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BUSH VS. HEALTH CARE/ MEDICARE ARCHIVES

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Bush Aides Push for Rule to Hamper Worker Health Protections
RAW STORY

Bush administration aides are rushing to pass a safety rule which would make government regulation of workers' exposure to toxic chemicals more difficult; a rule President-elect Barack Obama opposes.

Public health officials worry the decreased protections will result in additional, unnecessary deaths.

It is just one of about 20 controversial Labor Department proposals being pushed by large business interests, according to a published report.

Other proposals would allow power plants to be built closer to parks and wildlife preserves, and further limit the role of environmental and animal experts in determining where major infrastructure projects may be carried out.

President-elect Obama has long been critical of the Bush administration's removal of workplace protections. During the campaign, Obama co-sponsored legislation which would prohibit this specific deregulation.

While presidents have the authority to unilaterally repeal their predecessor's executive orders, the process to remove or add regulations is more complicated and takes longer. Obama has already undertaken a review of President Bush's executive orders, with the stated goal being the repeal of those he deems to be unconstitutional.

"I think across the board, on stem cell research, on a number of areas, you see the Bush administration even today moving aggressively to do things that I think are probably not in the interest of the country,” said John Podesta, co-chair of Obama's transition team. "I think that’s a mistake.”

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US Healthcare Costs More, Delivers Less: Study

The United States lags behind other industrialized nations in the quality of its healthcare despite having the costliest system in the world, according to a report released on Thursday.

The US healthcare system is plagued by inefficiency, inequality and an incoherent national policy, said the report from the private Commonwealth Fund foundation.

"The US spends twice per capita what other major industrialized countries spend on health care, and costs continue to rise faster than income," said the report.

"We should expect a better return on this investment."

The foundation used a 100-point scorecard to rate the system based on 37 categories, including access to health care, quality of care and efficiency.

The US average came to 65, two points down from a previous measure in 2006. The score is compared to other countries and the best performing US states, counties or hospitals.

The measures showed "that the US is losing ground in providing access to care and has uneven health care quality" and also revealed "broad evidence of inefficient and inequitable care," it said.

The United States ranked last among 19 industrialized states when it comes to preventing premature deaths from conditions such as heart attacks that can be treated with timely, effective care, the report said.

Up to 101,000 less people would die prematurely if the US achieved the lower mortality rates of top performing countries such as France or Japan, it said.

Infant mortality rates also remain high in the United States compared to other industrialized nations.

Access to health care was on the decline, with more Americans without health insurance or without adequate insurance. In 2007, 75 million working-age adults were either uninsured or underinsured, up from 61 million in 2003.

Americans reported more delays in securing appointments with doctors. "In 2007, as in 2005, less than half of US adults with health problems were able to get a rapid appointment with a physician when they were sick," it said.

The US scored poorly on efficiency, with patients subjected to duplicate tests, unnecessary hospital admissions, high administrative costs and outdated record keeping, it said.

Only 28 percent of US doctors use electronic medical records, compared to nearly 100 percent in leading countries.

The report, based on data from US government agencies and other sources, underlined some areas of progress, including improved safety at hospitals and better control of diabetes and high blood pressure.

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HEALTH CARE -- OB/GYNS WHO REFUSE TO PERFORM ABORTIONS MAY NOT HAVE TO REFER PATIENTS TO OTHER DOCTORS

In November, the American College of Obstetricians and Gynecologists (ACOG) issued new ethics guidelines stipulating that doctors "have the duty to refer patients in a timely manner to other providers if they do not feel they can in conscience provide the standard reproductive serves that patients request," such as abortions.

Yet last week, Health and Human Services Secretary Mike Leavitt wrote a letter to the American Board of Obstetrics and Gynecologists stating doctors have no such referral duty.

As OB/GYN Wendy Chavkin explained to NPR, Leavitt's opinion could mean that a woman who was raped could be denied emergency contraception, as a doctor wrongly conflating it with abortion would not have to refer her to another physician who could provide her with the care she requires.

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White House, Congress To Battle Over Medicaid For The Poor
Barbara Barrett | McClatchy Newspapers


WASHINGTON - As the last months of the Bush administration dwindle away, the White House might yet face another showdown with the Democratic Congress, this one over changes in Medicaid rules that could affect millions of low-income children and adults.

In the past year, the administration has tried to change the rules in a way that would reduce Medicaid spending by $15 billion over the next five years. The federal-state program pays for health care for the nation's poorest citizens.

The rule changes have brought objections from health-care leaders across the country. But the Bush administration say the changes represent tighter controls on Medicaid's rising costs.

Some rule changes, which would be enacted around Memorial Day, would reduce payments to North Carolina by an estimated $320 million next year alone. Hospital leaders and local government officials across the country say that if Congress doesn't block the regulations, patients will lose, particularly the uninsured, who may be turned away.

The state hospital association says workers will be hurt, too. It estimates 3,000 to 6,000 hospital jobs could be lost, up to a thousand of those in rural areas.

Hospital leaders have enlisted among their champions Sen. Elizabeth Dole, a Republican running for re-election. Though one of Bush's closest allies in the Senate, Dole is challenging the White House over its plans for Medicaid.

"This was a hastily made change," she said.

The Bush administration says that the changes aren't at all hasty and that they come as part of a needed examination of a program suffering from what federal Medicaid chief Dennis Smith called "mission creep." The phrase refers to the expansion of Medicaid coverage to populations and services that the administration thinks a program for poor people should not cover.

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Bush Administration Cuts $700 Million In Medicaid Funds For Schools
12/22/2007
Filed by Adam Doster


President Bush drew criticism this fall for his refusal to fund a children’s health insurance program. On Friday, his healthcare slashing continued.

According to the Washington Post, “the Bush administration eliminated about $700 million a year in Medicaid reimbursements to schools, sidestepping an attempt by Congress to block such a move.”

Issued by the Centers for Medicare and Medicaid Services, the new rule is projected to save the federal government $3.6 billion over five years, transferring those costs to school districts. Many school principals and superintendents said that the loss of the funding could force districts to cut other programs.

A wide variety of medical services, like speech and physical therapy, are provided to students in schools. Medicaid, the government's health insurance program for the poor, will continue to pay for those services for low-income children.

However, the law changes will pay schools for transporting students getting speech or physical therapy to school or back home. It will also limit when schools can bill the federal government for clerical work necessary with providing health care. For example, schools can no longer expect Medicaid reimbursement for planning student immunizations.

While hundreds of people who opposed to the change commented in writing to CMS on the proposal, CMS officials said that most of the comments validated their anxiety that schools were improperly using Medicaid funding to pay for services "that are clearly educational in nature."

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HEALTH CARE PLANS OF GOP CANCER SURVIVORS WON'T COVER CANCER SURVIVORS

Last month, former New York City mayor Rudy Giuliani claimed that if he had gotten the prostate cancer in a country with government-based health care, his "chances of surviving" would have been much slimmer.

Giuliani said he preferred a "free market" approach that uses tax incentives to encourage Americans to enroll in private health plans. But as the Los Angeles Times reported, Giuliani's plan would be unlikely to cover cancer survivors such as himself.

Along with Giuliani, the plans of Sen. John McCain (R-AZ) and former senator Fred Thompson, who also are both survivors of cancer, would likely exclude Americans such as themselves. According to experts who spoke to the Times, it will take five to 10 years for insurance companies to consider providing coverage to cancer survivors.

For example, a prostate cancer survivor like Giuliani "could be covered after five years of being cancer-free, at a 40% higher premium" -- five years that is, if they had a "less severe form of the disease.

Though each of the candidate's campaigns say they are considering options for closing the gaps in their plans, tax credits and subsidies are unlikely to "cut it."

