How Painkillers can cause Cardiac Arrest

The death of pop icon Michael Jackson is raising questions over what might have caused it.

Photograph by: handout, morguefile.com

CHICAGO — The death of pop music icon Michael Jackson from cardiac arrest on Thursday has raised a host of questions about what might have caused it.

It may take weeks before an autopsy can reveal the true circumstances that led the singer’s heart to stop.

One possible cause reported by celebrity website TMZ.com is that he was injected with the potent painkiller Demerol before he went into cardiac arrest.

Others speculate it was a combination of Demerol and Oxycontin, another powerful painkiller that is among the most commonly abused prescription drugs.

Here are some facts about cardiac arrest and both these drugs.

HOW COULD DEMEROL CAUSE CARDIAC ARREST?

Cardiac arrest occurs when the heart stops circulating blood. In 80 percent of cases, the cause is heart disease, but narcotic painkillers like Demerol can cause cardiac arrest.

Dr. Daniel Simon, chief of cardiology at University Hospitals Case Medical Center in Cleveland, said if Jackson had been injected with too much Demerol, it might have caused him to stop breathing, a condition called respiratory arrest.

"The most likely scenario with Demerol would be that it caused a respiratory arrest because it takes away the drive to ventilate (breathe)," Simon said in a telephone interview.

He said low blood oxygen can trigger a deadly heart rhythm known as ventricular fibrillation in which the heart quivers but does not circulate blood. "Without CPR and a defibrillator, you have no chance," Simon said.

DEMEROL AND OXYCONTIN?

ABC News has reported that Jackson was addicted to prescription painkillers, and may have used Demerol in combination with Oxycontin.

Cleveland Clinic cardiologist Dr. Bruce Lindsay, past president of the Heart Rhythm Society, said the two drugs in combination could cause respiratory arrest.

"As with any of these painkillers, if you get too much on board, it really depresses the central nervous system so the patient could lapse into a deep sleep or even a coma. And if their respiratory capacity was too depressed, they would just stop breathing," Lindsay said.

"If they stop breathing, eventually of course the heart will go into cardiac arrest, but not because of some primary heart problem. It is simply because the final mode of death is that the heart stops beating."

COULD IT HAVE BEEN HEART DISEASE?

Simon said many media outlets are looking for exotic reasons to explain the singer’s death because it occurred in a relatively young man, but age 50 is not too young for sudden cardiac arrest.

"A lot of people are saying it’s a surprise a 50-year-old has cardiac arrest. Thirty percent of cardiac arrests are in people for whom it is their first symptom of heart disease," Simon said.

"When they do an autopsy, the first thing the medical examiner will look for is a scar in the heart muscle suggesting an old heart attack," Simon said.

He said 25 percent of patients who have cardiac arrest have had a prior heart attack without knowing it. "That is what the scar will tell them."

Big Pharma and doctors under the AMA push drugs, drugs, drugs and surgery rather than prevention, natural remedies and alternative treatments. Once nationalized healthcare takes over that trend away from natural and alternative cures will continue while their pattern of treatment will go unchanged except that it will be rationed.

BY JULIE STEENHUYSEN, REUTERSJUNE 26, 2009

(Editing by Mary Milliken; Editing by Will Dunham)

Source: The Vancouver Sun

Posted: True Health Is True Wealth

Related Articles:

• The Drug Story
• Western Medicine - Forbidden Cures
• Here Comes Health Care Rationing

Get Both Sides of the National Healthcare Story…

Thanks to the generous support of grassroots Republicans and Independents nationwide, the RNC exceeded Their goal of raising over $100,000 to help counter ABC's one-sided infomercial for government-run health care.

Fellow Americans

Though the television network (ABC and some NBC affiliates) have denied requests to air ads counter to President Obama's government-run health care "reform" plans, they can't keep us off the air. (Ask yourself… what kind of media refuses to run both sides??)

We are using the grassroots donations we received to spread our message against the one-sided, big government mantra being pushed by the Obama Democrats here in Washington --

watch it now!

We've made a good start, but we're still up against the biased mainstream media machine's effort to help President Obama and the Pelosi-Reid Democrats in Congress end individual health care choice and use your tax dollars to treat only the patients they deem deserving.

The Democrats have shown they will stop at nothing to blur the lines between government and private sector, so we must keep the pressure on them. And at the same time, we must get our message of common sense GOP health care reform alternative out to more Americans.

That's why I'm again asking you to support our continuing efforts to get our message past the mainstream media filter. If we don't stop the Obama Democrats' disastrous health care takeover now, we'll all be facing the end of health care choice and endlessly rising taxation very soon.

Don't let that happen -- help Americans keep their health care freedom. If you agree please make your contribution to the RNC today!

Sincerely,

Michael Steele
Chairman, Republican National Committee

P.S. You and the RNC are all that stand between sensible Republican health care reform and Democrat government-run medicine. Please help us win this fight by making an online contribution of $25, $50, $100, $500 or $1,000 to the RNC today. Thank you.

---

Posted: Daily Thought Pad

Related Resources:

• Canadian Health Care Coming Soon to the USA

Expert: Stimulus Fraud May Hit $50 Billion

Any large government endeavor is susceptible to fraud, and that’s certainly the case with the $787 billion fiscal stimulus package.

Up to $50 billion of that total could be siphoned off by fraudsters in current months, says David Williams, who runs Deloitte Financial Services Advisory.

He estimates that $500 billion of the package will flow through the traditional government procurement network.

"The rule of thumb typically is that of the… money that's going to run through the procurement process, somewhere between 5 percent and 10 percent… usually finds its way into potential problems," Williams tells MarketWatch.

"That's sort of the benchmark that I use."

The fact that the money flows electronically puts companies even more at risk of being ripped off, Williams points out.

"We're telling our clients to be very careful and to make sure their firms are resilient in terms of dealing with the potential opportunities for fraud and waste," he says.

"It becomes ever more important that firms remain diligent about their data."

FBI Director Robert Mueller also warns of fraud stemming from the stimulus package.

“These funds are inherently vulnerable to bribery, fraud, conflicts of interest, and collusion,” he said last month.

Many experts oppose the stimulus for issues far removed from fraud and corruption.

“It’s just a grab bag of every spending proposal that’s been banging around Congress for years,” publisher Steve Forbes told Bloomberg TV.

Tuesday, June 16, 2009 11:54 AM
By: Dan Weil – Newsmax

Next stop… Nationalized Medicine… If we don’t stop government run healthcare, this fraud will look like a ‘walk in the park’… while medical services become more and more restricted, the number of doctors and nurses diminish and government decides who qualifies for what services… or that you don’t qualify at all because you are too old etc etc, the fraud will be rampant!

Posted: Daily Thought Pad

Notes From Dr. Charles Krauthammer’s Speech to the Center for the American Experiment

Last Monday was a profound evening, hearing Dr. Charles Krauthammer speak to the Center for the American Experiment. He is brilliant intellectual, seasoned & articulate. He is forthright and careful in his analysis, and never resorts to emotions or personal insults. He is NOT a fearmonger nor an extremist in his comments and views. He is a fiscal conservative, and has a Pulitzer prize for writing. He is a frequent contributor to Fox News and writes weekly for the Washington Post. The entire room was held spellbound during his talk. I have shared this with many of you and several have asked me to summarize his comments, as we are living in uncharted waters economically and internationally. Even 2 Dems at my table agreed with everything he said! If you feel like forwarding this to those who are open minded and have not ‘drunk the Kool-Aid’, feel free...

...A summary of his comments:

1. Mr. Obama is a very intellectual, charming individual. He is not to be underestimated. He is a ‘cool customer’ who doesn't show his emotions. It's very hard to know what's ‘behind the mask’. Taking down the Clinton dynasty from a political neophyte was an amazing accomplishment. The Clintons still do not understand what hit them. Obama was in the perfect place at the perfect time.

2. Obama has political skills comparable to Reagan and Clinton. He has a way of making you think he's on your side, agreeing with your position, while doing the opposite. Pay no attention to what he SAYS; rather, watch what he DOES!

