Obama's priorities concerning healthcare in the U.S.A.

[Argirios Argiriou]

03/03/2009
BMJ.

Healthcare reform forms a big part of Obama’s budget.

Barack Obama’s proposed $3.1 trillion budget includes $634bn (£450bn; 500bn) for healthcare reform, including universal health insurance coverage, electronic medical records, and preventive health care.

He has nominated Kathleen Sebelius of Kansas, the Democratic governor in a Republican state, as head of the Department of Health and Human Services, and will convene a White House healthcare summit meeting this week.

The president presented the budget on 26 February, two days after the Institute of Medicine released a report, called America’s Uninsured Crisis: Consequences for Health and Health Care (available at Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος). The report says that nearly 46 million Americans lack health insurance, including one in five adults aged under 65 years and one in 10 children, and that numbers would increase as the economy worsened. It says, "For decades the health insurance crisis has grown without any decisive action by policy makers to stop it. Now is the time . . .




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[Argirios Argiriou]

Obama chooses family physician from rural Alabama to be nation's next surgeon general.

Associated Press - Tuesday, 14 July 2009.

By LAURAN NEERGAARD

President Barack Obama turned to the Deep South for the next surgeon general, choosing a rural Alabama family physician who made headlines with fierce determination to rebuild her nonprofit medical clinic in the wake of Hurricane Katrina.

Dr. Regina Benjamin is known along Alabama's impoverished Gulf Coast as a country doctor who makes house calls and doesn't turn away patients who can't pay -- even as she's had to find the money to rebuild a clinic repeatedly destroyed by hurricanes and once even fire.

"For all the tremendous obstacles that she has overcome, Regina Benjamin also represents what's best about health care in America,
  
doctors and nurses who give and care and sacrifice for the sake of their patients," Obama said Monday in introducing his choice for a job known as America's doctor.

He said Benjamin will bring insight as his administration struggles to revamp the health care system:

Saying she "has seen in a very personal way what is broken about our health care system," Obama said Benjamin will bring important insight as his administration tries to revamp that system.

Benjamin called the job "a physician's dream," and pledged to be a voice for patients in need -- and to fight the preventable diseases that claim too many lives each year, including nearly her entire family.

Her father died with diabetes and high blood pressure, her only brother of HIV, her mother of lung cancer "because as a young girl, she wanted to smoke just like her twin brother could" -- an uncle now on oxygen as a result, she noted.

"I cannot change my family's past. I can be a voice in the movement to improve our nation's health care and our nation's health," Benjamin said. "I want to be sure that no one falls through the cracks as we improve our health care system."

The surgeon general is the people's health advocate, a bully pulpit position that can be tremendously effective with a forceful personality. Benjamin has that reputation.

Pushed by the need in her own shrimping community of Bayou La Batre, Ala., and its diverse patient mix -- white, black and, increasingly immigrants from Vietnam, Cambodia and Laos -- Benjamin, 51, has emerged as a national leader in the call to improve health disparities. She became the first black woman and the first doctor under age 40 elected to the American Medical Association's board of trustees, and in 2002 became the first black woman to head a state medical society.

"She's always been very ambitious from a political standpoint. She has always, always been motivated by that ambition," said Dr. James Holland, CEO of Mostellar Medical Center in nearby Irvington, Ala., where Benjamin spent about three years in the early 1980s as a National Health Service Corps scholar.

Holland said Benjamin's selection as surgeon general "doesn't surprise me at all. The only thing that surprises me is that it hasn't happened before now."

Medical groups welcomed her ability for straight-talk, whether to patients or politicians, about the dire health needs of much of the country.

"We want to emphasize prevention, primary care and early intervention, and we have somebody now who does that for a living," said Dr. Georges Benjamin, no relation, of the American Public Health Association.

Added AMA President Dr. James Rohack, who has known Benjamin for more than two decades. With "her recognition that if you don't
have health insurance, you live sicker and you die younger, she can bring the real-world perspective as surgeon general of the things as a nation we need to do to keep ourselves healthy."

Benjamin made headlines in the wake of Katrina, as photographs showed her laying patient charts out to bake in the sun and lamenting the lack of pricey but more hurricane-resistant electronic records. Her nonprofit clinic was rebuilt by volunteers only to burn down just as it was about to reopen. Benjamin later told of her patients' desperation that she rebuild again, recalling on woman who handed her an envelope with a $7 donation to help.

"If she can find $7, I can figure out the rest," Benjamin said last fall as she received a $500,000 MacArthur Foundation "genius award," money she said she'd use to help finish that job.

