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To: Lizzie Tudor who wrote (13230)10/21/2003 2:37:06 AM
From: LindyBill  Respond to of 794368
 
Brownstein goes over what doesn't work. Pushing for a Universal Health care plan is politically convenient. When you look at Canada, you realize that the result is a national disaster.
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RONALD BROWNSTEIN / WASHINGTON OUTLOOK

Universal Coverage Is Within Reach, If the Pain Is Shared Equitably
Ronald Brownstein

October 20, 2003

Ten years ago, a vicious cycle of rising prices and declining access forced health care to the top of the national agenda. Now that destructive spiral is spinning again — with the same result.

Everywhere signs are proliferating that the health-care system is breaking down under the same pressures that inspired President Clinton's ill-fated crusade to guarantee universal coverage.

Three consecutive years of double-digit increases in health insurance premiums are straining employers and igniting conflicts with employees asked to bear part of the burden. Health-care costs have become a growing factor in labor confrontations, like the two bitter strikes underway in Southern California.

The rising costs are also compelling more employers to stop offering health coverage at all — and more employees to decline it even when it's offered. Since President Bush took office, the number of Americans without health insurance has soared by 3.7 million, to 43.6 million, the biggest two-year increase since his father was president.

These problems of cost and access are inextricably connected. It's easy to see how rising costs translate into reduced coverage. But the reverse is also true. The growing number of Americans without insurance means that doctors and hospitals have to provide more uncompensated care that must be subsidized by the premiums of those with insurance. As Bruce G. Bodaken, chairman and president of Blue Shield of California, put it in a speech last winter: "In essence, we are charging the private health-care system a hidden tax, a tax that can't be sustained"

That should be the real issue in the current struggle over health-care costs. As a group, employers are getting a bad rap. Some may be trying to shift an inordinate share of the health-care bill to their employees. But the employers providing coverage are not, en masse, abandoning their responsibilities.

Employers who provide health insurance are not shifting a larger share of the premium cost to their workers, according to the definitive annual surveys by the Kaiser Family Foundation. In fact, the trend is slightly in the opposite direction. Ten years ago, employees contributed 32% of the cost for insurance; now the number is 27%, Kaiser found.

And while total out-of-pocket health-care costs for employees have jumped 50% in the last three years, that's no faster than the rise in premiums paid by their employers, Kaiser's surveys show.

The real issue is that costs are rising so fast that the burdens are growing unbearable for employers and employees. Controlling costs will require many steps, including slowing the rise in prescription drug prices. But most experts agree it won't be possible to restrain health-care costs without significantly reducing the number of uninsured.

There's no shortage of ideas for how to do that. But the real question in all of them is the bottom line: Who pays?

In the last few months, at least three distinct answers have emerged.

As he prepares to leave office, Gov. Gray Davis recently signed legislation that would impose the burden overwhelmingly on the businesses that don't now provide coverage. The measure would require all firms in the state with 50 or more employees to cover their workers, or pay into a state fund that would provide insurance.

Reluctant to instigate such a political showdown with business, the Democratic presidential candidates are pushing plans that mostly would use taxpayer money to cover the uninsured. The most extreme example is the plan from Rep. Richard A. Gephardt of Missouri to provide employers a generous new tax credit to cover most of the cost of insurance. Gephardt's plan not only rejects any new cost to businesses that don't provide coverage today, it shifts to government, through the tax break, roughly one-quarter of the cost now paid by employers who do cover their workers.

Bush's approach looks largely to the uninsured to meet the cost. He's proposing a tax credit that low-income families without insurance could use to help buy coverage. But it would generally cover only half of their cost or less.

Each of these approaches has flaws. Bush's plan asks the uninsured to bear such a large burden that few could afford coverage even with the credit; the best estimates are that Bush would reduce the number of uninsured by less than 10%. The plan from Gephardt (and to a lesser extent, proposals by his Democratic rivals) could impose unsustainable costs on the federal treasury. And the California legislation probably asks too much of the low-wage employers who don't provide coverage, especially at a time when the economy is slow.

The answer is a more equitable sharing of the bill between government, employers and individuals. One guidepost should be the existing division of the tab: Today, individuals and government both contribute about one-third of the nation's $1.6-trillion health-care bill, with employers chipping in about one-fourth and foundations and charities the remainder, according to analysis by Emory University's Kenneth E. Thorpe.

