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Having paid off one high-profile litigant and facing protests by men's and fathers' rights organizations, British Airways has finally done what it should have been doing all along.  It's established gender-neutral policies about who can sit next to unaccompanied minors on international flights.  Better late than never, I suppose, but BA shareholders might be wondering why it took the geniuses in top management so long to figure out the obvious - that preventing men from sitting next to unaccompanied minors discriminates and stigmatizes men.  Read about it here (Telegraph, 8/21/10).

It took a lawsuit by Luxembourg resident Mirko Fischer and a £2,900 payout to him to goad BA into changing its policy.  That came after men's and fathers' rights protesters had long excoriated the company for its anti-male discrimination. 

BA, which carried out a review of its policy following the case, now says “seating of unaccompanied minors is managed in a safe but non discriminatory manner”.

Mr Fischer, who lives in Luxembourg, said he was “absolutely delighted” by the policy change. He has donated his compensation money to Kidscape and Orphans in the Wild, two child protection charities.

Predictably, BA now characterizes its anti-male discrimination as a “service” it offered to children.  Stated another way, it provided the “service” of holding men like Fischer up to public ridicule for no reason other than their sex.  Nice. 

Beyond that, it provided the “service” of creating a problem where there was none.  Has anyone ever seen a case in which a man abused a child he was sitting next to on a commercial flight?  I haven't, although I have seen one in which a woman is accused of doing so. 

And beyond even that, BA provided the “service” of forcing unaccompanied minors to sit beside women, who by the way, do far more child abuse than do men.  U.S. figures from the HHS Administration for Children and Families show that every year, mothers and other women do more than twice the abuse and neglect that fathers and other men do.

So, in addition to being discriminatory against men, BA's policy didn't make sense.  If anything, it might have increased the danger to children flying BA.

BA's official statement on its change in policy is mostly incomprehensible, but it seems that it's going to start setting aside a section for unaccompanied minors and dropping its policy of discriminating against men in seating.  Again, why they couldn't have figured that out long ago and without the assistance of a lawsuit, I'll never understand.

Apparently Qantas and Air New Zealand are the only airlines that still hew to the “all men are perverts and no women are” policy that BA has just abandoned.  So the next time you have an opportunity to fly Qantas or Air New Zealand, don't.

Thanks to John for the heads-up.

This entry was posted

on Thursday, August 26th, 2010 at 5:58 am and is filed under Misandry.

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President Barack Obama has proposed the creation of an Institute
for Comparative Effectiveness as a key component of an ambitious
health care reform. The institute would have the authority to
make official determinations of the clinical effectiveness and
cost-effectiveness of medical treatments, procedures, drugs, and
medical devices.

President Obama's initial nominee as Secretary of Health and
Human Services (HHS), former Senator Tom Daschle (D-SD), has
likewise proposed the creation of a supremely powerful Federal
Health Board, which would have similar authority to make decisions
that would be binding on health plans and providers financed by
federal taxpayers, and potentially on private health insurance
coverage. While Senator Daschle has withdrawn his
name from Senate consideration, the concept of such a board or
institute is strongly indicative of the Obama Administration's
policy orientation toward centralized health policy
decision-making.

The U.S. House of Representatives has just passed the $850
billion American Recovery and Reinvestment Act (H.R. 1), the
so-called economic stimulus bill, which would establish a Federal
Coordinating Council for Comparative Effectiveness Research. The
bill would provide $1.1 billion for the new council and delegate
spending authority to the HHS Secretary to investigate the
effectiveness of different drugs and medical devices. The
Senate version of the economic stimulus package contains a similar
provision.

Of course, there is no reason why private-sector or government
officials should not have access to the best information on what
works and what doesn't. Nor is there any reason why such scientific
evaluations should not be widely available to doctors and patients
alike. But studies of the comparative effectiveness of medical
devices, drugs, and technology should be conducted primarily within
the private sector, and there should be no government monopoly over
either the research or the distribution of information. The key
issue is the personal freedom of patients to be able to choose the
health care that, in the professional judgment of their doctors,
best serves their personal needs.

Focus on Medical Technology. Technology, in particular,
can be expensive. Over the past 20 years, health technology
assessment (HTA)–the synthetic coordination of information
assessing medicines and treatments–has become increasingly popular
with policymakers and legislators around the world. Advocates of
HTA invariably believe that such an approach has the capacity to
provide decision-makers in the public and private sectors with
objective information on the value of medical technologies,
devices, and medicines. Driven by concerned perceptions of
"unproven technology," "spiralling costs" and "increasing consumer
expectations," its proponents aim to produce synthesized research
information that they believe sheds light on the effects and costs
of various forms of health technology.

Such an approach, however, would guarantee the incremental
advance of government control of private medical decisions. While
formally touted as an instrument of efficiency and effectiveness,
it would distort scientific research in the service of political or
budgetary objectives while denying individual freedom of choice. In
that sense, this approach would serve as a propaganda tool designed
to legitimize anti-consumerist rationing.

Comparative Effectiveness in Health
Care: How It Started

The intellectual roots of effectiveness research can be traced
back to mid-18th century Scotland and the "arithmetical medicine"
practiced by the graduates of the Edinburgh medical school. It was
there that James Lind famously undertook a controlled trial of six
separate treatments for scurvy. During the 1830s, Pierre
Louis developed the méthode numérique in
Paris, whereby he demonstrated that phlebotomy did not actually
improve the survival rates of patients suffering from
pneumonia.

At the beginning of the 20th century, Ernest Codman, an American
physician, founded what is today known as "outcomes management" in
patient care. Shunned by established institutions, he set up his
own unit, the End Result Hospital. In line with his teachingsand
the findings from this unit, end results were made public in
a privately published book, A Study in Hospital
Efficiency. Of 337 patients discharged from the
hospital between 1911 and 1916, Codman recorded and publicized 123
errors.

In England, the 1930s saw the development of health services
research. In a world increasingly obsessed with egalitarian
uniformity, J. A. Glover found a tenfold variation in
tonsillectomy. Subsequently, following several decades of
socialized health care in the United Kingdom, the 1970s and 1980s
witnessed the release of a range of studies that highlighted wide
geographical variations in general medical admissions including
operations such as appendectomy, caesarean section,
cholecystectomy, hysterectomy, tonsillectomy, and prostatectomy. Such
variations not only demonstrated the inequities of the National
Health Service (NHS), but also raised questions about the probity
and cost-effectiveness of many of its treatments.

