LyrArc Article Gist
Senators Mike Lee of Utah and Jerry Moran of Kansas declare their opposition to the Republican Health Care bill proposed by Senator McConnell. This decision by the two senators makes it impossible to begin debate on the bill. Earlier two other senators, Susan Collins of Maine and Rand Paul of Kentucky announced their opposition. This means the Republican health care bill has no chance in the Senate even after changes to the bill passed by the House of Representatives. Republicans have a thin majority in the Senate make it difficult to pass legislation. Collins met with residents in Maine and Moran with people in his home state of Kansas, and both senators heard a lot about the negative effects of the Republican bill on people in their state. The bill is seen as hurting people in rural areas, elderly, and not likely to do enough to bring down premiums. Its plan to slash Medicaid spending has drawn strong opposition from all Democrats.

LyrArc Article Gist
Total public and private spending on health care in the U.S. will increase by 6.1% in 2014 compared to 2014 in a revised Commerce Department forecast. The total spending will reach $4.1 trillion in 2014 from $3.9 trillion in 2013. Some of the lower rise in spending than the earlier 7.4% forecast will come from 28 states opting out of Medicaid expansion under the health care overhaul because of a June 2012 Supreme Court ruling. Employers are trying to reduce costs and the public is reducing spending because of the recession. Less generous health plans mean users are paying more out of their own pocket, paying more attention to prices and even postponing care. Growth in health care costs is a about 3.9% a year since 2009 following the recession. The costs increase in 2015 by 5.8%, in 2018 by 5.9% and 2022 by 6.5%, according to U.S. government forecasts, because of enrollment in Medicare for baby boomers. This is still higher than the inflation rate of below 2%.

LyrArc Article Gist
The NYT editorial says budget reconciliation should kick in if by a certain date in the fall bipartisan agreement is not reached. With budget reconciliation, the term for a expedited processs, health care legislation can pass by a simple majority vote. NYT says bipartisan agreement is a good thing, but more important is effective health care reform. And there is little evidence of Republican cooperation so far on any issue.

LyrArc Article Gist
An average of major opinion polls compiled by Real Clear Politics website shows 50.5% of Americans opposed to the Obama U.S. health care law.

LyrArc Article Gist
Howard Dean, former Governor of Vermont, where Dean helped set up health care improvements, says the bill currently in Congress for health care reform does not deserve to be called reform and may do more harm than good. He points out that it does not insert competition into insurance markets, does not significantly lower costs, and does not improve the delivery and use of health care services. And few Americans will see any benefits till 2014, by which time premiums will have increased significantly. He sees insurance companies as winers in this bill, and the American taxpayer about to be fleeced with a bailout in a situation that dwarfs even AIG. One of his keen criticisms is already apparent to the public in this health care bill, that clear thinking has been thrown out in favor of compromise and political calculus, and by political moves the bill has been stripped of real reform , the end result being a bill crafted for votes and not to reform health care. It also then sets an irreversible course of how future healthcare reform is done, doing more harm in the future. ...