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Child health-care program gets congressional nod

Tony Pugh | McClatchy Newspapers

WASHINGTON — Senate and House of Representatives leaders reached agreement Friday on compromise legislation to reauthorize and expand a popular insurance program for low-income children, but President Bush is still promising to veto the measure.

The debate over the State Children's Health Insurance Program (SCHIP) has become a battle for the direction of America's health care. Democrats and health advocates want to use the program to bring health care to millions of uninsured youngsters. Republicans and others see the expansion as a return to big government and prefer to use tax incentives to help Americans buy their own coverage in the private market.

The compromise bill would boost SCHIP funding by $35 billion over five years and help cover 4 million children who are now without health insurance. The proposal closely matches the bipartisan measure that passed the Senate by a 68-31 vote. But it eliminates several controversial provisions of the House reauthorization bill that would have increased spending by $47 billion, hiked Medicare payments to physicians and cut funding for HMOs that provide Medicare coverage.

The House is expected to vote on the new proposal on Tuesday, with a Senate vote expected later in the week. If the measure passes both houses, it will go to the president.

The White House issued a statement Friday evening restating the president's intent to veto the measure. Bush called on Congress to pass a temporary funding extension for the program, which is scheduled to expire on Sept. 30.

A presidential veto would send the measure back to both chambers for an override vote. Observers say the Senate has enough votes to overturn a Bush veto, but Republicans are confident that they have the necessary votes in the House to sustain the president's veto. The original House bill passed by only 225-204.

"We are hopeful that the President will reconsider his veto threat and sign this bill into law on behalf of all our nation's children," House Speaker Nancy Pelosi said Friday in a press statement.

Republicans believe that Democrats are expanding the program beyond it's original purpose of covering low-income children and that expanded eligibility will cause parents to drop their children's private insurance for cheaper coverage through SCHIP. That phenomenon is known as "crowd out."

But Republicans who vote against the measure could face tough sledding from constituents and state officials, most of whom support the SCHIP program, which is designed to cover children whose parents earn up to twice the federal poverty level.

Senator Orrin Hatch, R-Utah, said he's sympathetic to the president's concerns about SCHIP, but is supportive of the new compromise bill.

"I am hoping that he will work with us on this program because this is a true compromise within the Senate between Democrats and Republicans, and between the House and the Senate," Hatch said Friday in a statement.

Like the Senate bill, the compromise legislation would boost program SCHIP funding by $35 billion, to a budget of $60 billion over five years. The money would come from steep tax increases on tobacco products.

Bush wants to expand the program by $1 billion a year, bringing total spending to $30 billion over the five years. That's about 36 percent of what the Congressional Budget Office says is needed to preserve current program levels. The CBO estimates that 800,000 children in the SCHIP program would lose coverage within five years without additional funding over the program's current $5 billion-a-year budget.

Of the 6.1 million new enrollees the Senate bill would attract by 2012, the CBO projects that 4 million would have been uninsured and SCHIP-eligible. About 2.1 million would drop private insurance to enroll.

The new package also would provide dental coverage for SCHIP youngsters, allow states the option of covering pregnant women in the program and prohibit future coverage of any other adults.

The compromise bill also eases new restrictions imposed by the Bush administration that make it extremely difficult for states to expand coverage to youngsters from higher-earning families.

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Medicare Auditing Program Could End Up Costing U.S. Taxpayers

September 16, 2007

 

 

WASHINGTON -- U.S. taxpayers will end up paying millions of dollars in commissions to an Atlanta-based auditor even though the firm's wholesale rejections of Medicare claims from California rehabilitation hospitals are now being reversed on appeal.

The rulings by administrative law judges for the Office of Medicare Hearings and Appeals will restore money withdrawn from California hospitals, some of which are suffering financial hardships and have trimmed services to Medicare patients as a result of the reviews.

But PRG-Schultz International, which is paid as much as 25 to 30 cents for each dollar of Medicare spending it identifies as wrongly paid, can keep its bounty as long as its findings are sustained through the first two levels of administrative review. The reversals are coming in the third level, the first time PRG-Schultz’s decisions are being looked at through independent eyes in trial-like settings.

The rulings are turning an experimental federal program to root out waste, fraud and abuse in Medicare into a costly fiasco. But they also could undermine the basis for a congressional decision to permanently expand the Centers for Medicare and Medicaid Services auditing program to all 50 states by 2010.

Medicare officials are worried.

“CMS is watching the ... rulings very closely and they will be one of the factors used when making future policy decisions concerning the program,” said program spokesman Dan McLeod.

A spokesman for PRG-Schultz said the firm is deferring to the Centers for Medicare and Medicaid Services for comment.

But lawyers representing California hospitals think the end is near for the controversial program. PRG-Schultz began its work by looking at the state’s 74 rehabilitation hospitals, swamping them with reviews of cases dating back to 2002.

Its auditors have rejected almost all of the claims for patients admitted after knee and hip replacement surgery, saying in essence that the highly focused therapy the patients received was medically unnecessary and that they should have been treated through outpatient services or sent to nursing homes.

As of Sept. 30, 2006, according to a CMS report, $105 million in charges had been rejected by PRG-Schultz under the program. The company's commission could be as high as $29 million. But since that report, the hospital association said thousands of additional claims have been rejected and that auditors are now starting to deny rehabilitation hospital services for stroke victims.

According to opinions trickling out from the administrative judges, auditors have no authority under Department of Health and Human Services rules to review cases older than a year without good cause, which PRG-Schultz has not shown. The rulings point to a fundamental flaw in the audit program, which according to a 2005 CMS press release was designed to look at cases at least a year old.

“We think this sets a precedent that applies to virtually all of the case denials,” said Patricia Blaisdell, vice president of medical rehabilitation services for the California Hospital Association. The decisions cannot be appealed by the federal government, lawyers said.

The audit program was established as a demonstration project in three states -- California, Florida and New York -- in 2005. Auditors were chosen for each state to review Medicare records for mistakes and overcharges. Their only compensation is the commissions, which critics see as a powerful incentive to find problems where there may be none.

While congressional aides said complaints are on the rise in Florida and New York, there has been an avalanche California. The California Hospital Association has asked for an investigation, and the powerful California congressional delegation demanded that CMS amend the program or face legislation.

Sen. Dianne Feinstein, D-Calif., sent a separate letter to CMS raising concerns about the program even though Blum Capitol Partners, a business interest of her husband, Richard Blum, is a large investor in PRG-Schultz and helped bail out the auditing company from financial difficulties about the time it was awarded the California contract.

CMS defended PRG-Schultz in a July response to Feinstein’s letter.

Leslie V. Norwalk, acting CMS administrator, said that after reviewing the hospital association’s complaints and PRG-Schultz’s work, the agency “concluded that it is acting in accordance with Medicare law and statutes.”

But that view may be shifting. McLeod, the audit program's spokesman, said last week that the agency is trying to establish whether “the determinations by PRG-Schultz are accurate.”

The first cases headed into administrative courtrooms last month, shifting from an internal paperwork review within the department into adversarial trials, with witnesses called and other evidence submitted.

In eight cases so far -- three of them one day last week -- administrative law judges are ruling for the hospitals without considering the medical evidence.

One case involved a 77 year-old woman admitted to the rehabilitation unit at Glendale Adventist Medical Hospital in 2002 following knee replacement surgery. She had heart problems and lived alone. When transferred to the rehabilitation unit, she could not stand without help, antibiotics were being given to her intravenously and she was in extreme pain. After eight days in the unit undergoing therapy, she was able to return home alone.

Even though Medicare had paid the claim in November 2002, PRG-Schultz sent the hospital a letter in June 2006 saying it was reopening the case “due to a recent review and discovery of potential overpayment.”