3. Obama has a ruthless quest for power. He did not come to Washington to make something out of himself, but rather to change everything, including dismantling capitalism. He can’t be straightforward on his ambitions, as the public would not go along. He has a heavy hand, and wants to ‘level the playing field’ with income redistribution and punishment to the achievers of society. He would like to model the USA to Great Britain or Canada.

4. His three main goals are to control ENERGY, PUBLIC EDUCATION, & NATIONAL HEALTHCARE by the Federal government. He doesn't care about the auto or financial services industries, but got them as an early bonus. The cap and trade will add costs to everything and stifle growth. Paying for FREE college education is his goal. Most scary is his healthcare program, because if you make it FREE and add 46,000,000 people to a Medicare-type single-payer system, the costs will go through the roof. The only way to control costs is with massive RATIONING of services, like in Canada. God forbid.

5. He’s surrounded himself with mostly far-left academic types. No one around him has ever even run a candy store. But they’re going to try and run the auto, financial, banking and other industries. This obviously can’t work in the long run. Obama’s not a socialist; rather he's a far-left secular progressive bent on nothing short of revolution. He ran as a moderate, but will govern from the hard left. Again, watch what he does, not what he says.

6. Obama doesn’t really see himself as President of the United States, but more as a ruler over the world. He sees himself above it all, trying to orchestrate & coordinate various countries and their agendas. He sees moral equivalency in all cultures. His apology tour in Germany and England was a prime example of how he sees America, as an imperialist nation that has been arrogant, rather than a great noble nation that has at times made errors. This is the first President ever who has chastised our allies and appeased our enemies!

7. He’s now handing out goodies. He hopes that the bill (and pain) will not ‘come due’ until after he’s reelected in 2012. He’d like to blame all problems on Bush from the past, and hopefully his successor in the future. He has a huge ego, and Mr. Krauthammer believes he is a narcissist.

8. Republicans are in the wilderness for a while, but will emerge strong. We’re ‘pining’ for another Reagan, but there’ll never be another like him. Krauthammer believes Mitt Romney, Tim Pawlenty & Bobby Jindahl (except for his terrible speech in February) are the future of the party. Newt Gingrich is brilliant, but has baggage. Sarah Palin is sincere and intelligent, but needs to really be seriously boning up on facts and info if she’s to be a serious candidate in the future. We need to return to the party of lower taxes, smaller government, personal responsibility, strong national defense, and states’ rights.

9. The current level of spending is irresponsible and outrageous. We’re spending trillions that we don’t have. This could lead to hyper inflation, depression or worse. No country has ever spent themselves into prosperity. The media is giving Obama, Reid and Pelosi a pass because they love their agenda. But eventually the bill will come due and people will realize the huge bailouts didn’t work, nor will the stimulus package. These were trillion-dollar payoffs to Obama’s allies, unions and the Congress to placate the left, so he can get support for #4 above.

10. The election was over in mid-September when Lehman brothers failed. fear and panic swept in, we had an unpopular President, and the war was grinding on indefinitely without a clear outcome. The people are in pain, and the mantra of ‘change’ caused people to act emotionally. Any Dem would have won this election; it was surprising it was as close as it was.

11. In 2012, if the unemployment rate is over 10%, Republicans will be swept back into power. If it's under 8%, the Dems continue to roll. If it's between 8-10%, it’ll be a dogfight. It’ll all be about the economy.

I hope this gets you really thinking about what's happening in Washington and Congress. There’s a left-wing revolution going on, according to Krauthammer, and he encourages us to keep the faith and join the loyal resistance. The work will be hard, but we’re right on most issues and can reclaim our country, before it's far too late.

Source: Knowledge Creates Power

Posted: Daily Thought Pad

Related Articles:

• Hovering on High: Obama Surveys the World
• Catastrophe – ITS TIME TO TAKE BACK OUR COUNTRY
• Power Grab
• Gingrich’s Group Offers 12 Solutions for America
• Liberty and Tyranny
• American Progressivism

Doctors Boo Obama In Chicago… Analysis: Tough Road Ahead

WASHINGTON (AP) — Barack Obama isn't used to hearing boos.

For all the young president's popularity, the response he got Monday from doctors at an American Medical Association meeting was a sign his road is only going to get rockier as he tries to sell his plan to overhaul the nation's health care system.

The boos erupted when Obama told the doctors in Chicago he wouldn't try to help them win their top legislative priority — limits on jury damages in medical malpractice cases.

But what could they expect? If Obama announced support for malpractice limits, that would set trial lawyers and unions — major supporters of Democratic candidates — on the attack. Not to mention consumer groups.

Every other group in the health care debate has a wish list and a top priority. Insurers don't want competition from the government. Employers don't want to be told they have to offer medical coverage to their workers. Hospitals want to stave off Medicare cuts. Drug companies want to charge what the market will bear.

Obama can't give all of them what they want. Instead, he's got to figure what's just enough to keep as many groups as possible on board — without alienating others. It's a fine line for him — and sometimes for them.

"It's a coalition issue," said Robert Blendon of the Harvard School of Public Health, an expert on public opinion and the politics of health care. "No major group is able by itself to sink health reform. But if numbers of them come together for different reasons, it could really hurt the direction the president wants to go in."

The doctors were only Obama's first house call. He'll be making his case to the other groups — and to the nation at large — in an increasingly energetic campaign to get a bill passed by the end of his first year in office.

AMA insiders shouldn't have been surprised by Obama's upfront refusal to consider malpractice caps.

The group couldn't get that idea passed by a Republican Congress and president a few years ago. Some states have such curbs, but anyone who can count votes knows the chances for national limits are slim to none with Democrats in charge of Congress.

Instead, Obama left the door open to some kind of compromise on malpractice.

The president said he's willing to explore alternatives to taking doctors to court. In the past, he supported special programs in which hospitals and doctors are encouraged to admit mistakes, correct them and offer compensation. Studies have shown the approach can work, because doctors' refusal to acknowledge mistakes is one reason many families file suit.

Doctors have special reasons to be wary of the president's plans to overhaul the health care system.

Not long ago, doctors' decisions were rarely questioned. Now they are being blamed for a big part of the wasteful spending in the nation's $2.5 trillion health care system. Studies have shown that as much as 30 cents of the U.S. health care dollar may be going for tests and procedures that are of little or no value to patients.

The Obama administration has cited such findings as evidence that the system is broken. Since doctors are the ones responsible for ordering tests and procedures, health care costs cannot be brought under control unless they change their decision-making habits.

"Change is scary," said Dartmouth University's Dr. Elliott Fisher, a doctor turned costs researcher. "I think there is a fear of loss of autonomy, that someone is going to tell you what to do." Fisher collaborated on research that showed wild differences in health care spending around the country — and no signs of better health in the high-cost areas.

But Obama did not blame the doctors. Instead, he tried to woo them, much as he has done with recalcitrant foreign leaders.

"It's the equivalent of international diplomacy. He's got to make them feel like it's possible to have dialogue about what the future looks like," said Blendon. "I think he's starting out with the AMA, but before the summer's over he's going to reach out to a lot of the other groups."

Obama assured the doctors that his plan would provide them with objective information on what treatments work best, with new computerized tools to better manage their patient case loads, and with support for harried solo practitioners to form networks.

He promised that Washington would not dictate clinical decisions. And he asked the doctors to imagine a world in which nearly every patient has insurance coverage and they can devote their full attention to the practice of medicine.

"You did not enter this profession to be bean-counters and paper-pushers," Obama said. "You entered this profession to be healers — and that's what our health care system should let you be."

That line got him an ovation.

By RICARDO ALONSO-ZALDIVAR – 2 hours ago - reports on health care policy for The Associated Press.