Her nomination for surgeon general requires Senate confirmation.



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[Argirios Argiriou]

Καθημερινή, 24-07-09.
Reuters, AP, AFP.
 
Ασφάλιση για όλους θέλει ο Ομπάμα.
Προτεραιότητά του οι μεταρρυθμίσεις.

ΟΥΑΣΙΓΚΤΟΝ.

Ολο το πολιτικό βάρος έχει ρίξει ο Αμερικανός πρόεδρος Μπαράκ Ομπάμα στη μεταρρύθμιση του αμερικανικού συστήματος υγειονομικής ασφάλισης, την ώρα που το κρίσιμο νομοσχέδιο εξετάζεται από τις αρμόδιες επιτροπές του Κογκρέσου. Το βράδυ της Τετάρτης, ο Ομπάμα απευθύνθηκε ευθέως στον αμερικανικό λαό, προειδοποιώντας ότι το παρόν σύστημα είναι αδύνατο να συνεχιστεί.

«Αν δεν δράσουμε, 14.000 Αμερικανοί θα εξακολουθήσουν να χάνουν την ασφάλισή τους κάθε μέρα» είπε ο Αμερικανός πρόεδρος, σημειώνοντας ότι ο αριθμός των ανασφάλιστων έχει φθάσει τα 47 εκατ. (επί πληθυσμού 300 εκατ.). Οι ΗΠΑ είναι η μόνη ανεπτυγμένη χώρα στον κόσμο που δεν προσφέρει στους πολίτες της ολοκληρωμένο σύστημα υγειονομικής κάλυψης.

Δημόσιο σύστημα

Στη συνέντευξη Τύπου που έδωσε σε πανεθνικό δίκτυο, ο Μπαράκ Ομπάμα είπε ότι ο κάθε Αμερικανός πληρώνει κατά μέσο όρο 6.000 δολάρια ετησίως παραπάνω από τους κατοίκους άλλων χωρών, χωρίς ωστόσο ο αμερικανικός πληθυσμός να είναι υγιέστερος. Η μεταρρύθμιση θα επιβάλλει κάποιους περιορισμούς στις ασφαλιστικές εταιρείες, θα υποχρεώνει όλους τους Αμερικανούς να αγοράσουν κάποιου τύπου ασφάλιση και, το πιο αμφιλεγόμενο σημείο, θα δημιουργεί κάτι που θεωρείται δεδομένο σε άλλες ανεπτυγμένες χώρες, ένα δημόσιο ασφαλιστικό σύστημα, το οποίο θα μπορεί οποιοσδήποτε να επιλέξει, αντί της εξ ολοκλήρου ιδιωτικής ασφάλισης που είναι διαθέσιμη σήμερα.

Ο Ομπάμα τόνισε ότι κάποιοι Ρεπουμπλικανοί αντιτίθενται στην υγειονομική μεταρρύθμιση προκειμένου να πλήξουν πολιτικά τον ίδιο. «Ομως το θέμα δεν είμαι εγώ. Εγώ εξάλλου έχω εξαιρετική υγειονομική κάλυψη, το ίδιο και οι βουλευτές και οι γερουσιαστές» απάντησε ο Αμερικανός πρόεδρος.

Πολλοί Ρεπουμπλικανοί στο Κογκρέσο αντιδρούν στο σχέδιο του Ομπάμα για διεύρυνση των παροχών στους ανασφάλιστους χαρακτηρίζοντάς το «σοσιαλιστικό», ενώ μια συμμαχία 52 δημοκρατικών βουλευτών έχει επίσης αντιρρήσεις, χαρακτηρίζοντας το σχέδιο του Ομπάμα πολυέξοδο.

Στη συνέντευξη Τύπου, ο Αμερικανός πρόεδρος είπε ότι τα δύο τρίτα των χρημάτων που θα απαιτηθούν για τα νέα προγράμματα θα προέλθουν από την εξοικονόμηση πόρων μέσω του περιορισμού των τωρινών δαπανών, ενώ υπάρχουν διάφορες σκέψεις σχετικά με το πώς μπορεί να καλυφθεί το υπόλοιπο ένα τρίτο. Ο Ομπάμα προτείνει να καλυφθεί εν μέρει μέσω αυξημένων εισφορών από τις εύπορες οικογένειες που έχουν εισόδημα άνω των 350.000 δολ. ετησίως.