Following the publication of Archie Cochrane's Effectiveness
and Efficiency: Random Reflections on Health Services in the
United States, researchers demonstrated large variations in the
rates of prostatectomy for patients with benign prostatic
hyperplasia. This work and others suggested that such
variations "meant either under-provision in some places and/or
over-provision (and possibly ineffective treatment) in others."
While "comparative effectiveness" builds on skepticism, the
investigation of variations, randomized control trials, and
cost-benefit analysis, its reviews purport to be systematic. As
such, they attempt to go beyond the more narrative-based reviews
that used to dominate the typical review article in medical
literature.

Comparative Effectiveness: The
Rationale

In recent decades, health care has advanced in significant ways.
Across the developed world, not only has medical knowledge
progressed, but investment in equipment and drugs has delivered
unprecedented gains. Treatments are safer and more effective than
ever before. Quality of life and life expectancy have been
enhanced. Alongside aging populations has come the world of
ever-increasing consumer expectations.

The rapid growth of medical knowledge and technology means it is
much harder for doctors and other health care providers to keep up
to date. Indeed, the problem of information and practice
transference is rendered almost impossible by the fact that health
care is now a highly statist and corporatist venture. Today, there
is no such thing as a free market in health care, and many of the
problems popularly associated with it are in fact the result of
state failure.

Today, in virtually every country in the world, health care is
heavily influenced by government policy and fosters professional
monopoly of supply and strict top-down regulation. While there is
nothing inherent in health care that guarantees such an outcome,
governments, either actively or passively, grant special
legislative favor to interest groups when it comes to people's
medical treatments and insurance.

The idea that government is intrinsically a superior agent, over
and above a spontaneous and free market, is groundless. As David
Friedman, a professor of law at Santa Clara University in
California, has argued, both the notion of market failure in health
economics and its popularity with most opinion leaders have arisen
because many health policy analysts "interpret the problem in terms
of fairness rather than efficiency." This almost unconscious
adherence to the notion of market failure in health care is rooted
in:

the error of judging a system by the comparison between its
outcome and the best outcome that can be described, rather than
judging it by a comparison between its outcome and the outcome that
would actually be produced by the best alternative system
available. If, as seems likely, all possible sets of institutions
fall short of producing perfect outcomes, then a policy of
comparing observed outcomes to ideal ones will reject any existing
system…. The question we should ask, and try to answer, is
not what outcome would be ideal but what outcome we can expect from
each of various alternative sets of institutions, and which, from
that limited set of alternatives, we prefer.… My conclusion
is that there is no good reason to expect government involvement in
the medical market, either the extensive involvement that now
exists or the still more extensive involvement that many advocated,
to produce desirable results.

Curiously, it is within the context of government control and
anti-competitive corporatism that new and innovative medical
treatments are met with initiatives for even more rationing by
government officials, as well as other highly regulated players
including private medical insurers. In recent years, many countries
have introduced comparative effectiveness or HTA programs,
ostensibly to improve their decision-making and their allocation of
relatively scarce medical resources. In reality, many politicians
and officials have done so not least because they are trying to get
themselves off the hook of past promises they made concerning the
provision of comprehensive, unlimited, or, as in the case of the
United Kingdom, seemingly "free" health care at the point of
service.

Since extensive government intervention has distorted health
care markets and has made it impossible for individuals to
determine a clear and transparent value of the costs and benefits
of health care technology through a normally functioning price
system, the proponents of comparative effectiveness, or health
technology assessment, have instead resorted to a predictably
pseudoscientific methodology to give their bureaucratic
determinations a sheen of objectivity. As with other forms of
centralized government planning, the practitioners of these
bureaucratic arts attempt to capture and mathematically profile and
model their assessments; in assessing health technology, they seek
"to compare and prioritize new technologies based on different
units that aggregate…benefits."

In a study of HTA for the Stockholm Network, a prominent
European think tank, research has focused on these assessments in
terms of the value of human life:

In HTA, the dominant aggregate natural unit is called
quality-adjusted life years (QALYs). Generally, QALYs factor in
both the quantity and the quality of life generated by new health
care interventions. It is the arithmetic calculation of life
expectancy and a measure of the quality of the remaining life
years…. To date QALYs are the preferred indicator of HTAs
calculations, although one may find additional tools in use by HTA
bodies such as HRQol ("health related quality of life," which
considers physical function, social function, cognitive function,
distress, pain: in brief, anything to do with quality of life),
DALYs ("disability life adjusted years"–of life lost due to
premature mortality in the population and the years lost due to
disability for incidents of the studied health condition), and
healthy-year equivalents (HYEs).

Despite the pretense of scientific objectivity, this type of
health technology assessment is nothing of the sort. It is designed
primarily to provide policymakers with a legitimizing rubric by
which they can mimic a few elements of the market and therefore
deploy a degree of fake economic rationality in justifying their
decisions. In this way, practitioners of HTA attempt to balance the
requirement to provide innovative health care technologies with
ham-fisted efforts at controlling the costs of those
technologies.

Consider the quality of human life and lifespan. The use of
QALYs is pseudoscience. It is nothing more than a tool for central
planning that attempts to objectify what is inherently subjective.
The limited attempts to capture accurately the various "units of
healthcare benefit" mean that there is an inevitable gulf between
the theoretical underpinnings of QALYs and the actual behavior of
ordinary people. Moreover, the artificial prioritization of
so-called cost-based considerations by practitioners of health
technology assessment is invariably made at the expense of other
considerations. As Dr. Meir Pugatch and Francesca Ficai of the
Stockholm Network note, "Thus, a decision to prioritize a less
therapeutically effective medicine because of cost-based
considerations over an effective, but more expensive, medicine
could lead to some serious political, social and moral dilemmas."

Not only is this type of health technology assessment
methodologically flawed: It is incompatible with personal freedom
and contradicts the subjective choices of genuine economic agents.
When deployed at the national level through the power of a
government agency, it is inevitably subject to additional political
pressures. Indeed, in 2009, it is clear that national organizations
that conduct these assessments–such as the National Institute for
Health and Clinical Excellence in the United Kingdom or the
Institute for Quality and Efficiency in Health Care in Germany–are
in the business of rationing health care technologies so that they
mesh with the politically fixed budgetary allocations of the
national government.

Today, it is clear that the political economy of these
government bodies means that their structures, processes, and
pseudoscientific constructs have a significant and detrimental
impact on the practice of, and even the public discourse on, health
care. Far from reflecting scientific rationality and economics,
health technology assessments often reflect either politically
driven social judgments of the decision-makers in these agencies
or, worse, a thinly veiled attempt to accommodate whatever
political pressures happen to be momentarily dominant.