Since the uninsured are overwhelmingly low-wage workers, they probably can't pay as much as individuals now contribute overall, Thorpe notes. That means a sensible plan would allocate more of the cost to government and business (though not as great a share as California is imposing). One promising model might be the plan that Bodaken of Blue Shield proposed last winter that would impose a mandate on employers to provide coverage, a mandate on individuals to purchase coverage (which solves the problem of the young and healthy skewing the risk pool by opting out), and provide government subsidies for both.

In an economy that already spends $1.6 trillion on health care, the cost of universal coverage is almost trivial: about $75 billion more a year. But it won't be possible to find those funds unless business, individuals and government all shoulder their share of the load.

Ronald Brownstein's column appears every Monday. See current and past Brownstein columns on The Times' Web site at latimes.com .



To: Lizzie Tudor who wrote (13230)10/21/2003 4:39:25 AM
From: LindyBill  Read Replies (2) | Respond to of 794368
 
We spent a good bit of time discussing this issue over the weekend.
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The drug-importation mob
By Robert Goldberg
THE WASHINGTON TIMES
Robert Goldberg is director of the Manhattan Institute's Center for Medical Progress.

Genuine Medicare reform is not dying in Congress due to a lack of effort. Both the White House and congressional conferees are working hard to craft a bill. Instead, it is being poisoned to death by politicians who want to give the mob and media what it has been yowling for these past months, importation legislation that reduces the prices and profits of drug and biotech firms.

Gil Gutknecht, JoAnn Emerson and Rahm Emanuel claim that importing drugs from Europe, Canada and South Africa is a safe way of cutting in half what the government, insurers and consumers spend on drugs without undermining the future development of any new medicine. Why would anyone want to reform Medicare when all you have to do is buy your drugs over the Internet from Canada?

Supporting importation is not an act of political courage. Who's against a discount, especially if it comes at the expense of drug companies? Rather, what Mr. Gutknecht and others are doing is telling people and other politicians what they want to hear: that there are absolutely no risks or negative consequences from importation. And they have an eager cross-section of Congress — liberal and conservative — along with every Democratic presidential candidate, willing to be conduits rather than a check on such stupidity.

Mr. Gutknecht claims re-importation does not impose price controls, thereby easing the conscience of conservatives. That will be news to the European Commission, which reviewed the negative impact on what it called "administered prices" on patient access to medicines and the development of new medicines. Canada's Patented Medicines Price Review Board also states that it regulates drug and biotech prices. In other cases, countries "let" companies price products at any level but only reimburse at the cheapest drug for that disease or only let a certain number of patients have access to a new drug. These are all forms of price controls, and they are the reason re-imported drugs are cheaper.

Price and reimbursement controls not only delay access — they deny it at a significant cost in patient health. Europeans and Canadians don't survive cancer as often as Americans; they also suffer more with asthma, depression, epilepsy, multiple sclerosis and Alzheimer's. Conservatives drinking Mr. Gutknecht's Kool-aid love to chant his mantra that "an unaffordable drug is neither safe nor effective ." What about a drug that is unavailable thanks to price controls?

If these health problems trouble you, consider the impact of drugs that won't be developed because price controls undermine future research and development. Over the past decade, pharmaceutical research and development in Europe has declined and shifted to the America's free market. It has fallen by 20 percent in Canada in less than three years. Today, only three of the 25 best-selling drugs will belong to European companies. Only a decade ago, half of all top-selling drugs were European.

If America resold its medicine through Europe's price system, it could cut future research by about 40 percent a year. Some conservatives claim that if importation did cut biotech and pharmaceutical research, all Congress has to do to make up the difference would be to boost the National Institutes of Health (NIH) budget. This is another half-truth that people who want to punish drug companies want to believe, and that Mr. Gutknecht and his crew are more than willing to reinforce.

But government labs don't have the ability to discover and develop new drugs. Europe's national labs have increased spending over the past decade with few results. And despite a doubling of funding over the past 20 years, NIH has a patentable claim for exactly six of the top 200 drugs used by the Department of Veterans Affairs in Defense Department health plan drug lists.

The claim that importation will save half of what insurance companies, government and consumers spend on medicines is laughable. This summer, IMS Global Health found that importation in Europe saved a mere half percent of the ¤82 billion EU pharmaceutical market. Once the bogus Canadian Internet pharmacies and wholesalers take their cut, Americans will save next to nothing.

Mr. Bush is committed to restructuring Medicare and has made his opposition to importation clear. Many politicians and presidential candidates want to scuttle Medicare reform and move to a straight vote on drug imports. If they succeed, here's the question the president should ask the importation mob, since the media has failed to do so: If importation is the right response to rising drug costs, why import European price controls? Why not impose our own and see if it doesn't hurt patients and medical progress? Or would that expose importation for the sham it is?
washtimes.com



To: Lizzie Tudor who wrote (13230)10/21/2003 5:33:42 AM
From: LindyBill  Respond to of 794368
 
Will they get away with it? It will take a filibuster to stop them. "The Hill"
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GOP: We’ll strip loan language
Leadership says Bush will prevail in conference
By Klaus Marre


Republican leaders predict that President Bush is likely to prevail in a House-Senate dispute over Iraqi spending.

