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Politics : The Obama - Clinton Disaster -- Ignore unavailable to you. Want to Upgrade?

To: GROUND ZERO™ who wrote (13981)	6/20/2009 9:13:27 PM
From: puborectalis	Read Replies (1) \| Respond to of 103300

WASHINGTON - The pharmaceutical industry agreed Saturday to spend $80 billion over the next decade improving drug benefits for seniors on Medicare and defraying the cost of President Barack Obama's health care legislation, capping secretive negotiations involving key lawmakers and the White House. "This new coverage means affordable prices on prescription drugs when Medicare benefits don't cover the cost of prescriptions," Sen. Max Baucus, chairman of the Senate Finance Committee, said in a statement announcing the accord. The deal marked a major triumph for Baucus as well as the administration. Obama praised the deal. --------------------------------------------------------------------------------

To: GROUND ZERO™ who wrote (13981)	6/20/2009 9:31:43 PM
From: puborectalis	Respond to of 103300

June 21, 2009 Obama Says ‘Justice’ Is Needed for Iranians By HELENE COOPER WASHINGTON — President Obama ratcheted up his language against Iran’s leadership on Saturday, in a statement that invoked the American civil rights movement as an analogy for what was unfolding on the streets of Tehran. “Martin Luther King once said, ‘The arc of the moral universe is long, but it bends toward justice,’ ” Mr. Obama said in a statement released after security forces in the Iranian capital clashed repeatedly with protesters. “I believe that. The international community believes that. And right now, we are bearing witness to the Iranian people’s belief in that truth, and we will continue to bear witness.” Mr. Obama’s remarks came after intense debate and multiple meetings all day Saturday at the White House, administration officials said, and reflected growing concern within the administration that the violence in Iran could continue to escalate. Despite his forceful words, however, Mr. Obama is still resisting calls from conservatives and Republicans to harshly and publicly condemn the Iranian government and impose stiff sanctions on refined gas exports to Iran. In particular, the president’s use of the word “justice,” which White House officials have been debating all week, is a sharp departure from the more measured tones he had struck during the week. “The Iranian government must understand that the world is watching,” Mr. Obama said. “We mourn each and every innocent life that is lost. We call on the Iranian government to stop all violent and unjust actions against its own people.” Mr. Obama said that the “universal rights to assembly and free speech must be respected, and the United States stands with all who seek to exercise those rights.” White House officials were monitoring the events unfolding in Tehran throughout the day on Saturday, including in meetings in the president’s study next to the Oval Office. But they were hampered by the fact that the United States does not have an embassy in Tehran, or consulates in any Iranian cities, because the two countries do not have diplomatic relations. In addition to intelligence reports, the White House also is relying on information from European and other allies with more resources in Iran, along with news reports. In invoking Martin Luther King Jr. and the American civil rights movement, Mr. Obama moved toward adorning the protesters on the streets of Tehran with the mantle of America’s most intense movement for human rights and justice. Even as Mr. Obama’s statement was released, on Saturday afternoon Eastern time, the leader of Iran’s opposition, Mir Hussein Moussavi, announced to supporters that he was ready to take on that role, and its risks. “I am ready for martyrdom,” he told supporters at a street gathering in southern Tehran, as he called for more civil disobedience and an annulment of the announced result that Mahmoud Ahmadinejad had been re-elected as president. Mr. Obama did not comment on the disputed election results. But he did appear to take on a difficult balancing act, trying to strike a note of moral clarity while still shying away from demonizing Iran’s clerical leadership. “As I said in Cairo, suppressing ideas never succeeds in making them go away,” Mr. Obama said. “The Iranian people will ultimately judge the actions of their own government.” And he delivered a warning to the Iranian authorities: “If the Iranian government seeks the respect of the international community, it must respect the dignity of its own people and govern through consent, not coercion.”

