In today's Dose:

• Health care reform
(A public option plan emerges from HELP committee; Arguments for the public option from the Urban Institute; Obama stands Harry & Louise on their heads)
• Health news
(Should Steve Jobs use his celebrity status for pancreatic cancer awareness and funding?)
• Industrialized agriculture
(Labeling organic food: What can you believe?; Food, Inc. available in more theaters)

Health care reform

• The latest health care reform proposal to emerge from the Senate HELP (Health, Education, Labor and Pensions) committee includes a public option. The plan is called the Community Health Insurance Option (CHIO). Here's a one-page summary (PDF) of details from the website of Senator Chris Dodd.

The CHIO would be administered by the Department of Health and Human Services. It would follow the same rules that apply to private, for-profit insurance companies. Rates would be no more than local average private rates, but could be less. Doctor and other health care provider participation is optional. Physicians had been concerned that they would be required to participate. Now that this is clear, we'll soon see if the medical profession gets behind this plan.

In today's Dose:

• Health care reform
(Kennedy-Dodd committee proposal released)
• Health news
(Is Tylenol (acetaminophen) safe to take every day?)
• Aging
(Doctors lack training in care of the elderly)
• Pop culture
(Michael Jackson and Diprivan (propofol), Jackson's weight, Jackson's doctor)

Health care reform

• The Senate health committee proposal on health care has been released. Turns out all that fuss over the Congressional Budget Office (CBO) report was for nothing, as could have been predicted. The CBO's report was based on a very incomplete proposal. This roller coaster reporting on health care reform will continue throughout July. Congress would like to wrap things up before their August recess.

There are lots of stories today on the Kennedy-Dodd plan just released. This one from Bloomberg has lots of details. The cost is now $600 billion, not over a trillion. 20 million or 3 percent of Americans would not be covered by health insurance. The previous estimate had been over 30 percent. On the issue of the insurance industry raising premiums for those who become ill:

Even though I've been writing about Arash Hejazi (here and here), the doctor seen in the video of Neda Agha-Soltan's death in Iran, I have to admit I still haven't seen the video. I realized early on that I didn't want to watch someone die a tragic and violent death. I didn't want to see her alive and then see her dead. Every second in real time. I don't need to watch the video to understand why Soltan's death is so symbolic or why the widespread viewing of it is significant.

It could have been 20 years ago that I watched a PBS broadcast about a women who prepared to kill herself. She filmed the entire sequence: Her thoughts, the elaborate preparations, and the actual death. What struck me was not that I watched someone die, but that the event was filmed and presented for public consumption. I believe assisted suicide can be a rational decision when there is incurable, intolerable pain. I don't find witnessing an actual death in a documentary helpful in thinking about this issue.

Photo by Laurent Champoussin

I'm currently watching a series of lectures by Malcolm W. Watson on Theories of Human Development. Watson talks mostly about theories of childhood, such as Freud's outdated theory of the oral, anal, phallic, latency, and genital stages. The discussion of Eric Erikson, however, follows stages of development through an entire life. (The lectures are available from The Teaching Company on DVD, CD, and by audio download.)

Scott Harrington is a professor at Wharton and "adjunct scholar" at the conservative American Enterprise Institute. Two weeks ago he wrote a Wall Street Journal opinion piece that gave the standard Republican argument against a public option: It will inevitably lead to a single-payer system.

"Private health plans have a strong incentive to spend a dollar as long as the expected savings in payments is at least a dollar,' he said in that article, justifying the profit motive of private insurance companies. Yes, and we all know how insurance companies save dollars: By finding an excuse to cancel the insurance of patients who become ill and by exorbitantly raising the premiums for small businesses. (See Health insurance insider speaks out.)

In today's Dose:

• Health care reform
(Use of language to oppose health care reform; Goozner on media and the uninformed electorate; Doctor blames patients; Doctor importunes Obama and Congress; Doctors salaries doubled in Iran; Another Atul Gawande interview; Political scandals and evangelicals)

Health care reform

• There's an interesting article in the Washington Post on the importance of language in current health care reform arguments.

