WASHINGTON – Barack Obama praised the health care industry's promise to cut $2 trillion in costs over 10 years Monday, taking a sharply different course than President Bill Clinton did 16 years ago in an opening bid to overhaul the U.S. health system.
Drawing skepticism from lawmakers, Obama summoned representatives of the insurance industry, doctors, hospitals, pharmaceutical companies and labor groups to the White House for what he called "a watershed event in the long and elusive quest for health care reform."
It was a gathering of strange bedfellows. More than a decade ago, then-President Bill Clinton and his wife, now-Secretary of State Hillary Rodham Clinton, designed a health care plan in secret, fought industry leaders over it and lost — setting back the Democratic Party's cause for years.
If Obama succeeds in lowering costs and increasing access to health care, the meeting will be remembered as pivotal. If not, it will be just another Washington photo-op.
Indeed, the industry's proposal was short on specifics. And it appeared to do little to change minds in Congress as lawmakers attempt to write legislation to implement Obama's goal of extending health care to some 50 million uninsured Americans.
Within moments of Obama's appearance with the industry leaders, lawmakers praised the effort but suggested it didn't go to the heart of the health care debate.
Several lawmakers made clear that the industry proposal would do nothing to stave off the outcome that health insurers and others are trying to avoid — a new government insurance plan that would be available to middle-income Americans. Health insurers say such a plan would drive them out of business.
Sen. Ron Wyden, D-Ore., cautiously welcomed the industry's offer while saying, "I am not about to take the fox's word that the hen house is safe." He said the industry's promises need to be given the weight of law.
The industry groups said they would slow the growth of health care costs by 1.5 percent a year by coordinating care, reducing administrative costs and focusing on quality, efficiency and standardization. Health care costs would still grow faster than the economy as a whole, but not as fast as they otherwise would.
The specifics, industry officials said, would come later.
Obama has spoken often of the exorbitant costs in the nation's health care system, but slowing the rate price increases doesn't translate directly to paying the estimated $1.5 trillion cost of covering the uninsured. Money saved by the private sector doesn't flow directly to the federal treasury.
The top Republican on the Senate Finance Committee, Chuck Grassley of Iowa, called the announcement a "move in the right direction," but said it would be more significant if the Congressional Budget Office, Washington's arbiter of what costs or saves money for the government, determined it saved money.
"When the White House and the industry put concrete proposals on paper and get a score from the Congressional Budget Office, then we'll know if the suggestions really achieve that kind of savings, and it'll be big news," Grassley said. "For health care budgeting purposes, CBO's word is the only one that counts."
Karen Ignagni, president of America's Health Insurance Plans, contended that the voluntary cost-containment effort would help lawmakers who are aiming to craft health overhaul legislation by August.
"They need help from the stakeholder community on cost containment and what you're hearing from all of us is we intend to help and that I think is the story today," Ignagni said.
The groups who signed onto Monday's effort were the American Medical Association, America's Health Insurance Plans, the Pharmaceutical Research and Manufacturers of America, the Service Employees International Union, the American Hospital Association and the Advanced Medical Technology Association.
Officials said they could bring costs down even while continuing to stay profitable — noting that if health care legislation passes they'd be able to tap into a huge pool of currently uninsured people.
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Associated Press writers Henry C. Jackson and Ricardo Alonso-Zaldivar contributed to this report.
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Senin, 11 Mei 2009
Obama praises health industry's vow to cut costs
Worry over weight: Poll finds health disconnect
WASHINGTON – Scan the breathless headlines at any magazine rack — Fight Flab in Minutes! Get Beach Ready! Add the skinny yet buxom model, and it should be no surprise that the average woman feels insecure if not downright unhappy with her real-world figure. Hang on: Are we worried just about appearance, or about whether our size signals a health problem?
There's a big disconnect between body image and true physical condition, an Associated Press-iVillage poll suggests. A lot of women say they're dieting despite somehow avoiding healthy fruits and veggies. Many others think they're fat when they're not.
"The priorities are flipped," says Dr. Molly Poag, chief of psychiatry at New York's Lennox Hill Hospital.
She points to women athletes as much better role models than supermodels: "There's an undervaluing of physical fitness and an overvaluing of absolute weight and appearance for women in our culture."
About 60 percent of Americans are overweight or obese. The AP-iVillage poll of 1,000 adult women mirrors the government's count on that. More surprising, perhaps, are women's attitudes and actions.
