By Rep. Jim Himes

Last week at the White House, I sat next to John Lewis, hero of the civil rights movement, and watched the President sign health care reform into law. For Congressman Lewis it was the fulfillment of the promise of a just society for which he was nearly beaten to death in Selma, Alabama in 1965. The President’s signature ushered us into the company of every other industrialized nation on the planet in offering each of our citizens a basic level of healthcare.

It’s odd that this was so controversial. It is a core American value that we defend and protect our own. When terrorists fly planes into our buildings and murder thousands of our innocents, we stop at nothing to find and destroy them. If fire threatens your life or property, we stop at nothing to protect you. If you are assaulted, we never hesitate to send people and equipment to save you.

Previously, if you got breast cancer, kidney disease, or diabetes, you might have gotten help. Maybe—if you were employed and had insurance; were 65 or older and had Medicare; or didn’t have any pre-existing conditions. If not, you, like tens of thousands of other Americans each year, may have died from inadequate access to health care.

I believe that America looks after its own. On values, I believe that America leads, not follows. But not everyone does. Congressman Lewis was taunted with racial epithets as he walked, still bearing the scars of his Selma beating, to the Capitol last week. And now, as we turn the page on a year of consideration and debate, the American people will finally begin to see their health care system change for the better.

Starting right now, our families, small businesses, seniors, and young people will begin to feel the benefits of health care reform. Immediate benefits include a 35% tax credit to small businesses that provide coverage to their employees and a $250 rebate on prescription drugs for seniors paying thousands of dollars for their prescriptions in the “donut hole.”

Other reforms kick in soon. In June, Americans formerly shut out by pre-existing conditions will have access to affordable coverage provided through a high-risk pool. In September, young people up to the age of 26 will be able to join their parents’ health insurance, and health insurance companies will be banned from dropping someone’s coverage when that person gets sick. There will also be no more lifetime or annual caps on expenditures for the exceedingly ill.

Despite the misinformation peddled by opponents of health care reform, this legislation will not harm Medicare. While the opposition outrageously tried to scare our seniors into believing that their benefits would be cut and that they would face “death panels,” the reality is that seniors will now benefit from a more secure Medicare and from the comfort that the donut hole will be completely closed over time. Remember, the AARP, our nation’s lead advocate for our senior citizens, enthusiastically endorsed the reform.

In terms of reducing the out-of-control increases in health care costs, nearly every proven idea for controlling costs is contained in this bill. These include new requirements for insurers to disclose and justify premium increases; the creation of insurance exchanges to promote competition that will result in more competitive rates for coverage; national pilot programs to increase payments for doctors and hospitals who deliver high-quality care at a lower cost; and new incentives for wellness and preventive care. Over time, some of these provisions will lead to much more efficient care.

Finally, according to the non-partisan Congressional Budget Office (CBO), this reform is the largest deficit reduction measure in decades. Over the course of the next 10 years, it will reduce the federal deficit by�$138 billion. In the ensuing decade, that savings grows to over $1 trillion. The CBO is appropriately required to be conservative, and to substantially discount uncertain savings. Because of this policy, nearly $600 billion in savings over the next decade, as estimated by leading Harvard economist David Cutler in the Wall Street Journal, doesn’t show up in CBO’s budget scores. We know—and economists agree—that these cost savings exist.

Like all major change, health reform is not without risk. Some cost savings ideas will fail. The system will be subject to political pressure just as it is today. But the risks associated with maintaining the status quo far outweigh the risks of reform. Health care costs currently consume one in every six dollars we spend. We spend twice per person what the average industrialized country spends with far worse results, the very definition of inefficiency.

Perhaps most importantly, after a century of failed attempts by Presidents going back to Teddy Roosevelt, through Eisenhower, Nixon, and Clinton, we are finally able to offer all Americans access to life-saving medical care. Now, we can say without reservation that we Americans look after our own.

So Anthem, which is owned by Wellpoint, set a firestorm of controversy in California when they announced individual policy rate hikes of 39%. Now other states are being targeted by Anthem. Like Maine. No reports yet on Anthem raising rates in Connecticut From the AP:

Consumers in at least four states who buy their own health insurance are getting hit with premium increases of 15 percent or more — and people in other states could see the same thing.
Anthem Blue Cross, a subsidiary of WellPoint Inc., has been under fire for a week from regulators and politicians for notifying some of its 800,000 individual policyholders in California that it plans to raise rates by up to 39 percent March 1.
The Anthem Blue Cross plan in Maine is asking for increases of about 23 percent this year for some individual policyholders. Last year, they raised rates up to 32 percent.
And in Oregon, multiple insurers were granted rate hikes of 15 percent or more this year after increases of around 25 percent last year for customers who purchase individual health insurance, rather than getting it through their employer.
Premiums are far more volatile for individual policies than for those bought by employers and other large groups, which have bargaining clout and a sizable pool of people among which to spread risk. As more people have lost jobs, many who are healthy have decided to go without health insurance or get a bare-bones, high-deductible policy, reducing the amount of premiums insurers receive.
Steep rate hikes in this sliver of the insurance market — about 13 million Americans, as of 2008 — have popped up sporadically for years. Experts see them becoming increasingly common.