Obama needs to take time and give Congress and the American People time to examine all the options and do the needed research about American Healthcare Reform, not push through another nightmare (costing 1 Trillion Dollars over 10-years), like the TARP and Omnibus Bills without reading or researching with the gun of immediacy to all our heads. Obama also needs to stop rewarding the organized labor, who spent $80 Million dollars getting Obama and the Democrats elected. Doing something just to fulfill your uninformed campaign promises is not a good enough reason to spend another Trillion Dollars and to do this wrong!! This time around is everyone's job to get this right and to stand up to the Obama Administration and Congress to get it right, or let it go until we have our ducks in a row and can afford the needed decisions. - Ask/Marion – Daily Thought Pad

--------------------

OBAMA BOOED BY DOCTORS IN ILLINOIS TODAY

Seems pretty funny to me that doctors booed the Obama and it was told by CNN today and it's not on the internet yet. Doctors in Illinois didn't like what he had to say and it was big on CNN. Thought I'd look into the Liberal side and see what was happening.

Oh, and what he meant about having it costing less as it goes along - is the Government going to make sure the elderly get their coverage or operations or whether they will tell them to go home and die is that what they mean about costing less as it goes along. Makes one wonder, doesn't it?

Seems a lot of doctors feel this will be offensive to them - and NO CAPS on the way people sue doctors looks to me that less men or women will want to be doctors in the future.

By: Teatime1 on AARP.org/blog

Posted: Daily Thought Pad

Related Articles:

• Obama challenges GOP healthcare critics
• House Health-Care Proposal Adds $600 Billion in Taxes
• How To Stop Socialized Health Care
• Democrats Set to Rush Through Government-Run Healthcare
• Understanding the House Democrat’s Health care bill
• What a Week With Healthcare
• Kennedy Healthcare Plan Meets Resistance – Full of Pork
• Healthcare: You Think Michael Moore Will Contribute? Don’t Hold Your Breath
• Here Comes Rationing Healthcare
• Rights, Responsibilities and Healthcare
• British HealthCare - Don't Treat The Old!! - And Senator Coburn Warns Same For USA
• Universal Health and Old People
• Once Considered Unthinkable, U.S. Sales Tax Gets Fresh Look
• Conservatives for Patient's Rights
• Obama's Attack on Medical Civil Liberties
• Socialized Medicine in cartoon form.
• Voters Steer Europe to the Right – Why… Because Socialism Isn’t Working
• Progressivism – The Progressive Movement Is A Cancer – How We Got Here

Obama challenges GOP healthcare critics

Will address the AMA with insurance plans

President Obama addressed healthcare issues during a town hall-style meeting yesterday in Green Bay, Wisc. (Scott Olson/Getty Images)

GREEN BAY, Wis. - Undertaking a new and aggressive push to enact a sweeping healthcare plan this year, President Obama bluntly challenged Republican critics yesterday to put forward their own plan to expand coverage to the uninsured and help struggling families afford care.

"To those who criticize our efforts, I ask them, 'What's the alternative?' " Obama said at a town hall-style meeting, surrounded by supportive citizens in the heartland.

"What else do we say to all those families who spend more on health care than on housing or on food? What do we tell those businesses that are choosing between closing their doors and letting their workers go?"

A dispute over Obama's desire to create a new government-sponsored health plan to compete with private insurers is forming a major obstacle to bipartisan consensus. There also remain major disagreements over how to pay for the $1.5 trillion it will cost over the next decade to cover uninsured Americans, and whether to require employers to offer coverage.

Obama described his critics as naysayers, saying, "I can assure you that doing nothing will cost us far more in the coming years." But he also said he won't run roughshod over Congress with a "my way or the highway" approach and is "happy to steal other people's ideas."

Green Bay resident Laura Klitzka, 35, a married mother of two who has breast cancer that has now spread to her bones, introduced Obama at the town hall. She carries about $12,000 in unpaid medical bills that continue to pile up as treatment continues that she said her family cannot afford.

The White House considers such emotional pleas critical to selling reform. Obama's political arm, the grass-roots machine known as Organizing for America, has collected hundreds of thousands of similar stories that could shame lawmakers who don't sign on.

But the brief ride from the airport to the high school where he spoke featured a rare sight for the new president: a large gathering of protesters.

Signs held among the several hundred demonstrators lining his route said "NObama" and "No to Socialism."

Back in Washington, Republicans assailed any inclusion of a public insurance option in a new system of expanded healthcare. "We see that as a slippery slope to having the government run everything," Senator Mike Enzi, a Wyoming Republican, said at a news conference.

But Obama, answering a question, said no one - "certainly not me" - is interested in a nationalized healthcare system, like that in Great Britain. "When you hear people saying socialized medicine, understand, I don't know anybody in Washington who is proposing that," he said.

Still, opposition is building to the direction of proposals from Obama and fellow Democrats.

The US Chamber of Commerce is convening business groups today to plot strategy. A chamber vice president, Randy Johnson, said that though business groups have been largely restrained to date about voicing opposition, it might be time for that to change. Johnson testified yesterday at a Senate hearing where he expressed strong opposition to Democratic proposals to require employers to purchase health care for their employees.

Obama will also face some foes to his healthcare proposals in Chicago on Monday, when he addresses the American Medical Association, the nation's largest doctors group, which is wary of a public insurance plan.

But the AMA now represents barely one-fourth of the nation's physicians, and just how much that body can sway Obama's health reform efforts will be a test of its once mighty clout.

Asked about the AMA's stand, White House spokesman Bill Burton told reporters yesterday: "He knew at the beginning of this process that people would oppose and support different elements that were on and off the table, and this is just one part of the process." He's going to talk to the AMA on Monday, and thinks that we'll be able to have an open and honest dialogue about the issues that we're all very concerned about."

By Philip Elliott - Globe Newspaper Company.

CORY DELLENBACH / AP

Photo: Kennedy Corpus, 10, holds a note President Obama gave to her Thursday.

Related Stories:

What a note: Kennedy Corpus, 10, has a rock-solid excuse for missing the last day of school: a personal note to her teacher from President Obama. Her father, John Corpus, of Green Bay, Wis., stood to ask Obama about health care and mentioned that his daughter was missing school to attend the event. "Do you need me to write a note?" Obama asked. He wrote: "To Kennedy's teacher: Please excuse Kennedy's absence. She's with me. Barack Obama." He stepped off the stage to hand-deliver the note. "It was like the best thing ever," the fourth-grader said later.

Catastrophe - IT'S TIME TO TAKE BACK OUR COUNTRY

Now. It's that simple. It's that urgent.

So begins Dick Morris and Eileen McGann's latest and most important book. They say that we must act before President Barack Obama fully implements his radical political agenda. Because after Obama has won his war on prosperity and canceled the war on terror, it will be too late to regain our liberty or our security.

At a time when we needed a pragmatic centrist to lead us out of recession, we got a doctrinaire socialist who wants to use the crisis to put the government in charge of the economy and enact European socialism here in the United States. Cars, banks-what's next? He will keep at it until Washington governs every major business in America and sets all our salaries.

It's a catastrophe.

Dick Morris and Eileen McGann saw the meltdown coming. In their book "Outrage", they called out the house of cards that was Fannie Mae. In "Fleeced", they went after the credit card companies, the subprime mortgage lenders, and the hedge fund billionaires who conspired to wreck the economy-and Barack Obama, whose policies, they predicted last summer, would "trigger a stock market crash."

Now, in Catastrophe, Morris and McGann take a hard look at America in free fall-and at how Obama is transforming a vulnerable America into a socialist state.

They tell the truth about Obama and his radical policies:

• He will destroy our health care system so that no one gets adequate care.
• He designed his bank rescue plan to pave the way for nationalization of the banks and socialization of the economy.
• He firmly believes in government control of our major industries-he's already commandeered the banks and the automobile industry.
• He plans to reshape the political landscape to keep the left in power for decades by cooking the census, enfranchising illegal immigrants, muzzling talk radio, and coercing workers into unions.
• He is attacking those who fight terrorism while letting the terrorists go free.
• He gives aid to Hamas while Shariah Law threatens to take over America.
• He has repealed the Declaration of Independence and put us under a worldwide, European-dominated financial regulatory system.

But Obama is not working alone. Morris and McGann spell out how Congress is complicit:

• How Senator Chris Dodd and Congressman Charlie Rangel use special interests and special friends for their own enrichment and glorification.
• How Ted Kennedy Jr. is exploiting his father's health care power.

"This is no time for apathy or alienation or hopelessness," Morris and McGann remind us. "It's a time for action." And that action must begin now-before it's too late.