“There are no documents in the record that show what PRG-Schultz did to review or discover a potential overpayment in this manner,” wrote administrative law judge Richard B. Gould in his Aug. 13 ruling. “There was no evidence of good cause.”

Ronald Connelly, the Washington, D.C., attorney representing Glendale Adventist in this and other cases, said he expects similar rulings in the “tsunami of appeals” coming out of California.

“The gist of this is that CMS has sent PRG-Schultz on a fishing expedition without giving them good cause to look at these claims,” he said. “We can expect many more, if not the vast majority, will be overturned in favor of the hospitals.

“This could be extremely damaging to the audit program,” he said. “This was a program intended to root out overpayments to save the Medicare Trust Fund money, and it appears now it will end up costing money.”

Lloyd Bookman, a Los Angeles attorney, said he and other lawyers representing California hospitals are now asking judges for summary reversal of PRG-Schultz determinations.

“There are literally thousands of cases in the pipeline in our office,” he said. “I think the ruling is going to result in almost all of the cases being overturned.”

For hospitals, it is the end of a costly nightmare.

Warren Tetz, a senior vice president at Glendale Adventist, said Medicare officials yanked more than $4 million out of the hospital’s account based on PRG-Shultz audits. Patients have suffered, he said.

“We have almost shut the door on these types of cases because of financial fear,” Tetz said.

This is happening, said Glendale rehabilitation director Marion Watson, even though studies show clearly that joint-replacement patients recover faster and are discharged to their homes more frequently than if cared for in nursing homes or outpatient units.

For some rehabilitation hospitals already in a financial struggle, the PRG-Schultz audits have been disastrous.

Melinda Staveley, president of the 38-bed Rehabilitation Institution at Santa Barbara, said the hospital is in the final stages of selling to Santa Barbara Cottage Hospital because the cost of preparing for the PRG-Schultz audits were too much on top of its other problems.

“It is one thing after another,” she said of the institution, which has operated as a non-profit for 53 years. “This whole audit process has pushed (the hospital) over the edge.”

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Bush Vetoes Kids

"America's children must also have a healthy start in life," President Bush declared on the campaign trail in 2004 while running for reelection. "In a new term, we will lead an aggressive effort to enroll millions of poor children who are eligible but not signed up for the government's health insurance programs."

But now, instead of living up to his word, Bush has become the one man standing between 9 million low-income children and their health insurance.

Bush threatened again this week to veto legislation that will renew and improve the State Children's Health Insurance Program (SCHIP), which provides health coverage to low-income, uninsured American children who do not qualify for Medicaid, but who cannot afford private health insurance.

According to the nonpartisan Congressional Budget Office, nearly 1 million American children will lose their health insurance if the veto blocks reauthorization. Yet Bush says he cannot support it, citing "philosophical differences."

He told reporters Wednesday, "My concern is that when you expand eligibility...you're really beginning to open up an avenue for people to switch from private insurance to the government."

SCHIP WORKS

The United States spends more on health care every year than any other country, and yet nine million American children remain uninsured. SCHIP, which this year marks its 10th anniversary as a bipartisan, federal-state collaboration to improve the nation's health coverage, has put a significant dent in that number.

Bruce Lesley of First Focus calls SCHIP "the one major healthcare success story over the past 10 years" for providing "cost-effective health coverage to millions of children with coverage that the private market by itself has been unable to provide."

Along with Medicaid, SCHIP has "reduced the proportion and the number of low-income children who are uninsured by about one third since 1997."

ADMINISTRATION MISLEADS TO SPIN BUSH'S VETO

At a recent press conference, Health and Human Services Secretary Mike Leavitt characterized the SCHIP legislation as "a Washington-run, government-owned plan, where government makes the choices, where government sets the prices, where government then taxes people to pay the bill."

This is a total fabrication.

In fact, both SCHIP and the Medicaid program "use private doctors and private health care plans." Moreover, "it is the states, not Washington, that set the income limits, contract with providers and set provider reimbursement rates, and determine most of the particulars of the health care benefit packages in these programs."

THE TAX SCARE RHETORIC

The increased health coverage for kids would be paid for with an increase of the federal tobacco taxes, from the current 40 cents per pack to one dollar. With the support of tobacco lobbyists, Bush said this week, "If Congress continues to insist upon expanding healthcare through the SCHIP program -- which, by the way, would entail a huge tax increase for the American people -- I'll veto the bill."

But the American people actually support using tobacco taxes to pay for children's health coverage, by a margin of 67 percent to 28 percent. Additionally, as Sen. Orrin Hatch (R-UT) has pointed out, tobacco taxes were used to fund the SCHIP program when it began a decade ago.

Such taxes have additional positive effects: according to the American Medical Association, "for each 10 percent increase in the price of cigarettes, youth smoking is reduced by 7 percent, and overall consumption by 4 percent."

WHAT HAPPENS NEXT

If the SCHIP legislation currently on the table were signed by Bush, roughly 4.1 million children "who otherwise would be uninsured would have health care coverage by 2012," according to the nonpartisan Congressional Budget Office.

Many of these children will manage to maintain some insurance even if Bush wields his veto -- it will just mean a massive additional burden on their state governments. But another 800,000 children "will end up uninsured under the 'budget baseline' (because states would have insufficient federal SCHIP funding to sustain their existing programs)."

Also, "inadequate federal support could mean increased costs to states that do not consider scaling back on children's coverage an option. Private health insurance costs could increase from the cost shifting of uncompensated care and, eventually, Medicare costs could rise as children with unattended health problems become seniors with chronic diseases."

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KATRINA -- FEMA KNOWINGLY ALLOWED KATRINA REFUGEES TO SUFFER FROM 'TOXIC TRAILERS'

An investigation of 5,000 documents subpoenaed by the House Oversight and Government Reform Committee reveals that the Federal Emergency Management Agency (FEMA) received multiple warnings about dangerous levels of formaldehyde in FEMA trailers provided for victims of Hurricane Katrina but refused to conduct testing of occupied trailers because testing "would imply FEMA's ownership of this issue."

Formaldehyde is "reasonably anticipated to be a human carcinogen" and can cause respiratory ailments, allergic reactions of the skin and eyes, and menstrual disorders, to name a few.

In a hearing before the committee, "three people who had lived in the trailers said they believed that exposure to formaldehyde... was the cause of health problems including sore throats, burning eyes and respiratory problems.

FEMA administrator R. David Paulison claimed he was not "100 percent sure that it was the trailers" that caused the health problems, but "Mary C. DeVany, an occupational health and safety engineer advising the Sierra Club, testified that the exposure limit of 0.3 parts per million is 400 times the normal limit for year-round exposure set by the Centers for Disease Control."

Furthermore, the documents "show that the agency repeatedly received complaints from occupants about high formaldehyde levels, but brushed them aside." Several residents complained to FEMA and testified yesterday that FEMA did not warn residents about formaldehyde levels, denied new accommodations, and in one case, said a conference call about the death of a resident due to formaldehyde was "not acceptable."

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Surgeon General Sees 4-Year Term as Compromised

WASHINGTON — Former Surgeon General Richard H. Carmona told a Congressional panel Tuesday that top Bush administration officials repeatedly tried to weaken or suppress important public health reports because of political considerations.

The administration, Dr. Carmona said, would not allow him to speak or issue reports about stem cells, emergency contraception, sex education, or prison, mental and global health issues. Top officials delayed for years and tried to “water down” a landmark report on secondhand smoke, he said. Released last year, the report concluded that even brief exposure to cigarette smoke could cause immediate harm.

Dr. Carmona said he was ordered to mention President Bush three times on every page of his speeches. He also said he was asked to make speeches to support Republican political candidates and to attend political briefings.

And administration officials even discouraged him from attending the Special Olympics because, he said, of that charitable organization’s longtime ties to a “prominent family” that he refused to name.

