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Crafty_Dog
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« Reply #150 on: May 08, 2009, 10:55:20 AM »

Listen. That sound of silence? That's what's known as the united Republican response to President Barack Obama's drive to socialize health care.

The president has a plan, and he's laid it on the table. The industry groups that once helped Republicans beat HillaryCare are today sitting at that table. Unions are mobilized. A liberal umbrella group, Health Care for American Now, is spending $40 million to get a "public option," a new federal entitlement that would kill off private insurance. Democrats passed a budget blueprint that will allow them to cram through that "public option" with just 51 votes.

Republicans? They're trying to figure out what they think.

Well, not all of them. Earlier this week I ended up in the office of Oklahoma Sen. Tom Coburn, where the doctor was hosting North Carolina Sen. Richard Burr. The duo is, for the second time, crafting a comprehensive reform that would lower costs, cover the uninsured, and put Americans in control of their health care. And while the senators decline to talk GOP politics, their bill raises the multitrillion-dollar question: Will the party have the nerve or sense to coalesce behind some such conservative alternative to the Democratic product?

They'd better, because the days of Republicans winning these battles solely by spooking Americans are over. Phil Gramm, Harry and Louise might have scored with that approach in the 1990s, but the intervening years have brought spiraling costs and public unrest. Americans want a fix. Democrats promise one. The GOP can't tank the public option simply by complaining it will kill private insurance. The party has to finally elucidate how it plans to allow the private market to work.

Not that the senators don't think Republicans need to make clear to the country that the public option is, in Mr. Burr's words, "a fast track to a single-payer system." But they are also operating on the belief that Republicans must go beyond Band-Aid solutions to embrace, as Mr. Coburn puts it, a "complete transformation" of a system that is "structurally" flawed.

Their own bill overhauls the tax code, currently stacked in favor of corporate employees, to provide a tax credit to every American to purchase insurance. It expands health-savings accounts. It creates state health-insurance exchanges, where private insurers compete to cover Americans, including the uninsured. (This is partly modeled on the Medicare drug program, which has provided seniors with choice and held down costs.)

More broadly, it seeks to reorient financial incentives so that the system is no longer focused, as Mr. Coburn puts it, on "sick care," but on preventing the chronic diseases that eat 75% of health expenditures. These incentives would be used to lower costs and discourage insurers from cherry-picking patients. The bill also dives into Medicare and Medicaid reform.

Yet no small number of Senate Republicans are biding their time in Max Baucus land, waiting to see what the Democratic finance chairman produces as a "bipartisan" product. (Read: A bill the president wants.) This crowd has taken to heart Mr. Obama's accusation that they are the party of "no," and think it might be easier to be the party of Baucus, or the party of Baucus-lite, or the party of nothing whatsoever.

The White House is targeting folks like Chuck Grassley, Orrin Hatch and other Senate Republicans who back in 1997 voted for the State Children's Health Insurance Program, which was pitched by Democrats at the time as a modest program to help poor kids. It has, of course, become exactly what Democrats always intended it to be: a ballooning federal entitlement that is today transferring middle-class children from private insurance onto the federal rolls. This might be thought of as a teachable moment. But now Republican "moderates" are all ears for the administration's soothing suggestions that perhaps the "public option" can be "structured" so as to protect private insurance. Uh-huh.

Another group of Republicans are still going 50 rounds over taxes -- namely, whether a deduction isn't a more principled and cleaner way than credits to equalize the tax treatment of insurance. This is a legitimate debate, but one that should've been had 10 years ago when Republicans were in the majority. While the GOP fiddled, Democrats focused the argument on "uninsureds," which has made a tax deduction (which would only cover those who pay taxes) even less politically palatable.

Over in the House time runs on, as the Republican leadership and a health-care working group continue to noodle over platforms, policies, egos and timing. Democrats intend to be debating their bill by June.

As for Messrs. Coburn and Burr, they spent a good half hour with me enthusiastically explaining why a competitive market would improve health, provide control and choice, lower costs, and tackle entitlements. It's a good pitch. If only the rest of America could hear the party make it.
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Crafty_Dog
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« Reply #151 on: May 11, 2009, 10:49:25 AM »

So Democrats have declared their willingness to use a parliamentary tactic to force a far-reaching restructuring of U.S. health care through Congress on a partisan vote. Imagine if Tom DeLay had tried to do that on, say, Social Security. Would Democrats have rolled over?

On the one hand, President Obama and his party say they're hoping to strike a good-faith compromise on health care. On the other, they're threatening this "budget reconciliation" maneuver to coerce Republicans into rubber-stamping liberal policy. And if the GOP won't oblige, Democrats say they'll add a new multitrillion-dollar liability to the federal fisc anyway, using a process that was designed to cut spending and reduce the deficit.

The political game here is that Democrats want to use this threat to peel off a handful of GOP Senators before the bill comes to the floor in June. That would short-circuit this year's health-care debate before it begins. Their targets include the likes of Chuck Grassley, Orrin Hatch, Susan Collins and Olympia Snowe, all of whom bowed to the Democrats in 2007 on expanding the state children's insurance program (Schip). But those were minor stakes compared to this year's battle, especially over the so-called public option for health insurance.

This new entitlement -- like Medicare but open to all ages and all incomes -- would quickly crowd out private insurance as people gravitated to heavily subsidized policies, eventually leading to a single-payer system. So Democrats are trying to seduce diffident Republicans with a Potemkin compromise. A "soft" public option would limit enrollment only to the uninsured or those employed by small businesses, or include promises that the plan will pay market rates. As recently proposed by Chuck Schumer, it would pay claims entirely with premiums and co-pays. But if the plan can't force down reimbursement rates through brute force, and doesn't get taxpayer dollars, why bother to "compete" with private plans?

The truth is Democrats know that any policy guardrails built this year can be dismantled once the basic public option architecture is in place. The White House strategy is to dilute it just enough to win over credulous Republicans. That is what has always happened with government health programs:

When Medicare was created in 1965, benefits were relatively limited and retirees paid a substantial percentage of the costs of their own care. But the clout of retirees has always led to expanding benefits for seniors while raising taxes on younger workers.

In 1965, Congressional actuaries expected Medicare to cost $3.1 billion by 1970. In 1969, that estimate was revised to $5 billion, and it actually came in at $6.8 billion. That same year, the Senate Finance Committee declared a Medicare cost emergency. In 1979, Jimmy Carter proposed limiting benefits, only to have the bill killed by fellow Democrats. Things have gotten worse since, and Medicare today costs $455 billion and rising.

Medicaid was intended as a last resort for the poor but now covers one-third of all long-term care expenses in the U.S. -- that is, it has become a middle-class subsidy for aging parents of the Baby Boomers. Its annual bill is $227 billion, and so far this fiscal year is rising by 17%.

Schip was pitched a decade ago as a safety net for poor kids, and some Republicans helped sell it as a free-market reform. But Schip is now open to families that earn up to 300% of the poverty level, or $63,081 for a family of four. In New York, you can qualify at 400% of poverty.

Any new federal health plan will inevitably follow the same trajectory, no matter how much Republican Senators might claim they've guaranteed otherwise. The Lewin Group consultants estimate that 119 million people who now have private insurance could potentially be captured by the government under the Obama public option. This is on top of the 90 million already in Medicare or Medicaid. This would guarantee a spending explosion that would over time lift federal outlays as a share of GDP into the upper 20% range or higher. Republicans would spend the rest of their days deciding whether to vote for tax increases to finance this, or stand accused of denying health care to the middle class.