A 10% tax on indoor tanning? This is buried in the� pages of the Senate� health care bill.

What gives? Well originally the Senate bill propsoed a 5% tax on elective cosmetic surgery. Think botox, hair plugs and face lifts. And somehow lobbyists got involved. Specifically the America Medical Association.� The elective cosmetic surgery tax was replaced by a 10% tax on indoor tanning. According to reports, the tanning tax is expected to net $2.7 billion over the next decade — less than half of the� 5.8 billion “Botax” was expected to net.

Among the arguments put forth by critics of the Botax proposal? Since 85-90% of elective cosmetic surgery patients are women, a Botax would be discriminatory, an argument backed by the American Medical Association and the National Organization for Women, which opposes the Botax proposal.

Yet most tanning salon owners are women and most clients of tanning salons are women.

According to a recent blog post at Wallet-Pop,� John Overstreet, executive director of the ITA (Indoor Tanning Association) said, “It is not surprising that one primarily cosmetic business is trying to throw another under the bus by transferring a tax from rich doctors and their wealthy customers to struggling small businesses. The irony is that ultraviolet light at least has proven health benefits, where botox treatments have none.”

According to the NYTimes:

Dr. David M. Pariser, the president of the American Academy of Dermatology, said his association proposed that an indoor-tanning tax be considered in place of the cosmetic tax, and that it contacted the offices of senators. “We made the case this will reduce health care costs by hopefully reducing skin cancer in the future — that’s the point — and also raise a little revenue now,” Dr. Pariser said.

So people who like to go to tanning salons may now be bearing some of the costs of the new legislation. And the lobbyists have saved botox nation from any additional taxes.

Forget the talking heads, typing pundits, spinning political flunkies. The polemics are so last decade, er, oops they will be in a few short days. Bet behold, the Health Care Reform subsidy calculator. Does health care change for you? Take a calculated guess:

This tool illustrates premiums and government assistance under the types of reform proposals being considered in Congress for people under age 65 who purchase coverage on their own in an Exchange and are not covered through their employer, Medicare or Medicaid. …

www.healthreform.kff.org/SubsidyCalculator.aspx

I’m glad that someone is taking a look at the provision in the recently passes Senate health care reform bill that has Nebraska’s medicare Medicaid reimbursement at a full 100%. The Courant’s Christopher Keating�reports:

In a move being made by other states,�Republican Gov. M. Jodi Rell called for legal action Wednesday if Nebraska receives more Medicaid money than the other 49 states as part of the national health care bill.

Rell wrote a letter to Connecticut Attorney General Richard Blumenthal regarding a provision inserted into the massive federal legislation that would fully fund Medicaid for the home state of Senator Ben Nelson, a Nebraska Democrat. The provision has been widely reported as part of the many deals struck to reach a compromise on health care.

Across the country,�attorneys general in at least seven states are voicing similar concerns about the Nebraska compromise and�questioning its legality.

The Senate vote on the bill is scheduled at 8 a.m. Thursday. The Christmas Eve vote is highly unusual as the Senate has not been in session on that day in the past 46 years.

Unlike Connecticut, Nebraska would be able to receive 100 percent reimbursement of its Medicaid costs if the provision is enacted and signed into law by President Barack Obama. Currently, Connecticut receives 50 percent of the cost for Medicaid, which is a federal-state program that provides health care for the poor.

“The inequity of this provision is astonishing,” Rell wrote Wednesday in her�letter to Blumenthal. “The�doling out of favors for senators is appalling. The cost of this federal health care bill is beyond comprehension because of all the special provisions included to garner the 60 votes for passage.”

“By the time Washington finishes with this proposal and drops it at the taxpayers’ doorsteps, it will be monstrous,” Rell said. “The�Senate may get their votes, but the American taxpayer will get the bill. The best Christmas gift Congress could deliver to the American people would be to strip out every special consideration, every gift, every piece of pork and concentrate on the heart of the matter – real and affordable reform.”