How Comparative Effectiveness Works in
Europe

According to the International Network of Agencies for Health
Technology Assessments (INAHTA), many industrialized
countries have bodies that are charged with health technology
assessments or comparative effectiveness studies. Despite this, the
evolution of these bodies and their responsibilities at the
national decision-making level has been far from uniform.

For example, some of these bodies have an advisory role. They
make reimbursements or pricing recommendations to a national or
regional governing body, as is the case in Denmark. Others have a
more explicit regulatory role. They are accountable to government
ministers and are responsible for listing and pricing medicines and
devices. This is the case in France, Germany, and the United
Kingdom.

The United Kingdom. The experience of the United Kingdom
in making the difficult decisions about what kind of health care
technologies, devices, drugs, and medical treatments and procedures
should be favored in Britain's National Health Service has been
cited favorably by Senator Daschle.

The NHS was established in 1948. It is a single-payer health
care system, directly administered by the British government,
funded through taxation, and provided mainly by public-sector
institutions. Because the NHS is a fully nationalized entity, the
central government specifies the capital and current budgets of its
regional health authorities and determines the expenditure on drugs
by controlling the budgets given to each general practitioner.
Overall, NHS health care is rationed through long waiting lists
and, in some cases, omission of various treatments.

For the British government, the practice of HTA facilitates
rationing by delay. It is a tool that aims to ensure that expensive
new technologies are initially provided only in hospitals that have
the technical capacity to evaluate them. While the NHS Research and
Development Health Technology Assessment Programme is funded by the
Department of Health and, according to its criteria, researches the
costs, effectiveness, and impact of health technologies, the
Medicines and Healthcare Products Regulatory Agency (MHRA) ensures
that drugs and devices are safe.

In 1999, the government went a step further and set up the
National Institute of Health and Clinical Excellence (NICE). At
its heart is the Centre for Health Technology Evaluation that
issues formal guidance on the use of new and existing medicines
based on rigid and proscriptive "economic" and clinical formulas.
With the NHS obliged to adhere to NICE's pronouncements, criticism
of NICE has been ceaseless, particularly from various patient
organizations.

NICE is a controversial body. It has tried repeatedly to stop
breast cancer patients from receiving the powerful breakthrough
drug Herceptin and patients with Alzheimer's disease from receiving
the drug Aricept. The criteria by which this agency makes its
decisions have been kept largely secret from the public. As is
inevitable with any nationalized health care system, life-extending
medicines such as those to treat renal cancers are refused on the
grounds of limited resources and the need to make decisions based
not on genuine market economics but on an artificial assessment of
the benefit that may be gained by the patient and society "as a
whole."

In 2001, NICE deliberately restricted state-insured sufferers of
multiple sclerosis from receiving the innovative medicine Beta
Interferon. Claiming that its relatively high price jeopardized the
efficacy of the NHS, patients with the more severe forms of the
disease were told that they would have to go on suffering in the
name of politically defined equity.

In more recent years, patients with painful and debilitating
forms of rheumatoid arthritis have been informed by NICE that in
many instances they will not be allowed to receive a sequential
range of medicines that have often been proved to be of significant
benefit. Instead, the institute decreed that "people will be
prevented from trying a second anti-TNF treatment if the first does
not work for their condition."

Similarly, in August 2008, patients with kidney cancer continued
to be denied effective treatments designed to prolong their lives,
often by months or even a few years. The calculations used by NICE
have been systematically disputed by clinical experts who are more
concerned with patient welfare than with vote-seeking, but the
institute has also come under fire for not involving doctors who
are active on the front line of medicine: "With Sutent for
instance, there was just one oncologist on the panel."

In January 2009, patients with osteoporosis also fell foul of
NICE. The institute declared that only a small minority of patients
with this debilitating disease would receive the medicine Protelos,
and even they would receive it only as an extreme last resort.
While clinicians and osteoporosis support groups have pointed out
that more than 70,000 hip fractures result in 13,000 premature
deaths in the U.K. each year and that these otherwise avoidable
episodes needlessly cost the NHS billions of pounds, not only are
patients being denied necessary treatments, but taxpayers' money is
wasted.

Indeed, according to its annual reports and accounts, NICE is
now spending more money on communicating its decisions than would
be spent if it allowed patients access to many of the medicines it
is so busy denying them. The money that the institute now spends on
public relations campaigns "could have paid for 5,000 Alzheimer's
sufferers to get £2.50-a-day drugs for a year," according to
The Daily Mail.

Devoid of a market and the language of price, this top-down
system ironically ignores many of the societal costs associated
with failure to treat severe illness, such as illness-related
unemployment. Moreover, the fact that preventing access to more
costly medicines may save money in the short term overlooks the
costs for the future. If older medicines lead to more rapid
deterioration of a condition, the effect could be a more expensive
hospital or nursing home episode later.

Denmark. The Danish health care system is
completely state-funded, with public provision of hospital beds
representing more than 90 percent of thehospital sector. Under the
Healthcare Act, citizens are covered for all or part of
expenditures for treatment, including reimbursement for all
pharmaceutical products listed with the Danish Medicines Agency.
Therefore, there is no need for price regulation of drugs. With
central and municipal government having significant control of the
funding and provision of health care, the acquisition of new
technology is left initially to the five regions that run the
hospitals.

Denmark's national HTA system was explicitly established on the
basis of its making prioritized resource-allocation decisions.
Carried out by the unit known as the Danish Centre for Evaluation
and Health Technology Assessment (DACEHTA), it operates within the
framework of the National Board of Health (NBH), itself a part of
the Danish Ministry of Health. In reality, this means
that "he Ministry keeps a close watch on it in order to
neutralize 'expensive' healthcare technologies, as their adoption
results in requests for extra funding from the regions."

France. In France, health care is a statutory
right enshrined in the Constitution of the Fifth Republic. Unlike
in Denmark or the United Kingdom, however, French health care is
financed mainly by social insurance and delivered by a mixture of
public and private providers. While two-thirds of French hospitals
are state-owned, one-third are private, with half of the latter
group being not-for-profit.

There have been various attempts in recent years to extend
government control of health care costs. In 1991, the French
government extended its Health Map system by which it controls the
capital construction of all hospitals as well as their budgets, the
purchase of medical equipment, the rates charged by private
hospitals, the number of pharmacies per head, and even the price of
drugs.