This doesn't mean the die is cast. Democrats also know that durable reforms in America have typically passed with bipartisan majorities. They understand that a national health plan that passes on partisan lines could be pared back as unaffordable or unfair, the way the "catastrophic" health plan for seniors was repealed in 1989.

As New Hampshire Republican Judd Gregg recently told us, Democrats also don't want their swing-state Senators to have to defend such a partisan process in the 2010 election. That's why they're eager for even the veneer of bipartisanship that three or four GOP Senators would provide. And that's why they're willing to threaten a procedural bludgeon to intimidate Republicans to provide that veneer.

This health-care debate isn't like the "stimulus" bill, which was largely about short-term spending and deficits. This one is about whether to turn 17% of the U.S. economy entirely and permanently into the arms of the government. For Republicans, this is about whether they still stand for anything at all.
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ccp
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« Reply #152 on: May 11, 2009, 12:12:05 PM »

Oh really?  How?
It sounds like special interest group panic at the thought of BO in charge.
All weird to me:

Obama lauds industry offer to contain health costs
WASHINGTON – President Barack Obama has praised health industry groups for coming forward with an offer to reduce the growth of spending by $2 trillion a year to overhaul the system.

Obama appeared at the White House with an array of industry figures, including union representatives, and called it the occasion "historic."

Industry figures pledged that they would voluntarily slow their rate increases over the next 10 years.

Obama said the step the industry took Monday must be carried out as part of "a broader effort" to change the health care system, keep costs under control and provide health insurance for the some 46 million Americans who do not now have it.

He said, "I will not rest until the dream of health care reform is achieved in the United States of America."

THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.

WASHINGTON (AP) — Health industry groups are promising to reduce the growth of spending by $2 trillion over 10 years by improving coordination, focusing on efficiency and embracing better technology and regulatory reform.

Hospitals, insurance companies, drug makers and doctors have told President Barack Obama in a letter that they'll voluntarily slow their rate increases in coming years. It's a move that government economists say would create breathing room to help provide health insurance to an estimated 50 million Americans who now do not have it.

The industry letter released Monday said "these and other reforms will make our health care system stronger and more sustainable."

It's a change from the time in the early 1990s when then-President Bill Clinton took on health care reform and industry leaders fought back.

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Crafty_Dog
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« Reply #153 on: May 12, 2009, 12:02:49 AM »

By SCOTT GOTTLIEB
At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.

 
Chad Crowe
 Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.

Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage.

The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty.

Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan.

Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals.

The 60% of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. But it also includes tens of thousands of primary-care doctors, the very physicians the Obama administration says need the most help.

Doctors will consolidate into larger practices to spread overhead costs, and they'll cram more patients into tight schedules to make up in volume what's lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists.

Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice.

These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves.

So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy.

But while Medicare has stumbled with these efforts, private health plans have made notable progress on similar payment reforms. Private plans are more likely to lead payment reform efforts because they have more motivation than Medicare to use pay as a way to achieve better outcomes.

Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level.

Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care; or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes.

There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients.

Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans.

There are also measures available that could fix structural flaws in our delivery system and make coverage more affordable without top-down controls set in Washington. The surest way to intensify flaws in the delivery of health care is to extend a Medicare-like "public option" into more corners of the private market. More government control of doctors and their reimbursement schemes will only create more problems.

Dr. Gottlieb, a former official at the Centers for Medicare and Medicaid Services, is a fellow at the American Enterprise Institute and a practicing internist. He's partner to a firm that invests in health-care companies
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ccp
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« Reply #154 on: May 12, 2009, 08:59:53 AM »

Isn't this the same Gottleib who wrote a biotech newsletter for Gilder?

"Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care;"

This I want nothing to do with.  Do you want your doctor deciding between ordering more care or saving him/herself money at every turn?   This "option" is something that I am reading more and more about and its not a good idea.

"or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes."  This is too general a statement.  If he means better BP control, better diabetes control - mabye.


"There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients."

Why in the part above he points to ways that increase insurance carriers management between doctors and patients.  So it winds up being wealthier people can afford to pay off the carriers to not intrude into that relationship.

"Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans."

I don't know.  Lower income Americans already pay little in taxes.  Gottleib actually thinks this will make it easier and cheaper for Small Business to pay for employee health care?  Tax credits to these people?  Isn't the tax code already too complicated?

Folks, Gottlieb makes it sound like its so simple and the answers are staring us in the face.
There really is only one answer that is staring me in the face.  You want to hold down costs, you want to add tens of millions of people to the roles.  Than we have to ration care.   There is no other answer.  Paying providers based on "outcomes" is often a code word for this folks.  It is based on large populations, not an individuals unique medical situation.  You will have liberals in DC and Boston, and New Haven deciding what is  best and that will become the dictum. 
Yes waste can be squeezed out of the system but it will never do enough of what the politians are saying it will without significant rationing of care. 
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ccp
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« Reply #155 on: May 12, 2009, 10:51:45 AM »

"and limit government management over what are inherently personal transactions between doctors and patients"

One other thought.

Ther real question is thus should private insurance carriers limit care or government?

That is the "to be or not to be question" at the bottom line.

So who would one rather have limiting or controlling care?  Private insurance administrators or government bureaucrats?

Personally I don't have a fondness for either.
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Body-by-Guinness
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« Reply #156 on: May 12, 2009, 08:47:26 PM »

http://www.reason.com/news/show/133439.html


Health Care Corporatism Arrives

Consumers will pay the price if government partners with the health care industry

Ronald Bailey | May 12, 2009

In the past few months, Americans have seen their government essentially seize control of one sector of the economy after another. Federal authorities now tell the automobile, banking, credit card, and insurance industries what products and services to offer, all while hiring and firing industry executives in order to implement government orders.

Health care represents the latest frontier in this drive to centrally manage the American economy. Yesterday, the country's major health care producers, including insurance companies, hospital and physician organizations, pharmaceutical companies, and health care labor unions, promised President Barack Obama they would reduce the growth rate of their future incomes by 1.5 percent over the next ten years. If those cuts actually happened, it would mean that in 2019 health care costs (both government and patient) would be $700 billion lower than current projections, reducing health care spending by $2 trillion over the next ten years.

Why would the industry agree to this preemptive surrender? Because it means the end of competition. Under the proposed agreement, the government would guarantee a certain level of profit for each health care producer. From the industry's point of view, the goal is to get a seat at the table as politicians and government technocrats "reform" health care—which means it will decide who the winners and losers will be.

There's a word for when the government directs the production of goods and services and divides the economic pie: corporatism. The Concise Oxford Dictionary of Politics succinctly defines coporatism as "a system of interest intermediation linking producer interests and the state, in which explicitly recognized interest organizations are incorporated into the policy-making process, both in terms of the negotiation of policy and of securing compliance from their members with the agreed policy."

If the coporativist bargain works out as they plan, both insurers and hospitals expect to profit from the government mandating health insurance coverage for all Americans. Insurers look forward to millions of new customers who will have to buy insurance either individually, through their employers, or through government vouchers. In addition, since the government will set rates and benefits, health insurers won't have to bother with the vexing problem of competition. Of course, state and federal mandates and regulations have already taken us a ways down this road, but corporativist "health care reform" should eliminate any lingering vestiges of consumer choice. For their part, hospitals will have plenty of newly-insured patients to fill their wards and will no longer need to offer uncompensated care to the health care indigent.

As for the pharmaceutical companies, they have experienced rapidly increasing price controls over the years. For example, the Obama administration's 2010 budget lowers what Medicare will pay for drugs from 15 percent below average price to 22 percent below average. In agreeing to the corporativist bargain, those companies hope to get a better deal and to prevent the adoption of cost-benefit tests for the approval of new drugs.