«Ο πρόεδρος είπε ότι δεν θέλει να αυξήσει το έλλειμμα, ότι δεν θέλει κυβερνητικό έλεγχο της υγείας, ότι θέλει να κρατήσει ο κόσμος την ασφάλειά του. Οτι θέλει να σταματήσουν οι καταχρήσεις και οι σπατάλες. Ολα αυτά είναι πολύ ωραία, αλλά δεν βρίσκονται στο νομοσχέδιο που έχουν προτείνει οι δημοκρατικοί βουλευτές» είπε ο κυβερνήτης της Λουιζιάνα Μπόμπι Τζίνταλ, επικριτής των σχεδίων του Αμερικανού προέδρου και εκ των πλέον προβεβλημένων στελεχών του ρεπουμπλικανικού κόμματος.

Σύμφωνα με τις δημοσκοπήσεις, το 50% των Αμερικανών εγκρίνουν τους χειρισμούς του Ομπάμα στον τομέα της υγειονομικής περίθαλψης, ενώ το 43% διαφωνούν. Ο Ομπάμα, με την εξαιρετική επικοινωνιακή του αμεσότητα, επιχειρεί να μιλήσει απευθείας στον αμερικανικό λαό εξηγώντας τα οφέλη του σχεδίου του. «Η μεταρρύθμιση αφορά κάθε Αμερικανό που έχει ποτέ φοβηθεί ότι η ασφάλειά του δεν θα τον καλύψει αν αρρωστήσει πολύ σοβαρά, αν χάσει τη δουλειά του ή αν αλλάξει δουλειά» είπε ο Ομπάμα. «Αφορά κάθε μικρή επιχείρηση που έχει υποχρεωθεί να απολύσει εργαζομένους ή να τους προσφέρει χειρότερη κάλυψη επειδή η κάλυψη έγινε πολύ ακριβή».

Πολλές διαφορετικές εκδοχές του νομοσχεδίου εξετάζονται αυτή τη στιγμή από επιτροπές της Βουλής και της Γερουσίας, υπό το αυστηρό βλέμμα 1.000 λομπιστών και άνω που εργάζονται για λογαριασμό των ασφαλιστικών, φαρμακευτικών κ.τ.λ. εταιρειών.

Την Τετάρτη, ο Λευκός Οίκος έδωσε στη δημοσιότητα τη λίστα των εκπροσώπων της βιομηχανίας της υγείας που πέρασαν το κατώφλι του από τις αρχές του 2009, αποφεύγοντας έτσι το ενδεχόμενο δικαστικής διαμάχης για τη δημοσίευση των ονομάτων αυτών, όπως απειλούσε ομάδα πολιτών.

Κορυφαία προτεραιότητα

Ο Ομπάμα έχει καταστήσει τη μεταρρύθμιση του συστήματος υγειονομικής ασφάλισης κορυφαία προτεραιότητα της προεδρίας του και ζητά από το Κογκρέσο να περάσει τη σχετική νομοθεσία το αργότερο μέχρι το φθινόπωρο. Προσπαθεί παράλληλα να πείσει κάποιους Ρεπουμπλικανούς βουλευτές και γερουσιαστές να στηρίξουν τα σχέδιά του, στρατηγική που κάποιοι στο δημοκρατικό κόμμα θεωρούν χρονοβόρα και αναποτελεσματική.


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[πρώτη & καλύτερη]

O Paul Krugman σχολιάζει στους NYTimes τα σχέδια του Obama και την πολιτική του Bush στην πολιτική υγείας. Υποστηρίζει, ότι μόνο ένα σύστημα όπου η "αποζημίωση" θα είναι βάση της αποτελεσματικότητας και όχι του αριθμού των ιατρικών πράξεων θα καταφέρει να μειώσει τα δυσθεώρητα κόστη της υγείας στην Αμερική. Ο Obama έχει μιλήσει για comparative effectiveness research, που θα αποδεικνύει ποιά θεραπεία, μέθοδος, κλπ δουλεύει.

Ο Krugman ισχυρίζεται ότι αν θέλουμε να έχουμε compassion δε θα πρέπει να κλείνουμε τα μάτια στη μείωση του κόστους, γιατί έτσι θα καταφέρουμε να έχουμε ισότιμη και ελεύθερη πρόσβαση στην υγεία. Είναι σχόλιο που ταιριάζει και στην ελληνική πραγματικότητα: όταν τα κόστη είναι τεράστια και η πρόσβαση ανισότιμη, δε μπορούμε να αιτούμαστε ...και ΔΩΡΕΑΝ ΥΓΕΙΑ!!! Ποιά δωρεάν υγεία? Έτσι, κλείνουμε τα μάτια μας και ταμπουρωνόμαστε πίσω από συνθηματικό λόγο. As a practical, political matter, then, controlling health care costs and expanding health care access aren’t opposing alternatives — you have to do both, or neither.