“I was specifically told by a senior person, ‘Why would you want to help those people?’ ” Dr. Carmona said.

The Special Olympics is one of the nation’s premier charitable organizations to benefit disabled people, and the Kennedys have long been deeply involved in it.

When asked after the hearing if that “prominent family” was the Kennedys, Dr. Carmona responded, “You said it. I didn’t.”

In response to lawmakers’ questions, Dr. Carmona refused to name specific people in the administration who had instructed him to put political considerations over scientific ones. He said, however, that they included assistant secretaries of health and human services as well as top political appointees outside the department of health.

Dr. Carmona did offer to provide the names to the committee in a private meeting.

Bill Hall, a spokesman for the Department of Health and Human Services, said that the administration disagreed with Dr. Carmona’s statements. “It has always been this administration’s position that public health policy should be rooted in sound science,” Mr. Hall said.

Complete Story Here

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Bush Plans To Veto Expansion Of Health Program For Children
BY ROBERT PEAR
The New York Times, LA Daily News

 
WASHINGTON — The White House said Saturday that President Bush would veto a bipartisan plan to expand the Children's Health Insurance Program, drafted over the last six months by senior members of the Senate Finance Committee.
That puts Bush at odds with the Democratic majority in Congress, with a substantial number of Republican lawmakers and with many governors of both parties, who want to expand the popular program to cover some of the nation's 8 million uninsured children.

Tony Fratto, a White House spokesman, said: "The president's senior advisers will certainly recommend a veto of this proposal. And there is no question that the president would veto it."

The program, which insured 7.4 million people at some time in the last year, is set to expire Sept. 30.

The Finance Committee is expected to approve the Senate plan next week, sending it to the full Senate for action later this month.

Sen. Max Baucus, the Montana Democrat who is chairman of the committee, said he would move ahead despite the veto threat.

"The Senate will not be deterred from helping more kids in need," Baucus said. "The president should stop playing politics and start working with Congress to help kids, through renewal of this program."

The proposal would increase current levels of spending by $35 billion over the next five years, bringing the total to $60 billion. The Congressional Budget Office says the plan would reduce the number of uninsured children by 4.1 million.

The new spending would be financed by an increase in the federal excise tax on tobacco products. The tax on cigarettes would rise to $1 a pack, from the current 39 cents, with proportionate increases for other tobacco products.

Fratto, the White House spokesman, said, "Tax increases are neither necessary nor advisable to fund the program appropriately."

"Congress needs to deliver a bill the president can sign," or a simple extension of the existing law, "so people don't worry about losing their current coverage," Fratto said. Federal and state officials, however, said the current level of spending was not adequate to continue coverage for all the people now on the rolls.

Democrats in the House would go much further than the bipartisan Senate plan. They would add $50 billion to the program over five years, bringing the total to $75 billion. By contrast, in his latest budget request, Bush proposed an increase of $5 billion over five years, which would bring the total to $30 billion.

White House officials said the president had several other reasons to veto the bipartisan Senate plan.

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HEALTHCARE -- BUSH ATTACKS POPULAR CHILDREN'S HEALTH PROGRAM

Speaking at a White House event last week, President Bush "criticized a push by Democrats and some moderate Republicans to broaden a popular children's insurance program," the State Children's Health Insurance Program (SCHIP).

Supporters of the program want "to take incremental steps down the path to government-run healthcare for every American," said Bush. Despite Bush's spin, what supporters actually want is to make sure millions of children don't go without health coverage.

The current program covers more than 6 million youths nationally, a large percentage of whom come from low-income working families. "Legal authority for the program expires in a few months, and its reauthorization is generally considered the most important healthcare decision Congress will make this year." Both Democrats and moderate Republicans want "to use the reauthorization as a springboard to provide coverage" to the roughly 7 million children who are still uninsured.

According to Sherry Glied, a Columbia University professor who studies the uninsured, SCHIP "seems to be the main explanation" for why "the number of uninsured children has dropped from about 10 million to about 7 million from 1997 to 2006. 

In a statement Wednesday, Senate Majority Leader Harry Reid (D-NV) said it was "disheartening" that Bush is "opposing" a "plan to provide health coverage to millions of American children."

The Senate Finance Committee is expected to take up the measure soon. "Policymakers should firmly reject proposals that seek to promote private coverage standards at the expense of children's health and well-being, and ensure, instead that SCHIP builds upon its record of providing appropriate, high-quality coverage to our nation's children," stated Karen Davenport, the director of health policy at the Center for American Progress. 

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VITAMINS - FDA

Despite suspect safety, dietary supplements receive little oversight


McClatchy Newspapers

WASHINGTON - The $22 billion dietary supplement industry operates with minimal oversight from the U.S. Food and Drug Administration, despite a history of suspect quality and safety - and independent lab tests that have found one in four products to be substandard.

About one in four dietary supplements tested don't meet quality or safety standards, according to former FDA research scientist William Obermeyer, a co-founder of the independent testing firm, ConsumerLab.com, which tests thousands of supplement products.

Some are tainted with pesticides, salmonella, glass, bacteria or heavy metals such as lead and cadmium. Others fail for a variety of reasons, including a lack of ingredients, improper ingredients, failure to disintegrate properly and mislabeling.

Because manufacturers seek low-cost ingredients, Obermeyer said it's a safe bet that some of the tainted products contain ingredients from China, which typically are cheaper.

Under a 1994 federal law, most dietary supplements - vitamins, minerals, herbs, amino acids and other substances such as enzymes and metabolites, which are taken orally and intended to augment the diet - don't need to be registered or approved by the FDA.

FDA inspections have found supplement manufacturing plants with pest infestations, defective equipment and pipes that leak liquid onto products.

"There's no question the vitamin supplement area is as susceptible, if not more, to this type of adulteration," said ConsumerLab President Tod Cooperman.

But after more than 10 years of development, the FDA still hasn't set minimum standards for the safe manufacture of dietary supplements. Instead, manufacturers set their own standards.

Because supplements are classified as food, they aren't regulated by the same strict guidelines that govern drugs. Supplement manufacturers are responsible for ensuring that their products are safe and include all the ingredients listed on the package label.

And like food manufacturers, supplement makers don't have to record, review or provide the FDA with reported injuries or illnesses that result from their products. Reporting is voluntary, although information typically is provided willingly.

If safety, health or mislabeling problems develop, the FDA can restrict or remove a supplement from the market. Drugs, on the other hand, must be deemed safe and effective before they can be prescribed or sold.

China's emergence as a leading ingredient supplier for the supplement industry has raised new fears since a recent pet food scare was traced to adulterated Chinese wheat gluten. Earlier this year, a shipment of bacteria-contaminated vitamin A from China also was flagged before it could be added to infant formula in Europe. And the FDA will start testing toothpaste imported from China after a poisonous ingredient used in antifreeze was found in Chinese-made toothpaste in Panama.

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HEALTH CARE -- FDA REMAINS A 'BROKEN' AGENCY:

The U.S. Food and Drug Administration (FDA) is suffering from "growing internal dissension between officials who approve drugs and those who track the safety of drugs after they have been approved."

This "dissension" was made public last month when it was revealed that FDA had ignored indications that Avandia, a diabetes pill, "substantially increased the risks of heart attack" in patients.

The FDA's "safety group recommended months ago that the drug agency put its severest warning on Avandia." As of yet, no action has been taken. Dr. David Graham, who first discovered Avandia's risks, said that "top agency officials had demanded an unreasonable level of certainty about a drug's risks before agreeing to warn the public" and another FDA doctor said, "Safety is just not a high priority to them."

Such safety concerns were also raised last week when the FDA reported that "levels of a chemical used to make rocket fuel" -- known as "perchlorate" -- "found in commonly consumed food are not high enough to pose a health risk."