Right on. Strip them out, but then wouldn’t that derail Chris Dodd’s attempt at erasing his very negative polling numbers in Connecticut? From another story, this time from Politico’s John Bresnahan:

Sen. Chris Dodd (D-Conn.) is using every last bit of clout he has accumulated during three decades in the Senate, calling in favors, winning sweetheart deals and steering hundreds of millions of dollars to his home state.

He’s one of the most politically vulnerable Democratic senators, and he’s not being shy about using his influence to insert into 2010 spending bills dozens of earmarks for senior citizen centers, low-income heating assistance, education programs, new buses and highway funds in Connecticut.

Dodd is pushing the Pentagon to buy more Connecticut-built aircraft engines, and he’s pressing for more federal dollars for high-speed rail in the Nutmeg State.

And his earmark largesse doesn’t include a $100 million provision he anonymously stuck into the Senate Democratic health care package, money that Dodd wants to go to the University of Connecticut’s medical center.

At first, Dodd didn’t want to claim credit for that one, but he ’fessed up when asked by The Associated Press.

“With a tough reelection battle next year, Sen. Dodd is trying to move anything in Washington that isn’t nailed down up to Connecticut,” said Steve Ellis, vice president of Taxpayers for Common Sense, a spending watchdog group.

Ellis’s group estimates that Dodd — either by himself or with other lawmakers — has secured 92 earmarks worth at least $121 million for Connecticut.

I think Rell is thinking along those lines too, not to say the Nebraskan Medicare Medicaidlargess is particularly bad for Connecticut when you consider that the medicare tab for the state is about 20% of the budget, or 3,724 million. About half of that is covered by the feds, so that leaves 1.8 billion on the hook for Connecticut Taxpayers.

To read the assemblage of media stories on the health care bill that the Senate is working on, you’d have thought that there was some there, there. On the one hand you have Howard Dean saying “the protectionist legislation for the insurance companies that is in there now needs to be stripped out entirely.” Meanwhile the lefty blogsphere is upset that Senator Joe Lieberman opposed the expansion of medicare. So what exactly is this bill that has Democrats fumbling through Red Bull in hopes of passing, something, anything, before Christmas?

The bill alledgedly does the following:

1. Insurance comapnies will be required to spend a lesser pecentage on administrative costs and profits.
2. Insureres have to participate in exchanges, and if they jack up rates before the exchanges start they won’t get to be in them.
3. No child will be denied coverage for pre-existing conditions.
4. By 2014 no caps on annual treatments.
5. Patients will have right to an internal (read insurance company) appeakl and an external appeal.
6. Consumers can pick out of state inusrance providors.
7. Consumers have to buy health insurance.
8. And some other boring stuff.

You can read the Salon rundown here. Everyone else is delving into the sausage making of who supports what. And somehow abortion becomes a flashpoint on who signs on and who doesn’t. Moveon.org is generating a petition against the Senate bill, Olympia Snowe isn’t supporting, but now Lieberman is. Kinda confusing isn’t it.

What the bill isn’t is health care reform. For that you’d have to actually have stuff in that relates to health care, not insurance. Things like, how much does procedure XYZ cost? Shouldn’t it cost the same for someone who has insurance as for someone who doesn’t? Forget the big traumatic life threatening things. What about my favorite example, the broken arm. Shouldn’t any patient anywhere know is adavance what it will cost if they go to a clinic, hosiptial, private practitioner, etc.? Does anyone in Congress care?

Apparently not, because all this bill does is add a layer of bureaucracy on top of a system predicated on keeping the consumer in teh dark about true health care costs, tied to employer provided benefits for jobs that every company is desperate to ship over seas to a labor market where there is nationalized healthcare. Hey and don’t you feel good that Nebraska will pick up $100 million to fund its medicare program? Not yet? How about Louisiana getting $300 million for its medicare tab? A reminder on which states are donor states and which states receive donor states tax dollars:

President Obama says “the American people will have the vote they deserve on health reform.” Oh yeah, it kinda sucks doesn’t it no matter which side of the of the health care reform aisle you are on. The vote we deserve? Kinda like the vote we had on TARP. The vote we had on cash for clunkers and the vote we had on bailouts in general.

The debate, such as it is, over how to reform health care, or health insurance, or whatever the hell we’re trying to do, or not do, often seems a muddle to me. I found this refreshing take – from someone who claims to have actually perused the document – on the Senate bill in my copy of The New Yorker, 14 December 2009.

You may enjoy it online here.