Sen. Rick Santorum (R-Pa.), the Republican Conference chairman, told The Hill that a Senate vote last week requiring some of the Iraq reconstruction funds to be made available as loans was a “temporary setback.” He said the language “will be taken out in conference” with the House.

Nevertheless, both chambers had sent a warning shot across the White House bow by paring back the president’s initial $20.3 billion Iraq reconstruction budget by $1.65 billion and at least temporarily opposing in part the administration’s funding approach.

However, Santorum and other key GOP lawmakers are now confident that they can kill the Senate provision requiring half the Iraq aid be conditioned as a loan unless other nations forgive debts accumulated by Baghdad under Saddam Hussein.

The lopsided House and Senate vote margins in favor of the supplemental measure indicate that final approval could come in time for an international conference in Madrid on Iraq’s future later this week.

In an interview Friday, Santorum said the knowledge that the GOP has “enough votes to pass this” would make it easier to take the language out in conference.
Senate Minority Leader Thomas Daschle (D-S.D.) has indicated that most members of his caucus would vote for the supplemental spending bill in the Senate even if the loan provision were deleted.

The Senate is the only place where Democrats could conceivably stop the supplemental spending bill. However, nobody expects this to happen because most of the money would go to the military and Democrats do not want to be seen as not supporting the troops in Iraq and Afghanistan.

While final passage of the conference agreement is not in doubt, Daschle argued that Republicans would take out the loan provision “at their own peril” and that such a move would be a “big mistake” that sends “all the wrong messages to the American people.”

Sen. Ben Nelson (D-Neb.) said it would be “delicate” to strip out the loan provision. He added it would be one thing for a lawmaker to not support the language during a floor vote but another to take it out in conference.

Nelson said there would be “a political cost associated with taking it out.” However, the lawmaker also said that the fact that final passage of the legislation is not in doubt would make it easier for Republicans to take out the loan provision in conference.

Prior to the vote, Senate Minority Whip Harry Reid (D-Nev.) said if the loan provision would attract a lot of support, supporters of the language could apply pressure in conference. The amendment cleared the Senate 51 to 47 with eight Republicans crossing party lines.

Daschle applauded the Republicans who voted with the Democrats on the loan provision. He called the vote a “critical moment,” saying it is “encouraging” that GOP lawmakers are more frequently “willing to stand up to this administration on issues that they care deeply about.”

Furthermore, he said that GOP leaders who want to provide all construction money in the form of grants are not taking the concerns of the American people as seriously as they should.

“I think that people’s concern about our priorities are far more consequential than a lot of my colleagues seem to appreciate,” he said.

The Senate approved the supplemental bill 87-12, with 11 Democrats and independent James Jeffords (Vt.) voting against the measure and one Republican, Sen. Lamar Alexander (Tenn.), not voting.

Daschle last week also called on GOP leaders to include Democrats in the conference negotiations. “This is too important and it is too bipartisan an issue for us to delegate responsibility to one or two people in the House and the Senate to resolve these matters. We insist on being there to have the opportunity to make the case that we made on the Senate floor last night,” Daschle said.

The Democratic leader added that the Senate stated “loudly and clearly” that Iraq should share some of the financial burden of its own reconstruction. Passing the amendment, Daschle said, responded “to the concerns expressed to us overwhelmingly by the American people.”
thehill.com



To: Lizzie Tudor who wrote (13230)10/21/2003 7:15:57 AM
From: LindyBill  Respond to of 794368
 
Let's hear it for the Retailers! BTW, if you aren't getting rid of stuff around the house on EBay, get with it!
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Retail Economics
Comsumers have helped ward off a serious recession, but the stores which have kept them spending deserve credit, too.
by Irwin M. Stelzer - Weekly Standard
10/21/2003 12:00:00 AM

YOU DON'T HAVE TO BE a close reader of the business pages to know that the free-spending American consumer gets credit for keeping the American economy from slipping into a serious recession. What is less heralded is just how the supply side of the economy has contributed to the willingness of American consumers to put their hard-earned and easily borrowed dollars to work shoring up the economy.