The Washington Post reports, however, that current standards adopted in 2005, are "more than 20 times the amount of perchlorate contamination in food found to be safe under previous standards." The Natural Resources Defense Council has opposed the new levels and argues that "new FDA estimates show that some food items 'come perilously close to what EPA considers an unsafe level.'"

Members from both houses of Congress have pledged to address both of these issues in the coming weeks.

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Lawmakers push for change in food safety oversight
By David S. Martin
Story Highlights

• Lawmakers pushing to put all food safety oversight under a single federal agency
• 12 federal agencies, 35 laws govern food safety
• USDA oversees meat and poultry; FDA governs eggs and produce
• Since 2003, FDA has cut field staff by 12 percent, from 2,217 to 1,962


(CNN) -- Spurred by deadly outbreaks of E. coli and other food-borne pathogens, a group of U.S. lawmakers is pushing to put all food safety oversight under a single federal agency.

"I believe the food safety system is broken. It's collapsing," Rep. Rosa DeLauro, D-Connecticut, told CNN "We're unable to protect the public health. We're unable to protect public confidence in the food supply."

DeLauro has introduced the Food Safety Act of 2007, which would create a Food Safety Administration responsible for ensuring the security of the food supply from all forms of contamination.

Sens. Dick Durbin, D-Illinois, and Chuck Schumer, D-New York, introduced a companion bill in the Senate.

The proposed legislation comes on the heels of a number of widespread outbreaks of food-borne illness.

An E. coli outbreak in spinach last year killed three people and sickened more than 200. The FDA has confirmed 22 outbreaks of E. coli O157 linked to fresh leafy greens (20 lettuce, 2 spinach) since 1995. Half of those were linked to bagged salads.

Further fueling public concern, more than 400 people fell ill between last fall and this spring after eating peanut butter contaminated by salmonella spread by a sprinkler system.

In March, growing reports of sick and dying cats and dogs led to a recall of pet food whose maker had used melamine-laced food additives from China. Chickens and hogs that had consumed pet food remnants were withheld from slaughter for a time out of concerns about human melamine consumption.

Currently, 12 federal agencies and 35 laws govern food safety, often with overlapping jurisdictions and different priorities.

The U.S. Department of Agriculture and the U.S. Food and Drug Administration play the biggest roles in making sure the food Americans eat is safe. The USDA oversees meat and poultry, while the FDA is responsible for eggs and produce.

The lines are not always clear-cut. For example, cheese pizzas fall under the FDA, while pepperoni pizzas fall under the Department of Agriculture.

In January, the Government Accountability Office added federal oversight of food safety to its list of "high risk" programs in need of "broad-based transformation." The GAO urged Congress to consider "a fundamental re-examination of the system ... before public health and safety is compromised."

Critics point to the FDA, in particular, as needing reform. The FDA oversees 80 percent of the food supply but receives only 20 percent of the funding.

"I call it 'Katrina on your plate.' You've got an agency, the FDA, that's understaffed, under-funded, without leadership, and it's not doing its job. And it's causing a real life suffering and death for people," said Andrew Kimbrell, director of the Center for Food Safety, a nonprofit watchdog group in Washington.

By the FDA's own accounting, the agency is operating under a $135 million shortfall. Since 2003, the FDA has cut field staff (inspectors and their support staff) by 12 percent, from 2,217 to 1,962. Inspections dropped 32 percent during the same period, according to FDA budget documents.

Robert E. Brackett, director of the Center for Food Safety and Applied Nutrition at the FDA, defended the job his agency is doing in an interview with CNN chief medical correspondent Dr. Sanjay Gupta.

"I think food is very safe in this country, by and large," Brackett said. "In fact, according to the CDC [Centers for Disease Control and Prevention] statistics, it appears to be getting even safer over the last few years."

According to the CDC, each year there are 76 million incidents of food poisoning, leading to 325,000 hospitalizations and 5,000 deaths.

Recurring outbreaks linked to produce have prompted a number of congressional hearings on food safety in recent months, but even the biggest proponents of overhauling government oversight of the food supply are not predicting passage of the Safe Food Act this year.

"We've begun a process," DeLauro said. "I believe more and more that my colleagues on both sides of the aisle are realizing that the public health is at risk."

A new Food Safety Administration isn't needed because USDA and FDA investigators already work well together to track and stop food-borne illness, Agriculture Department spokesman Keith Williams said.

The FDA's Brackett said he supports any change that would make food safer, but added that protections in place now may be lost in the transition to a single agency.

David S. Martin is a senior producer with CNN Medical News.

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Republicans Block Drug Price Bill in Senate


WASHINGTON (Reuters) - A bill that would let the U.S. government negotiate prices for Medicare prescription drugs stalled in the U.S. Senate on Wednesday when Republican opponents blocked a vote on the legislation.

Senate Majority Leader Harry Reid fell five votes short of the 60 needed to end a Republican filibuster and move to a vote on the bill. A filibuster is a tactic for delaying or obstructing legislation by making long speeches.

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Senate Democrats Block Republican Move for Cuts in Medicare
By ANDREW TAYLOR
Associated Press


WASHINGTON (AP) The Senate easily defeated conservative Republicans' efforts to curb the Medicare program's spiraling growth as debate on a $2.9 trillion budget outline for 2008 entered a third day Thursday.

And a vote was likely Friday on a bid by Sen. Gordon Smith, R-Ore., to put lawmakers on record in favor of increasing taxes on tobacco to pay for a big boost in a popular program providing health insurance for children from poor families.

On Medicare, the Senate voted 74-23 to dismiss a proposal by Sen. John Cornyn, R-Texas, to trim $34 billion from the program's $2.2 trillion budget over the next five years. His plan was aimed at reducing payment increases to Medicare providers and was roughly half the size of the cost curbs President Bush proposed in February.

A move by Sen. John Ensign, R-Nev., to require well-off Medicare beneficiaries to pay higher premiums for prescription drugs was subsequently defeated by a 52-44 vote.

The twin moves are the types of steps Congress would consider if it turned to overhauling Medicare to absorb the influx of retiring baby boomers in coming decades. But the efforts also exposed the difficult politics of cutting the popular Medicare program that delivers health care and prescription drugs to the elderly.

Republicans, said Sen. Sherrod Brown, D-Ohio, "come to the floor of this chamber ... over and over, from every different direction they attack one of the single greatest programs that this government has ever done."

Cornyn said his amendment "might be a little unpopular back home, but you know that's what happens when you go on a budget. We've been on a binge with no limitation on spending, and it's time for the federal government, like the American family, to get on a budget."

Smith's plan for tobacco taxes faced uncertain prospects. His nonbinding amendment says lawmakers should consider increasing taxes in the future on a pack of cigarettes by as much as 61 cents, to $1. Such a move could raise up to $35 billion over five years to eliminate chronic budget shortfalls in the popular State Children's Health Insurance Plan.

The budget before the Senate has already been rewritten under pressure from moderate Democrats eager to go on record as favoring extending $180 billion worth of popular tax cuts that are to expire at the end of the decade.

The move, however, erased a $132 billion surplus predicted to appear in five years under the Democrats' original budget.

In fact, once the increased tax cuts' effect on federal borrowing costs are calculated, the Senate Democratic budget would produce a $6 billion deficit in 2012 instead of the surplus originally promised.

More votes on taxes loom Friday, with Democratic supporters of cutting the estate tax in a particularly ticklish position. They face a difficult vote on a move by Jon Kyl, R-Ariz., that mirrors a plan by Mary Landrieu, D-La., to establish a $5 million exemption from the estate tax, and a 35 percent tax rate on estates that exceed that level.

In any event, the Democratic-controlled Congress, like its GOP predecessors, is not expected this year to follow up with binding legislation on the estate tax or any of the Bush-backed tax cuts that expire in 2010. Those debates are expected after the 2008 presidential election.