LyrArc Article Gist
Kerala state of 35 million people who speak the language Malayalam, is one of the rare places today that has only 4 deaths from coronavirus, 524 cases confirmed and no community transmission. Here the Guardian looks at the reasons why. The Health minister KK Shailaja started very early on January 23, with a meeting of her rapid response team when the virus was still in China.  She setup a control room and instructed Kerala's 14 districts to do this on Jan. 24. When the first case arrived on Jan. 27 on a plane from Wuhan, Kerala had already adopted the WHO  protocol of test, trace, isolate and support. These passengers were checked for temperature, tested and quarantined. With some at a nearby hospital and others in home isolation. This is all the more amazing considering that Kerala is a state in southern India on the west coast that has a large number of people living and working overseas. Many are in the Gulf countries and the arrival of these refugees could have triggered a second outbreak. This was prevented by careful testing, and contact tracing of clusters.  When one group was evasive and concealed information from an airport surveillance team -arriving from Venice, Italy,  in late Feb- a case was detected back to them.  Contact tracers tracked down all of the hundreds whom they had been in contact with and quarantined them.  By 23 March all flights to 4 Kerala airports from overseas were stopped, including Cochin and Trivandrum. On March 25 India went into lockdown.  Some of the achievements in Kerala include quarantining 170,000 people early. with strict surveillance, which is now down to 21,000. Accomodating and feeding 150,000 migrant workers from other states, before returning them on charter trains to their home areas. A big reason for the success is the high literacy rate in the state. A big emphasis on education and healthcare is a part of the Kerala model. Shailaja is a secondary school teacher, and Health minister. From the days since independence of India in 1947 the state has a strong socialist tradition of taking care of the basics- health, education and public services. It also generates a part of its GDP with income from workers who are overseas.  Another reason for the success in dealing with coronavirus is experience. The state had a virus epidemic called Nipah in 2018 which has become the story for a movie called Virus in Malayalam. There is decentralized public health system in the state and people value their health care facilities, understand and trust the health care authorites. There are hospitals at every level of administration and 10 medical colleges. But trust and education, experience tackling the virus before, are key. Kerala is showing that poor countries can deal effectively with the virus, and create a better life by adopting the right model of creating good societies that value education, healthcare services, better economic structures and distribution of wealth, and  a degree of trust and responsibility found in a state that values public spiritedness. ...

LyrArc Article Gist
How the French health care system works. France comes in first and the USA 37th in aWHO health care ranking. THe difference in deaths from respiratory disease is half that in the USA, and lower rates of death from heart disease and diabetes. IT has more hospital beds and doctors per capita than the USA. 65% of French people are satisfied with their health system compared to 40% in the USA, and yet France spends 10.7% of GDP on health care and the USA spends 16% for poorer results. THe French system is more generous to its seniors. Unlike Medicare there are no deductibles, just modest co-payments that are often dismissed for chronically ill. And diabetes and critical surgeries are covered 100%. French also buy supplemental insurance like Medigap for extra expenses like dental and eyglasses. Cancer patients are treated free of charge. Avastin treatments costing $48,000 a year are provided at no charge. France's PMI or Protection Maternelle et Infantile, is rated highly. It is anetwork of thousands of healthcare facilities, that ensure that every mother and child in the country receives basic preventive care. Mothers even receive afinancial incentive for attending their pre and post natal visits. France makes this care affordable by reibursing doctors at a much lower rate. The average yearly net income for doctors is around $55,000, about athird of what doctors in the USA make. But French doctors don't have to pay back huge student loans as medical school is paid for by the state and malpractice insurance premiums are only a tiny fraction of that in the USA. And again the French government pays two thirds of the social security tax for most French physicians- which is typically 40% of income. So the $55,000, is more like $92,000 taking that into account and more like $110,000 when student loans and malpractice is taken into account at US levels. Specialists who have 4 or more years experience can charge what they want, but as one gastroenterologist says, there in an unspoken and undefined limit to what you can cahrge or what is socially acceptable. Yet even in France there is inflation in health care costs that the government deals with through price controls and more spending. The French national insurance system is running increased deficits each year and this is now $13.5 billion, and it has led to higher taxes for employers and workers. ...

LyrArc Article Gist
Britain's National Health Service IT initiative failed because of a top down emphasis and focus on procurement. The project was started by Labor in 2002 and budgeted for 12 billion pounds. Lohr talks with Dr. David Brailer, and Dr. David Blumenthal, who headed the program for health IT in the Bush and Obama administrations, and with Richard Alvarez of Canada Health Infoway, which is the nonprofit corporation setup for conversion to electronic health records in Canada. Dr Brailer says the program in the UK was forced top down on doctors and nurses, and seen as a procurement program, ignoring the human aspects related to doctor preferences. Dr. Blumenthal empasized the need for collaborative effort all the way with doctors and nurses in a program of this kind. The confrontation that resulted from the lack of participation by health care professionals led to failure. Britain's new Cameron government ended the program.

