell, Waxman et al), is that the plan is required to be run "fully" out of revenue from premiums (Section 222(a)(1)(B). That puts it on the same competitive footing from a pricing standpoint as any other nationwide non-profit health insurance plan that can spread out its costs over a wide swath of the population.

There should in principle be no objection to this by sane Republicans or Democratic Blue Dogs. At the very least, even if the public option ultimately has to be shelved (at least for now), this talking should be pushed simply for the purpose of winning points in the national debate. If the public realizes that the objection to the public option is not reasonable – i.e., will not destroy competition because it must be funded out of premiums like any other plan, and is opposed solely to allow insurance companies to maximize their profits out of your hide – giving in on that (for now) will be seen as a huge concession that might reduce the need to cave on something else. It will also start greasing the way for introducing a public option later.

Over the top

Back for a short break between vacations. Frankly, I used to think the crazies in the Republican Party were just making themselves look ridiculous, but now I'm beginning to think twice about that. Had dinner last night with two close friends whom I used to consider to be reasonably intelligent and well-informed. I couldn't believe it when they started mouthing the "death squads" talk about the health care bill. Then, one complained she had not seen Obama's birth certificate and wasn't sure he was legally president. I asked if she'd ever seen Bush's. "No," she said, "but that's different because he was a normal person." Whatever that means ... I guess it means white.

While we were on vacation in Montana, we stayed one night at a B&B where everyone was openly talking about the need for armed revolution and hoping that someone would have the guts to assassinate "these commies who have taken over the government." Of course, they're always pissed about taxes. I asked one fellow how much he paid in real estate tax. He said $2,000, and he was really pissed about it. When I told him I paid $22,000, he almost flipped. Of course, these guys get back something like $2.00 for every $1.00 of federal tax they pay, while we pay $2.00 for every $1.00 we get back. Nearly empty highways out there are being expanded, while we can't even fix the pot holes here in the east.

Sunday, August 09, 2009

How to get 100% agreement on a health insurance reform bill

This post by a contributor to Daily Kos named Stroszek is great: we give up, you win, Republican Brooks Brothers rioters, and we will eliminate all your concerns from the health bills. We will put in language that guarantees there will be no death panels telling granny it's time to die, that nobody will deny medical treatment for Sarah Palin's baby, that all hospitals will not be nationalized, or that private insurance will be outlawed. Stroszek has a considerable list of the nutcase lies that the right-wing is using to scare ordinary Americans. I could in an hour or two write the amendment to whatever bill makes it out of Congress for signature. Every one of them will be preceded by the words, “Notwithstanding any part of the foregoing sections that could be construed to the contrary, blah, blah, blah . . . .”

Once we have that language in place, we surely can all agree and pass the damned thing by a 535-0 margin in the House, and a 100-0 margin in the Senate.

Monday, August 03, 2009

One Small Step for Health Care Reform

The Energy and Commerce Committee approved H.R. 3200, "America's Affordable Health Choices Act," by a vote of 31 to 28. This legislation will build on what works in today's health care system, makes important insurance market reforms to protect consumers, encourages competition among insurance plans to improve choices for patients, and expands access to quality, affordable health care for all Americans.

"Today is a historic moment for the House of Representatives and a defining moment for our country," said Chairman Waxman. "It is a significant victory that all three committees in the House have worked together to pass comprehensive health reform legislation for all Americans. This bill will deliver the results the nation's health care system so desperately needs: lower costs, better quality, and broader coverage. I hope that when we return from recess, the House will act expeditiously to enact this bill into law."

The legislation contains critical insurance reforms to protect consumers. Insurance companies will no longer be able to discriminate on the basis of pre-existing conditions or drop coverage for those who become seriously ill. Insurers will no longer be able to discriminate on the basis of gender or selectively refuse to renew coverage. And they will be required to fully cover regular checkups and preventative care without cost-sharing and abide by limits on how much they can charge for out-of-pocket expenses.

The legislation also changes the structural costs in the health care system. It lays the groundwork for major reforms in the delivery system that will over time help improve the quality of care and put us on a path towards constraining the cost of our health care system. The bill is fully paid for and is deficit neutral.

The legislation is supported by hundreds of organizations representing doctors, surgeons, nurses, hospitals, providers, consumers, labor, researchers, state and local governments, public policy institutions, and others.

This legislation will be merged with provisions reported by the Committees on Ways and Means and Education and Labor for consideration by the full House of Representatives.

The key principles of legislation include, among other things:

Keeping what works today, and increasing choice and competition. First, the bill will protect and improve consumers' choices.

If an individual likes their current plan, they will be able to keep it.
For individuals who either aren't currently covered, or want to enroll in a new health care plan, the proposal will establish a health care exchange where consumers can select from a menu of affordable, quality health care options: either a new public health insurance option or a plan offered by private insurers.
This new marketplace will reduce costs, create competition that leads to better care for every American, and keep private insurers honest. Patients and doctors will have control over decisions about their health care, instead of insurance companies.
Giving Americans peace of mind about their health coverage. Second, the legislation will ensure that Americans have portable, secure health care plans - so that they won't lose care if their employer drops their plan or they lose their job.

Every American who receives coverage through the exchange will have a plan that includes standardized, comprehensive and quality health care benefits.
It will end increases in premiums or denials of care based on pre-existing conditions, race, or gender, and limited age rating (2:1).
The proposal will also eliminate co-pays for preventive care, cap out-of-pocket expenses, and guarantee catastrophic coverage that protects every American from bankruptcy.
Improving quality of care for every American. Third, the legislation will ensure that Americans of all ages, from young children to retirees have access to greater quality of care by focusing on prevention, wellness, and strengthening programs that work.

The proposal guarantees that every child in America will have health care coverage that includes dental and vision benefits.
It will provide better preventative and wellness care. Every health care plan offered through the exchange will cover preventative care.
By growing the health care workforce, the proposal will ensure that more doctors and nurses are available to provide quality care as more Americans get coverage.
The proposal strengthens Medicare and Medicaid so that seniors, people with disabilities and low-income Americans receive better quality of care and see lower prescription drug costs and out-of-pocket expenses.
Ensuring shared responsibility. Fourth, the bill will ensure that individuals, employers, and the federal government all share responsibility for a quality and affordable health care system.

Employers who currently offer coverage will be able to continue offering coverage to workers. Employers who don't currently offer coverage could choose to cover their workers or pay a penalty.
All individuals would be required to get coverage, either through their employer or the exchange, or pay a penalty.
The federal government will provide affordability credits, available on a sliding scale for low- and middle-income individuals and families to make premiums affordable and reduce cost-sharing.
Protecting consumers and reducing waste, fraud, and abuse. Fifth, the legislation will put the interests of consumers first, protect them from any problems in getting and keeping health care coverage, and reduce waste, fraud, and abuse.

The proposal provides complete transparency in plans in the health exchange so that consumers have the clear, complete information needed to select the plan that best meets their needs.
Additionally, it establishes Consumer Advocacy Offices as part of the exchange in order to protect consumers, answer questions, and assist with any problems related to their plans.
The proposal will identify and eliminate waste, fraud, and abuse by simplifying paperwork and other administrative burdens. Patients, doctors, nurses, insurance companies, providers, and employers will all encounter a streamlined, less confusing, more consumer friendly system.

Let's hope the plan is enacted in a victory over the denial that the present system is the ultimate in suboptimization, twice as expense and half as good as the key EU countries.