Worth reading.
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In a recent issue of WIRED, the odd grassroots movement against vaccines gets discussed. The idea that childhood vaccines are bad, is just one more sign that in America, bad science, takes root and flourishes. Science and data rejected because of irrational fears. Apparently though, the anti-rational thinking amongst the human species isn’t a new phenomena:

The rejection of hard-won knowledge is by no means a new phenomenon. In 1905, French mathematician and scientist Henri Poincar� said that the willingness to embrace pseudo-science flourished because people “know how cruel the truth often is, and we wonder whether illusion is not more consoling.” Decades later, the astronomer Carl Sagan reached a similar conclusion: Science loses ground to pseudo-science because the latter seems to offer more comfort. “A great many of these belief systems address real human needs that are not being met by our society,” Sagan wrote of certain Americans’ embrace of reincarnation, channeling, and extraterrestrials. “There are unsatisfied medical needs, spiritual needs, and needs for communion with the rest of the human community.”

Looking back over human history,�rationality has been the anomaly. Being rational takes work, education, and a sober determination to avoid making hasty inferences, even when they appear to make perfect sense. Much like infectious diseases themselves — beaten back by decades of effort to vaccinate the populace — the irrational lingers just below the surface, waiting for us to let down our guard.

Before smallpox was eradicated with a vaccine, it killed an estimated 500 million people. And just 60 years ago, polio paralyzed 16,000 Americans every year, while rubella caused birth defects and mental retardation in as many as 20,000 newborns. Measles infected 4 million children, killing 3,000 annually, and a bacterium called�Haemophilus influenzae type b caused Hib meningitis in more than 15,000 children, leaving many with permanent brain damage. Infant mortality and abbreviated life spans — now regarded as a third world problem — were a first world reality.

Today, because the looming risk of childhood death is out of sight, it is also largely out of mind, leading a growing number of Americans to worry about what is in fact a much lesser risk: the ill effects of vaccines. If your newborn gets pertussis, for example, there is a 1 percent chance that the baby will die of pulmonary hypertension or other complications. The risk of dying from the pertussis vaccine, by contrast, is practically nonexistent — in fact, no study has linked DTaP (the three-in-one immunization that protects against diphtheria, tetanus, and pertussis) to death in children. Nobody in the pro-vaccine camp asserts that vaccines are risk-free, but the risks are minute in comparison to the alternative.

Still, despite peer-reviewed evidence, many parents ignore the math and agonize about whether to vaccinate. Why? For starters, the human brain has a natural tendency to pattern-match — to ignore the old dictum “correlation does not imply causation” and stubbornly persist in associating proximate phenomena. If two things coexist, the brain often tells us, they must be related. Some parents of autistic children noticed that their child’s condition began to appear shortly after a vaccination. The conclusion: “The vaccine must have caused the autism.” Sounds reasonable, even though, as many scientists have noted, it has long been known that autism and other neurological impairments often become evident at or around the age of 18 to 24 months, which just happens to be the same time children receive multiple vaccinations. Correlation, perhaps. But not causation, as studies have shown.

That lack of understanding causation and correlation is evident in most of the things people complain about in Norwalk. Crime and traffic spring to mind.

Getting the measles is no walk in the park, either — not for you or those who come near you. In 2005, a 17-year-old Indiana girl got infected on a trip to Bucharest, Romania. On the return flight home, she was congested, coughing, and feverish but had no rash. The next day, without realizing she was contagious, she went to a church gathering of 500 people. She was there just a few hours. Of the 500 people present, about 450 had either been vaccinated or had developed a natural immunity. Two people in that group had vaccination failure and got measles. Thirty-two people who had not been vaccinated and therefore had no resistance to measles also got sick. Did the girl encounter each of these people face-to-face in her brief visit to the picnic? No. All you have to do to get the measles is to inhabit the airspace of a contagious person within two hours of them being there.

The frightening implications of this kind of anecdote were illustrated by a 2002 study published in�The Journal of Infectious Diseases. Looking at 3,292 cases of measles in the Netherlands, the study found that the risk of contracting the disease was lower if you were completely unvaccinated and living in a highly vaccinated community than if you were completely vaccinated and living in a relatively unvaccinated community. Why? Because vaccines don’t always take. What does that mean? You can’t minimize your individual risk unless your herd, your friends and neighbors, also buy in.