Both the Senate Democratic budget and a House counterpart approved by the House Budget Committee early Thursday morning envision big spending increases to domestic programs, including homeland security, education, and health care.

The immediate impact of the House and Senate budget blueprints for next year is to award increases above inflation to domestic agencies for the portion of their budgets passed each year by Congress.

The Senate's plan would give nondefense programs an $18 billion increase, about 4 percent more than current spending. The House measure proposes a $25 billion increase, almost 6 percent.

Both Democratic plans adopt Bush's $145 billion budget for the wars in Iraq and Afghanistan next year, as well as his double-digit increases for core Pentagon operations.

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HEALTH CARE -- BUSH ADMINISTRATION BRUSHES ASIDE CITIZENS' GROUP REPORT ON HEALTH CARE:

The Bush administration "rejected key recommendations from a citizens' group asked by Congress to find out people's health care wishes."

The Citizens' Health Care Working Group, submitted its report to the White House on Sept. 29, 2006, after "hearing from about 6,500 people at 84 meetings."

According to the Group's mission statement, it must foster "a nationwide public debate about improving the health care system to provide every American with the ability to obtain quality, affordable health care coverage" and develop "an action plan for Congress and the President to consider as they work to make health care that works for all Americans."

Some of its recommendations included a "guaranteed package of health benefits for everyone" by 2012, and the "creation of an independent, nonpartisan group to select those benefits, such as an annual breast cancer exam or physical."

Under federal law, Bush had 45 days to submit a response, which would have been Nov. 13; the White House's response came four months late.

Additionally, neither the White House nor the Department of Health and Human Services "issued a statement acknowledging receipt of the report when it came out."

The White House's unceremonious response to the Group's report last week, said that while the President "agrees it is important to make health care more affordable and expand insurance coverage," he disagreed with the Group's solutions.

Yet the American public is fed up with the Bush administration's approach to health care; 71 percent believe our health care system is in a state of crisis. Sixty-nine percent of Americans believe the federal government has the responsibility to ensure all Americans have health care coverage.

Wal-Mart, AT&T, the Service Employees International Union (SEIU), the Center for American Progress, and other businesses and non-profit organizations have launched a campaign to ensure "universal health coverage" by 2012.

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Marijuana Gains Wonder Drug Status
By Lester Grinspoon, Boston Globe

A new study in the journal Neurology is being hailed as unassailable proof that marijuana is a valuable medicine. It is a sad commentary on the state of modern medicine -- and US drug policy -- that we still need "proof" of something that medicine has known for 5,000 years.

The study, from the University of California at San Francisco, found smoked marijuana to be effective at relieving the extreme pain of a debilitating condition known as peripheral neuropathy. It was a study of HIV patients, but a similar type of pain caused by damage to nerves afflicts people with many other illnesses including diabetes and multiple sclerosis. Neuropathic pain is notoriously resistant to treatment with conventional pain drugs. Even powerful and addictive narcotics like morphine and OxyContin often provide little relief. This study leaves no doubt that marijuana can safely ease this type of pain.

As all marijuana research in the United States must be, the new study was conducted with government-supplied marijuana of notoriously poor quality. So it probably underestimated the potential benefit.

This is all good news, but it should not be news at all. In the 40-odd years I have been studying the medicinal uses of marijuana, I have learned that the recorded history of this medicine goes back to ancient times and that in the 19th century it became a well-established Western medicine whose versatility and safety were unquestioned. From 1840 to 1900, American and European medical journals published over 100 papers on the therapeutic uses of marijuana, also known as cannabis.

Of course, our knowledge has advanced greatly over the years. Scientists have identified over 60 unique constituents in marijuana, called cannabinoids, and we have learned much about how they work. We have also learned that our own bodies produce similar chemicals, called endocannabinoids.

The mountain of accumulated anecdotal evidence that pointed the way to the present and other clinical studies also strongly suggests there are a number of other devastating disorders and symptoms for which marijuana has been used for centuries; they deserve the same kind of careful, methodologically sound research. While few such studies have so far been completed, all have lent weight to what medicine already knew but had largely forgotten or ignored: Marijuana is effective at relieving nausea and vomiting, spasticity, appetite loss, certain types of pain, and other debilitating symptoms. And it is extraordinarily safe -- safer than most medicines prescribed every day. If marijuana were a new discovery rather than a well-known substance carrying cultural and political baggage, it would be hailed as a wonder drug.

The pharmaceutical industry is scrambling to isolate cannabinoids and synthesize analogs, and to package them in non-smokable forms. In time, companies will almost certainly come up with products and delivery systems that are more useful and less expensive than herbal marijuana. However, the analogs they have produced so far are more expensive than herbal marijuana, and none has shown any improvement over the plant nature gave us to take orally or to smoke.

We live in an antismoking environment. But as a method of delivering certain medicinal compounds, smoking marijuana has some real advantages: The effect is almost instantaneous, allowing the patient, who after all is the best judge, to fine-tune his or her dose to get the needed relief without intoxication. Smoked marijuana has never been demonstrated to have serious pulmonary consequences, but in any case the technology to inhale these cannabinoids without smoking marijuana already exists as vaporizers that allow for smoke-free inhalation.

Hopefully the UCSF study will add to the pressure on the US government to rethink its irrational ban on the medicinal use of marijuana -- and its destructive attacks on patients and caregivers in states that have chosen to allow such use. Rather than admit they have been mistaken all these years, federal officials can cite "important new data" and start revamping outdated and destructive policies. The new Congress could go far in establishing its bona fides as both reasonable and compassionate by immediately moving on this issue.

Such legislation would bring much-needed relief to millions of Americans suffering from cancer, AIDS, multiple sclerosis, arthritis, and other debilitating illnesses.

Lester Grinspoon, an emeritus professor of psychiatry at Harvard Medical School, is the coauthor of "Marijuana, the Forbidden Medicine."

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Government accused of denying ‘sick and dying’ from obtaining medicine

OAKLAND, Calif. - Armed with a new study showing the drug can ease pain in some HIV patients, medical-marijuana advocates sued the federal government Wednesday over its claim that pot has no accepted medical uses.

The lawsuit, filed in federal court by Americans for Safe Access, accuses the government of arbitrarily preventing "sick and dying persons from seeking to obtain medicine that could provide them needed and often lifesaving relief."

The Food and Drug Administration's position on medical marijuana "is incorrect, dishonest and a flagrant violation of laws requiring the government to base policy on sound science," Joe Elford, said chief counsel for Americans for Safe Access.

California is one of 11 states that have made marijuana legal for people with a doctor's recommendation. But because the U.S. government does not recognize pot's medical benefits, patients can still be arrested by federal authorities.

Last week, researchers from the University of California at San Francisco reported in the journal Neurology that a test involving 50 HIV patients showed that those who smoked pot experienced much less pain than those given placebos.

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HEALTH CARE -- U.S. RANKS NEAR BOTTOM IN CHILD WELFARE:

Among developed nations, the United States ranked second-to-last in child welfare, according to a study released yesterday by the United Nations Children's Fund (UNICEF).

Out of the 21 countries studied, the Netherlands, Sweden, and Denmark topped the first through third slots, respectively, with the United Kingdom faring the worst.

UNICEF used six criteria to compare the nations: material well-being, health, education, relationships, behaviors and risks, and young people's sense of happiness.

Jonathan Bradshaw, a contributing researcher, said kids fared so poorly in the United States because of greater economic inequality and poor social programs
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Nicotine In Cigarettes Rising: Harvard Study
By Jason Szep

The amount of nicotine that smokers typically inhale per cigarette rose by 11 percent from 1998 to 2005, perpetuating a "tobacco pandemic" that makes it harder for smokers to quit, a Harvard study said on Thursday.