Last month Frank Luntz, a prominent GOP pollster, circulated a memo advising Republicans on effective language to use against health care reform. Be on the side of "reform," he said, don't attack the popular president, talk about a "takeover" by "Washington bureaucrats" and about forcing patients to "stand in line" for health care. This has been the message in the television ads sponsored by Conservatives for Patients' Rights.

The Post's story on language is by Drew Westen, a psychology professor at Emory University. He's the author of a book on politics and the art of persuasion, The Political Brain: The Role of Emotion in Deciding the Fate of the Nation. He believes, as one reviewer said, that voters "think about politics with the touchy-feely part of their brains, rather than the rational."

To win the health care reform debate, Westen advises Democrats to concentrate on four points. The first involves telling a story. The Harry and Louise campaign, for example, was an insurance industry story the public could easily grasp. Frank Luntz, in his advice to Republicans, recommends the story "you can't trust 'em." When speaking of Democratic initiatives, the thing for Republicans to stress is:

In today's Dose:

• Health care reform
(Bipartisan support looks unlikely; Public option)
• Health news
(Medical research grants)

Health care reform

• As members of Congress headed home for a week-long Fourth of July recess, the consensus on health care reform legislation is that it will not be bi-partisan, as Obama and Democrats had hoped. Republicans are firmly opposed to the public option, despite its support by the public. Ohio Representative John Boehner said he did not know of any Republican in the House who supported legislation as proposed so far. Similarly, North Carolina Senator Richard Burr, asked how many Senate Republicans would sign the Democrats' plan, said "I think right now, none. Zero."

Of course, this could be strategic posturing, designed to win concessions. This gloomy picture is described in a NY Times story, "Little Hope for G.O.P. to Support Health Bill." Republicans, such as Iowa's Charles Grassley, say it's not a bipartisan bill with only three or four Republicans. Democrats say it will be sufficient if there are enough Republican votes for legislation to pass.

Source: Gedichten Gedacht

Legally grown opium is used by pharmaceutical companies to make morphine and other pain killers. Fifty percent of that opium is supplied by Australia. According to a BBC News report, a problem has developed with "wallabies entering poppy fields, getting as high as a kite and going around in circles. ... Then they crash." Other animals have also been spotted in the poppy fields "acting unusual."

The story is followed by a number of cute and creative comments. For example:

I've lived in Tasmania for many years. Not only do wallabies congregate in poppy fields, but also on the local golf courses. They do this mainly at night and I can only assume they're playing several rounds of golf while avoiding greens fees. You only need to be really worried when one of the stoned wallabies gets into a golf buggy.

In today's Dose:

• Health care reform
(Insurance industry practices; Maggie Mahar on insurance; Analysis of the public option's status)
• Health news
(Mid-life migraines update)
• The Medical profession
(More on Dr. Arash Hejazi)
• Foodborne illness
(Update on cookie dough)

Health care reform

• Ezra Klein has a column in the Washington Post on Wendell Potter's testimony before Rockefeller's Commerce Committee (see my posts from Wednesday: Health insurance insider speaks out and A health insurance executive changes sides).

On the practice of rescission - cancelling insurance coverage if a policy holder has omitted a minor illness when applying for coverage - Klein comments:

And don't be fooled: rescission is important to the business model. Last week, at a hearing before the House Subcommittee on Oversight and Investigation, Rep. Bart Stupak, the committee chairman, asked three insurance industry executives if they would commit to ending rescission except in cases of intentional fraud. "No," they each said.

Michael Jackson. August 29, 1958 - June 25, 2009

In today's Dose:

• The Medical profession
(Doctor's firsthand account of the death of Neda Soltan)
• Obesity politics
(Mediterranean diet, Weight-loss surgery and cancer)

The medical profession

• There is an amazing firsthand account of the shooting and death of Neda Soltan, the young Iranian woman who became a focal point for protesters after the video of her death was posted online. It's by Arash Hejazi, a doctor who happened to be nearby and attempted to assist her when she was shot. He immediately realized that she had been shot in the heart and that there was nothing he could do to save her.

  
  With his photo widely publicized, he feared he would not be able to leave the country, but he has returned to his home in Oxford, England. The article appears in The Times of London and is called "Doctor tells how Neda Soltan was shot dead by Ahmadinejad's basij."
  