By Dick Morris and Eileen McGann – Order Their New Book Today: Catastrophe

Source: Knowledge Creates Power

Posted: Daily Thought Pad

Related Posts:

• American capitalism gone with a whimper – Pravda
• End of Free Speech - Endoffreespeech.com
• OBAMA'S WAR ON TALK RADIO
• Obama May Grab for Guns
• Confirmed: The Obama DHS hit job on conservatives is real
• Michael Farris - United Nation’s Convention on Rights of a Child Material
• Click here to read the DHS extremism report
• Senior creditors: Chrysler deal violates 5th Amendment
• OBAMA'S LEAP TO SOCIALISM
• Conservatives for Patient's Rights
• Freedom of Speech, Freedom of Religion, Emotional Support For U.S. Troops Endangered
• Ronald Reagan - The Evil Empire Speech
• The Late Great U.S.A.
• American Progressivism – A Must Read

Safeway's Health Care Program Gets Attention

My "Citizens, heal thyselves" item Wednesday on the responsibility of individuals to reform their own health care prompted inquiries from readers wanting to know more about what I referred to as Safeway Inc.'s stick-and-carrot approach.

Based on the belief that rising health care costs are mostly driven by behavior (smoking, eating poorly, not checking your cholesterol, etc.), the Pleasanton company's Healthy Measures program uses screenings and questionnaires and offers access to prevention-related facilities like fitness clubs, along with advice and referrals to help improve behavior.

The carrot: discounted premiums or refunds for passing the screenings or showing improvement. The stick: higher premiums for failing tests and no measurable improvement in behavior. "Holding people accountable gives them incentives," said Ken Shachmut, the Safeway senior vice president who oversees the health program.

It has also kept Safeway's health care costs, amounting to $1 billion or so a year, mostly flat over the past five years, an achievement few other companies can claim, said Shachmut, who admits battling his own weight problems.

The voluntary program now covers 25,000 employees, or about three-quarters of Safeway's nonunion workforce. Elements of the program are included in contracts covering Safeway's union workers, who fall outside the company's self-insurance plan. Shachmut said most of its 200,000 union workers should be participating in the program within the next six years. The main thing that employees covered by the program seem to want, said Shachmut, is "more discounts."

In the meantime, Safeway is spreading its consumer-driven approach via the recently formed Coalition to Advance Healthcare Reform (coalition4healthcare.org), founded by company CEO Steve Burd. The 63 corporate members include Bay Area companies McKesson Corp., PG&E, Clorox Co., and Kaiser Permanente.

"This is the silver lining in the cloud of rising health costs. If we can design incentives in these core areas, we have a fighting chance of getting our arms around it," Shachmut said.

More details: You can find more on Safeway's program at links.sfgate.com/ZHIV. A Chronicle feature that ran earlier this year, is online at sfgate.com/ZHJB. Safeway CEO Burd penned on op-ed on the subject in Friday's Wall Street Journal, available at links.sfgate.com/ZHIX.

The Journal also has a news story in Friday's edition questioning the efficacy of prevention programs (links.sfgate.com/ZHIY). On the other hand, a 2007 nationwide survey of 355 human resources and health benefits managers suggested a strong correlation between wellness programs and increased productivity and market and shareholder value. (links.sfgate.com/ZHIZ).

-------

How Safeway Is Cutting Healthcare Costs

Effective health-care reform must meet two objectives: 1) It must secure coverage for all Americans, and 2) it must dramatically lower the cost of health care. Health-care spending has outpaced the rise in all other consumer spending by nearly a factor of three since 1980, increasing to 18% of GDP in 2009 from 9% of GDP. This disturbing trend will not change regardless of who pays these costs -- government or the private sector -- unless we can find a way to improve the health of our citizens. Failure to do so will make American companies less competitive in the global marketplace, increase taxes, and undermine our economy.

At Safeway we believe that well-designed health-care reform, utilizing market-based solutions, can ultimately reduce our nation's health-care bill by 40%. The key to achieving these savings is health-care plans that reward healthy behavior. As a self-insured employer, Safeway designed just such a plan in 2005 and has made continuous improvements each year. The results have been remarkable. During this four-year period, we have kept our per capita health-care costs flat (that includes both the employee and the employer portion), while most American companies' costs have increased 38% over the same four years.

Martin Kozlowski

Safeway's plan capitalizes on two key insights gained in 2005. The first is that 70% of all health-care costs are the direct result of behavior. The second insight, which is well understood by the providers of health care, is that 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity). Furthermore, 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.

As much as we would like to take credit for being a health-care innovator, Safeway has done nothing more than borrow from the well-tested automobile insurance model. For decades, driving behavior has been correlated with accident risk and has therefore translated into premium differences among drivers. Stated somewhat differently, the auto-insurance industry has long recognized the role of personal responsibility. As a result, bad behaviors (like speeding, tickets for failure to follow the rules of the road, and frequency of accidents) are considered when establishing insurance premiums. Bad driver premiums are not subsidized by the good driver premiums.

As with most employers, Safeway's employees pay a portion of their own health care through premiums, co-pays and deductibles. The big difference between Safeway and most employers is that we have pronounced differences in premiums that reflect each covered member's behaviors. Our plan utilizes a provision in the 1996 Health Insurance Portability and Accountability Act that permits employers to differentiate premiums based on behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.

Safeway's Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above and receive premium discounts off a "base level" premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families. Should they fail any or all tests, they can be tested again in 12 months. If they pass or have made appropriate progress on something like obesity, the company provides a refund equal to the premium differences established at the beginning of the plan year.

At Safeway, we are building a culture of health and fitness. The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant. When surveyed, 78% of our employees rated our plan good, very good or excellent. In addition, 76% asked for more financial incentives to reward healthy behaviors. We have heard from dozens of employees who lost weight, lowered their blood-pressure and cholesterol levels, and are enjoying better health because of this program. Many discovered for the first time that they have high blood pressure, and others have been told by their doctor that they have added years to their life.

Today, we are constrained by current laws from increasing these incentives. We reward plan members $312 per year for not using tobacco, yet the annual cost of insuring a tobacco user is $1,400. Reform legislation needs to raise the federal legal limits so that incentives can better match the true incremental benefit of not engaging in these unhealthy behaviors. If these limits are appropriately increased, I am confident Safeway's per capita health-care costs will decline for at least another five years as our work force becomes healthier.

The Healthy Measures program currently applies only to our nonunion work force. While we have numerous health and wellness provisions in our union contracts, we are working with union leaders like Joe Hansen of the United Food and Commercial Workers to incorporate healthy measures provisions in our union work force as well.

While comprehensive health-care reform needs to address a number of other key issues, we believe that personal responsibility and financial incentives are the path to a healthier America. By our calculation, if the nation had adopted our approach in 2005, the nation's direct health-care bill would be $550 billion less than it is today. This is almost four times the $150 billion that most experts estimate to be the cost of covering today's 47 million uninsured. The implication is that we can achieve health-care reform with universal coverage and declining per capita health-care costs.

There is a very real possibility that we will see positive transformational health-care reform in the near future. I am encouraged by the effort I see on Capitol Hill, particularly the bipartisan effort in the Senate. While some tough issues remain, if we continue to work in a bipartisan manner I believe we will resolve these issues successfully and find agreement on meaningful reform.

By STEVEN A. BURD - Mr. Burd is CEO of Safeway Inc., and the founder of the Coalition to Advance Healthcare Reform.

Steven Burd has testified in Washington D.C. and appeared on Fox News’ Huckabee. He has caught the attention of people from Senator Barbara Boxer to Rush Limbaugh; definitely opposite ends of the spectrum!! This is a great alternative to $600 Million in additional taxes and $400 Million in cuts to Medicare and Medicaid!!