Harvard School of Public Health researchers analyzed data submitted by major cigarette brands to the Massachusetts Department of Public Health, which in August released its own study showing nicotine levels steadily rising.

The amount of nicotine that smokers typically consume per cigarette regardless of brand per year rose by an average of 1.6 percent between 1998 and 2005, according to the Harvard analysis of the state's health records.

Massachusetts has required tobacco companies to submit annual reports on cigarette nicotine yields since 1997, longer than any U.S. state.

"Cigarettes are finely tuned drug delivery devices designed to perpetuate a tobacco pandemic," said Howard Koh, the school's associate dean for public health practice and former Massachusetts commissioner of public health.

To boost amounts of nicotine inhaled by smokers, cigarette makers intensified the concentration of nicotine in their tobacco and modified cigarette designs to increase the number of puffs per cigarette, the Harvard researchers said.

"The end result is a product that is potentially more addictive," the study said.

Nicotine yields rose in cigarettes of each of the four major manufacturers and across all major cigarette market categories -- from mentholated and non-mentholated to full-flavored, light and ultralight, the study said.

Phillip Morris, a unit of Altria Group Inc. and the largest cigarette maker, said in a statement its data reported to Massachusetts from 1997 to 2006 reflect "random variations in cigarette nicotine yields, both upwards and downwards."

The nicotine yield in Marlboro cigarettes was the same in both 1997 and 2006 -- at 1.86 mg per cigarette, it added.

R.J. Reynolds Tobacco Co., makers of Camel and Kool cigarettes, said in a statement it does not have a program to systematically increase the nicotine content or smoke nicotine yields of its products.

TOUGHER SCRUTINY URGED

U.S. cigarette sales hit a 55-year-low in 2005 and have fallen steadily since the Master Settlement Agreement between U.S. states and the tobacco industry in 1998 that settled state lawsuits over the costs of treating smoking-related illnesses.

"Our findings call into serious question whether the tobacco industry has changed at all in its pursuit of addicting smokers since signing the Master Settlement Agreement," said Gregory Connolly, director of the Harvard School of Public Health's Tobacco Control Research Program.

He said tobacco companies had failed to warn consumers about rising levels of nicotine since the 1998 settlement, urging U.S. states to step up scrutiny of the industry.

The major companies that signed the agreement are Philip Morris; R.J. Reynolds Tobacco Holdings Inc.; British American Tobacco Plc's Brown & Williamson unit; and Lorillard, which trades as Carolina Group and is part of Loews Corp.

The study received funding from the American Legacy Foundation and the National Cancer Institute.

The U.S. Centers for Disease Control and Prevention considers cigarette smoking the leading preventable cause of death in the United States. About 440,000 people die each year from lung cancer and other diseases related to tobacco use.

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HEALTH CARE -- PAYING MORE, GETTING LESS:

The U.S. health care system is in shambles. Health care costs are increasing faster than wages and nearly 47 million Americans -- 8 million of whom are children -- are uninsured.

Millions more are underinsured. Yet the United States continues to spend more on health care per person than any other country, including countries that provide health care coverage to its entire citizenry.

According to a new report by the Kaiser Family Foundation, in 2003 alone, health spending per person was at least 24 percent higher than that of Luxembourg (the second highest spending country) and over 90 percent higher than countries considered global competitors.

But unfortunately, our health care system spending is not buying us superior health. Americans, on average, die at a younger age compared to the average age of death of comparable nations and the U.S. infant mortality rate is 6.9 deaths per 1,000 live births, while Japan and Sweden have rates below 3.5 deaths per 1,000 live births.

Additionally, U.S. health care resources continue to lag. About 70 percent of deaths and health costs in the U.S. are attributable to chronic disease, which are largely preventable. Yet, only half of recommended preventive services are provided to adults.

The United States also has fewer practicing physicians and nurses per 1,000 people than comparable countries.

The Center for American Progress has a plan to provide every American affordable health care that emphasizes prevention, while controlling costs and maintaining individuals' choice of doctors and plans.

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HEALTH CARE--MEDICARE COVERAGE GAP GROWING, AND FEWER PLANS AVAILABLE TO AVOID IT:

The notorious coverage gap in the Medicare prescription drug plan -- the so-called donut hole -- is growing.

Additionally, state plans designed to plug it are growing scarcer and more expensive, according to a report based on government data by Families USA, a health consumer watchdog group.

The donut hole currently forces seniors to spend between $2,250 and $5,100 without coverage, a gap of $2,850.

In 2007, this gap will grow to $3,051, largely the result of spiraling drug costs.

In 2007, 13 states, including New York, Michigan, and Florida, will offer no plans to cover the gap, up from four states in 2006.

This expansion will leave 6.6 million people without access to donut hole coverage (an 18-fold increase from last year).

Plans in states maintaining coverage will become dramatically more expensive, jumping from a median monthly price of $55.08 in 2006 to $103.20 in 2007, an increase of 87.4 percent.

These findings directly contradict the Bush administration's claim that 2007 will bring "more plans with coverage in the gap," and reinforce the dramatic need for reform. Said Ron Pollack, Executive Director of Families USA: “This coverage gap never made sense, and now it is getting worse...

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HEALTH CARE -- NEW MEDICAID RULES A 'THREAT TO MILLIONS':

Starting tomorrow, 50 million low-income Americans will need to prove their citizenship or "lose their medical benefits or long-term care."

The new Medicaid rules will require recipients to provide a passport or birth certificate as proof of citizenship.

But several million Americans -- including Katrina evacuees, "mentally ill, mentally retarded and homeless people, as well as elderly men and women, especially African Americans" -- may be unable to provide the necessary documents.

Many African-Americans did not receive birth certificates because they were denied access to maternity wards during segregation days.

According to the Center for Budget and Policy Priorities, nine percent of African-American adults lack a passport or birth certificate, compared with just 5.7 percent of adults nationwide.

Another study estimates that "one-fifth of African-Americans born in the 1939-40 period [lack] a birth certificate" and  "[o]btaining required documents may be difficult and costly for low-income citizens," notes the Kaiser Family Foundation.

Low-income citizens, backed by antipoverty groups, have filed a class-action suit challenging the new rules.

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PRIVACY -- SOUTH DAKOTA PASSES ABORTION BAN WITH NO EXCEPTIONS FOR RAPE OR INCEST:

Last week, South Dakota's governor signed into law a bill that bans virtually all abortions in the state, with an exception only if the mother's life is at risk.

But most "polls show that between 70 and 80 percent of the public support access to safe and legal abortion in at least the case of rape and incest," notes Kate Looby of Planned Parenthood.

The South Dakota law is based upon misguided assumptions by lawmakers such as Rep. Bill Napoli (R), who said "most abortions are done out of "convenience."

But on PBS Newshour, Napoli said he could see an exception being made for rape victims if the girl "was a virgin.

She was religious. She planned on saving her virginity until she was married. She was brutalized and raped, sodomized as bad as you can possibly make it, and is impregnated."

Rep. Roger Hunt (R), the main sponsor of the legislation, notes a hypocritical "gray area" he carved into the bill for victims of rape and incest: a woman who goes to the emergency room immediately after being raped would be able to use emergency contraception, but she would have to do it "within the first few days after the assault, before any test can determine whether she was pregnant in the first place.

The lawmakers concluded that it's OK for a rape victim to have an abortion, so long as she doesn't know for certain that she's doing it."

But South Dakota's new law still criminalizes a woman's right to choose.

Seven other states are now considering similar abortion bans. Take action for women's rights here.