To: GROUND ZERO™ who wrote (13981)	6/20/2009 9:35:43 PM
From: puborectalis	Read Replies (1) \| Respond to of 103300

Why is it that our infant mortality rate is so high,then? Released in October 2008, a data brief from the Centers for Disease Control and Prevention’s National Center for Health Statistics ranks the United States 29th globally in infant mortality in 2004, the latest year such data were available for all countries. The U.S. ranking, which has risen from 12th in 1960 to 23rd in 1990, currently ties the United States with Poland and Slovakia

To: GROUND ZERO™ who wrote (13981)	6/21/2009 12:28:43 AM
From: puborectalis	Read Replies (1) \| Respond to of 103300

June 21, 2009 Editorial NYT A Public Health Plan As the debate on health care reform unfolds, no issue has caused such partisan rancor — and spawned such misleading rhetoric — as whether to create a new public insurance plan to compete with private plans. The nation already has several huge public plans, including Medicare for the elderly (once reviled by conservatives, it is now only short of the flag in its popularity) and Medicaid for the poor. Now the issue is whether to establish a new public plan to encourage more competition among health insurers and provide Americans with an alternative. Most Democrats and some Republicans have already accepted the need to create one or more health insurance exchanges where individuals without group coverage and possibly small businesses could buy insurance policies. Some proponents hope that big businesses could enroll their workers as well. An exchange would give the government (federal or state) a lot more power over insurers that choose to participate in order to tap a vast new market of previously uninsured people. It would determine the range of benefits that all participating plans would have to offer. It would presumably require those plans to accept all applicants, regardless of “pre-existing conditions.” What Republicans are adamantly opposed to is the idea of adding a public plan to that exchange. They portray it as a “government takeover” of the health care system, or even as socialized medicine. Those are egregious mischaracterizations. There is no serious consideration in Congress of a single-payer governmental program that would enroll virtually everyone. Nor is there any talk of extending the veterans health care system, a stellar example of “socialized medicine,” to the general public. The debate is really over whether to open the door a crack for a new public plan to compete with the private plans. Most Democrats see this as an important element in any health care reform, and so do we. A public plan would have lower administrative expenses than private plans, no need to generate big profits, and stronger bargaining power to obtain discounts from providers. That should enable it to charge lower premiums than many private plans. It would also provide an alternative for individuals who either can’t get adequate insurance from private insurers or don’t trust the private insurance industry to treat them fairly. And it could serve as a yardstick for comparing the performance of private plans and for testing innovative coverage schemes. Unfortunately, many Senate Democrats are so desperate to find a political compromise with Republicans — or so bullied by the rhetoric — that they are in danger of gravely weakening a public plan, or eliminating it entirely. That would be a mistake. Here is a look at the main proposals now under consideration: THE MOST ROBUST This approach, favored by many analysts, would allow the new public plan to piggy-back on the rate-setting powers of Medicare. As a result, it is the one most feared by Republicans, the insurance industry and doctors and hospitals. Any doctors who wanted to participate in Medicare, as virtually all do, would also have to participate in this plan and would have to accept the same payment rates as Medicare provides. With lower costs, it would be cheaper for consumers, charging its members premiums as much as 20 to 30 percent lower than premiums for comparable private coverage, a boon to hard-pressed families. It would also shave hundreds of billions of dollars from the amount needed to cover the uninsured — a crucial advantage as Congress scrambles to finance the reform effort. The risk is that if this plan, given its power, were too stingy, it might drive some financially stressed hospitals