In 2005, the government went a stage further with the
establishment of a centralized High Health Authority. While this
body has had only a limited impact–and France continues to enjoy a
comparatively higher diffusion rate for new technologies than is
found in many other countries in Europe–it is nevertheless
designed to stipulate the benefits of medicines and determine their
price-reimbursement levels. As such, it is set to raise the focus
on cost-containment and bring its decision-making under closer
state control.

Germany. As in France, health care in Germany is
financed primarily by social insurance and provided by a mixture of
public and private providers. While all services are contracted
instead of being provided directly by the government, more than 10
percent of Germans opt for full private medical insurance.
Providing a potent source of exit from the state, the regulated
private sector puts pressure on the government to ensure that the
sectoral differences in service do not become so wide that
ever-larger numbers of young, high-income consumers defect by going
private and delegitimizing a central pillar of the Bismarckian
philosophy.

While the pressure to maintain some semblance of parity with the
private sector meant that state spending rose dramatically for many
years after the introduction of a formal reference pricing system
in 1989, the strategic objective of the German Ministry of Health
has been to reduce supply, particularly through the use ofpublished
positive and negative lists concerning medicines and treatments.
Through these lists, pressure is applied to the statutory sick
funds to control costs.

It is in this context that health technology assessment has
played an ever-greater role in German health policy since the
1990s. In 1990, the Office of Technology Assessment at the German
Parliament (TAB) was established, and in 2004, the government set
up the Institute for Quality and Economic Efficiency in the
Healthcare Sector (IQWiG).

Tasked with the central goal of efficiency, IQWiG investigates
and stipulates which therapeutic and diagnostic services are
appropriate. Disseminating its pronouncements to
various self-governing bodies, its information is used concerning
the coverage of technologies in the benefits catalogue. With such
ventures being funded primarily by the German Ministry for Health
and Social Affairs, assessment bodies can refuse a hospital's claim
for reimbursement for the unauthorized use of new technology.

Lessons for American Policymakers

There is a pervasive European mythology: a widespread belief
that American health care is rooted in the free market. In reality,
much of American health care is a highly planned, regulated, and
government-funded system. Through major entitlement and welfare
programs such as Medicare and Medicaid, which contribute to rapidly
growing American health care costs, government takes a historically
higher proportion of gross domestic product than does even the
British NHS. Moreover, by virtue of the structure and financing of
private-sector health insurance, there is little consumer control
over health care dollars.

Nonetheless, the United States is not only a major consumer of
health care services, but also the world's largest producer of
medical technology. Investment in new medical technology is
comparatively high, as is its rate of diffusion: "This is
demonstrated by cross-national examinations of the comparative
availability of selected medical technologies such as radiation
therapy and open-heart surgery. Measured in units per million, the
United States experiences levels of availability up to three times
greater than in Canada and Germany."

During the presidential campaign, Barack Obama proposed an
Institute for Comparative Effectiveness that would make formal
recommendations on medical technologies, devices, and drugs. In
Congress, champions of comprehensive overhaul of U.S. health care
favor policies that would explicitly accelerate America's
trajectory downward toward a European-style medical
interventionism.

Fearing the impact of the rising costs of Medicare, Medicaid,
and the highly regulated arrangements of the private insurance
sector, many American legislators and other top policymakers are
becoming attracted to the idea of a body that would make top-down
pronouncements on the cost-effectiveness of new medical
technologies. The idea of a statutorily created agency charged with
system-wide cost containment and rationing of medical services and
technologies is becoming surprisingly fashionable in Washington
policy circles.

The implications of this trend are alarming for U.S. citizens,
particularly when one considers that the technology a society uses
reflects the wider and underlying incentive structures it adopts
for using it: "An incentive structure that encourages providers to
trade off the costs and benefits of health care gives providers
little incentive to use expensive technologies and thus researchers
will have little incentive to create it."

In the long term, a statist, centralized control of medical
technology offers little if any regulatory benefit. Through its own
logic, it not only stifles innovation, but also, in doing so, ends
up precluding those very inventions that could turn out to be of
immeasurable benefit to individuals and to society in general.

If comparative effectiveness and health technology assessment
especially are to be useful, they must be generated primarily by
the private sector on a competitive and non-coercive basis. In
avoiding the imposition of a uniformity of rules that comes with
government intervention, physicians and other medical professionals
would and should remain free to pick and choose from the best
practices and professional insights into the treatment of medical
conditions as they see fit (with, of course, the informed consent
of their patients).

It is only by returning health care to a genuinely
patient-centered and consumer-driven health care marketplace that
information, innovation, and best practice will permeate the
complex array of health care arrangements in both the public and
the private sectors. It is only through open competition and the
economic discipline of the free market that real progress and
productivity can be secured.

Therefore, in framing a policy on comparative effectiveness,
America's policymakers should be governed by four principles:

• They should reject the statutory creation of a board,
  council, or institute that would centralize government control of
  patient access to drugs, devices, medical technologies, treatments,
  or procedures. This is especially the case if such an agency
  were to have the power to override the considered judgment of
  competing professional expertise, especially the professional
  judgment of a patient's attending physician.
• Comparative effectiveness research and health technology
  assessments should be undertaken primarily by the private
  sector. While government can contribute to research efforts and
  promote the widespread availability of the best information, it
  must not exercise monopoly power over the conduct of research
  itself or the distribution of information.
• Comparative effectiveness research should be
  patient-centered and supportive of quality and value, not focused
  simply on cost-containment. In this respect, it should foster
  scientific advances, health information technology, and the
  emerging science of personalized medicine.
• Comparative effectiveness research must move beyond
  randomized clinical trials and embrace practical clinical
  trials. It should include observational data, and its
  methodologies should fully address issues such as the validity and
  applicability of findings.

Conclusion

As is clear from the British experience and other international
examples, a comparative effectiveness strategy that relies on
central planning and coercion would not only be counterproductive
in the long run–because it would undermine the incentives for
medical innovation–but would also lead to the imposition of cost
constraints that would worsen patients' medical conditions and
damage the quality of their lives.

Helen Evans, Ph.D., is a citizen of
the United Kingdom. A registered general nurse, she is the Director
of Nurses for Reform and a Health Fellow with the Adam Smith
Institute of London, England.

A new chain e-mail wrongly claims that the 2010 health care law will institute a new tax on home sales.

Here's the e-mail a reader recently forwarded to us:

"Under the new health care bill — did you know that all real estate transactions will be subject to a 3.8% Sales Tax? The bulk of these new taxes don't kick in until 2013 (presumably after Obama's re-election). You can thank Nancy, Harry and Barack and your local Democrat Congressman for this one. If you sell your $400,000 home, there will be a $15,200 tax. This bill is set to screw the retiring generation who often downsize their homes. Is this Hope & Change great or what? Does this stuff makes (sic) your November and 2012 votes more important?