Posted: Daily Thought Pad

Related Articles:

• House Health-Care Proposal Adds $600 Billion in Taxes
• How To Stop Socialized Health Care
• Democrats Set to Rush Through Government-Run Healthcare
• Understanding the House Democrat’s Health care bill
• What a Week With Healthcare
• Kennedy Healthcare Plan Meets Resistance – Full of Pork
• Healthcare: You Think Michael Moore Will Contribute? Don’t Hold Your Breath
• Here Comes Rationing Healthcare
• Rights, Responsibilities and Healthcare
• British HealthCare - Don't Treat The Old!! - And Senator Coburn Warns Same For USA
• Universal Health and Old People
• Once Considered Unthinkable, U.S. Sales Tax Gets Fresh Look
• Conservatives for Patient's Rights
• Obama's Attack on Medical Civil Liberties
• Socialized Medicine in cartoon form.
• Voters Steer Europe to the Right – Why… Because Socialism Isn’t Working
• Progressivism – The Progressive Movement Is A Cancer – How We Got Here

House Health-Care Proposal Adds $600 Billion in Taxes (Update-2)

What we are looking at:

$600 Billion in tax increases and $400 Billion in cuts to Medicare and Medicaid as the number of Babyboomers added to the rolls increases daily… while we already owe a Trillion in interest on the money the government (Obama Administration) has already borrowed and printed to this point, before this nationalized health-care proposal.

June 12 (Bloomberg) -- Health-care overhaul legislation being drafted by House Democrats will include $600 billion in tax increases and $400 billion in cuts to Medicare and Medicaid, Ways and Means Committee Chairman Charles Rangel said.

Democrats will work on the bill’s details next week as they struggle through “what kind of heartburn” it will cause to agree on how to pay for revamping the health-care system, Rangel, a New York Democrat, said today. The measure’s cost is reaching well beyond the $634 billion President Barack Obama proposed in his budget request to Congress as a 10-year down payment for the policy changes.

Asked whether the cost of a health-care overhaul would be more than $1 trillion over a decade, Rangel said, “the answer is yes.” Some Senate Republicans, including Senator Orrin Hatch of Utah, say the costs will likely exceed $1.5 trillion.

House Democrats plan to release their legislation next week. Obama is working with Congress to get legislation to his desk by October.

Democrats in the House and Senate are crafting legislation that would require all Americans to have health insurance, prohibit insurers from refusing to cover pre-existing conditions and place other restrictions on the industry.

Online Exchanges

The legislation would establish online exchanges for individuals to purchase insurance and would require employers to provide health benefits to workers or pay a penalty. Some Democrats also are backing creation of a government-run program to expand coverage to the uninsured. The issue is the subject of bipartisan negotiations with Republican who oppose the so-called public option.

Rangel said Democrats are still considering options for tax increases that might be in the bill, including a possible end to the income tax exclusion for employer-paid health benefits.

Senate Finance Committee Chairman Max Baucus, a Montana Democrat, is considering a proposal to apply income taxes to health-care plans if they are significantly more expensive than the basic health plan for federal employees -- $13,000 for a family of four.

Rangel said House Democrats want to avoid the deeper cuts to projected spending under Medicare and Medicaid that Obama has been putting forth. House Democrats want to achieve cost-savings by cuts in payments to private insurance plans under Medicare.

Covering the Costs

Obama has pledged that health-care changes won’t add to the deficit. To accomplish that, he’s proposed getting about $600 billion by reducing tax deductions available to the wealthy, and by trimming Medicare payments to insurance companies.

That won’t be enough to cover the overhaul costs. Obama said this week he plans in the coming days to disclose more proposals for raising “additional sources of revenue.” In a letter last week to Senate Democrats drafting legislation he said he will be proposing between $200 billion and $300 billion in further Medicare and Medicaid cuts.

Obama plans to give a speech Monday in Chicago to the American Medical Association as part of his campaign to build up support for what could be the biggest changes to healthcare policy since Medicare was established in 1965.

Rangel said that while House Democrats will likely release more details about health policy changes in their legislation next week, the package of offsetting tax increases and spending cuts likely will come later. Democrats, he said, want to put forth the more-positive aspects of an overhaul first. Rangel also wants to let lawmakers have time to study and weigh in on proposed offsets.

“We have a problem in not wanting to attract enough negative attention to the bill in terms of the pay-fors,” he said. “Let them get a good feel for the coverage.”

By: Laura Litvan in Washington at: llitvan@bloomberg.net

Last Updated: June 12, 2009 19:05 EDT

Source: Fox Nation

Posted: Daily Thought Pad

Related Articles:

• How To Stop Socialized Health Care
• Democrats Set to Rush Through Government-Run Healthcare
• Understanding the House Democrat’s Health care bill
• What a Week With Healthcare
• Kennedy Healthcare Plan Meets Resistance – Full of Pork
• Healthcare: You Think Michael Moore Will Contribute? Don’t Hold Your Breath
• Here Comes Rationing Healthcare
• Rights, Responsibilities and Healthcare
• British HealthCare - Don't Treat The Old!! - And Senator Coburn Warns Same For USA
• Universal Health and Old People
• Once Considered Unthinkable, U.S. Sales Tax Gets Fresh Look
• Conservatives for Patient's Rights
• Obama's Attack on Medical Civil Liberties
• Socialized Medicine in cartoon form.
• Voters Steer Europe to the Right – Why… Because Socialism Isn’t Working
• Progressivism – The Progressive Movement Is A Cancer – How We Got Here

Stop the Insanity!!

Updated: If you'd like to contact Speaker of the House Nancy Pelosi, here's the contact information that you'll need.

Contact info for Speaker of the House Nancy Pelosi

Please contact your representative, your Senator and Speaker Pelosi on this matter and others as they arise (almost daily these days).

Power Grab

The Obama administration is engaged in the most sweeping power grab in modern American history, but few people seem to care. In barely four months, we've witnessed the president and his minions taking over insurance companies, banks, and car companies, forcing private companies to sell off assets, appease unions, and stiff bondholders. Administration officials have insisted some companies take government handouts even if they don't want them and told others they can't pay back the money they've borrowed until the government gives them permission. Now, the president has decided he'll appoint a "compensation czar" whose job it will be to decide what constitutes fair pay for corporate executives. Why stop there? And, of course, they won't.

The latest move -- the appointment of Washington lawyer Kenneth Feinberg to oversee pay of the top employees at seven companies that have taken government funds -- may not seem radical, but it is. Earlier this year, in response to public criticism of the retention bonuses paid to some executives at the troubled insurance giant AIG, the administration proposed capping executive pay at $500,000 at firms receiving government assistance through the Troubled Asset Relief Program. But Treasury Secretary Tim Geithner abandoned that plan when he finally figured out that the execs would simply bail on the company, leaving the government without experienced and talented hands on deck.

So now the administration is moving to Plan B: Forget about pay caps per se but appoint a government overseer to set pay individually. Until now, in publicly traded companies that job fell to the board of directors and its compensation committee, whose legal and fiduciary responsibilities entail acting on behalf of shareholders. Directors are elected by the people who own the company: from individuals who own a few shares of stock to institutions and mutual funds that may own millions of shares.

The government, primarily through the Securities and Exchange Commission, oversees the board's stewardship, while other entities play a role as well. The securities exchanges -- the New York Stock Exchange, NASDAQ, etc. -- also have rules that govern the conduct of boards of directors, including restrictions on who sets executive compensation. The compensation committee at publicly traded companies must be composed of entirely of independent directors -- those who have no direct ties to the company or its management either by current or, in certain instances, former employment, for example.

Compensation committees act independent of management, but they don't act in a vacuum. They often hire compensation consultants (who must have no ties to the company) to advise them on the best pay practices. They evaluate their pay structure compared to other companies of similar size and complexity or who are in the same line of business. They evaluate the performance of key executives against financial results, the achievement of personal and company objectives, and other criteria. It is a long and arduous process (I know, for more than a decade I've served on and now chair the compensation committee of a NYSE company).

And the rules governing disclosure of executive compensation have become much stricter in recent years, especially since the enactment of Sarbanes-Oxley, federal legislation that passed in the wake of Enron and other recent corporate scandals. The law now requires that, in addition to a Compensation Committee Report on executive pay, management must produce an extensive compensation discussion and analysis to be included in proxy statements sent to all shareholders. The information includes a table showing exactly how much the CEO, chief financial officer, and three highest-paid employees in the company earn, including bonuses, stock options and grants, and what benefits and perquisites they are entitled to and their cost. Similar information is provided for director compensation. If shareholders don't think they're getting their money's worth from these executives or directors, they can dump the board of directors at the next election. Or at least that's how it is supposed to work.