Perceived risk — our changing relationship to it and our increasing intolerance of it — is at the crux of vaccine safety concerns, not to mention related fears of pesticides, genetically modified food, and cloning. Sharon Kaufman, a medical anthropologist at UC San Francisco, observes that our concept of risk has evolved from an external threat that’s out of our control (think: statistical probability of a plane crash) to something that can be managed and controlled if we just make the right decisions (eat less fat and you’ll live longer). Improved diagnostic tests, a change in consumer awareness, an aging society determined to stay youthful — all have contributed to the growing perception that risk (of death, illness, accident) is our responsibility to reduce or eliminate. In the old order, risk management was in the hands of your doctor — or God. Under the new dispensation, it’s all up to you. What are the odds that your child will be autistic? It’s your job to manage them, so get thee to the Internet, and fast.

The WIRED article focuses on vaccination and the anti-vaccination movement. But it’s a good read if your into as one of the Doctors profiled in the piece says, “What I loved about science was its reason. You have data. You stand back and you discuss the strengths and weaknesses of that data. There’s just something very calming about that. You formulate a hypothesis, you establish burdens of proof, you subject your hypothesis to rigorous testing. You’ve got 20 pieces of a 1,000-piece puzzle � It’s beautiful, really.”

source: WIRED,�An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All, By Amy Wallace,�October 19th, 2009

For the week of Sunday, Sept. 20, to Saturday, Sept.�26,�Connecticut�was�found�to not�have�widespread influenza activity, according to�a report prepared�by the�Centers for Disease Control and Prevention. The�27�states�listed as having widespread cases of the flu in the CDC”s most recent �”2009 H1N1 Flu�Situation Update”�were: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, Texas, Tennessee, Virginia, Washington, and Wyoming.

The CDC said almost all�influenza patients were found to be infected by�the�2009 H1N1 influenza A virus (“swine flu”), and said�reports of widespread influenza activity in September were�”very unusual.”

The CDC said the virus selected�for the 2009 H1N1�A�vaccine, which could�become available this week,�remains similar to the virus being detected in patients, and remains susceptible to the antiviral drugs oseltamivir and zanamivir, with rare exception.

The CDC also reported:

• Visits to doctors for influenza-like illness�continued to increase in some areas of the country, and overall are higher than levels expected for this time of the year.
• Total influenza�hospitalization rates for laboratory-confirmed influenza in adults and�children are higher than expected for this time of year,�and for children ages 5-17 and adults ages 18-49, hospitalization rates from April through�September 2009 exceeded average flu season rates.
• Based on reports from�122 cities, the proportion of deaths attributed to pneumonia and influenza�was low and within the bounds of what is expected�this time of year. However, 60 pediatric deaths related to 2009 H1N1 flu�have been�reported to the CDC since April 2009, including 11 deaths�in the week�covered by the latest Situation Update.

Further information from the CDC�about the influenza pandemic can be found at�www.flu.gov/ .

A nationwide poll conducted on behalf of a hospital belonging to the University of Michigan Health System found 40 percent of parents intended to get their children vaccinated against pandemic H1N1 influenza, while 54 percent would have their children vaccinated against seasonal flu.

The poll for the C.S. Mott Children’s Hospital in Ann Arbor found that among parents not planning to get their children vaccinated against H1N1, 46 percent indicated they were not worried about their children contracting pandemic flu, and 20 percent believed H1N1 flu is not a serious illness.

In a news release issued Thursday, the�hospital said the poll found parents planning to have their children vaccinated differed by racial and ethnic groups. More than half of Hispanic parents said they’d have their children vaccinated, compared to 38 percent of white parents and 30 percent of black parents.

Dr. Matthew Davis, director of the poll and associate professor of pediatric and internal medicine at the University of Michigan’s Child Health Evaluation and Research Unit, said the percentage of Hispanic parents who intended to have their children vaccinated may have reflected a higher perceived risk in their communities because the H1N1 flu’s initial outbreak occurred in Mexico.

In its release, the hospital said the lack of concern by parents to the risk of their children acquiring pandemic flu contrasts with information from the Centers for Disease Control and Prevention suggesting that — unlike what is typically seen with seasonal flu — rates of illness and hospitalizations for children infected with H1N1 are higher than for other age groups.

Among parents who did not plan to get their children vaccinated against H1N1 flu, or who were unsure, about half were worried about possible side effects of the vaccine.

Among parents who did plan to get their children vaccinated, about 4 in 5 believed H1N1 is a serious disease and were worried their children might contract it.

The poll, which was conducted by the survey research firm Knowledge Networks, surveyed 1,678 parents across the U.S. from August 13 to 31. It was funded by the University of Michigan Health System’s Department of Pediatrics and Communicable Diseases and the CDC.