"Oh, you weren't aware this was in the Obamacare bill? Guess what, you aren't alone. There are more than a few members of Congress that aren't aware of it either (result of clandestine midnight voting for huge bills they've never read). AND, there are a few other surprises lurking."

The root of this claim appears to be Section 1402 of the Health Care and Education Reconciliation Act of 2010, titled "Unearned income Medicare contribution."  Legislative wonks might remember that this was the second part of the health care bill, passed via reconciliation so that it only required 50 votes. Democrats had to do it that way after they lost their 60-seat majority due to a special election for the U.S. Senate in Massachusetts. (Republican Scott Brown won the seat that Sen. Edward Kennedy, a Democrat, held until his death.)

The health care law imposes a 3.8 percent tax on the investment income of couples who make more than $250,000 or individuals who make more than $200,000. That investment income could include income from real estate transactions. But it would only apply to those high earners, who make up less than 5 percent of all taxpayers. We're not sure why the e-mail extrapolates this tax to all real estate transactions, but that's the only 3.8 percent tax we could find in the new law. We ran this by two tax policy experts who confirmed our analysis of the new law.

Under current law, workers pay Medicare hospital taxes on wages, up to $106,800. Workers and employers split a 2.9 percent tax; the self-employed pay all of it.

The new tax marks the first time investment income will be subject to Medicare taxes, said Clint Stretch, the managing principal for tax policy at Deloitte Tax LLP. We should point out that the government currently taxes investment income in various ways and could have simply raised current rates.

But lawmakers wanted to link the new revenues to health care, Stretch said. "The point of doing it as a Medicare tax was to have the money go to the Medicare trust fund and have it act like a tax that is paying for health care. So there is additional complexity," he said.

And by the way, if you're an empty-nester of any means, and you're thinking of downsizing, part of your profits are already tax-free. There are long-standing tax exemptions on the profits from home sales. In general, if you sell your own home, individuals are not taxed on the first $250,000 of profit and married couples are not taxed on the first $500,000 of profit. Again, that's profit, not the sales price.

If you're wealthy and sell your home at a substantial profit, it's possible you might get hit with the new 3.8 percent tax on investment income. Most Americans won't have to worry about this, though.

Not that our chain e-mail acknowledges any of those pesky facts. It says that a 3.8 percent tax applies to all real estate transactions as a sales tax. That is not the case. The e-mail seems intended to scare people, particularly older Americans, and it urges them to vote a particular way based on false information. And for that, we award this chain e-mail a Pants on Fire!

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Congress is in recess, and there are no Food and Drug Administration scientific panels meeting this week.

But with the election only a few months away, we can expect the incumbents who voted on the health care overhaul and their political opponents to try to drum up news supporting or attacking the changes on the horizon. Kathleen Sebelius, the health and human services secretary, and Senator Max Baucus, the Democratic chairman of the Senate Finance Committee, are appearing in his home state of Montana on Monday. First up on their agenda is a discussion of rural health care in Missoula.

Likewise, in business, no earnings reports or other significant events are scheduled but last week’s announcement by Eli Lilly, dropping an experimental Alzheimer’s drug in late-stage clinical trials, was totally unexpected. So don’t spend the whole week at the beach.

The European Society of Cardiology holds its annual congress in Stockholm starting Saturday and continuing to the following Wednesday. That event is likely to produce news in late-breaking announcements about heart drugs and treatments.

In one abstract released last week, a Dutch study with Pfizer support says generic cholesterol-lowering statins are not as effective as Pfizer’s Lipitor in lowering the rate of heart disease. The study is based on a computer simulation of a 20-year timeline.

Other previews of work to be presented at the conference show research on genetic profiling to increase benefits of hypertension drugs, advice on coffee consumption for older people with hypertension (moderate is good), and the risks or benefits of snow skiing and marathon running.

For your reading pleasure, consider the Sunday Times story by Robert Pear (if you missed it) on the Obama administration’s response to outcries over medical privacy. The Department of Health and Human Services is reconsidering when to notify consumers about their breaches of medical information.

Politico reports today on the HHS Secretary Kathleen Sebelius’s role in the upcoming report from the National Association of Insurance Commissioners on rules for how much insurance companies spend on medical care versus administration and profits.

In neighboring Bulgaria, another poor EU member which spends just 4.2 percent of its GDP on health, patients also often pay for medical supplies and medicines – and preferential treatment.

“Typical forms of corruption in hospitals are bribes to secure hospital admission, purchase of medical supplies and medicines, soliciting official donations to the hospital, extra charges for treatments and operations,” says Konstantin Pashev from the Center for the Study of Democracy.

Romanian leaders regularly go abroad for treatment of serious medical conditions. The less fortunate have grim stories to tell.

“My sister had an ovarian cyst which was operated on two years ago,” says accountant Agnes Sekely, from the western Romanian city of Cluj. “She saved as much money as she could to give to the doctor (but) a month later, when she went for a checkup, the doctor said to her: 'You owe me something.'

“My cousin … has a kidney stone and she was told that without 1,000 euros she should not bother to go to hospital for the operation.”

Standards are inconsistent. Costel Rotaru, 55, says he had to buy bandages when he was recently hospitalized with a hand infection. But Mihaela Stroe, 40, who gave birth this week in another Bucharest hospital, said that hospital provided everything.

In small towns outdated equipment is the norm, and overcrowded wards – sometimes with even two to a bed – are not unusual. Scuttling cockroaches are seen in some hospitals even in the capital and it is standard practice to pay nurses to change dirty bed linen.

Doctors and nurses in both Romania and Bulgaria are poorly paid – in Romania, a specialist at a hospital makes the equivalent of less than euro1,000 ($1,300) a month. This has ensured the survival of bribes, a common practice under communism.

In contrast, medical staff in most West European countries are not even allowed to accept flowers or a box of chocolate from grateful patients.

At 73, average life expectancies in both countries are five years less than the EU norm. And things are set to get worse.

The Romanian health ministry says that 8,000 doctors have requested documents allowing them to work abroad in the last three years. This comes at a time when Vasile Astarastoae, chairman of the College of Doctors in Romania, says the country needs to double the number of its doctors to reach the EU average of physicians per patient.

Conditions are similar in Bulgaria. Stanka Markova, chairperson of Bulgaria's nurses association, says the Balkan nation needs to double the number of nurses to reach the required doctors-nurses ratio.