Along similar lines, Medicare and Medicaid price controls have been squeezing doctors' fees for decades. As the federal government either converts private insurance companies into minutely regulated public utilities, creates a rival government health care payment system, or simply adopts a national single-payer (government entitlement) system, doctors rightfully worry that their fees will drop even further as government bureaucrats attempt to slash costs. But with a seat at the health care negotiating table, doctors hope to make the best out of a very bad situation. Interestingly, health care labor unions will probably emerge as the biggest winners in this corporatist arrangement, because they'll be able to extract higher than market wages from politicians dependent on union votes.

In his remarks welcoming the "historic" concessions by the health care industry, President Barack Obama noted that health care "costs are out of control." The goal of corporatist health care reform is to cut those costs. It's a noble aim. The only problem is that the one surefire way to cut costs is completely off the bargaining table: competition. Producers certainly won't reduce costs unless competitors force them to do so. And why would they? Reducing costs means reducing incomes.

Indeed, costs in our current health care system rise faster than the rate of inflation precisely because there is so little competition. The third party payment system, where employers or government agencies pay for insurance, gives consumers few incentives to shop around and bid down prices. On top of that, the federal and state governments have piled so many mandates on insurers that consumers are offered little more than one-size-fits-all policies with similar rates.

It's no secret the current health care system is rife with inefficiencies. But without effective competition, there will be no effective way to discover them and root them out. Competition incentivizes consumers and competitors to eliminate inefficiencies. The notion that wise government regulators can wring them out is beyond laughable.

Consider the recent announcement that a line-by-line review of the federal budget by the Obama administration found just $17 billion in savings from $3.6 trillion budget. That's far less than one half of 1 percent of the total budget. And the constituencies who benefit from that $17 billion are now mobilizing to oppose even those absurdly modest cuts. Just like producers who have no competition, federal agencies have no incentive to improve or to cut their budgets. History shows that the government agencies cut health care "costs" chiefly by imposing price controls on the private sector.

Corporatism represents an ugly deal between governments and producers. The hospitals, doctors, pharmaceutical companies, and health care labor unions hope that the corporativist bargain will guarantee future profits while eliminating competition. Perhaps it will, perhaps it won't. But there's absolutely no question that corporativist health care will increase inefficiencies, stifle innovation, and reduce consumer choice. That's a disastrous deal for the rest of us.

Ronald Bailey is Reason magazine's science correspondent. His book Liberation Biology: The Scientific and Moral Case for the Biotech Revolution is now available from Prometheus Books.
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G M
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« Reply #157 on: May 12, 2009, 09:54:00 PM »

http://hotair.com/archives/2009/05/12/video-are-the-elderly-cost-effective/

Logan's Run, anyone?
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Body-by-Guinness
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« Reply #158 on: May 13, 2009, 12:40:00 PM »

How ObamaCare Will Affect Your Doctor
Expect longer waits for appointments as physicians get pinched on reimbursements.
By SCOTT GOTTLIEB

At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.

Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.

Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage.

The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty.

Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan.

Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals.

The 60% of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. But it also includes tens of thousands of primary-care doctors, the very physicians the Obama administration says need the most help.

Doctors will consolidate into larger practices to spread overhead costs, and they'll cram more patients into tight schedules to make up in volume what's lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists.

Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice.

These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves.

So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy.

But while Medicare has stumbled with these efforts, private health plans have made notable progress on similar payment reforms. Private plans are more likely to lead payment reform efforts because they have more motivation than Medicare to use pay as a way to achieve better outcomes.

Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level.

Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care; or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes.

There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients.

Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans.

There are also measures available that could fix structural flaws in our delivery system and make coverage more affordable without top-down controls set in Washington. The surest way to intensify flaws in the delivery of health care is to extend a Medicare-like "public option" into more corners of the private market. More government control of doctors and their reimbursement schemes will only create more problems.

Dr. Gottlieb, a former official at the Centers for Medicare and Medicaid Services, is a fellow at the American Enterprise Institute and a practicing internist. He's partner to a firm that invests in health-care companies .

http://online.wsj.com/article/SB124208383695408513.html
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ccp
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« Reply #159 on: May 15, 2009, 10:19:23 AM »

I disagree with most of this.
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Crafty_Dog
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« Reply #160 on: May 16, 2009, 12:10:36 AM »

Ok, I'll beg-- please tell us why  cheesy
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Body-by-Guinness
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« Reply #161 on: May 18, 2009, 05:44:29 PM »

May 18, 2009, 4:00 a.m.

Alternative to Obamacare
A new plan, courtesy of Richard Burr and Tom Coburn.

By Duncan Currie

Without much fanfare, Sens. Richard Burr (R., N.C.) and Tom Coburn (R., Okla.) have become leading advocates of market-based health reform. This week they will introduce their alternative to Obamacare. It has no chance of passing in the current Congress.

But it does signify progress for GOP health-care reformers, who recognize that if Republicans are to improve their credibility on this issue, they must offer their own proposals for reducing costs and expanding coverage. Among other things, the Burr-Coburn bill would establish an advanceable, refundable tax credit for health insurance, worth nearly $2,300 for individuals and just over $5,700 for families. This would make coverage more affordable for the self-employed, the unemployed, and those whose employers don’t provide health benefits — all of whom lose out under the current employer-based system. It would also help workers who are between jobs or are dissatisfied with their employer-provided insurance.

Meanwhile, the legislation would make Health Savings Accounts (HSAs) more attractive by removing the tax penalty on health-insurance premium payments made with HSA money, and by raising the ceiling on annual HSA contributions. In addition, the bill would let High Deductible Health Plans — which are paired with HSAs — cover preventative services.

HSAs were first introduced as part of the 2003 Medicare Modernization Act. In January, Diamond Management & Technology Consultants reported that, while the recent expansion of the HSA market had been “slower than expected,” HSAs “have become an integral element of the consumer-directed health-care trend.” According to Diamond, HSAs grew at an average annual rate of almost 70 percent between 2005 and 2008. Diamond reckons that the number of HSA accounts will swell to at least 11 million and perhaps as high as 13 million by 2012, at which point those accounts will have $35 billion–$45 billion in total assets.

Burr and Coburn also want to create State Health Insurance Exchanges that would function as marketplaces for consumers. These exchanges would have safeguards to protect patients with preexisting conditions. States would also have the opportunity to form new health-insurance pools.

The bill does not shy away from entitlement reform. It would subsidize the transfer of certain low-income families from Medicaid to private insurance plans, an important step in ensuring that these Americans have ready access to health care. It would also restructure how federal and state governments share the burdens of Medicaid and Medicare; revamp the Medicare Advantage program; establish Medicare Accountable Care Organizations; and force wealthy Medicare recipients to pay more for the services they receive under Medicare Part B.

Nancy Pelosi has declared that the goal of health-care reform is to achieve “quality, affordable, accessible health care for all Americans.” The Burr-Coburn legislation would not guarantee “universal” insurance coverage, but it would make quality health insurance and care more affordable and accessible. Conservative policy wonks will doubtless find nits to pick in the bill, and it’s unclear how many Republicans will embrace the Burr-Coburn approach. In recent years, says former GOP whip Rep. Roy Blunt, “no more than two dozen” Republican House members have been deeply engaged in the health-care issue. That is now changing, thanks in large part to the challenge of defeating Obamacare.