But enter the Obama administration to rewrite the already extensive rules. Now one man -- the compensation czar -- is going to oversee this process at seven major corporations. And who oversees him?

From the president on down, the Obama administration is filled with people who have little or no idea how the market works. Most have never drawn a paycheck in the private sector, much less had to meet a payroll or make a profit. But they're convinced they know how to run things, down to the last detail. There's no word adequate to describe the sheer arrogance of this group.

by Linda Chavez - Chairman of the Center for Equal Opportunity and author of Betrayal: How Union Bosses Shake Down Their Members and Corrupt American Politics

Source: Townhall.com

Posted: Daily Thought Pad

Related Resources:

• Obama: The Grand Strategy
• White House Set To Appoint A 'Pay' Czar
• Obama's Attack on Medical Civil Liberties
• We Warned You About The Czars
• American Progressivism

How to Stop Socialized Health Care

Five arguments Republicans must make…

It was a sobering breakfast with one of the smartest Republicans on Capitol Hill. We can fix a lot of bad stuff President Barack Obama might do, he told me. But if Mr. Obama signs into law a "public option," government-run insurance program as part of health-care reform we won't be able to undo the damage.

I'd go the Republican member of Congress one further: If Democrats enact a public-option health-insurance program, America is on the way to becoming a European-style welfare state. To prevent this from happening, there are five arguments Republicans must make.

Getty Images

The first is it's unnecessary. Advocates say a government-run insurance program is needed to provide competition for private health insurance. But 1,300 companies sell health insurance plans. That's competition enough. The results of robust private competition to provide the Medicare drug benefit underscore this. When it was approved, the Congressional Budget Office estimated it would cost $74 billion a year by 2008. Nearly 100 providers deliver the drug benefit, competing on better benefits, more choices, and lower prices. So the actual cost was $44 billion in 2008 -- nearly 41% less than predicted. No government plan was needed to guarantee competition's benefits.

Second, a public option will undercut private insurers and pass the tab to taxpayers and health providers just as it does in existing government-run programs. For example, Medicare pays hospitals 71% and doctors 81% of what private insurers pay.

Who covers the rest? Government passes the bill for the outstanding balance to providers and families not covered by government programs. This cost-shifting amounts to a forced subsidy. Families pay about $1,800 more a year for someone else's health care as a result, according to a recent study by Milliman Inc. It's also why many doctors limit how many Medicare patients they take: They can afford only so much charity care.

Fixing prices at less than market rates will continue under any public option. Sen. Edward Kennedy's proposal, for example, has Washington paying providers what Medicare does plus 10%. That will lead to health providers offering less care.

Third, government-run health insurance would crater the private insurance market, forcing most Americans onto the government plan. The Lewin Group estimates 70% of people with private insurance -- 120 million Americans -- will quickly lose what they now get from private companies and be forced onto the government-run rolls as businesses decide it is more cost-effective for them to drop coverage. They'd be happy to shift some of the expense -- and all of the administration headaches -- to Washington. And once the private insurance market has been dismantled it will be gone.

Fourth, the public option is far too expensive. The cost of Medicare -- the purest form of a government-run "public choice" for seniors -- will start exceeding its payroll-tax "trust fund" in 2017. The Obama administration estimates its health reforms will cost as much as $1.5 trillion over the next 10 years. It is no coincidence the Obama budget nearly triples the national debt over that same period.

Medicare and Medicaid cost much more than estimated when they were adopted. One reason is there's no competition for these government-run insurance programs. In the same way, Americans can expect a public option to cost far more than the Obama administration's rosy estimates.

Fifth, the public option puts government firmly in the middle of the relationship between patients and their doctors. If you think insurance companies are bad, imagine what happens when government is the insurance carrier, with little or no competition and no concern you'll change to another company.

In other words, the public option is just phony. It's a bait-and-switch tactic meant to reassure people that the president's goals are less radical than they are. Mr. Obama's real aim, as some candid Democrats admit, is a single-payer, government-run health-care system.

Health care desperately needs far-reaching reforms that put patients and their doctors in charge, bring the benefits of competition and market forces to bear, and ensure access to affordable and portable health care for every American. Republicans have plans to achieve this, and they must make their case for reform in every available forum.

Defeating the public option should be a top priority for the GOP this year. Otherwise, our nation will be changed in damaging ways almost impossible to reverse.

By Karl Rove

About Karl Rove - Karl Rove served as Senior Advisor to President George W. Bush from 2000–2007 and Deputy Chief of Staff from 2004–2007. At the White House he oversaw the Offices of Strategic Initiatives, Political Affairs, Public Liaison, and Intergovernmental Affairs and was Deputy Chief of Staff for Policy, coordinating the White House policy making process.

Before Karl became known as "The Architect" of President Bush's 2000 and 2004 campaigns, he was president of Karl Rove + Company, an Austin-based public affairs firm that worked for Republican candidates, nonpartisan causes, and nonprofit groups. His clients included over 75 Republican U.S. Senate, Congressional and gubernatorial candidates in 24 states, as well as the Moderate Party of Sweden.

Karl writes a weekly op-ed for The Wall Street Journal, is a Newsweek columnist and is now writing a book to be published by Simon & Schuster. Email the author at Karl@Rove.com or visit him on the web at Rove.com.

Or, you can send him a Tweet @karlrove.

Posted: Daily Thought Pad

Related Articles:

• House Health-Care Proposal Adds $600 Billion in Taxes (Update-2)
• Democrats Set to Rush Through Government-Run Healthcare
• Understanding the House Democrat’s Health care bill
• What a Week With Healthcare
• Kennedy Healthcare Plan Meets Resistance – Full of Pork
• Healthcare: You Think Michael Moore Will Contribute? Don’t Hold Your Breath
• Here Comes Rationing Healthcare
• Rights, Responsibilities and Healthcare
• British HealthCare - Don't Treat The Old!! - And Senator Coburn Warns Same For USA
• Universal Health and Old People
• Once Considered Unthinkable, U.S. Sales Tax Gets Fresh Look
• Conservatives for Patient's Rights
• Obama's Attack on Medical Civil Liberties
• Socialized Medicine in cartoon form.
• Voters Steer Europe to the Right – Why… Because Socialism Isn’t Working
• Progressivism – The Progressive Movement Is A Cancer – How We Got Here

Democrats Set to Rush Through Government-Run Healthcare

Senate Democrats announced plans Tuesday to begin committee work next week on health care legislation designed to assure coverage for millions of Americans who now lack it, a key objective of the Obama administration.

IBut Sen. Chris Dodd, D-Conn., said the measure that goes before the Senate Health, Education, Labor and Pensions Committee would contain gaps rather than include several controversial features included in a draft that circulated only last week. Among them are a proposed government-run insurance plan to compete with private companies -- vociferously opposed by nearly all Republicans -- and a requirement for employers to pay a penalty if they fail to provide coverage for their workforce.

Dodd said he would preside over the sessions in the place of Sen. Edward M. Kennedy, D-Mass., the committee chairman, who was diagnosed more than a year ago with brain cancer and has not been in the Capitol in recent days. The committee work will take about three weeks, he said.

Sen. Mike Enzi, R-Wyo., the top Republican on the health committee, responded dismissively to Dodd's comments about leaving gaps for GOP lawmakers to debate.

He said Democrats did so "because they know we're not going to like what they've written and they don't want us to have any time to comment," he said in an interview.

Enzi also said Democrats would have behaved differently if Kennedy were present.

"I've never worked a process on any bill with him that went like this where there was absolutely no input taken from the other party," Enzi said. "And I never treated him that way either."

"What the question is, is Senator Dodd in charge or is he just running the meeting, and we don't know yet," Enzi said.