She says understaffing is affecting the quality of treatment with hospitals with fewer nurses having higher mortality rates. As in Romania, medical staff are looking for jobs in Britain, Spain, and Greece, where the average salaries for nurses are five to six times higher than in Bulgaria.

Romania has 19 doctors and 42 nurses to 10,000 people, compared to a regional Balkan average of 32 doctors and 79 nurses, according to the World Health Organization.

Some of the critically injured newborns suffered burns to 80 percent of their tiny bodies and respiratory tracts and treatment was gladly shared with a medical team from Israel, headed by Dr. Josef Haik, director of the burn unit at Sheba Medical Center at Tel Hashomer.

Defying calls for his resignation in the face of public anger, Health Minister Attila Cseke called this week to be allowed to hire more staff, saying that the system needs “thousands” of professionals.

But money is a problem. Romania remains on an IMF drip as it seeks to cut down spending, reduce its budget deficit and avoid the worst case scenario of default. And there is lack of clarity about how the money available is spent.

“We must discuss about stopping wastage in the health system, a system which had in 2001 funding of 1 billion euro, and today has over 4 billion euro,” said President Traian Basescu this week.

Tragic accidents happen as well in the most prosperous EU countries. In Germany prosecutors on Monday were investigating the deaths of two infants who may have been infected by a tainted infusion at a hospital in the western city of Mainz. A third infant remained in critical condition.

But Romania's problems appear more deeply rooted.

Investigators noted an overloading of the electrical wiring system in the intensive care unit for premature babies, which could have sparked the fire. The prosecutor's office was investigating reports that the missing nurse was celebrating a local holiday with colleagues in another room. The door of the unit was locked and could only be opened with a card.

Surveillance video showed staff and parents trying desperately to enter the unit amid swirling smoke. Firefighters finally managed to break down the reinforced glass door.

The management of the hospital has been suspended and the health ministry has pledged to install fire detectors in hospitals.

However, for some, the measures are too little, too late.

“Incompetence, indifference and irresponsibility together equal crime,” said Sekely, the accountant. “Guilty are the doctors, the nurses, the guards, the electricians, the lack of funding, in short the whole system.

“It makes me sick.”

___

Associated Press writers Veselin Toshkov in Sofia, Bulgaria, Alison Mutler in Bucharest and George Jahn in Vienna contributed to this report.

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• Seniors Mobile Health Monitor

  Fujitsu and local govt offices in Hokaido will give special ’simple’ phone to Sr. citizens as life support service via monitor of GPS and pedometer data http://bit.ly/cgDHM1

  Machine Translation:

  Fujitsu and the town office of Shiraoi. watch the elderly person of living alone with the phone
  Fujitsu and Hokkaido and the Shiraoi town office announced that they jointly constructed a contact central system in the region as life support service for the senior citizen who used universal cellular phone “ phone” of Fujitsu on August 19, and began operating on August 23.

  In this service, it turns over ..60.. lazing about ..the allocation of the where to make contact of “Anther”, “..seeming.. ”, and “Coming moxa cautery” in three buttons.. and the phone is distributed to the senior citizen of living alone. It consulted the support volunteer in the region only by pushing the button, and it informed the 119.

  Moreover, the data of the pedometer built into carry is notified to the contact center by the automatic operation once a day. The watch functions such as grasps of the location information such as GPS sensors when abnormality of no movement from the specific location etc. is detected and taking the safety confirmation are offered.

  Fujitsu and Fujitsu Research Institute propose it to the Shiraoi-cho, and as for this service, the Shiraoi-cho will expand the object of this system besides the senior citizen in the future, and examine the local populace’s convenience improvement and use for the local revitalization etc. by constructed what.

  This is almost unbelievable to think about: the last time I exchanged more than a few pleasantries with Portland Trail Blazers center Greg Oden was all the way back in January, as he addressed a media crowd regarding nude pictures of him that had leaked online.  Sure, I saw him in the locker room during the playoffs, saw him in the workout room right before Summer League and read all the articles following his summer activities. But Oden has redefined the term “low key” during his current rehabilitation.

  Today, I found myself in the birthday party room at Big Al's in Vancouver, watching as Oden moved easily and happily through a crowd of hundreds of kids (dubbed “Team Oden”) assembled for an event hosted by Oregon Mentors, handing out autographed photographs and posing for picture after picture. Here's a slideshow of images from the event.

  It was an unlikely scene for the conversation — amidst party balloons and with happy bowling noises going on in the background — but it didn't seem to matter, as Oden was at ease even though he was hunched over a kid-sized round table.  He took questions patiently and with an easy smile, the Shaq-esque charisma that has been so elusive was back in full force, especially as he recalled meeting new general manager Rich Cho for the first time and not recognizing him.  Given that access to Oden is so guarded and his profile has been so low, I left Big Al's thinking this was probably the happiest and easiest I'd seen him in at least a year.

  With that said, as you read the following transcript of our conversation, you'll realize his answers raise some questions.  For starters, a full 8 months after he injured his knee in December, Oden still has yet to commit to a firm recovery timeline.  Pushed for details, Oden referred specific questions about the rehabilitation process to his doctor.  

  Here's the full transcript of our conversation. 

  Blazersedge: Tell me first about the event today and the progress you've made with developing this mentorship program.

  “Originally, the thing at the start was to do whatever I can to put my name on it. To definitely try to help to get as many mentors as possible. The goal was 40,000 by the end of 2010. We've got 35,000 now and that's something I'm very excited about. In the next couple months I'm trying to get 5,000 more and hopefully keep it going.”

  Blazersedge: What kind of people are signing up as mentors? Are they Blazers fans attracted to your name and the cause that way? 

  “I think there's a lot of different people. I'd say a majority of them are probably Blazers fans, seeing what I'm doing brings them to this. But a lot of people who aren't Blazers fans are probably seeing me, at least know who I am, and seeing that I'm actually doing something for a good cause, probably think if I'm doing it they should go out and do it themselves.”

  Blazersedge: It's been a summer of causes for you with the Brian Grant fundraiser and the golf tournament back in Indiana.  I read you were a little nervous stepping into the tee box. How'd it go?

  “It went good. I actually golfed the whole 18. i was pretty excited. I've never golfed a whole 18. We actually ended 7 under but that was because we had a guy on our team who actually golfs for Indiana University. We had a ringer.”

  Blazersedge: What's your workout like at this point? I saw you jogging back in July on a treadmill. Doing the balance work.  Where are you right now in your schedule and how do you feel?