LyrArc Article Gist
Health officials around the world, companies, governments, and schools are creating health policy on the fly, and prefer to err on the side of caution in setting policy. The American government said that it would deny entry to foreign citizens who traveled to China in past 14 days, and American citizens returning from Hubei province, china, will be quarantined for 14 days. Major airlines have stopped flights to China. Nothing like this has happened before. A major public health experiment in setting policy is underway, mostly preferring lockdown or quarantine as preferred method. 

LyrArc Article Gist
Coca-Cola is introducing to the US an blended unsweetened tea called Sokenbicha. This tea was originally developed for health conscious young Japanese women. Sales of tea drinks are up 15.6%, while soft drinks are down 5.6%, for the first 10 months of 2010. Soft drinks still make up 47% of ready to drink beverages in the US, according to Beverage Digest, even with the increasing emphasis on the dangers of obesity in the US.

LyrArc Article Gist
Of the people asked the question "what issue do you see as the most important for health care" 44% in a NBC/WSJ poll said they considered Cost as the biggest issue, and 37% said that they considered the Uninsured as the biggest issue, 11% said quality of care was the biggest issue. The President is focussing on cost as he develops the health care plan. He is also saying that to provide health care for all and cover the uninsured without controlling costs would break the bank. Another thing that the White House shows it has learned from previous failed attempts, is that it is doing this with an open Health Care Forum with participation of different sides in the health care discussion. Clinton's effort in 1993 ran into problems because it was developed secretively, and without much discussion, and little effort to get different people's views. The previous attempt also waited too long after the election, and this time the President is moving quickly when he enjoys large popular support. Its also true now that there is serious concern especially in this downturn of what a threat spiralling costs of health care are becoming to the future prosperity of the American people. This time the leaders in Congress are setting an aggressive schedule to get health care palns legislation on the floor by June and get a floor vote in August 2009....

LyrArc Article Gist
In a new WSJ/NBC New poll, conducted July 24-27, 2009, 42% called the Obama health plan a bad idea, and 36% called it a good idea. In mid June the poll showed Americans evenly divided on this question. It reflects rising anxiety over the costs of the health plan and what it will do to the deficit, and also shows public anxiety about the ways in which Obama and Congress are reaching compromises to pay for it and to control costs. Added to this are the anxieties raised about government involvement in healthcare and medical decisions about care. Noteworthy are two differing pieces of evidence. In the WSJ/NBC News poll, only two in ten people thought the quality of their own care would improve, only 15% of those with private insurance thought that it would improve the quality of their care. And 4 in ten people thought quality of care would get worse, and 45% of those with private insurance thought quality of care would get worse. By focussing on the cost of health care, the administration seems to have ignored or missed the concerns of people about the quality of care if government focussed on cutting costs. These concerns are real as a vast majority of the public, or about 85% of the people, as Martin Feldstein points out in a recent Washington Post column, are insured. The question is what cost would they be willing to pay for the admittedly worthy cause of insuring the uninsured? And even with the unisured, it seems likely with the current Obama reform plan that immigrants and other people may still remain uninsured, at least for some time. Would a huge burden of $1 trillion make this worthwhile, and is there some better way to do this without the prospect of higher taxes further down the road to pay for this. These are points Feldstein makes. The other piece of evidence is that at the same time that there are reservations about what is coming out of Congress today, there is general support for making constructive changes to healthcare. The WSJ poll showed 56% of respondents favoring the basic ideas in the reforms being considered in Congress, with 38% opposing it....