Costs and Compassion

By PAUL KRUGMAN
Published: July 23, 2009

The talking heads on cable TV panned President Obama’s Wednesday press conference. You see, he didn’t offer a lot of folksy anecdotes.

Shame on them. The health care system is in crisis. The fate of America’s middle class hangs in the balance. And there on our TVs was a president with an impressive command of the issues, who truly understands the stakes.

Mr. Obama was especially good when he talked about controlling medical costs. And there’s a crucial lesson there — namely, that when it comes to reforming health care, compassion and cost-effectiveness go hand in hand.

To see what I mean, compare what Mr. Obama has said and done about health care with the statements and actions of his predecessor.

President Bush, you may remember, was notably unconcerned with the plight of the uninsured. “I mean, people have access to health care in America,” he once remarked. “After all, you just go to an emergency room.”

Meanwhile, Mr. Bush claimed to be against excessive government expenditure. So what did he do to rein in the cost of Medicare, the biggest single item driving federal spending?

Nothing. In fact, the 2003 Medicare Modernization Act drove costs up both by preventing bargaining over drug prices and by locking in subsidies to insurance companies.

Now President Obama is trying to provide every American with access to health insurance — and he’s also doing more to control health care costs than any previous president.

I don’t know how many people understand the significance of Mr. Obama’s proposal to give MedPAC, the expert advisory board to Medicare, real power. But it’s a major step toward reducing the useless spending — the proliferation of procedures with no medical benefits — that bloats American health care costs.

And both the Obama administration and Congressional Democrats have also been emphasizing the importance of “comparative effectiveness research” — seeing which medical procedures actually work.

So the Obama administration’s commitment to health care for all goes along with an unprecedented willingness to get serious about spending health care dollars wisely. And that’s part of a broader pattern.

Many health care experts believe that one main reason we spend far more on health than any other advanced nation, without better health outcomes, is the fee-for-service system in which hospitals and doctors are paid for procedures, not results. As the president said Wednesday, this creates an incentive for health providers to do more tests, more operations, and so on, whether or not these procedures actually help patients.

So where in America is there serious consideration of moving away from fee-for-service to a more comprehensive, integrated approach to health care? The answer is: Massachusetts — which introduced a health-care plan three years ago that was, in some respects, a dress rehearsal for national health reform, and is now looking for ways to help control costs.

Why does meaningful action on medical costs go along with compassion? One answer is that compassion means not closing your eyes to the human consequences of rising costs. When health insurance premiums doubled during the Bush years, our health care system “controlled costs” by dropping coverage for many workers — but as far as the Bush administration was concerned, that wasn’t a problem. If you believe in universal coverage, on the other hand, it is a problem, and demands a solution.

Beyond that, I’d suggest that would-be health reformers won’t have the moral authority to confront our system’s inefficiency unless they’re also prepared to end its cruelty. If President Bush had tried to rein in Medicare spending, he would have been accused, with considerable justice, of cutting benefits so that he could give the wealthy even more tax cuts. President Obama, by contrast, can link Medicare reform with the goal of protecting less fortunate Americans and making the middle class more secure.

As a practical, political matter, then, controlling health care costs and expanding health care access aren’t opposing alternatives — you have to do both, or neither.

At one point in his remarks Mr. Obama talked about a red pill and a blue pill. I suspect, though I’m not sure, that he was alluding to the scene in the movie “The Matrix” in which one pill brings ignorance and the other knowledge.

Well, in the case of health care, one pill means continuing on our current path — a path along which health care premiums will continue to soar, the number of uninsured Americans will skyrocket and Medicare costs will break the federal budget. The other pill means reforming our system, guaranteeing health care for all Americans at the same time we make medicine more cost-effective.

Which pill would you choose?


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[Argirios Argiriou]

Associated Press,
By Philip Elliot,
16/8/2009.

Bowing to Republican pressure and an uneasy public, President Barack Obama's administration signaled Sunday it is ready to abandon the idea of giving Americans the option of government-run insurance as part of a new health care system.

Facing mounting opposition to the overhaul, administration officials left open the chance for a compromise with Republicans that would include health insurance cooperatives instead of a government-run plan. Such a concession probably would enrage Obama's liberal supporters but could deliver a much-needed victory on a top domestic priority opposed by GOP lawmakers.

Officials from both political parties reached across the aisle in an effort to find compromises on proposals they left behind when they returned to their districts for an August recess. Obama had wanted the government to run a health insurance organization to help cover the nation's almost 50 million uninsured, but didn't include it as one of his core principles of reform.