As the debate unfolds, Americans will be swamped with data and projections. Analysts at McKinsey and Co., the consulting giant, have compiled some especially striking numbers. According to Diana Farrell, Eric Jensen, and Bob Kocher, “the United States spends $650 billion more on health care than might be expected given the country’s wealth and the experience of comparable members of the Organization for Economic Cooperation and Development (OECD).” Outpatient care — which now constitutes 65 percent of all American health care, compared with 43 percent in 1980 — accounts for roughly two-thirds ($436 billion) of that $650 billion. Today, U.S. health-care spending represents about 17 percent of GDP. Based on present trends and historic growth rates, Jean Drouin, Viktor Hediger, and Nicolaus Henke estimate that this figure could rise to 30 percent by 2040 and to more than 50 percent by 2080.

As Farrell, Jensen, and Kocher observe, most Americans do not have “any real value consciousness” when it comes to health-care costs, partly because they are heavily insulated from those costs: “In the United States, the ‘average’ consumer of health care pays for only 12 percent of its total cost directly out of pocket (down from 47 percent in 1960), as well as for 25 percent of health-care insurance premiums, a share that has stayed relatively constant for the last decade.” Meanwhile, much of the information about health-care pricing remains inaccessible. The Burr-Coburn bill would set up a new commission designed to make this information more transparent.

Politicians from both parties have warned that soaring health-care spending is unsustainable and could lead to a fiscal and economic disaster. Just last week, a new report from the Medicare trustees announced that the Medicare Part A trust fund will be “exhausted” by 2017. Total Medicare expenditures are projected to reach of 11.4 percent of GDP in 2083, compared with 3.2 percent of GDP today. “Growth of this magnitude, if realized, would substantially increase the strain on the nation’s workers, Medicare beneficiaries, and the Federal Budget,” the report states.

Of course, Democrats and Republicans disagree sharply about how to rein in health-care spending. But Americans could do their part by making certain lifestyle and dietary changes. Farrell, Jensen, and Kocher reckon that the overall decline in the health of the U.S. population from 2003 to 2005 raised medical costs by between $20 billion and $40 billion. A new study published in the peer-reviewed journal PLoS Medicine calculates that in 2005, smoking was responsible for one-third of all deaths from cancer and high blood pressure was responsible for 45 percent of all deaths from cardiovascular diseases.

The Burr-Coburn legislation notes that roughly 75 percent of American health-care expenditures go toward the treatment of five chronic but “largely preventable” diseases, and it would give states new incentives to lower the rates of these diseases. The bill would boost health-education efforts. It would also allocate $50 million a year to make vaccines more widely available and reward states that meet a vaccine coverage target.

The health-care showdown is bound to be fiercely contentious, given its sweeping implications. As countless pundits have remarked, the political terrain looks much different today than it did in 1993 and 1994, when President Clinton took his ill-fated stab at transforming the U.S. health system. Republicans are fighting an uphill battle. But the Burr-Coburn bill indicates that at least some of them are serious about developing their own version of comprehensive reform.

— Duncan Currie is deputy managing editor of National Review Online.
National Review Online - http://article.nationalreview.com/?q=MjBjYjBmMGVjYzE5MGJiZmM4YjExNTUxZDVhNDk3ODU=
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ccp
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« Reply #162 on: May 18, 2009, 07:43:17 PM »

I really don't have answers and was not playing coy.  It is that complicated.  Gottlieb it seems to me makes a lot of assumptions.
Some of his solutions are experimental.
Some doctors would do better if more people were covered, not worse.
I guess it depends on the saturation of doctors in the area.
Not many doctors could survive on cash only practices. No one would show up.
Or this one, Medicare's incentives are wrong.  Payments increase for those who stay sick.
Well of course.  The more one's legal problems persist the more one pays lawyers.  The more one's house falls apart the more we spend fixing it.
Were talking chronic progressives diseases.  Not problems that can be fixed forever in most instances.
Or pay based on outcomes?  Every human being and every situation is unique.

What about this one:

"The Burr-Coburn legislation notes that roughly 75 percent of American health-care expenditures go toward the treatment of five chronic but “largely preventable” diseases, and it would give states new incentives to lower the rates of these diseases. The bill would boost health-education efforts."

So is this implying if we live healthier 75% of health care costs could go away?

What kind of a statement is this?

Has this guy ever heard of aging?

I don't know.  The more I read about opinions on what should be done the more I think no one has a clue.


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HUSS
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« Reply #163 on: May 18, 2009, 09:02:39 PM »

So is this implying if we live healthier 75% of health care costs could go away?

What kind of a statement is this?

Has this guy ever heard of aging?

I don't know.  The more I read about opinions on what should be done the more I think no one has a clue.




You guys sure do have a lot of fat people in the U.S.  Im always disturbed by the amount of fat people riding around on scooters when i go to American walmarts.  I'll bet that if you got rid of obesity your health care costs would go down dramatically.
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HUSS
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« Reply #164 on: May 18, 2009, 09:07:21 PM »

My opinion on this topic causes me to be flamed quite a bit here in Canada, but here it goes.  Universal health care should not exist period.  taxes should be lowered and people should be forced to buget.  But that is not going to happen.  The next best thing would see people who are fat, smoke or drink pay a massive sur charge for access to health care.  and before you say it, i have an older brother who is a drunk and one 6pak away from needing a liver transplant.  My thoughts are, if he cant afford to pay for his selfish life style why should i.  Have fun in the next life bro, hope the bar is closed on the other side.  Maybe im cold, but i have grown tierd of seeing selfish people cause others to suffer.
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G M
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« Reply #165 on: May 18, 2009, 09:09:40 PM »

Huss,

Um, every time i've gone to Canada, the population looks pretty.....American.

Aside from Looneys and liters, it's hard to tell i'm in a different country.
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G M
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« Reply #166 on: May 18, 2009, 09:36:56 PM »

http://www.forbes.com/2007/02/07/worlds-fattest-countries-forbeslife-cx_ls_0208worldfat_2.html

Rank   Country   %
1.   Nauru   94.5
2.   Micronesia, Federated States of   91.1
3.   Cook Islands   90.9
4.   Tonga   90.8
5.   Niue   81.7
6.   Samoa   80.4
7.   Palau   78.4
8.   Kuwait   74.2
9.   United States   74.1
10.   Kiribati   73.6
11.   Dominica   71.0
12.   Barbados   69.7
13.   Argentina   69.4
14.   Egypt   69.4
15.   Malta   68.7
16.   Greece   68.5
17.   New Zealand   68.4
18.   United Arab Emirates   68.3
19.   Mexico   68.1
20.   Trinidad and Tobago   67.9
21.   Australia   67.4
22.   Belarus   66.8
23.   Chile   65.3
24.   Venezuela (Bolivarian Republic of)   65.2
25.   Seychelles   64.6
26.   Bahrain   64.1
27.   Andorra   63.8
28.   United Kingdom   63.8
29.   Saudi Arabia   63.5
30.   Monaco   62.4
31.   Bolivia   62.2
32.   San Marino   62.1
33.   Guatemala   61.2
34.   Mongolia   61.2
35.   Canada   61.1
36.   Qatar   61.0
37.   Uruguay   60.9
38.   Jordan   60.5
39.   Bahamas   60.4
40.   Iceland   60.4
41.   Nicaragua   60.4
42.   Cuba   60.1
43.   Germany   60.1
44.   Brunei Darussalam   59.8
45.   Slovenia   59.8
46.   Peru   59.6
47.   Vanuatu   59.6
48.   Finland   58.7
49.   Jamaica   57.4
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Crafty_Dog
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« Reply #167 on: May 18, 2009, 10:54:02 PM »

"You guys sure do have a lot of fat people in the U.S."