Dodd's announcement signaled a quickening pace of activity on health care legislation, and came as senior House Democrats disclosed they are considering a new tax on employer-provided health benefits to help pay for expanding coverage to the 50 million uninsured. President Barack Obama opposed a tax on benefits during last year's campaign and aired numerous television commercials criticizing the idea when his Republican rival, Sen. John McCain, proposed it.

Several officials also said an outline of emerging legislation in the House envisions a requirement for all individuals to purchase affordable coverage, with an unspecified penalty for those who refuse and a waiver for those who cannot cover the cost.

"There's no sense having a mandate unless you have a contribution," Rep. Charles Rangel, D-N.Y., chairman of the House Ways and Means Committee, said Monday. He referred to the suggestion as "play or pay."

Rangel and other senior Democrats arranged to bring members of the party's rank and file up to date at a midday session Tuesday on the effort to draft health care legislation at the top of President Barack Obama's agenda.

The officials spoke on condition of anonymity, saying they did not want to pre-empt the presentation to rank-and-file Democrats on Tuesday.

Under an outline of the House Democratic plan, individuals and small businesses would be able to purchase coverage from a "health exchange" and the government would require all plans to contain a minimum benefit. No applicant could be rejected for pre-existing conditions, nor could one be charged a higher premium.

The outline shows Democrats want to provide subsidies to families up to about $88,000 a year to help them pay for insurance, and to require new policies to limit out-of-pocket spending as a way to prevent personal bankruptcies.

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

The measure also envisions several changes to Medicare, the government program that provides health care to seniors, although details are lacking.

According to the outline, the gap between primary care physician fees and those of specialists would be narrowed, and beneficiaries would not incur out-of-pocket costs for preventive services. The outline also mentions unspecified improvements in the prescription drug benefit. Democrats vociferously opposed that benefit when Republicans passed it, saying it provided billions in unnecessary subsidies to pharmaceutical companies.

The outline does not include an overall cost for the legislation, which is expected to exceed the $1.2 trillion, 10-year price tag Obama's proposal carried last winter.

Part of the cost would be covered in the form of cuts in the government payments under Medicare plans run by private insurance companies, which receive more per patient than the cost of traditional coverage.

Strikingly, the outline made no mention of the possible tax on health benefits, or of the proposed penalty for those refusing to purchase affordable insurance.

Several officials stressed that no final decisions would be made for several days on the possible tax on health benefits.

The idea has been gaining currency in recent weeks as Congress intensifies its search for more than $1 trillion to help pay for a health care overhaul.

America… Do your homework, contract your Representative and Senator (no matter which side you are on) and do not let them pass this legislation without reading it, without having ‘real’ funds to pay for it and a real plan, and without being satisfied that you will be receiving and will continue to receive the same or better health care treatment than you do today… which means better than the care in any country that now has socialized or nationalized healthcare. If not… do not let the government force you into a plan of worse healthcare that nobody can pay for!!

Source: Associated Press/MoneyNews.com

Understanding the House Democrats’ health care bill

Posted Tuesday, June 9th, 2009, at 10:30 am

Yesterday I posted and described the draft Kennedy-Dodd health care bill. Today I would like to do the same for an outline produced by House Democrats.

Here is a three-page outline of “Key Features of the Tri-Committee Health Reform Draft Proposal in the House of Representatives,” dated yesterday (June 8, 2009).

The three committees are:

• The House Ways & Means Committee, chaired by Rep. Charlie Rangel (D-NY). The Health Subcommittee is chaired by Rep. Pete Stark (D-CA).
• The House Energy & Commerce Committee, chaired by Rep. Henry Waxman (D-CA). The Health Subcommittee is chaired by Rep. Frank Pallone, Jr. (D-NJ).
• The House Committee on Education & Labor, chaired by Rep. George Miller (D-CA). The Health, Employment, Labor and Pensions Subcommittee is chaired by Rep. Robert Andrews (D-NJ).

The document suggests this is a joint product of the three committees and/or their subcommittees. My sense, however, is that it is Speaker Pelosi who is driving the bus. This is in contrast to the Senate, where the committee chairmen (Kennedy/Dodd and Baucus) appear to have the pen, in less well-coordinated efforts.

Kennedy-Dodd and the House bill outline are remarkably similar. Whether this represents House-Senate coordination or parallel thought processes is unclear.

I think the easiest way for me to present the House bill outline is in comparison with the Kennedy-Dodd bill. So here my description from yesterday of the Kennedy-Dodd bill, with today’s comparison to the House bill outline in red. I hope it’s comprehensible and useful this way. If you read yesterday’s post, you can skim the text in black and focus on the new text in blue.

Here are 15 things to know about the draft Kennedy-Dodd health bill and the House bill outline.

1. The Kennedy-Dodd bill would create an individual mandate requiring you to buy a “qualified” health insurance plan, as defined by the government. If you don’t have “qualified” health insurance for a given month, you will pay a new Federal tax. Incredibly, the amount and structure of this new tax is left to the discretion of the Secretaries of Treasury and Health and Human Services (HHS), whose only guidance is “to establish the minimum practicable amount that can accomplish the goal of enhancing participation in qualifying coverage (as so defined).” The new Medical Advisory Council (see #3D) could exempt classes of people from this new tax. To avoid this tax, you would have to report your health insurance information for each month of the prior year to the Secretary of HHS, along with “any such other information as the Secretary may prescribe.”

   The House bill also contains an individual mandate. The outline is less specific but parallel: “Once market reforms and affordability credits are in effect to ensure access and affordability, individuals are responsible for having health insurance with an exception in cases of hardship.”

2. The Kennedy-Dodd bill would also create an employer mandate. Employers would have to offer insurance to their employees. Employers would have to pay at least a certain percentage (TBD) of the premium, and at least a certain dollar amount (TBD). Any employer that did not would pay a new tax. Again, the amount and structure of the tax is left to the discretion of the Secretaries of Treasury and HHS. Small employers (TBD) would be exempt.

   The House bill outline also contains an employer mandate that appears to parallel that in Kennedy-Dodd: “Employers choose between providing coverage for their workers or contributing funds on behalf of their uncovered workers.”

3. In the Kennedy-Dodd bill, the government would define a qualified plan:
   1. All health insurance would be required to have guaranteed issue and renewal, modified community rating, no exclusions for pre-existing conditions, no lifetime or annual limits on benefits, and family policies would have to cover “children” up to age 26.

      The House bill outline is consistent with but less specific than the Kennedy-Dodd legislative language. The House bill outline would “prohibit insurers from excluding pre-existing conditions or engaging in other discriminatory practices.” I will keep my eye on what “other discriminatory practices” means in the legislative language. Does that mean that a health plan cannot charge higher premiums to smokers?

      Like the Kennedy/Dodd bill, the House bill outline would preclude health plans from imposing lifetime or annual limits on benefits: “Caps total out-of-pocket spending in all new policies to prevent bankruptcies from medical expenses.” This would raise premiums for new policies.

      The House bill outline “introduces administrative simplification and standardization to reduce administrative costs across all plans and providers.” I don’t know what this means, but suggest keeping an eye on it.

   2. A qualified plan would have to meet one of three levels of standardized cost-sharing defined by the government, “gold, silver, and bronze.” Details TBD.

      Same: “… by creating various levels of standardized benefits and cost-sharing arrangements…”. It also contains this addition relative to Kennedy-Dodd: “… with additional benefits available in higher-cost plans.”

      But note the “various levels of standardized benefits.” This appears to be more expansive government control of health plan design than in the Kennedy-Dodd draft.

   3. Plans would be required to cover a list of preventive services approved by the Federal government.

      This is unspecified in the House bill outline. We’ll have to wait to see legislative language. The House bill would require plans to “waive cost-sharing for preventive services in benefit packages.”

   4. A qualified plan would have to cover “essential health benefits,” as defined by a new Medical Advisory Council (MAC), appointed by the Secretary of Health and Human Services. The MAC would determine what items and services are “essential benefits.” The MAC would have to include items and services in at least the following categories: ambulatory patient services, emergency services, hospitalization, maternity and new born care, medical and surgical, mental health, prescription drugs, rehab and lab services, preventive/wellness services, pediatric services, and anything else the MAC thought appropriate.