Start with Wal-Mart, as any discussion of the retail sector must. With revenues of almost $250 billion, it is the world's largest company. As BusinessWeek points out in a recent cover story, "Every week, 138 million shoppers visit Wal-Mart's 4,750 stores; last year, 82 percent of American households made at least one purchase at Wal-Mart."

For President Bush that is both good and bad news. The good news is that Wal-Mart's use of its mass buying power to keep its costs, and therefore consumer prices, low, has made it unnecessary for the Federal Reserve Board's monetary policy makers to worry that low interest rates will trigger inflation. The bad news for the president is that Wal-Mart's purchases account for some 10 percent of America's trade deficit with China, a deficit that manufacturers and trade unions complain is costing American workers their jobs. To cool things down at home, and to head off congressional pressure to impose tariffs on Chinese goods, President Bush will use the Asian Pacific Economic Conference (APEC) later this week to press China to allow its currency to float upwards so as to make its goods less competitive in the U.S. market.

BUT EVEN IF Bush gets what he wants, the increase in retail prices should not be great, given Wal-Mart's power vis-à-vis its major suppliers. So it will continue to dominate the pile-'em-high-and-sell-'em-low segment of the retail market, and keep customers spending.

The emergence of Wal-Mart is not the only revolution on the sell side of the consumer market. The Internet, discounted as a force when the dot.com bust hit the high-tech sector, is finally making an impact on consumer markets. Books and CDs have always been products that webtailers can move. But consumers are now using the Internet for purchases of apparel, something few thought would ever happen. ComScore Networks Inc. estimates that in one month alone 34 million consumers bought more than $500 million worth of clothes at websites, up 44 percent on the previous year.

And another consultancy, Jupiter/Ipsos, estimates that between 16 percent and 25 percent of Americans purchased a product or service online. Which is why Barry Diller's InterActive Corp., which includes the Expedia travel agency, general TV and web retailer HSN, Ticketmaster, and other e-commerce operations, is expecting revenues to rise by 34 percent this year, to $6.2 billion.

Not only must the retail segment accommodate a growing Web segment. It must also find a way of separating increasingly affluent and fickle youngsters from funds that now consist of a lot more than the measly allowances of yesteryear. Youth will be served--and well served--or else. Teenagers last year spent about $120 billion in the shops, about 40 percent of it on clothing and accessories, according to Trevor Delaney, writing in Smart Money. Not for them any item that is "so five minutes ago," meaning that retailers now have to be more fleet of foot than ever to guess just what will strike the fancy of this with-it crowd. That means low inventories, quick adjustments of ad campaigns, and the risk of rack upon rack of discounted merchandise.

ADDING TO THE TURMOIL in the retail sector is the demand of many customers for something more than good prices or an easy transaction. They want a shopping experience. This is forcing many malls to become what can only be described as destination resorts. The more than 150 malls managed by publicly traded General Growth Properties cover the United States, and in addition to their 15,000 stores, these malls include theaters, ice skating rinks and other forms of family entertainment. Every week during the peak shopping season in Minnesota, 900,000 customers visit the Mall of America's 4.2 million square feet ("big enough to hold 32 Boeing 747s", boasts its website). That mall is home to more than 520 shops, over 80 eateries, 8 nightclubs, and 2,500 marriages since its opening.

All of which means that in addition to the cheery service and low prices of a Wal-Mart, consumers can boost the economy in the more pricey shops that populate the malls that offer "free" entertainment and a place to socialize--the Pentagon City mall in Washington opens early to allow pensioners to use its oval balcony as a running (well, actually a walking) track.

And for those for whom fashion counts, there are always the boutiques with the top brands. But it isn't the unwearable dresses from the catwalks of New York, Paris, and Milan that really matter. It is the accessories that have been developed to keep tills ringing. Handbags and such account for 70 percent of Gucci's sales and 60 percent of the profits of LVMH. Expect a 10 to 20 percent rise in that sector this year. And while female customers are choosing among ever-widening lines of fashion accessories, what Forbes magazine calls the "metrosexual male," modeled on "David Beckham, the tough soccer player who isn't afraid to wear sarongs and nail polish (off the field)," is buying cosmetics, defoliating, and choosing among washers and dryers designed specifically for men.

In short, consumers may be the heroes of the economic recovery. But sellers have done their bit by keeping prices low for price-conscious consumers, expanding the number of ways customers can order goods and services, putting fun into buying, and dazzling the high rollers with great products. They deserve a bit of credit, too.

Irwin M. Stelzer is director of economic policy studies at the Hudson Institute, a columnist for the Sunday Times (London), a contributing editor to The Weekly Standard, and a contributing writer to The Daily Standard.
weeklystandard.com