Reminds me of a very international after dinner conversation in Bern, Switzerland.  We were riffing on national stereotypes.  I asked what the stereotype was of Americans.  "Fat people in shorts with white socks" came the answer.  Ouch!!!
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Body-by-Guinness
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« Reply #168 on: May 19, 2009, 08:18:40 AM »

How Washington Rations
ObamaCare omen: a case study in 'cost-control.'
Try to follow this logic: Last week the Medicare trustees reported that the program has an "unfunded liability" of nearly $38 trillion -- which is the amount of benefits promised but not covered by taxes over the next 75 years. So Democrats have decided that the way to close this gap is to create a new "universal" health insurance entitlement for the middle class.

Such thinking may be a non sequitur, but it will have drastic effects on the health care of all Americans -- and as it happens, this future is playing out in miniature in Medicare right now. Desperate to prevent medical costs from engulfing the federal budget, the program's central planners decided last week to deny payment for a new version of one of life's most unpleasant routine procedures, the colonoscopy. This is a preview of how health care will be rationed when Democrats get their way.

At issue are "virtual colonoscopies," or CT scans of the abdomen. Colon cancer is the second leading cause of U.S. cancer death but one of the most preventable. Found early, the cure rate is 93%, but only 8% at later stages. Virtual colonoscopies are likely to boost screenings because they are quicker, more comfortable and significantly cheaper than the standard "optical" procedure, which involves anesthesia and threading an endoscope through the lower intestine.

Virtual colonoscopies are endorsed by the American Cancer Society and covered by a growing number of private insurers including Cigna and UnitedHealthcare. The problem for Medicare is that if cancerous lesions are found using a scan, then patients must follow up with a traditional colonoscopy anyway. Costs would be lower if everyone simply took the invasive route, where doctors can remove polyps on the spot. As Medicare noted in its ruling, "If there is a relatively high referral rate [for traditional colonoscopy], the utility of an intermediate test such as CT colonography is limited." In other words, duplication would be too pricey.

This is precisely the sort of complexity that the Democrats would prefer to ignore as they try to restructure health care. Led by budget chief Peter Orszag, the White House believes that comparative effectiveness research, which examines clinical evidence to determine what "works best," will let them cut wasteful or ineffective treatments and thus contain health spending.

The problem is that what "works best" isn't the same for everyone. While not painless or risk free, virtual colonoscopy might be better for some patients -- especially among seniors who are infirm or because the presence of other diseases puts them at risk for complications. Ideally doctors would decide with their patients. But Medicare instead made the hard-and-fast choice that it was cheaper to cut it off for all beneficiaries. If some patients are worse off, well, too bad.

Medicare is already the country's largest purchaser of health care. Private carriers generally adopt its rates and policies, and the virtual colonoscopy decision may run this technology out of the marketplace. Now multiply that by the new "public option" that Democrats favor, which would transfer millions of patients to a new insurance program managed by the federal government. Washington's utilitarian judgments about costs would reshape the practice of medicine.

Initially, the open-ended style of American care will barely be touched, if only for political self-preservation. Health planners will adjust at the margins, as with virtual colonoscopy. But scarcity forces choices. As the Medicare trustees note in their report, the tax increases necessary to fund merely the current benefit schedule for the elderly would cripple the economy. The far more expensive public option will not turn into a pumpkin when cost savings do not materialize. At that point, government will clamp down with price controls in the form of lines and rock-bottom reimbursement rates.

Mr. Orszag says that a federal health board will make these Solomonic decisions, which is only true until the lobbies get to Congress and the White House. With virtual colonoscopy, radiologists and gastroenterologists are feuding over which group should get paid for colon cancer screening. Companies like General Electric and Seimens that make CT technology are pressuring Medicare administrators too. More than 50 Congressmen are demanding that the decision be overturned.

All this is merely a preview of the life-and-death decisions that will be determined by politics once government finances substantially more health care than the 46% it already does. Anyone who buys Democratic claims about "choice" and "affordability" will be in for a very rude awakening.

http://online.wsj.com/article/SB124268737705832167.html
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JDN
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« Reply #169 on: May 19, 2009, 08:55:34 AM »

"Nearly everyone wants to limit the costs of rising medical care."
"Nearly everyone wants the newest and best technology"

Unfortunately, these two statements are not congruous.  Choices, difficult choices must be made.

Of course, "Companies like General Electric and Seimens that make CT technology are pressuring Medicare administrators too."
Whether needed or not, that's how GE makes it profits and why it pays it's lobbyists. 

Yet the National Cancer Institute says;
"While there is always room for technological improvements, we need to do a better job of using the current screening technologies. Because, despite their limitations, they have been proven effective in reducing the burden of disease."

Where do you draw the line at costs?

Is a virtual colonoscopy more patient friendly?  Sure.  In most cases does it produce any better results? No.  Does it cost more?  A lot more...

So someone needs to make the tough choices.  Individuals seem to want the newest and best, regardless if the results are the same and regardless of the cost
since they don't individually pay for it.  The "insurance company pays" or "Medicare pays" yet in reality we all pay.
And new technology will continue to be pushed by corporations.  Do you really think they have our best interest at heart?

IF we go to a National Health Care Plan maybe it should offer basic care WITHOUT all the bells and whistles?  Sure you have to wait.  And maybe you don't get
the latest technology.  Or the newest wonder/experimental drugs.  But as a nation, at least everyone would have basic coverage.

And perhaps there is room for supplemental coverage?  My father has Medicare, but he pays a fortune (money well spent) for his excellent supplemental care.  But it is
a choice on the table.

My point is that we cannot have our cake (newest technology) and eat it (affordability) too.  One/We must choose.

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ccp
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« Reply #170 on: May 19, 2009, 09:16:22 AM »

JDN - that's it in a nutshell.  Speaking of vitual colonoscopy the imaging lobbyists who were set to make a bundle doing this test were of course outraged it was not approved for reimbursement by Medicare.  Of course it is all in the goal of better patient care.
And of course the gastroenterologist who may (or may not) lose out were delighted in the name of patient care that it was not approved.  Who does one believe?
Bottom line your right.  We either ration care, or we don't provide care to all, or/and we go broke.

And who does Gottlieb work for now?

"Medicare Shoots Down Virtual Colonoscopy Reimbursement (GE, SI)
Posted: May 12, 2009 at 4:26 pm

Today was a big day for the world of colonoscopies and the battle in detecting colon cancer and polyps.  The Center for Medicare and Medicaid Services issued a final decision that Medicare would not cover the reimbursement for virtual colonoscopies.  This is a blow for the medical imaging sector, particularly for leaders such as General Electric Co. (NYSE: GE) and Siemens AG (NYSE: SI).  This is also a blow in the battle for detecting of polyps or early stages of colon cancer.

The CMS noted in its memo, “The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test….  CT colonography for colorectal cancer screening remains noncovered.”

Whether you have to get a colonoscopy done the old fashioned way or virtually it still requires the material you have to consume to clear out the bowels.  The difference of a virtual or traditional method is rather simple.  The CT machine scan is a relatively non-invasive procedure besides an ingestion of a chemical marker and requires no real sedation followed by a CT/MRI scan.  For the traditional exam, sedation is required and a fiber optic camera on a flexible tube is inserted through the anus and snaked up all the way through your intestine.  Guess which one is more desirable if you are the patient.

Detecting colon cancer while it is a mere polyp or in the very early stages is far better from a cost-basis, a quality of life basis, and on the basis of what is a better use of the medical system.  The belief is that there would be many more colonoscopies conducted if this was approved in a virtual manner, and in theory much fewer colon cancer cases.  The downside to the virtual colonoscopy is that if polyps (or worse are detected, then a traditional colonoscopy and then whatever procedure would be required anyhow.