  “I feel good. My body feels good. Still doing my workout, my rehab stuff. Getting on the court, running some. Everything feels good and everything looks like it's going to be pretty good for me this season. The big thing for me is to do all I can to make sure all my focus is on basketball. I'm definitely doing that. I think Indiana was the right place for me, the right place for me to be.”

  Blazersedge: Were there things taking your focus off of basketball?

  “Oh, no, I didn't mean to say that. I was just saying that being home is giving me a chance to concentrate on getting my game back and basically stay out of the media, stay out of doing stuff like that. Just worried about doing what I'm doing for myself. Not trying to make a big deal.”

  Blazersedge: Eliminate the distractions?

  “Yeah.”

  Blazersedge: Where's your head at? You've had a long layoff and it's only a few months until training camp. Are you pumped, confident, what's your mental mindframe right now?

  “I'm all of the above. I'm definitely confident. I definitely have a chip on my shoulder. I have something to strive for. This is a big year for me. No matter what happens. I gotta get a contract also. There's a lot of stuff that goes into going into this year. I'm excited about it, I'm ready for it to start, I'm ready to just get going and show everybody what I can do.”

  Blazersedge: Have you met and talked to Rich Cho yet?

  “Yes. Yes.”

  Blazersedge: What has he told you about his expectations for you?

  “We haven't had that conversation yet but we've talked briefly. Pretty soon me and him are going to sit down and have dinner and talk about all that. What I've seen is that he's a good guy. He's seen me workout but we really haven't had that sit down chat yet.” 

  Blazersedge: What was your first impression of him?

  “It's funny because the first time I met him — I hadn't met him before — but when I saw [the hiring] on TV I was in Indiana, I didn't really see his face or anything like that. So then I was at the Brian Grant event and I was talking to him. And then he started asking me real serious questions. And then I was like, 'I… think… this is him… I'm … not …sure.' That was kind of funny.”

  Blazersedge: It was a case of mistaken identity?

  “Yeah, I started realizing like, 'Oh…. this is him.'”

  Blazersedge: You're here talking about mentors.  There's a lot of theories that have floated around the internet about where you've been, what you've been up to since we haven't seen you in so long.  Who would you say serves as your mentors or your support staff right now?

  “First, I wanna know what they're saying on the internet. I don't read that stuff.”

  Blazersedge: They say things like you go out and party, you've been seen in Vegas a few times this summer. They've heard you talk about some distractions or trying to focus on basketball. Some fans or readers think that perhaps you're not focused.  And some of that comes from the fact that we haven't seen you a lot. 

  “I guess the big thing this summer is that I didn't want all that media attention this summer. I wanted to concentrate on ball. I didn't want everybody in every aspect of my workouts. If I had a bad workout, the media is going to be there, 'Is he going to be ready?' All of those conclusions come from nobody seeing me.

  “I'm back in Indiana and back to your original question, my mentor, somebody who I can have there for me by my side, is my mom. For the first half of the summer I was there living with her, before I got my own place. Just to have that rock there, somebody who I've grown up with. If I needed anything, even if I wanted a glass of water and I didn't want to get out of bed, she comes down and helps me out. That's why I'm back home and that's my biggest mentor, person who helps me out.”

  Blazersedge: What's your relationship like with Blazers President Larry Miller and Blazers Head Coach Nate McMillan like right now? Do you see those guys as people in your life?

  “Those guys are in my life. I definitely make it a point to try to call or talk to one of them every couple of weeks. I've definitely been trying that this summer with calling Nate a lot, talking to him. Definitely building a relationship with Larry. And now starting to try to build one with Rich. Just try to get close to these guys so they can trust me and believe in me this year.”

  Blazersedge: Do you feel like they believe in you right now?

  “I feel like they believe in me but I just want to build it a little closer. The closer that we are, the better that the team is going to do.”

  Blazersedge: I ask because I've heard some people around the team throw out the words “all star” when they talk about you and your future.  I get the sense that that belief is there pretty solidly.

  “That's where I plan to be. That's where I'm striving towards. Like I said in an interview earlier this summer, I'm preparing myself right now to be an all star. I can't predict the future but I know right now that whatever happens I'm prepared for.”

  Blazersedge: Are you ready to say today that you'll be playing opening night?

  “No, I'm on whatever the doctors says. Right now I'm not going to put a timetable on it. I just keep moving in segments. Whenever the doctor says I can move here, then I can move here. If that's opening night, then that's opening night. I can't say that I can give you a timetable because I can't.”

  Blazersedge: What's the next segment you've got to do?

  “You'd have to talk to the doctor about that one. I just know my body feels good. I'm happy. I'm on schedule to heal. Take that however you want to. I'm excited for this year. I will be playing this year. So I'm excited.”

  Blazersedge: It's good to see you on Twitter.

  “Yeah, finally they got me to make it public. It's cool.”

  Blazersedge: How do you like it?

  “Actually I'm not that big a fan of Twitter. I hear it different ways. People are like, 'It's like text messaging to a whole bunch of people' or it's 'letting everybody know what you're doing.' I'm not into that. I like reading what other people say though. It's funny to me.”

  – Ben Golliver | benjamin.golliver@gmail.com | Twitter

  PS You can follow Greg Oden on Twitter here.

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Aug. 18, 2010 — Children with the eye condition strabismus, often called cross-eyed or squint, are less likely to be accepted by their peers, according to a new study.

“Negative attitudes appear to emerge at approximately 6 years and increase with age,” write the Swiss researchers in the report of their study, published online in the British Journal of Ophthalmology.

In most cases, ''parents really should not wait longer than age 5 for surgery,” researcher Daniel Stephane Mojon, MD, head of the department of strabismology and neuro-ophthalmology at Kantonsspital, St. Gallen, Switzerland, tells WebMD.

A U.S.-based expert says the study results are not surprising, but that there is good news. “Fortunately, strabismus is often a treatable condition,” says James Plotnik, MD, a pediatric ophthalmologist in Scottsdale, Ariz., and a clinical correspondent for the American Academy of Ophthalmology, who reviewed the study for WebMD.

The study finding ''demonstrates another potential benefit of early intervention to align the eyes,” Plotnik says.

Children With Strabismus: A Closer Look

Although research has found that adults with strabismus can be negatively affected psychologically, fewer studies have looked at children with the condition and how they are affected socially, according to the research team from the University of St. Gallen, University of Bern, and Kantonsspital.

Strabismus is common, Plotnik says, occurring in about 4% of children in the U.S. and sometimes also occurring later in life.