into bankruptcy. The hope is that the downward pressure on reimbursements might force them to innovate and find big savings. Republicans and private insurers fear, with some reason, that such an inexpensive public plan would entice or drive tens of millions of Americans away from private insurance, especially if big employers were allowed to enroll their workers in an exchange. The challenge is to craft rules to discourage employers from simply dropping their own subsidies entirely. The prospect of competing with a government plan terrifies the private insurers. But in our judgment, if that many Americans were to decide that such a plan is a better deal for them and their families, that would be a good thing. Innovative private plans that already deliver better services at lower costs would survive. Inefficient private plans would wither. In an effort to address some of these fears, Senator Jay Rockefeller has introduced a bill that would use Medicare provider payment rates for only the first two years and let doctors opt out after three years while remaining in Medicare. That would get the new public plan off to a good start, after which it would compete on its own. LIGHTER VERSIONS Other proposals are circulating that would level the playing field with private plans. They would require the public plan to hold the same reserves as private plans and sustain itself from premium income without drawing on the federal treasury. It would probably pay providers higher rates than Medicare but lower rates than most private plans. Its administrative costs would be far lower, allowing it to offer lower premiums. These more modest versions could be worth having, but they would save individuals and the health care system far less money. STATE-BASED PLANS A bipartisan group, led by three former Senate leaders — Republicans Bob Dole and Howard Baker and Democrat Tom Daschle — has proposed leaving it to states to create public plans if they wish. The federal government would be able to step in after five years if a state has failed to establish an exchange with affordable insurance options. That looks like a formula for delay and inaction. COOPERATIVES Propelled by a belief that no public plan could survive a Republican filibuster, Senator Kent Conrad, Democrat of North Dakota, has proposed instead setting up private nonprofit cooperatives — run for the benefit of their members rather than stockholders — to compete with profit making insurance plans. The presumed advantage of this approach is that cooperatives might be able to charge lower premiums because they would not have to earn large profits. Their performance, too, would be a yardstick against which to measure whether profit making plans are charging fair premiums. Health care cooperatives have existed at the local or regional level for decades in this country. Many have gone belly up. A few still provide high quality care at reasonable prices. Given sufficient size, seed money and negotiating power, a cooperative organization could help transform the health care system. But Republicans seem unlikely to accept a strong national organization, so creation of cooperatives is apt to be local and spotty. They would be unlikely to deliver as much savings as a large public plan. TIGHT REGULATION Right from the start of the debate, some experts have suggested that much tighter regulation of the new insurance exchange could achieve many of the goals of a public plan. Regulators could insist that insurers not exclude people with pre-existing conditions or charge them higher premiums. The exchange could offer customers a menu of private plans and be modeled on the federal program that serves Congress and other government personnel. Several European countries, including Germany, provide better health care at lower cost than the United States without relying on a public plan. And the near-universal coverage in Massachusetts was achieved without a public plan option. We continue to believe that a public plan would be desirable. Surveys by the Commonwealth Fund have found that Medicare beneficiaries report fewer problems obtaining medical care, less financial hardship due to medical bills, and higher satisfaction with their coverage than do workers insured by private employers. If Senate Republicans block a public plan, much tighter regulation will be essential to guarantee affordable private coverage for millions of Americans.