LyrArc Article Gist
Peter Orszag's role in the healthcare debate and the formulation of health care policy proposals. One proposal of Orszag, who heads the Congressional Budget Office, is to set up a new agency with powers to cut spending and implement changes in Medicare. Says Orszag, "one of the reasons we have such disjointed and skewed incentives is that we have an excessively political process." At a recent meeting with House Democrats, one Congresswoman said her top priority is winning higher payments for oxygen suppliers, and Orszag was taken aback. For years officials have been trying to cut payments to oxygen and medical equipment suppliers, which are said to be inflated. When a new competitive bidding process was set to take effect last year, industry supporters in Congress were able to delay the plan, and these supporters are still fighting to block changes says the WSJ. Here is a 40 year old Orszag, with degrees from Princeton and London School of Economics, who got his early experience in the Clinton adminstration at age 24. He then followed this with a number of policy oriented jobs, ending with appointment to head CBO in 2007. And he faces the whole system of Congressmen from both parties beholden to interests in the healthcare industry, who provide the donations for them to finance their election campaigns. Dan Eggen describes this in the Washington Post, 7/21/2009. Max Baucus of Montana, and to some extent Grassley of Iowa, are senators from both parties who Eggen points out are beholden to the healthcare industry because of large donations they receive from the interests in the healthcare industry. These interests want to see their payments system protected. The further escalation in health care costs, which would make the whole healthcare system unaffordable even as it delivers poor results, can only be prevented by making cost control an exercize that is not influenced by healthcare industry donations. Jackie Calmes describes the huge hurdles in achieving a deficit neutral move to universal health care in the U.S. in the NYT 6/26/2009. See the link. The exchange between Grassley and Orszag on the issue of the $177 billion in savings needed from the payments to health insurers under the Medicare managed care plans- which allow seniors to obtain Medicare coverage outside the government run program -went as follows. These are dubbed overpayments by outside experts and efforts have been made to cut them in Congress. When Mr Grassley raised concerns about the impact of such cuts in a hearing, -and Grassley has opposed the cut for this overpayment to insurers- Orszag responded saying: "I very firmly believe that capitalism is not founded on excessively high subsidies to private firms. This is what this system delivers right now." ...

LyrArc Article Gist
Baucus is a six term senator from Montana. He won easy re-election in the fall. Question are being raised about the extent of fundraising Baucus is doing even as he is conducting the negotiations for writing up the health care reform bill. He continues to accept donations from health care executives and health care companies. Public Citizen advocacy group says that Baucus's fundraising in the middle of the health care debate is very troubling. As chairman of the Senate Finance Committee, Baucus is a key person in the health care legislation development.The Washington Post says health care companies gave Baucus $1.5 million in 2007 and 2008 as he began to hold hearings for the health care reform debate. The health care industry gave $170 million to federal lawmakers in 2007 and 2008, with 54% going to Democrats, according to the Center for Responsive Politics. Senator Grassley of Iowa, the ranking Republican in Baucus's committee received more than $2 million from the health care industry since 2003. House Ways and Means Committee chairman Rangel took in $1.6 million, and ranking Republican Dave Camp $1 million. Clearly any new health care legislation will fall short on achieving the critical reduction in health care costs that is needed to help the U.S. economy as long as lawmakers are beholden to lobbyists and donations....

LyrArc Article Gist
Problems with China's health care system stem form years of underspending. About 1% of GDP went to healthcare in 2006,according to the WHO, ranking China at No. 156 of 196 nations. This underinvestment has caused great hardship to the rural poor who have postponed or been denied access to healthcare because of exorbitant expenses. It shows up in the number of trained medical workers- only 17% of China's medical workers are university graduates. In village and township clinics the number falls to 2%. The government has dedicated $121 billion for health care through 2011. But this may not be enough. Aobut 300 million in the rural areas have no coverage at all. The government's plan is to get farmers insured through county level rural- cooperative insurance plans. These programs begun in 2003, offer only scanty coverage. Outpatient services and medications are not covered and coverage varies from county to county for hospitalization bills. The goal of th health ministry is to get the coverage for hospitalization bills up to 50%....

LyrArc Article Gist
Leonhardt argues that rationing is rational allocation of limited resources, health care budgets are limited resources even in rich countries like the USA, and if you overpay here you cut somewhere else. Now the cuts that are not noticed he says are in take home pay as employers face increased premiums from insurers. Rationing is taking place all the time with poor health outcomes relative to the cost for poor allocation of resources as survival rate for many diseases are not that much better than other countries. Rationing takes place everyday when patients see doctors only for a few minutes as doctors race to see more patients, and when diseases are not caught early on in the process as doctors do not know their patients well enough. And rationing is taking place as patients simply delay or forego treatments based on the extra cost, or as uninsured get no care. There are so many buzzwords like this thrown around, with doctors, hospitals and insurers and other groups trying to preserve the status quo, even as it is becoming rapidly unaffordable fort the US to be spending so much on health care....