      This appears parallel but is less specific for now: “Independent public/private advisory committee recommends benefit packages based on standards set in statute.” I find the “standards set in statute” interesting. It suggests that provider and disease interest groups will have two fora in which to lobby for their benefits to be mandated: Congress, and the advisory committee.

   5. The MAC would also define what “affordable and available coverage” is for different income levels, affecting who has to pay the tax if they don’t buy health insurance. The MAC’s rules would go into effect unless Congress passed a joint resolution (under a fast-track process) to turn them off.

      The House bill outline is silent on this.

4. Health insurance plans could not charge higher premiums for risky behaviors: “Such rate shall not vary by health status-related factors, … or any other factor not described in paragraph (1).” Smokers, drinkers, drug users, and those in terrible physical shape would all have their premiums subsidized by the healthy.

   The House bill outline says it would “prohibit plans [from] rating (charging higher premiums) based on gender, health status, or occupation and strictly limits premium variation based on age.” If the bill were to provide nothing more, this would appear to parallel the Senate bill and preclude plans from charging higher premiums for risky behaviors.

5. Guaranteed issue and renewal combined with modified community rating would dramatically increase premiums for the overwhelming majority of those Americans who now have private health insurance. New Jersey is the best example of health insurance mandates gone wild. In the name of protecting their citizens, premiums are extremely high to cover the cross-subsidization of those who are uninsurable.

   The House bill outline is silent on guaranteed issue and renewal. I’m going to make an educated guess that the bill includes these provisions as part of “other discriminatory practices,” and they have just left them out of the outline. Given the philosophy behind this outline (with which I disagree), it would be a striking omission. But for now, the outline says nothing specific on these topics.

6. The bill would expand Medicaid to cover everyone up to 150% of poverty, with the Federal government paying all incremental costs (no State share). This means adding childless adults with income below 150% of the poverty line.

   The House bill outline “expands Medicaid for the most vulnerable, low-income populations,” so we have no specifics other than that there’s an expansion. I cannot tell if this is expanding eligibility or benefits. The outline also “improves payment rates to enhance access to primary care under Medicaid.” I assume this means the bill would expand the Federal share paid of each dollar spent by a State Medicaid program on primary care, rather than the Federal government actually mandating specific payment rates to be implemented by States. Federal micromanagement of specific Medicaid provider payment rates was eliminated in the mid 1990’s.

7. People from 150% of poverty up to 500% (!!) would get their health insurance subsidized (on a sliding scale). If this were in effect in 2009, a family of four with income of $110,000 would get a small subsidy. The bill does not indicate the source of funds to finance these subsidies.

   The House bill outline has a sliding scale up to 400% of poverty. If this were in effect in 2009, a family of four with income of $88,000 would get small subsidy.

8. People in high cost areas (e.g., New York City, Boston, South Florida, Chicago, Los Angeles) would get much bigger subsidies than those in low cost areas (e.g., much of the rest of the country, especially in rural areas). The subsidies are calculated as a percentage of the “reference premium,” which is determined based on the cost of plans sold in that particular geographic area.

   The House bill outline is not specific on this point. I would not expect it to be – this is something you can tell only from legislative language.

9. There would be a “public plan option” of health insurance offered by the federal government. In this new government health plan, the federal government would pay health care providers Medicare rates + 10%. The +10% is clearly intended to attract short-term legislative support from medical providers. I hope they are not so naive that they think that differential would last.

   The House bill outline “creates a new public health insurance within the Exchange … the public health insurance option competes on ‘level field’ with private insurers in the Exchange.” There are no specifics on how the public plan would work, or on provider payment rates.

10. Group health plans with 250 or fewer members would be prohibited from self-insuring. ERISA would only be for big businesses.

    The House bill outline is silent on this point.

11. States would have to set up “gateways” (health insurance exchanges) to market only qualified health insurance plans. If they don’t, the Feds will set up a gateway for them.

    The House calls it an Exchange rather than a Gateway. While the Senate bill would tell each State, “Create a Gateway or we’ll create one for you,” the House bill outline says to each State, “We’re creating a single new national Exchange. You’re in it unless you develop your own State or Regional Exchange.”

12. Health insurance plans in existence before the law would not have to meet the new insurance standards. This creates a weird bifurcated system and means you would (probably) be subject to a different set of rules when you change jobs.

    The House bill outline appears to parallel the Kennedy-Dodd draft: “Phases-in requirements to benefit and quality standards for employer plans.” This means that new plans will be more expensive than old plans. It also means they’re creating a bifurcated system with all sorts of perverse unintended consequences for employment flexibility.

13. The bill does not specify what spending will be cut or what taxes will be raised to pay for the increased spending. That is presumably for the Finance Committee to determine, since it’s their jurisdiction.

    The House bill outline lists specific topics for changes to Medicare reimbursement:

    • Changing (how?) the Medicare reimbursement for doctors, called the “Sustainable Growth Rate” (SGR).
    • “Increasing reimbursement for primary care providers”
    • “Improving” the Medicare drug program. I won’t be surprised if, when I see the specifics, I disagree that their changes are “improvements.” In the past this has meant having the federal government mandate specific prices for drugs.
    • Cutting payments to Medicare Advantage plans.
    • Expanding low-income subsidies for seniors and eliminating cost-sharing for all preventive services in Medicare.

    The House bill outline also uses positive language to describe things that might generate budgetary savings from Medicare and/or Medicaid. The hospital readmissions point is specific. The first two points could increase or decrease federal spending, depending on the specifics.

    • “Use federal health programs … to reward high quality, efficient care, and reduce disparities.”
    • “Adopt innovative payment approaches and promote[s] better coordinated care in Medicare and the new public option through programs such as accountable care organizations.”
    • “Attack the high rate of cost growth to generate savings for reform and fiscal sustainability, including a program in Medicare to reduce preventable hospital readmissions.”
14. The bill defines an “eligible individual” as “a citizen or national of the United States or an alien lawfully admitted to the United States for permanent residence or an alien lawfully present in the United States.”

    The House bill outline is silent on this point.

15. The bill would create a new pot of money for state gateways to pay “navigators” to educate people about the new bill, distribute information about health plans, and help people enroll. Navigators receiving federal funds “may include … unions, …”

    The House bill outline is silent on this point.

This would have severe effects on the more than 100 million Americans who have private health insurance today:

• The government would mandate not only that you must buy health insurance, but what health insurance counts as “qualifying.”
• Health insurance premiums would rise as a result of the law, meaning lower wages.
• A government-appointed board would determine what items and services are “essential benefits” that your qualifying plan must cover.
• You would find a tremendous new disincentive to switch jobs, because your new health insurance may be subject to the new rules and would therefore be significantly more expensive.
• Those who keep themselves healthy would be subsidizing premiums for those with risky or unhealthy behaviors.
• Far more than half of all Americans would be eligible for subsidies, but we have not yet been told who would pay the bill.
• The Secretaries of Treasury and HHS would have unlimited discretion to impose new taxes on individuals and employers who do not comply with the new mandates. (The House bill outline is not specific on this point.)
• The Secretary of HHS could mandate that you provide him or her with “any such other information as [he/she] may prescribe.” (The House bill outline is not specific on this point.)

I strongly oppose the Kennedy-Dodd bill and the House Tri-Committee bill.

If this topic interests you, I highly recommend Jim Capretta’s blog Diagnosis.

Source: Keith Hennessey.com

Posted: Daily Thought Pad

Related Resources and Posts:

• Healthcare: You Think Michael Moore Will Contribute? Don’t Hold Your Breath
• Here Comes Rationing Healthcare
• Rights, Responsibilities and Healthcare
• British HealthCare - Don't Treat The Old!! - And Senator Coburn Warns Same For USA
• Universal Health and Old People
• Once Considered Unthinkable, U.S. Sales Tax Gets Fresh Look
• Conservatives for Patient's Rights
• Obama's Attack on Medical Civil Liberties
• Socialized Medicine in cartoon form.
• Voters Steer Europe to the Right – Why… Because Socialism Isn’t Working
• Progressivism – The Progressive Movement Is A Cancer – How We Got Here