Obesity politics

• Research shows that you can lose weight by dieting, but it doesn't last. You regain the weight and, over time, your weight increases. Dieting is a huge industry, however, so you don't hear the scientific facts too often. Most people have heard that a pattern of yo-yo dieting -- losing and gaining -- is unhealthy, but there are so many encouragements to diet that we ignore that information. What gets lost in all the promotion of weight loss is the importance of eating healthy food, not simply losing weight.

Wendell Potter is a former executive at health insurance giant Cigna. In testimony before Congress today, he provided an insider's view of the insurance industry. On his blog he's posted a moving description of his decision to leave his 20-year career, which had been lucrative and successful, and play on the other team for health care reform.

As a Public Relations professional, Potter was very aware that the industry used behind-the-scenes PR and lobbying. The insurance industry opposes any health care reform that might reduce their profits. He was also aware that industry practices were responsible for the growing number of uninsured.

What I saw happening over the past few years was a steady movement away from the concept of insurance and toward "individual responsibility" ... a continuous shifting of the financial burden of health care costs away from insurers and employers and onto the backs of individuals.

Source: Cheap health insurance services in India

Wendell Potter, a former executive at health insurance giant Cigna, was one of three health care specialists who testified today before the Senate Commerce Committee. You can read the entire transcript of his testimony at The New Republic.

Potter began by identifying himself as an insider who had witnessed for-profit insurance companies in pursuit of their primary goal: Satisfying investors. Their strategy for accomplishing this goal includes deliberately confusing customers and "dumping the sick."

Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand -- or even to obtain -- information we need.

In today's Dose:

• Health care reform
(Robert Reich on the public option)
• Health news
(Migraines, Nipple piercing and breast feeding)
• Obesity politics
(TB and the thrifty gene)
• Medical journalism
(Drug company ties to journalists)

Health care reform

• Be sure to see today's two posts on Wendell Potter, the former health insurance executive who testified today before the Commerce Committee. Potter left the industry after witnessing the plight of the uninsured. Health insurance insider speaks out and A health insurance executive changes sides

• As you may have noticed by now, I'm a fan of Robert Reich. He has an opinion column in the Wall Street Journal that pulls together much of what he's been saying in his blog posts on health care, such as his insistence on the importance of a public health insurance option.

• Health care reform
(Wyden-Bennett plan, Fundamental Democrat/Republican differences, Gawande on building from what we have)
• The Medical profession
(Stress vs. balance for doctors, Doctors' Diaries on NOVA)

Health care reform

• Last week's figures on cost and coverage from the Congressional Budget Office (CBO) shifted attention to those health care reform initiatives that are less costly. One of these is the Healthy Americans Act sponsored by Senators Ron Wyden (Oregon Democrat) and Bob Bennett (Utah Republican). The Wyden-Bennett plan rules out a public option (insurance from the government), but requires an individual mandate (everyone must have insurance). It taxes health benefits, although there would be a $19,000 income tax deduction for a family of four.

In an interview with The Wall Street Journal, Senator Wyden argued that it's far better to pass a bill with broad support from both Democrats and Republicans than to use the reconciliation option. Otherwise you'll have members of Congress trying to repeal the plan as soon as it's passed.

The Wyden-Bennett plan combines the Democrats' desire to have everyone covered and the Republicans' interest in relying on the markets and preserving consumer choice. The Healthy Americans Act is supported by 14 Senators. Many Democrats are skeptical, especially those with ties to labor unions.

On unions, Wyeth says:

Unions have every right to bargain for the best possible package .... "But nobody, be it a CEO or a labor [union] member ought to be getting what amounts to gold-plated coverage with the tax subsidies paid for by somebody who is a modestly compensated woman at a small business who doesn't have a health plan."

In today's Dose:

• Health care reform
(Public health insurance option, Congressional Budget Office, Optimism in the White House, Doctors and reform, Doctors pay)
• The Medical profession
(What doctors earn)

Health care reform

• Paul Krugman, in the New York Times, writes about health care today with his usual intelligence and trenchant prose. His argument: Democrats who oppose the public option could torpedo reform that the public clearly wants.