Half don't like their weight, even 26 percent of those whose body mass index or BMI — a measure of weight for height — is in the normal range. But just a third don't like their physical condition, even though being overweight and sedentary are big risk factors for Type 2 diabetes, heart disease and other ailments.
The poll found women putting in a median of 80 minutes of exercise a week, meaning half do even less. The average adult is supposed to get 2 1/2 hours of exercise a week for good health.
And just 8 percent of women ate the minimum recommended servings of fruits and vegetables — five a day. A staggering 28 percent admit they get that recommended serving once a week or less.
Time is a big barrier.
"I was a fanatic about exercise when I was younger, and I quit focusing on that when I had kids," says Laura Comer, 45, of Sugar Land, Texas, a mother of two.
But she just her lost her job as a hospital system vice president and is using the new free time to ease in more activity. First up: walking 10,000 steps a day.
Vesna Stemwell, 51, of Delano, Minn., has a sedentary job — she's a computer programmer — with lots of overtime and a 45-minute commute.
Temporarily giving up meat and dairy products for a religious observance helped her drop five pounds, so she's considering becoming vegetarian to drop more. But her husband isn't keen about a menu change.
"Changing the diet," Stemwell said, "affects everybody in the house and it's hard to have something different."
About a quarter of the women surveyed said they'd consider plastic surgery to feel more beautiful. Their overwhelming choice: a tummy tuck.
"There isn't any quick fix," says Dr. Nieca Goldberg, who directs the women's heart program at the New York University Langone Medical Center.
A tummy tuck is cosmetic, removing just some surface fat, and a far cry from more radical surgeries like stomach stapling that are reserved to help the health of the very obese.
"People can't see the damage that's being done inside their body," says Goldberg. "If you increase your fitness but don't lose as much weight, you still have a lower heart disease risk than someone who is obese and sedentary."
At the other end of the spectrum, the poll found 16 percent of normal-weight women who nonetheless are dieting to drop pounds. Most extreme are eating disorders like the anorexia that has tormented Daleen Johnson of Oceanside, Calif., for years.
Her two children spurred the 5-foot-9 Johnson to put on 20 pounds in the past year, getting up to 125.
"My 8-year-old came up to me and was like, 'Mom, why don't my hip bones stick out like yours?'" said Johnson, 28. "I could put my selfishness aside so that she didn't think being skinny is what matters."
Still, Johnson says, "Summer's coming and I'm panicking because I don't think that I'm good enough. I don't look like the supermodel on TV."
Eating disorders aside, normal-skinny doesn't automatically mean healthy, stresses University of Houston sociologist Samantha Kwan, who studies gender and body image.
"Someone who is fat or even overweight can be healthy if they have a balanced diet and are physically active," Kwan says. "Our culture really does put a lot of pressure on women to look a certain way," taking precedence over health measures.
Olive James, 60, of Cincinnati gets that message. She calls herself about 10 pounds over her target weight, but exercises 30 minutes a day and takes her cholesterol and blood pressure medicine.
"I do get a lot of compliments for the way I carry myself," she says. "I feel great."
The AP-iVillage poll was conducted April 20-30 by Knowledge Networks, which contacted survey participants using traditional telephone and mail polling methods but then intensively questioned them online, providing Internet access for those who needed it. The poll has a margin of error of plus or minus 3.7 percentage points.
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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
AP Polling Director Trevor Tompson and Associated Press Writer Christine Simmons contributed to this report.
On the Net:
iVillage sites: http://healthvideo.com/ap_poll and http://yourtotalhealth.ivillage.com/healthier-habits-tummy-tuck.html
AP survey results: http://surveys.ap.org/
Swine flu spreads in world; Mexico opens schools
MEXICO CITY – Mexico welcomed millions of children back to school Monday with masks, thermometers and globs of hand sanitizer, as scientists estimated the new strain of swine flu could have sickened 23,000 people before anyone realized it was an epidemic.
At least 61 people have been killed by swine flu around the world, and the World Health Organization has confirmed 4,800 cases, including the first in mainland China. China scrambled Monday to find and quarantine more than 200 people on the infected man's flight from the U.S., though the University of Missouri campus where he had been studying planned no special precautions.
A study published Monday in the journal Science estimated Mexico alone may have had 23,000 cases by April 23, the day it announced the epidemic. The study estimates swine flu kills between 0.4 percent and 1.4 percent of its victims, but lead author Neil Ferguson of Imperial College, London, said the data remain incomplete.