Health and Human Services Secretary Kathleen Sebelius said that government alternative to private health insurance is "not the essential element" of the administration's health care overhaul. The White House would be open to co-ops, she said, a sign that Democrats want a compromise so they can declare a victory.

Under a proposal by Sen. Kent Conrad, D-N.D., consumer-owned nonprofit cooperatives would sell insurance in competition with private industry, not unlike the way electric and agriculture co-ops operate, especially in rural states such as his own.

With $3 billion to $4 billion in initial support from the government, the co-ops would operate under a national structure with state affiliates, but independent of the government. They would be required to maintain the type of financial reserves that private companies are required to keep in case of unexpectedly high claims.

"I think there will be a competitor to private insurers," Sebelius said. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing."

Obama's spokesman refused to say a public option was a make-or-break choice.

"What I am saying is the bottom line for this for the president is, what we have to have is choice and competition in the insurance market," White House press secretary Robert Gibbs said Sunday.

A day before, Obama appeared to hedge his bets.

"All I'm saying is, though, that the public option, whether we have it or we don't have it, is not the entirety of health care reform," Obama said at a town hall meeting in Grand Junction, Colo. "This is just one sliver of it, one aspect of it."

It's hardly the same rhetoric Obama employed during a constant, personal campaign for legislation.

"I am pleased by the progress we're making on health care reform and still believe, as I've said before, that one of the best ways to bring down costs, provide more choices and assure quality is a public option that will force the insurance companies to compete and keep them honest," Obama said in July.

Lawmakers have discussed the co-op model for months although the Democratic leadership and the White House have said they prefer a government-run option.

Conrad, chairman of the Senate Budget Committee, called the argument for a government-run public plan little more than a "wasted effort." He added there are enough votes in the Senate for a cooperative plan.

"It's not government-run and government-controlled," he said. "It's membership-run and membership-controlled. But it does provide a nonprofit competitor for the for-profit insurance companies, and that's why it has appeal on both sides."

Sen. Richard Shelby, R-Ala., said Obama's team is making a political calculation and embracing the co-op alternative as "a step away from the government takeover of the health care system" that the GOP has pummeled.

"I don't know if it will do everything people want, but we ought to look at it. I think it's a far cry from the original proposals," he said.

Republicans say a public option would have unfair advantages that would drive private insurers out of business. Critics say co-ops would not be genuine public options for health insurance.

Rep. Eddie Bernice Johnson, D-Texas, said it would be difficult to pass any legislation through the Democratic-controlled Congress without the promised public plan.

"We'll have the same number of people uninsured," she said. "If the insurance companies wanted to insure these people now, they'd be insured."

Rep. Tom Price, R-Ga., said the Democrats' option would force individuals from their private plans to a government-run plan as some employers may choose not to provide health insurance.

"Tens of millions of individuals would be moved from their personal, private insurance to the government-run program. We simply don't think that's acceptable," he said.

A shift to a cooperative plan would certainly give some cover to fiscally conservative Blue Dog Democrats who are hardly cheering for the government-run plan.

"The reality is that it takes 60 percent to get this done in the Senate. It's probably going to have to be bipartisan in the Senate, which I think it should be," said Rep. Mike Ross, D-Ark., who added that the proposals still need changes before he can support them.

Obama, writing in Sunday's New York Times, said political maneuvers should be excluded from the debate.

"In the coming weeks, the cynics and the naysayers will continue to exploit fear and concerns for political gain," he wrote. "But for all the scare tactics out there, what's truly scary -- truly risky -- is the prospect of doing nothing."

Congress' proposals, however, seemed likely to strike end-of-life counseling sessions. Former Alaska Gov. Sarah Palin has called the session "death panels," a label that has drawn rebuke from her fellow Republicans as well as Democrats.

Sen. Orrin Hatch, R-Utah, declined to criticize Palin's comments and said Obama wants to create a government-run panel to advise what types of care would be available to citizens.

"In all honesty, I don't want a bunch of nameless, faceless bureaucrats setting health care for my aged citizens in Utah," Hatch said.

Sebelius said the end-of-life proposal was likely to be dropped from the final bill.

"We wanted to make sure doctors were reimbursed for that very important consultation if family members chose to make it, and instead it's been turned into this scare tactic and probably will be off the table," she said.

Sebelius spoke on CNN's "State of the Union" and ABC's "This Week." Gibbs appeared on CBS' "Face the Nation." Conrad and Shelby appeared on "Fox News Sunday." Johnson, Price and Ross spoke with "State of the Union." Hatch was interviewed on "This Week."


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