LyrArc Article Gist
The loss of state support in the 1980's resulted in the gradual withering of the health care system in China as individuals bore the brunt of health care costs. Hospitals and clinics shifted to pay as you go system, with the emphasis on prescribing treatment that would boost income including costly tests.

LyrArc Article Gist
Senators Murphy and Cornyn have helped pass legislation on gun control and mental health, public safety, with the support of all Democrats and 15 Senators from Republicans including majority leader McConnell. This comes after shooting in their home states and the two shootings at an elementary school and a supermarket in Uvalde, Texas and Buffalo, New York. The bill passed the Senate 65 to 34 and crossed the 60 vote filibuster threshold which was a barrier in the past. Only two senators from the 15 Republicans are up for election this year, Romney faces an election in 2024, four are retiring and 8 senators of the 15 are up for reelection in 2026. This made a compromise possible separating those who wanted strict gun control from those who want no gun control from the compromise group to achieve a consensus that all could vote for.

 

LyrArc Article Gist
A wealth tax on the wealthiest 1% of the population is being introduced to finance efforts to help middle and lower income families and workers by Finance Minister Maria Montero in Spain.

LyrArc Article Gist
Politico magazine says wealth inequality is a worse situation than a country's income inequality. By this measure the situation has deteriorated badly in the U.S. It cites a study by Thomas Piketty of France with Saez and Zucman, showing that a shocking 75% of household wealth, and 97% of capital income-income generated from dividends, interest and capital gains- is concentrated in the top 10% of households in America. More shocking it says is another study showing that nearly 50% of American households could not come up with $400 in an emergency to meet and unexpected expense, while a tiny fraction controls trillions of dollars in assets. Why is this important? Beyond the obvious short term immediate needs there is the need to build a plan for the future, to be resilient in the face of a job loss or major illness, to seek higher education for job retraining,  to save for a home to retire.  In America the history shows that for most of its history since the founding fathers, in the 1750's the situation was that of a rising tide for all sections of society interrupted by the breakdown during post tech boom failures in the 1890's and 1930's. This is embodied in the Declaration of Independence itself the perception of this as something to be taken for granted- "we hold these truths to be self-evident, that all men were created equal and endowed by their creator with certain inalienable rights ..." One proposal is for a universal income. Others are for employees to have ownership in the business that they work for and contribute their skills. Setting up Permanent Funds that pay dividends to all citizens of a state. Some of these proposals are being considered in Britain by the Labour Party, and Democrats in the U.S. as they forge ways to tackle the rising inequality in Britain after a decade of austerity cuts, and in the U.S. after the tech boom and regional inequality.  ...

LyrArc Article Gist
German Heath Minister Karl Lauterbach says vaccine mandates are the only way out of this pandemic. Speaking to German daily Welt he said, gaining immunity through infection was a "dirty vaccination" that made little sense as it would not protect one against a more harmful variant. He saiid that it "would be naive to think that omicron is the end of the pandemic." Omicron would not make one immune to the next viral variant. "No one can guarantee that a variant will not develop soon that is much more dangerous."

Lauterbach says 25 million doses of the Moderna vaccine have been procured that would be enough for 50 million booster shots to be done in the first quarter of 2022.

LyrArc Article Gist
Margot Sanger-Katz of the NYT provides an excellent summary of winners and losers under the new Republican House healthcare bill that passed the House in a 217-213 vote on May 4, 2017. On the whole middle income people and higher income people stand to benefit, with sharp cuts in Medicaid, and higher premiums as well as smaller subsidies based on age affecting older people. Pre-existing conditions and minimum benefits are included as in ACA, with the provision that states can in some ways limit that coverage. Employers are no longer required to provide mandatory health coverage, helping large and small business owners.