To: GROUND ZERO™ who wrote (13981)	6/21/2009 7:18:35 AM
From: puborectalis	Read Replies (1) \| Respond to of 103300

Gods in White Coats Hold Key to Health Care: Margaret Carlson Commentary by Margaret Carlson June 19 (Bloomberg) -- Give me your arm, make a fist, relax. This isn’t going to hurt. It always does but that just makes doctor and patient even. What really, really hurts, physicians say, are medical malpractice suits -- those humongous awards ladled out by gullible juries are more painful than a thousand hypodermic needles. If only President Barack Obama would fix that, the American Medical Association says, it would be more open to his reforms. When the president traveled to Chicago last Monday to ask for the AMA’s support in overhauling the nation’s health-care system, some of his prescriptions were welcomed with applause. When he said that he wouldn’t propose a cap on malpractice awards, he got booed. It’s hard to picture that authoritative figure with the stethoscope descending to heckle a president. Should the moment make it to YouTube, it will make the man in the starched white coat harder to believe next time he says take these too-invasive procedures and call me in the morning. But a funny thing has happened over the last decade that organized medicine doesn’t talk about. All those exorbitant awards that made the cover of Time magazine and provided grist for “60 Minutes” and “Dateline”? They’re old. Juries, the backbone of the legal system, heard the stories, too, and started making the awards smaller so that the number of medical malpractice verdicts among the top jury awards declined dramatically over the past 20 years. So far this year, of the top 25 jury awards, only one was a malpractice case. Deserving Victims Amitabh Chandra, a Harvard University economist, said such awards are “a drop in the bucket,” about $3.6 billion out of $2.3 trillion spent annually on health care, with much of that money going to deserving victims. It’s not exorbitant awards breaking the system, it’s the practice of overly defensive medicine -- tests, procedures, referrals, hospitalizations, and prescriptions ordered by physicians and justified by the fear of malpractice suits. Ask your own doctor if he orders unnecessary procedures to protect against litigious patients and he’ll likely hedge a bit, say rarely, but go off into a brief speech against tort lawyers. But it isn’t so rare. In a 2008 survey of specialists in Massachusetts, 83 percent reported practicing defensive medicine. According to researchers at Dartmouth Medical School, almost $700 billion a year is wasted on unnecessary care. It’s easy to see one reason for that: it’s better to be safe than sorry. What a sickening feeling for the doctor who gets the call that he missed a growth on a lung or a dangerously clogged artery. Follow the Money But there is a perverse outcome when fear of lawsuits combines with a fee-for-service setup. Doctors may believe over- servicing patients is where peace of mind lies, although studies show it doesn’t. It also happens to be where the money is. Alan Woodward, vice chairman of Massachusetts Medical Society’s professional liability committee, estimates that 10 percent of health-care costs go to defensive medicine justified by the threat of lawsuits. A first-of-its-kind survey of physicians by the Massachusetts Medical Society on the practice of defensive medicine showed that the practice is widespread and adds billions of dollars to the cost of health care. Not only that, it reduces access -- the insured get more care than they need and the uninsured much less -- and adds to risk. Too much medicine is not a victimless crime. Although patients get a break on some diagnostic procedures -- does anyone want to undergo an extra colonoscopy -- it doesn’t mean increased reliability. Errors and complications can occur in the most routine situations. Over-exposure to radiation is a real risk. Creeping Socialism But when doctors are told that reform is going to correct an out-of-whack incentive system, they scream socialized medicine. Let a bureaucrat get their hands on my practice, the cry goes, and the result will be people waiting months for surgery and lines out the door for check-ups. Congressional Republicans amplify the concern. Recently Senate Minority Leader Mitch McConnell warned darkly that Democrats were intent on putting “bureaucrats between patients and doctors.” Well, we already have bureaucrats between patients and doctors and socialized medicine -- it’s just that the bureaucrats are from Aetna. Fear of rationing by government is irrational. Insurance companies have perfected that art of claim denial at call centers that suck up your health-care dollar. I’m a lawyer and I can’t decode the “explanation of benefits” (or non-benefits) letters I get. Code of Silence Malpractice suits will only go away if doctors find a reliable way to police themselves. Peer review doesn’t work. No one turns in doctors publishing puff pieces about drugs and devices they’re being paid to like. They practice omerta when it comes to testifying against a fellow doctor. Woodward has a solution. “To resolve disputes,” he says, “use mediation and arbitration.” But, he says, doctors will be less likely to have to resort to that if they explain to a patient what went wrong, “offer timely and fair compensation” and “a sincere apology.” With such a system in place at the University of Michigan, Woodward says, lawsuits have dropped to 70 from 300 and malpractice-insurance premiums have dropped by a third. Imagine the god in the white coat admitting error. I promise, really, it isn’t going to hurt. (Margaret Carlson, author of “Anyone Can Grow Up: How George Bush and I Made It to the White House” and former White House correspondent for Time magazine, is a Bloomberg News columnist. The opinions expressed are her own.)