What the balking Democrats seem most determined to do is to kill the public option, either by eliminating it or by carrying out a bait-and-switch, replacing a true public option with something meaningless. For the record, neither regional health cooperatives nor state-level public plans, both of which have been proposed as alternatives, would have the financial stability and bargaining power needed to bring down health care costs. ...

... Senator Ben Nelson of Nebraska initially declared that the public option -- which, remember, has overwhelming popular support -- was a "deal-breaker." Why? Because he didn't think private insurers could compete: "At the end of the day, the public plan wins the day." Um, isn't the purpose of health care reform to protect American citizens, not insurance companies? ...

Honestly, I don't know what these Democrats are trying to achieve. Yes, some of the balking senators receive large campaign contributions from the medical-industrial complex -- but who in politics doesn't? If I had to guess, I'd say that what's really going on is that relatively conservative Democrats still cling to the old dream of becoming kingmakers, of recreating the bipartisan center that used to run America.

In today's Dose:

• Health care reform
(Congressionional Budget Office numbers; Why Maggie Mahar isn't worried; Kevin MD, Daniel Callahan)
• Foodborne illness
(Cookie dough)
• Industrialized agriculture
(Food Inc.)
• The risk society
(Jodi Picoult novels)

Health care reform

• A recent Ezra Klein Klein column in the Washington Post discussed the bad news this week from the Congressional Budget Office. Health care reform will cost $1.6 trillion over 10 years, not the $1 trillion the Senate HELP committee was targeting, and that's with one-third of the uninsured still without coverage.

[H]ealth reform has just gotten harder. The hope that we could expand the current system while holding costs down appears to have been just that: a hope. ... The question now becomes whether we want health-care reform that achieves less of what we say the system needs, or more. Doing less would be cruel to those who have laid their hopes upon health reform. But doing more will be very, very hard.

• Maggie Mahar discusses the same subject: the gloomy reactions to the CBO's estimates. But she calls her post "Why I am not worried about health care reform." The CBO report is very preliminary and was probably leaked. They did not issue a formal report.

I have always thought that reform would be very hard. I knew that conservatives and lobbyists would fight with every weapon at their disposal--and that they wouldn't mind distorting the truth, which is what they have done by making a mountain out of CBO's preliminary mark-up of the Senate's rough draft. ...

The headlines are correct in one sense: reform is not "inevitable." This is not a Greek Drama where the final Act is written in the stars. As I have said all along, the battle will be fierce, and, in the end it will not be pretty.

Those who have been gouging the system will have to be gored. Imagine a slaughterhouse with gobs of fat and pools of blood on the floor. But the White House understands that the alternative is to pour billions of tax-payer dollars into a $1.6 trillion dollar medical-industrial complex that, too often, provides profits for the industry, but no benefits for patients. This administration is too smart to let that happen.

This is an excellent post, especially if you enjoy getting into the nitty-gritty of the economics and politics of health care reform. I came away from it with a sense that Obama and his White House advisors are on top of this issue and doing a good job. The post is followed by extensive comments.

Maggie Mahar has a first rate mind. I highly recommend her book, Money-Driven Medicine: The Real Reason Health Care Costs So Much and the recent documentary of the book, produced by Alex Gibney (director of Enron: The Smartest Guys in the Room).

In today's Dose:

• Health care reform
(Health care reform won't make us healthier)
• The medical profession
(Does the AMA represent doctors?; Does the public trust doctors?)
• Obesity politics
(The cost of healthy eating)
• The doctor/patient relationship
(The effects of malpractice on doctors)
• Graphic art
(Anatomically correct shoes)
• Video
(Sanjay Gupta performs surgery)

Health care reform

• Ezra Klein has an article in The American Prospect called "Wealth-Care Reform: Fixing our health-care system will make us more economically secure. It won't make us much healthier."

Health-care reform is, in practice, health-care-system-spending reform. Politicians promise that their plans will "bend the curve" and pursue "universal coverage." They do not promise the plans will make everyone healthier, reduce infant mortality, or set targets for life expectancy. The health of the nation, as opposed to its ability to pay hospital bills, is hardly under consideration. ...