"It's very difficult to quantify the human health impact at this stage," he said.
The reopening of kindergartens and primary and middle schools shut since April 24 was the latest step in Mexico's efforts to restore a sense of normality. Businesses, government services, high schools and universities reopened last week.
But six of Mexico's 31 states put off reopening schools for a week because of local rises in the number of cases, and a seventh ordered a one-day delay.
In Mexico City, children lined up outside the Ignacio L. Vallarta public elementary school so teachers could check students for flu symptoms. Some parents worried schools were opening too soon, but many were also relieved after spending two weeks trying to entertain bored children. Officials said any students with symptoms would be sent home.
"It's good that schools are reopening. Our children were getting lazy," said Eugenia Martinez as her 8-year-old son, Edgar, ran around in a white mask and Power Rangers T-shirt. "I think everything is under control."
The federal Education Department said Monday that all 250,000 schools — except some 30,000 in states that did not reopen Monday — had been cleaned and disinfected as 25 million children prepared to return to class.
"It's very important for families to know that the disease is curable; we have enough medicine to treat any cases that arise," Education Secretary Alonso Lujambio Irazabal said. "As soon as we suspect we have a case we are going to offer antivirals to that person, that teacher, that student."
Mexico also is trying to revive its economy after the epidemic pummeled tourism, the country's third-largest source of legal foreign income. Mexico provided details Monday of a 14 billion peso ($1.1 billion) package to help restaurants, hotels and other businesses.
At least 10 commercial banks are involved in the plan, promising three-month reprieves for small businesses with outstanding loans in Mexico City and two hard-hit states. Small businesses in beach resorts and other tourist destinations were promised a six-month grace period.
"We are not looking for magical or spectacular solutions — which would be illusory — only that businesses have the liquidity need to recover from this emergency," Finance Secretary Agustin Carstens said. "Mexico is facing a very complicated year that combines a flu outbreak with one of the most severe global recessions in the last 60 years."
Later in the day, Tourism Secretary Rodolfo Elizondo said the government would launch a 1.2 billion peso ($90 million) publicity campaign this week urging Mexicans to take vacations in their own country.
Noting several nations have issued travel warnings or restricted airline flights to Mexico, Elizondo said that for now trying to promote trips to Mexico by foreigners "would be like throwing money away." He said occupancy rates at Mexico's top beach resorts are averaging between 15 percent and 23 percent.
The number of countries reporting confirmed swine flu cases grew to 31, with Cuba saying a Mexican who came to the island to study was sick with the virus. Cuba said the student was among a group from several Mexican states that began arriving April 25 — four days before Cuban authorities halted airline flights from Mexico in hopes of keeping out the illness.
The United States now has the most confirmed cases — 2,618 — according to the U.S. Centers for Disease Control and Prevention. Mexico has confirmed 2,059 cases. Swine flu has killed 56 people in Mexico, three in the U.S., one in Canada and one in Costa Rica.
The analysis in Science suggests there are many more cases than those confirmed by laboratories — anywhere from 6,000 to 32,000 cases in Mexico as of April 23. The flu has since spread around the world, and the study said it appears to be substantially more contagious than normal, seasonal flu.
Researchers also compared the DNA of the viruses in 23 confirmed cases, and came up with an estimate of Jan. 12 for their earliest common ancestor — presumably when person-to-person transmission began. But with everything that isn't known, they said it could have been anywhere from Nov. 3 to March 2.
The researchers said the 2009 H1N1 flu appears to be about equal in severity to the flu of 1957 and less severe than the deadly 1918 version.
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Associated Press writers Maria Cheng in London, Randolph E. Schmid in Washington and Gillian Wong in Beijing contributed to this report.
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Critics: WHO slow on generics for swine flu
LONDON – As poor countries face a possible swine flu pandemic with only enough Tamiflu to treat a tiny fraction of their populations, some experts are calling for a simple but contentious solution: massive production of generics.
Antivirals such as Tamiflu are believed to be effective against swine flu if administered early.
Tamiflu, made by the Swiss drugmaker Roche, sells for as much as $100 per treatment in countries such as the U.S., but since 2005 the company has offered a discounted price of $16 per treatment to poor nations. Cheap generics also can easily be manufactured by other companies, if the drug producers allow it.
Many rich nations sit on stockpiles of expensive Tamiflu, which was created in 1996 and is patent protected in most countries. However, Roche granted two companies in China and one in India permission to produce generic versions of Tamiflu in 2006. It also announced a transfer of the technology needed to make the drug to a company in South Africa.