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HEALTH -- INTERNAL DOCUMENTS REVEAL FDA PLAYING POLITICS WITH 'PLAN B':

Internal documents made public by Rep. Harry Waxman (D-CA) last week, have raised new questions about the Bush administration's refusal to allow over-the-counter sales of the emergency contraceptive known as "Plan B."

The documents show that, in February 2004, policymakers at the U.S. Food and Drug Administration found no problem allowing the so-called morning-after pill to be sold without a prescription to women of all ages.

Yet 18 months later, former FDA Commissioner Lester Crawford cited concerns about selling the drug to younger teens as a major reason for blocking the move.

The new revelation is just the latest proof that the Bush administration is playing politics with "Plan B."

Last year, the Bush administration promised to make a decision on the issue if Crawford were confirmed by the Senate.

Then, in August 2005, after Crawford was confirmed, the Food and Drug Administration indefinitely postponed its decision on whether the "morning after pill" could be sold to women without a prescription.

The administration has rejected the overwhelming judgment of scientists; instead, it has prioritized politics over women's health.

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HEALTH -- RIGHT-WING WEAKENS FOOD SAFETY:

A Center for Disease Control and Prevention report found the federal government "declined to alert the public about suspect ground beef or request a recall after a 2004 salmonella outbreak that sickened at least 31 people nationwide."

Although the Agriculture Department had traced the source of the salmonella to "a national supermarket chain and a single meat processing plant," they did not ask the company to recall the tainted meat.

"No company has ever refused a recall request."

Meanwhile, the House voted last week to "strip many warnings from food labels, potentially affecting alerts about arsenic in bottled water, lead in candy and allergy-causing sulfites, among others."

The legislation "would prevent states from adding food warnings that go beyond federal law."

Lawmakers "have family, friends and former staff among the lobbyists for the bill" including Abigail Blunt, wife of Rep. Roy Blunt (R-MO); Brad Card, brother of White House Chief of Staff Andrew Card; and former staffers of Majority Leader John Boehner (R-OH).

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HEALTH CARE -- GENERIC DRUG APPLICATIONS REMAIN BACKLOGGED DESPITE PR PUSH:

Food and Drug Administration officials held a news conference announcing the approval of a generic version of the popular allergy spray Flonase.

"The heightened attention may have been intended to rebut criticism in recent weeks that the agency is falling behind in its review of generic-drug applications," the New York Times reports.

Despite a backlog of 850 generic drug applications, the Bush administration has not proposed an increase in the Office of Generic Drugs's budget.

Prescription drug companies are working hard to slow the approval process, as GlaxoSmithKline demonstrated in its treatment of Flonase.

These companies know a generic drug "usually costs 60 to 90 percent less than the brand-name version," and they want to remain one of "the nation’s most profitable" industries.

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HEALTH CARE
’Bush’s plan to screw the poor’

President Bush is proposing slashing health care funding for the poorest Americans, leaving cash-strapped states to pick up the pieces. The administration's budget proposes reducing the federal share of funding for Medicaid – the joint federal/state program that provides health insurance for more than 50 million low-income Americans – by $60 billion over ten years. At the winter meeting of the National Governors Association, which ended Tuesday, the Bush administration tried to convince state leaders to accept the cuts in exchange for "flexibility." Democratic and Republican governors aren't buying it. Gov. Kathleen Sebelius (D-KS) said, "If flexibility comes with $60 billion worth of cuts, that will give us the flexibility to cut off people from health care that they desperately need." Sebelius echoes the sentiments of Gov. Mike Huckabee (R-AR), who said previously, "people need to remember that to balance the federal budget on the backs of the poorest people in the country is simply unacceptable. You don't pull feeding tubes from people. You don't pull the wheelchair out from under the child with muscular dystrophy." Write to your members of Congress and tell them not to let President Bush cut Medicaid.

IT'S ABOUT PRIORITIES, STUPID: President Bush has no problem spending $2.1 trillion over 10 years to extend his tax cuts for the wealthy, but calls $60 billion in federal Medicaid spending unaffordable. The administration suggests states could make up for the funding shortfall by requiring "low-income people to make a co-payment before receiving Medicaid benefits." Secretary of Health and Human Services Mike Leavitt tried this as governor of Utah and ended up reducing hospital admissions, clinic visits and access to prescription drugs for the state's poorest residents. In other words, the plan would "price the neediest people out of basic medical treatment and drive up the number of uninsured people."

THE FAKE CONSENSUS: Nevertheless, Leavitt claimed that "he has support among the nation's governors" for the proposal. That's not true. Interviews conducted by the New York Times "with numerous governors suggest that the consensus described by Mr. Leavitt does not exist."

THE FRAUD FALLACY: Leavitt claims that much of the shortfall can be made up by closing loopholes that supposedly allow "many older Americans...to become eligible for Medicaid by giving away assets to their children." Governors are skeptical of the claim that "millionaires were exploiting Medicaid to gain coverage of nursing home care." Gov. James E. Doyle (D-WI) said, "To suggest that there is widespread abuse and that we can get big savings – really question that." Doyle noted that in most cases "these are hard-working people who have put aside a small amount and desperately want to leave it to their children."

THE REAL IMPACT: While Leavitt and Bush present the cuts as a "streamlining" of the program, the size of the cuts will inevitably mean real consequences for the poor. Some perspective: the cuts Bush is proposing, just in the fifth year of the plan, are "the equivalent of providing health coverage for over 345,000 seniors or almost 1.8 million children."

MEDICAID'S BIG SECRET – IT'S EFFICIENT: Leavitt also is trying to convince governors that the $60 billion can be made up through improving inefficiencies in the system. That's unlikely, since Medicaid is actually quite efficient now. Physician Mark Johnson noted in the Seattle Inquirer, "Medicaid is one of the most cost-effective sources of health coverage among both private and public plans." Johnson points out that "spending growth in Medicaid and in private coverage is comparable – even though Medicaid disproportionately provides services to individuals who require more and costlier care."

Conservatives Bilk Public on Medicare, Cash In With Drug Industry

Rep. Billy Tauzin (R-LA), one of the chief authors of the new Medicare prescription drug law, is set to become the new president of the Pharmaceutical Research and Manufacturers of America (PhRMA), the chief lobbying organization for brand-name drug companies. The Medicare bill poured billions of dollars into drug companies' coffers while doing almost nothing to reduce prices for seniors. The legislation actually forbids Medicare from using its bulk purchasing power to negotiate lower prices on medicines.

       Tauzin could reap more than $2 million per year for selling out elderly Americans to drug interests. Tauzin raised huge sums from the drug companies while in Congress, taking in more than a quarter million dollars from the drug industry since 2000. All in all, he accepted more than $218,000 from drug makers over the past 15 years he's been in office. Rep. Pete Stark (D-CA) summed it up, saying, "As a member of Congress, Billy negotiated a large payout to the pharmaceutical industry by the federal government. He's now about to receive one of the largest salaries ever paid to any advocate by an industry." Those in the business say they believe Tauzin will make at least $2 million a year, if not more, according to the New York Times.

       Tauzin is not the first conservative leader to cash in on drug connections. Last year, the Bush administration's chief of Medicare, Tom Scully, obtained a waiver on a federal ethics rule in order to negotiate a job with the drug industry at the same time he was running the Medicare program. Scully, who threatened to fire the Medicare actuary if he revealed the much higher cost of the legislation to Congress, resigned to become a lobbyist for health care companies. And two top U.S. trade officials, Ralph Ives and Claude Burcky, both left their government jobs this past August to work for the same health care and drug industries they went to bat for in White House trade negotiations with Australia.

       Conservative leaders should defend the interests of the American public rather than the bottom line of pharmaceutical giants.  The Bush administration and its conservative allies have shown their priorities.  Rather than making real reforms to reduce drug costs for seniors, they spend their time in office bilking Americans as they plan their exit strategy into the arms of grateful drug companies.

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