"The irony is that we use health as a rhetorical trope a lot in the health-reform debate. ... There's a big payoff to pointing to health as a beneficial outcome from health reform. There's not a big political payoff to advocating for enacting specific measures that would improve health."

"Our agricultural policy is actually counterproductive for health. We subsidize everything that gives you diabetes and nothing that keeps you healthy. Every grain you can think of is subsidized, particularly corn, but are carrots subsidized? No. Is the advertising of carrots subsidized? No."

"College graduates ... can expect to live at least five years longer than Americans who have not completed high school. Poor Americans are more than three times as likely as Americans with upper-middle-class incomes to suffer physical limitations from a chronic illness. Upper-middle-class Americans can expect to live more than six years longer than poor Americans. People with middle incomes are less healthy and can expect to live shorter lives than those with higher incomes -- even when they are insured." ... Our health is not determined by what happens inside a hospital ward or a doctor's office. It is determined ... by "where people live, learn, work and play."

The question should not be how much health care we can buy. It should be how much health we can buy. Whether that health comes through a doctor's office or a preschool is immaterial.

Right on! A great article.

In today's Dose:

• Health care reform
(Public option; Gawande's article)
• Health news
(Parkinson's and pesticide)
• Sleep
(Sleep and mental illness)
• Social networking technology
(The digital brain and higher education)

Health care reform

• The Washington Post reports that there is no 'public option' in the Senate's health care draft.

The absence of a "public option" marks perhaps the most significant omission. Obama and many Democrats had sought a public option to ensure affordable, universal coverage, but as many as 10 Senate Democrats have protested the idea as unfair to private insurers.

• In a roundtable discussion at Health Affairs, panelists talk about Atul Gawande's New Yorker article on McAllen, Texas and about geographical variations in health care costs (the Dartmouth Atlas Project).

  
  One of the first questions discussed is why the Gawande article has aroused so much interest. Other questions addressed: Have things changed enough since Nixon's time so that health care reform can succeed this time around? Can physicians be moved away from fee-for-service payments? Can we change how specialists and primary care physicians are paid?

[S]ome of the finest, most well-respected multispecialty groups will acknowledge in confidence that they're able to ask for 200 or even 250 percent of Medicare [costs] to do what they are doing very well. ... this issue of market power is a real one. ...

I agree we need to strengthen primary care, but I think it's a little bit of a chicken and egg issue as well. Who would want to go into primary care in the current work environments?

In today's Dose:

• Health care reform
(Gawande radio interview; Public option)
• Health news
(Bayer and prostate cancer)
• Obesity politics
(Michelle Obama)
• Social networking technology
(Doctors on Twitter and email)

Health care reform

• National Public Radio has an interview with Atul Gawande about his recent New Yorker article. It's 30 minutes and covers much the same material as the article. At the end, the interviewer asks Gawande what it was like to learn that Obama and his staff were reading and discussing the article. His reply:

Completely shocking. This is the dream you have, that anything you write is absorbed by the people who affect your life. And right now the folks in Washington are deeply important to us as patients and as clinicians, and so it felt like a victory. At the same time I also knew that the brickbats would come and I had better suit up.

(Thanks, Joanne, for the heads up.)

• More on the fate of the public option: Marie Cocco on AlterNet, "Warning: Health Care Lobbyists Are Winning the Battle to Screw All of Us," and Digby on Hullabaloo, "But I Thought Tom Daschle Was So Crucial To Real Health Care Reform."

From Cocco:

Advocates of a single, national insurance system that would involve explicit cost controls and guidelines for care -- that might put an end to such wasteful practices as over-testing -- have been shunted aside. This is in part because Democrats quiver when Republicans call them "socialists." But Republicans cry "socialist" even when Democrats promote weak reforms that barely nick the vested interests. That's what's happening now. No one has seriously proposed an overhaul that would achieve what a single-payer system has been shown to accomplish in most other countries: universal coverage with lower costs that delivers better results than we now get in the United States.

From Digby:

Financing was always going to be a problem. ... [W]atching Baucus run for cover, watching Daschle do the old el foldo, I'm seriously pessimistic that anything out of Washington will meet the expectations of anyone in the country.