This is perhaps one of the first tests of what may or may not be coming down the pipe with the new healthcare system, yet this decision may be independent of any of the comparisons between the healthcare system of today versus the system of tomorrow.  Some form of universal healthcare is much more likely than ever.  That will be a welcome wagon for the army of uninsured or underinsured Americans.  For the rest of us we all really want to know what the new system will really be, and what sort of service we can expect.

When it comes to old fashioned colonoscopies versus the virtual colonoscopies, the CMS just said “Up Yours!”… Quite literally in this case."

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Body-by-Guinness
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« Reply #171 on: May 19, 2009, 10:35:58 AM »

Don't have an issue with any of the economic realities being mentioned, though I do have one with some of the pronouns being bandied. Who is this "we" that's gonna determine how health care is rationed? The current debate employs so much smoke and so many mirrors that informed constituencies are hard to find in the first place, and then many of the mechanisms being discussed for use in "solving" health care finance issues are regulatory in nature and hence make it hard to identify lawmakers who can be held accountable when a program fails. There is so much obfuscation employed on all sides of the issue and so many of the mechanisms lay so far beyond the control of most voters that I have a hard time accepting that "we" are much of an actor in this passion play.

My read on the current single payer effort is that it will paint the sunniest face on they type of care it seeks to shill, make all sorts of promises, suck folks into it's system, and then at some point declare "golly gee willikers, we have unfunded mandates that dwarf the $35 trillion deficit projected for Medicare and hence have to ration care." Never heard of a system that adopted single payer going back to a more market based solution--once you get folks suckling at the teat there are too many "wheet wheets" to move 'em off--so a one size fits all single payer system becomes what you're stuck with.

Make all the legiscreatures and their staffs adopt the system they seek to peddle for four years first. If it works then they can try to make the sale.
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DougMacG
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« Reply #172 on: May 19, 2009, 11:13:13 AM »

CCP and all , thanks for health care info.  One piece said the virtual was cheaper (assuming no follow up invasion is needed) and I think another said virtual costs more (maybe because of the follow up).  I will be getting quotes soon.  I have only major medical coverage so I will be the ever so rare, cost-conscious patient.  We have family history of colon cancer - I should have done this starting at age 45.  The photo sounds a lot better to me than the snake.  Besides the cost, I think I have snake through anus phobia.  Now at 52 and change I should be a fine candidate for a free one at a medical university (wiulling to travel) - any suggestions? 

As a polical matter, liberals contend that health care is much better in western Europe than the US but then they measure it in percentage insured.  I would measure heath care systems by survival rates of the worst ailments we are most likely to face.  For men here that include prostate and colon cancer (women - breast concer etc.)and I think survival rates are much higher in the US.(?)  http://coloncancer.about.com/od/stagesandsurvivalrate1/a/CCSurvivalCount.htm
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JDN
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« Reply #173 on: May 19, 2009, 12:00:19 PM »

Doug, on the medical side (CCP) can do a much better job, but it is my understanding that IF (God forbid) there is a problem or question, and a biopsy is needed,
the regular (up your....) colonoscopy will still need to be done; you pay double.

As for health care being better or worse, I think one needs to look at overall mortality, not just mortality from a select few diseases.  And in doing so you will find that
we lag many industrialized countries.  By the way, I too have a High Deductible Major Medical policy.

Regarding your colon cancer example, yes, our High Technology (think high cost) can often assure a higher mortality rate after cancer has been discovered, BUT as your own article
points out, "Colon cancer survival rates vary throughout the world. Quality of care is one reason, but another is colon cancer screening programs. In general, the earlier colon
cancer is detected, the easier it is to treat."
  Japan (national health care) at much less cost than the USA has an equal or better colon cancer survival rate
than we do. (again see your posted article).  And they definitely do not have any better technology or talent.

So if people simply get a basic colonoscopy, catch it early, the easier it is to treat.  Yet, as you pointed out, cost is a very real issue.  Given you family history, no doubt whatever the cost
you should proceed with the test, but would you pay the money without the family history to wake you up?  I question that...  Yet, if a basic colonoscopy was "free" (no out of pocket)
I bet you might consider doing so and therefore hopefully catch the disease in the early stages. 
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Body-by-Guinness
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« Reply #174 on: May 19, 2009, 01:43:16 PM »

Please keep in mind that the comparative survival rate data can lead to a lot of apple and oranges conflation. Many industrial nations have far more stringent immigration/citizenry requirements that skew things. If you do your comparisons across similar demographics all of a sudden many of the gaps shorten significantly. Compare immigrant communities, or blacks living at the poverty line across countries and you'll find those numbers similar, though the US has a greater percentage of the population that fits those categories and hence its overall survival rate data skews that direction.
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JDN
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« Reply #175 on: May 19, 2009, 02:00:40 PM »

Gee, and I thought France and England were going to $%^& due to their liberal immigration policy and
growing ghetto areas?   smiley

As for Japan (little immigration) they have an aging population which translates into higher morbidity yet
they still have a better mortality rate.


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Body-by-Guinness
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« Reply #176 on: May 19, 2009, 05:22:52 PM »

Gee back at you, how 'bout Sweden, Norway, Holland, Switzerland, Finland, and so on? I'm sure there are many others, but I don't follow this issue as part any health debate, but I do as part of the firearm rights debate where, what do you know, rates of firearms crime stays pretty consistent across ethnic groups in various contiguous countries, which suggest a strong cultural component is involved.

But hey, since you asked the question how 'bout you do some follow up research? The UK already cooks its books where its crime figures are concerned, do they do the same with health outcomes? Are non-citizen immigrants counted among the data? Much of the recent car torching and rioting in France was caused by non-citizen immigrants annoyed about economic opportunities, or the lack thereof, in France; are they counted as citizens in health stats? If not, what would that do to the curve?

BTW, I deal all day with folks who think facile deconstruction of a point is the acme of argumentation, and regularly then hand them their fannies. Doubt you're aware you consistently employ the same tactic and so would like to suggest you add a couple more tools to your rhetorical tool box.
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JDN
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« Reply #177 on: May 19, 2009, 06:32:42 PM »

What does firearm rights have to do with health care? huh
By the way, since you brought it up, I am in favor of firearm rights for all adult individuals.

And I didn't ask any health care question...  So no interest in doing additional research.

As for my tool box, it's fine thank you, as is my fanny.  You might check yours though.   
It might be kind of sore lately...
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Crafty_Dog
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« Reply #178 on: May 20, 2009, 05:10:42 AM »

Now, now, gentlemen, lets stick to the merits of the subject matter at hand , , ,
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Body-by-Guinness
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« Reply #179 on: May 20, 2009, 08:03:32 AM »

Whoa, parallel universe alert. . . .
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Crafty_Dog
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« Reply #180 on: May 20, 2009, 08:07:44 AM »

 huh
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Body-by-Guinness
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« Reply #181 on: May 20, 2009, 09:51:47 AM »

huh

Sorry for the confusion, it's just on a regular basis when I read one of JDN's responses I feel like I've encountered some sort of rift in space and time.
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Crafty_Dog
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« Reply #182 on: May 20, 2009, 10:21:17 AM »

Not that I ever read them, but a HS friend who read the Cliff Notes version told me that in Plato's writings of the conversations with Socrates that there was a member of the group who asked questions seen by most of the rest of the group as foolish.   I wonder how Socrates dealt with his questions?
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JDN
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« Reply #183 on: May 20, 2009, 10:34:44 AM »

According to Plato's Apology, Socrates' life was that of being the "gadfly" of Athens.