Roche could not say how many developing countries have ordered Tamiflu at the cheaper price.
"We remain ready to discuss options with any manufacturers who can make Tamiflu," David Reddy, who works on Roche's global pandemic task force in Basel, Switzerland, said Monday.
Despite this availability, the World Health Organization — which maintains its own stockpiles of Tamiflu for poor nations — has not ordered up new batches of generic Tamiflu, even though WHO raised its pandemic alert level to phase 5, signaling it believes a global flu outbreak to be "imminent."
Critics say Roche should allow even more companies to produce generic Tamiflu, and that money from donor countries would go further in the Third World, if WHO was buying generic flu medicines itself or advising poorer countries to do so.
Meanwhile, in India, which does not recognize Roche's patent, the pharmaceutical giant Cipla has said it will charge about $12 per course of a generic Tamiflu.
Some critics suspect WHO is reluctant to anger drug companies, which supply it with free stockpiles of drugs, by encouraging the use of generics. Given all they spend on research and development to produce new drugs, Western pharmaceuticals have long fought to keep generics out of the market in all circumstances.
"There needs to be a better system in place so that WHO does not have to rely on the goodwill and charity of drug makers to get medicines for poor countries," said Sangeeta Shashikant of Third World Network, a nonprofit development organization.
WHO insists it's doing its best to secure antivirals for poor countries.
"WHO will work on behalf of its member states to secure further antivirals as needed, either through donations or purchase at the lowest possible price, to support developing countries in need," said Elil Renganathan, a WHO official working on antivirals.
Tamiflu and a similar medicine, Relenza, are mainly used to treat flu, but they only work if started within 48 hours of first symptoms. Studies show they cut the duration of illness by about one day, compared with no treatment. Little is known about whether these medicines cut the chances of serious flu complications, like pneumonia, and few studies have tested them in children.
Experts say vaccines would offer the best protection against a swine flu pandemic, but they won't be available for months.
And even when they are, rich countries are first in line: Britain, Canada, Denmark, France, the United States and others have all signed deals with vaccine makers to ensure they get the first batches of pandemic vaccine off the production line.
WHO is appealing to vaccine makers to save some of their vaccines for poor countries, but it's doubtful they will get enough to treat a significant portion of the population.
Last week, Cipla said it could produce 1.5 million treatments of a generic version of Tamiflu in the next few weeks. But Yusuf Hamied, the company's chairman, said it is ready to make millions more courses as soon as poor countries and agencies like WHO place orders.
"We could make a lot more, but there needs to be firm commitment from countries and international agencies like WHO," he said. "The ball is in their court."
So far, WHO has not recommended that countries with production capacity start making their own generic supplies of antivirals.
WHO has a stockpile of about 5 million Tamiflu treatment courses donated by Roche, and last week the agency began sending 2.4 million treatments to 72 poor countries. But such numbers pale in comparison to hundreds of millions of people in the developing world who would be vulnerable in a flu pandemic.
WHO says it is exploring generic production, but no decisions have been made. WHO says it is unsure how much massive generic production could increase the global supply and would not estimate a cost.
Renganathan said WHO wants to ensure any generic medicines meet drug safety standards. He said they are investigating the possibility of generic production with companies wherever they are located.
Still, critics say WHO has been slowfooted on generics.
"I don't know why WHO hasn't pursued generics," said Tido von Schoen-Angerer, director of Medecins Sans Frontieres' Access to Essential Medicines Campaign.
"A big role for WHO is to increase the world's generics supply of antivirals and make sure all countries have access," von Schoen-Angerer said. "It's not clear why WHO hasn't prioritized this."
With a large supply of generics, developing countries that could afford them, like Thailand and Brazil, could reinforce their own supplies. For poorer nations, agencies like UNICEF might buy the antivirals and distribute them to countries in need.
High rates of HIV, malaria, tuberculosis, malnutrition and other health problems greatly deepen the vulnerability of the world's poorest countries to a flu pandemic.
So far, critics say there's no indication from WHO that generic options will be prioritized for poor countries that can't afford Roche's Tamiflu.
"Countries are going to scramble to get as many medicines as they can in this situation," said Martin Khor, executive director of the South Centre, a think tank focused on developing countries.
"WHO should be helping countries to get stockpiles of antivirals as cheaply as possible."
news source www.news.yahoo.com
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