Sometimes I too feel like I am the Gadfly of this forum.   smiley
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Body-by-Guinness
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« Reply #184 on: May 20, 2009, 12:33:23 PM »

Would suggesting "hemlock" be too coarse a response?
« Last Edit: May 20, 2009, 12:38:56 PM by Body-by-Guinness » Logged
JDN
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« Reply #185 on: May 20, 2009, 02:20:49 PM »

Socrates is seen as a wise and benevolent father figure, martyred for his intellectual beliefs.
After Socrates' death opinion in Athens turned against his accusers.
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Crafty_Dog
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« Reply #186 on: May 21, 2009, 12:06:36 AM »

Ummm , , , JDN , , , I was thinking of you less in the role of Socrates and more in the role of "a member of the group who asked questions seen by most of the rest of the group as foolish"  cheesy
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JDN
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« Reply #187 on: May 21, 2009, 12:21:22 AM »

Ummmm Marc, I somehow got that... I just chose to ignore it  smiley

My final post was to BbyG "Hemlock" comment.  "martyred for his intellectual beliefs".  and, after his death,
the Forum turned against his accusers.  smiley
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Body-by-Guinness
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« Reply #188 on: May 21, 2009, 07:16:07 AM »

Now all we gotta see is an intellectual belief, and, with 3 pairs of socks, the shoe might fit.  evil
« Last Edit: May 21, 2009, 07:18:45 AM by Body-by-Guinness » Logged
JDN
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« Reply #189 on: May 21, 2009, 08:19:31 AM »

You're like a dog with an old bone; you just can't quit.
BbyG, I'm sorry if your fanny is STILL sore....

But really, you really should take Crafty's advice and "move on"...

And maybe move back to topic...



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Body-by-Guinness
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« Reply #190 on: May 21, 2009, 09:48:45 AM »

Pot calls kettle black, film at 11.

Get a million JDNs banging on a million keyboards and not so much as a zit would be raised on my butt.

Feel free to move on when the mood strikes you. Until then, if an inanity hammer is all you got, I guess that's all you'll swing.
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JDN
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« Reply #191 on: May 21, 2009, 09:57:21 AM »

 shocked    grin
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Crafty_Dog
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« Reply #192 on: May 21, 2009, 10:54:18 AM »

GENTLEMEN:

Let us return to the merits of the subject at hand please!!!

THANK YOU!
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Body-by-Guinness
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« Reply #193 on: May 21, 2009, 11:42:26 AM »

Summary of new CATO report examining likely aspects of BHO's health care. Entire report, a very long read, available here:

http://www.cato.org/pubs/pas/pa638.pdf


May 21, 2009
Policy Analysis no. 638



Obamacare to Come: Seven Bad Ideas for Health Care Reform

by Michael D. Tanner

 
President Obama has made it clear that reforming the American health care system will be one of his top priorities. In response, congressional leaders have promised to introduce legislation by this summer, and they hope for an initial vote in the Senate before the Labor Day recess.

While the Obama administration has not, and does not seem likely to, put forward a specific reform plan, it is possible to discern the key components of any plan likely to emerge from Congress:

At a time of rising unemployment, the government would raise the cost of hiring workers by requiring employers to provide health insurance to their workers or pay a fee (tax) to subsidize government coverage.

Every American would be required to buy an insurance policy that meets certain government requirements. Even individuals who are currently insured — and happy with their insurance — will have to switch to insurance that meets the government's definition of "acceptable insurance."
A government-run plan similar to Medicare would be set up in competition with private insurance, with people able to choose either private insurance or the taxpayer-subsidized public plan. Subsidies and cost-shifting would encourage Americans to shift to the government plan.

The government would undertake comparative-effectiveness research and cost-effectiveness research, and use the results of that research to impose practice guidelines on providers — initially, in government programs such as Medicare and Medicaid, but possibly eventually extending such rationing to private insurance plans.
Michael D. Tanner is a senior fellow with the Cato Institute and coauthor of Healthy Competition: What's Holding Back Health Care and How to Free It (2007).

Private insurance would face a host of new regulations, including a requirement to insure all applicants and a prohibition on pricing premiums on the basis of risk.
Subsidies would be available to help middle-income people purchase insurance, while government programs such as Medicare and Medicaid would be expanded.
Finally, the government would subsidize and manage the development of a national system of electronic medical records.
Taken individually, each of these proposals would be a bad idea. Taken collectively, they would dramatically transform the American health care system in a way that would harm taxpayers, health care providers, and — most importantly — the quality and range of care given to patients.

http://www.cato.org/pub_display.php?pub_id=10218
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ccp
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« Reply #194 on: May 21, 2009, 03:46:15 PM »

"Private insurance would face a host of new regulations, including a requirement to insure all applicants and a prohibition on pricing premiums on the basis of risk."

Personally I think it is necessary that insurance be available to all regardless of pre-existing conditions.  In reality many of these people go onto disability because that is the only way they can get medical care.  Or those who don't qualify wind up using more care down the road.

I do think that providing insurance to some should also come with the requirement that are partners in keeing costs down.  They follow doctors suggestions, at least make efforts to quit smoking, lose weight, take their medicines.  So I am not as sure that I agree with prohibition of pricing based on risk though - perhaps based on patient contribution to their own health and well being perhaps.

"Subsidies would be available to help middle-income people purchase insurance, while government programs such as Medicare and Medicaid would be expanded."

I dont know enough to commment on the merits of this.  But we all know that some of us will be bearing the extra burden of paying for these things.  Why is that fair?

"Finally, the government would subsidize and manage the development of a national system of electronic medical records."

There are so many vendors with so many products not all of which are compatible.  One size or style or brand is best for all medical practice types or goals.

I am not even sure how cost/benefit ratios work out for these.  But it is as inevitable as the internet is in general.
I am not electronic in my office.  I don't mind the government helping us subsidize this if it must be done.
But like anything the gov grants us it comes with strings attached.  Not least of which has been mentioned - gathering, monitoring, surveillancing health records for multiple imaginable purposes including but limited to control over delivery of care, outcomes data, rationing, delivery and following the adherence to "guidelines" ( to be developed by the big liberals in medical care at Yale and Harvard - many who are PhDs - not MDs), controlling and redirecting payments to providers based on their behavior as deemed appropriate not by them or their patients but by the bamas of the world.
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ccp
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« Reply #195 on: May 21, 2009, 08:04:40 PM »

One size or style or brand is best for all medical practice types or goals.

Correction: "is NOT best"

"Not least of which has been mentioned - gathering, monitoring, surveillancing health records for multiple imaginable purposes including but limited to control over

Correction:  "but NOT limited to"

Sorry. Sometimes I post without re reading and checking the language like I should.
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JDN
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« Reply #196 on: May 23, 2009, 09:47:48 AM »

The newest WHO report was just issued.
L.A. Times

Japan tops world life expectancies with 83 years

Girls born in Japan today are likely to live until 2095, some with a good chance of seeing the dawn of the next century thanks to having the world's longest life expectancy, the World Health Organization reported from Geneva on Thursday.

The tiny nation of San Marino boasts the longest average life span for men,

at 81 years. The United States lags behind the top nations, with an average life expectancy of 78 for the two sexes combined.

Men in Sierra Leone fare the worst worldwide, living on average just 39 years.

Here are the nations at the top of life expectancies for the two sexes combined as of 2007, according to WHO:

Longest life expectancies

Japan: 83

Australia: 82

Iceland: 82

Italy: 82

San Marino: 82

Switzerland: 82

Andorra: 81

Canada: 81

France: 81

Israel: 81

Monaco: 81

New Zealand: 81

Norway: 81

Singapore: 81

Spain: 81

Sweden: 81
__________

Embarrassingly; the list is too long to show the order where America finally ranks.
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Boyo
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« Reply #197 on: May 23, 2009, 10:09:13 AM »

Hey to answer CCp's qustion from the other day
Quote
So who would one rather have limiting or controlling care?  Private insurance administrators or government bureaucrats?

I would rather have private insurance  . Do to the fact that a if a private provider is awful the  negative effects are limited and eventually the provider goes out of buisness.While in the govt version the negative effects are wide spread and never goes out of buisness or improves it just costs more.

Boyo
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Body-by-Guinness
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« Reply #198 on: May 23, 2009, 12:03:01 PM »

Not sure where the WHO data JDN cites came from as the CDC, that collects mortality data in the US, only had 2004-05 data available. As that may be, and as mentioned previously, there is a strong cultural component to these sorts of stats, a component that culturally homogenous countries with restrictive immigration policies (such as Japan) don't have to contend with.


Life Expectancy at Birth by Race and Sex, 1930–2005
Learn the life expectancy (measured at birth) of American men and women, differentiated by race. For the 2005, the latest data available, the life expectancy for men of all races is 75.2 years and 80.4 years for women.

     All races    White    Black
Year    Both sexes    Male    Female    Both sexes    Male    Female    Both sexes    Male    Female
2005    77.8    75.2    80.4    78.3    75.7    80.8    73.2    69.5    76.5
20041    77.8    75.2    80.4    78.3    75.7    80.8    73.1    69.8    76.3
2003    77.5    74.8    80.1    78.0    75.3    80.5    72.7    69.0    76.1
2002    77.3    74.5    79.9    77.7    75.1    80.3    72.3    68.8    75.6
2001    77.2    74.4    79.8    77.7    75.0    80.2    72.2    68.6    75.5
2000    77.0    74.3    79.7    77.6    74.9    80.1    71.9    68.3    75.2
1999    76.7    73.9    79.4    77.3    74.6    79.9    71.4    67.8    74.7
1998    76.7    73.8    79.5    77.3    74.5    80.0    71.3    67.6    74.8
1997    76.5    73.6    79.4    77.2    74.3    79.9    71.1    67.2    74.7
1996    76.1    73.1    79.1    76.8    73.9    79.7    70.2    66.1    74.2
1995    75.8    72.5    78.9    76.5    73.4    79.6    69.6    65.2    73.9
1994    75.7    72.4    79.0    76.5    73.3    79.6    69.5    64.9    73.9
1993    75.5    72.2    78.8    76.3    73.1    79.5    69.2    64.6    73.7
1992    75.8    72.3    79.1    76.5    73.2    79.8    69.6    65.0    73.9
1991    75.5    72.0    78.9    76.3    72.9    79.6    69.3    64.6    73.8
1990    75.4    71.8    78.8    76.1    72.7    79.4    69.1    64.5    73.6
1989    75.1    71.7    78.5    75.9    72.5    79.2    68.8    64.3    73.3
1988    74.9    71.4    78.3    75.6    72.2    78.9    68.9    64.4    73.2
1987    74.9    71.4    78.3    75.6    72.1    78.9    69.1    64.7    73.4
1986    74.7    71.2    78.2    75.4    71.9    78.8    69.1    64.8    73.4
1985    74.7    71.1    78.2    75.3    71.8    78.7    69.3    65.0    73.4
1984    74.7    71.1    78.2    75.3    71.8    78.7    69.5    65.3    73.6
1983    74.6    71.0    78.1    75.2    71.6    78.7    69.4    65.2    73.5
1982    74.5    70.8    78.1    75.1    71.5    78.7    69.4    65.1    73.6
1981    74.1    70.4    77.8    74.8    71.1    78.4    68.9    64.5    73.2
1980    73.7    70.0    77.4    74.4    70.7    78.1    68.1    63.8    72.5
1979    73.9    70.0    77.8    74.6    70.8    78.4    68.5    64.0    72.9
1978    73.5    69.6    77.3    74.1    70.4    78.0    68.1    63.7    72.4
1977    73.3    69.5    77.2    74.0    70.2    77.9    67.7    63.4    72.0
1976    72.9    69.1    76.8    73.6    69.9    77.5    67.2    62.9    71.6
1975    72.6    68.8    76.6    73.4    69.5    77.3    66.8    62.4    71.3
1974    72.0    68.2    75.9    72.8    69.0    76.7    66.0    61.7    70.3
1973    71.4    67.6    75.3    72.2    68.5    76.1    65.0    60.9    69.3
19722    71.2    67.4    75.1    72.0    68.3    75.9    64.7    60.4    69.1
1971    71.1    67.4    75.0    72.0    68.3    75.8    64.6    60.5    68.9
1970    70.8    67.1    74.7    71.7    68.0    75.6    64.1    60.0    68.3
1960    69.7    66.6    73.1    70.6    67.4    74.1    —    —    —
1950    68.2    65.6    71.1    69.1    66.5    72.2    —    —    —
1940    62.9    60.8    65.2    64.2    62.1    66.6    —    —    —
1935    61.7    59.9    63.9    62.9    61.0    65.0    53.1    51.1    55.2
1930    59.7    58.1    61.6    61.4    59.7    63.5    48.1    47.3    49.2
(—) Data not available.
1. Preliminary data.
2. Deaths based on a 50% sample.
Source: National Center for Health Statistics, National Vital Statistics Reports, vol. 54, no. 19, June 28, 2006. Web:www.cdc.gov/nchs.

http://www.infoplease.com/ipa/A0005148.html
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JDN
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« Reply #199 on: May 23, 2009, 01:26:47 PM »

Not surprising that blacks do not live as long as whites.  Being poor, uneducated, lack of adequate social welfare programs,
availability of top physicians and care, ability to pay, etc. all have a negative influence on longevity. 

Japan is homogenous.  Welfare systems are in place to protect the poor and in general Japan's National Health System seems
to offer good quality care from cradle to grave to all individuals. 
__________
Social factors have bigger effect on longevity than genes
Posted in Longevity and Age Management, Demographics, Longevity on Tue September 02, 2008
A three-year-long analysis of the “social determinants” of health by the World Health Organization (WHO) has led them to the conclusion that social factors - not genetics - are to blame for the huge variations in ill health and life expectancy seen around the world, a report concludes.

The report, which was complied by a panel of experts forming the WHO’s Commission on the Social Determinants of Health, found that a girl born in Japan is, on average, likely to live for 42 years longer than a girl born in the African country of Lesotho. Inequities in life expectancy and morbidity between countries have been reported for many years, however this report is the first to highlight the large variations in life expectancy that also occur within different regions of countries and suburbs of cities throught the world. For example, a boy living in Calton, a deprived suburb of the Scottish city of Glasgow will, on average, live for 28 years less than a boy born in Lenzie, an affluent suburb a couple of miles away.
Â
In short, the report showed that poor socioeconomic circumstances equated to poor health. Furthermore, the differences in morbidity and longevity were so significant that genetics were deemed insignificant in comparison. It also revealed that wealth alone does not determine the health of a nation. Several countries, including: Cuba, Costa Rica, China, and Sri Lanka, have managed to achieve good levels of health despite their relatively low national incomes. Â

The authors wrote: “[The] toxic combination of bad policies, economics, and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible." To combat the problem of health inequity, they recommend that governments follow the shining example of Nordic countries that have introduced policies which encourage equality of benefits and service, full employment, gender equity, and low levels of social exclusion.

Closing the gap in a generation: Health equity through action on the social determinants of health. Commission on Social Determinants of Health. World Health Organization. Full report from WHO website.
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