Crossed eyes is the most common form, Mojon says, although strabismus can describe eyes that turn outward, inward, up, or down.

Experts don't know the cause, but sometimes the condition is related to problems with the muscles that control eye movement.

The Swiss researchers gathered 118 children, ages 3 to 12, with an average age of 7, and showed them photographs of six identical twin pairs, half boys and half girls. The photos were digitally altered so that one child had misaligned eyes and a darker or lighter shirt.

The researchers asked the children which of the two ''twins'' they would invite to their birthday party. The children were asked to make a choice four different times, so that meant they could select the faces of up to four children with misaligned eyes.

How Strabismus Affects Children: Results

The children who were aged 6 and older were much less likely to invite a child with strabismus to their party.

Although only one of the 31 children aged 4 to 6 didn't select a single child with strabismus, 18 of the 48 children aged 6 to 8 did not.

None of the children aged 6 to 8 chose a child with strabismus all four times, but three of the children aged 4 to 6 did.

When asked if they noticed anything in particular about the twins, the percentage of kids who made specific comments about the eyes increased with age:

• 19% of kids aged 4 to 6 commented on eye alignment without being asked to pay attention to eyes.
• 48% of kids aged 6 to 8 commented on the eyes without being asked to notice eyes.

Wasn't the new health care reform law supposed to make health care more affordable for everyone?  Well, imagine my surprise when I opened up a letter from my health insurance company recently and found out that my health insurance premiums were going up by nearly 50 percent.  I am in perfect health and I have never had a single health insurance claim with this company.  Unfortunately, after doing a little research, I discovered that I am far from alone.  All over the United States, people are being hit with double-digit percentage increases in their health insurance premiums even as the health insurance predators continue to rake in record profits.  At a time when millions of American families are barely making it from month to month, the last thing they need is to be figuratively kicked in the groin by the health insurance companies.  But that is exactly what is happening. 

Not that health insurance companies ever needed an excuse to raise rates, but in 2010 many of them are blaming changes in health care law for the dramatic rise in premiums. 

Of course it is true that there are over a dozen new taxes on the health care industry in the “health care reform” law that Barack Obama and the Democrats rammed down the throats of the American people, and everyone should have realized that those taxes would ultimately be passed on to the consumer.

But what is also true is that the health insurance companies basically wrote large sections of the health care reform law and health insurance company stocks rose when this new law was passed.

So why is this new law so good for health insurance companies?

Well, the new health care law requires all of us to purchase health insurance from them.

We are no longer going to have the choice of opting out of their system.

We are going to be forced to buy health insurance.

And since they are all raising rates, there is no escape from the pillaging.

As the new health care bill was being debated, Obama promised that the average American family would save $2,500 in yearly premiums under the new law.

If any of you still believe that claim I have got a bridge to sell you.

The Congressional Budget office says that yearly health insurance premiums are actually going to increase by about $2,300 each year as a result of the new law, but that estimate is probably far, far too low.

The truth is that rates are already shooting through the roof.  Just consider the following excerpt from a recent article on Fox News….

Here is the terse reason CareFirst/Blue Cross/Blue Shield of Washington gave its subscribers for raising a monthly premium from $333 to $512 on a middle aged man who is healthy, is not a smoker and is not obese: “Your new rate reflects the overall rise in health care costs and we regret having to pass these additional costs on to you.”

Could you afford to pay $512 a month for health insurance just for yourself?

Unfortunately, the truth is that this is nothing new.  Many health insurance companies have been increasing health insurance premiums by double-digit percentages year after year after year even as they continue to reel in record profits.

In particular, health insurance companies seem to love to stick it to small businesses and the self-employed.

According to an article on the Mother Jones website, health insurance premiums for small employers increased 180% between 1999 and 2009.

The greed of the health insurance companies seems to know no bounds.  For example, the 39% hike that Anthem Blue Cross sent some California customers last year made headlines across the nation.  But executives defended the dramatic premium hikes as perfectly justifiable.

The reality is that health insurance is becoming so insanely expensive that millions of Americans can't even afford it anymore.

But thanks to the new health care law they are being forced to keep shelling out their hard-earned money for it.

It is getting really hard for anyone to deny that the health care system in the United States is deeply, deeply broken.  The new health care law is not going to reduce costs.  It is only going to help the health insurance companies continue to rake in obscene profits.

But wasn't the new health care law supposed to prevent the health insurance companies from abusing all of us?

Well, as it turns out, the new health care law does not give the federal government much regulatory power at all to prevent premium increases.

But what about the states?

Can't they do something?

Well, yes they can, but unfortunately most state legislatures have been bought off by the health insurance industry.

Since 2003, health insurance companies have shelled out more than $42 million in state-level campaign contributions.

That is a lot of money, and they wouldn't be spending that kind of money if they did not expect a return for it.

“The pressure that the industry can bring to bear in state legislatures is unbelievable,” J. Robert Hunter, a former insurance commissioner in the state of Texas recently told the Los Angeles Times. “They pretty much get what they want.”

The cold, hard reality is that health insurance companies are not in business to help people and provide affordable health care.  They are in business to make money and they are very good at it.

But there are a few states that have stood up to the health insurance companies.  States that have “prior approval” laws have been able to successfully fend off some of the over-the-top rate increases that health insurance companies have been trying to ram down the throats of consumers.  For example, the Los Angeles Times recently reported on what has been happening in the state of Oregon….

Regence BlueCross BlueShield of Oregon was forced to cut back a proposed 26.4% increase in one of its individual plans to 17.3%. Other carriers were ordered to scrap altogether hikes as high as 20%.

Unfortunately, a number of these states that have these “prior approval” laws are now being sued by insurance companies.

That is how these folks work - they will either try to buy off politicians or they will keep filing lawsuits until they get what they want.

Meanwhile, the top executives at the five largest for-profit health insurance companies in the United States received nearly $200 million in total compensation in 2009.

Are you upset yet?

You should be.

And you know what?

When it finally comes time to actually use your health insurance, these predators will do anything they can to get out of paying up.

In fact, it has been documented that some of the largest health insurance companies actually pay their employees large bonuses for denying claims.  The employees who deny the most claims are the ones that get the largest bonuses.

The health care system in the United States is messed up beyond all recognition, and the new health care law has made things worse than ever.  Americans pay more than anyone else in the world for health care, and all that we get in return is a system that is deeply, deeply broken.

If you have a health insurance horror story of your own, please feel free to share it in the comments section below….

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The oil spill along the United States Gulf Coast poses health risks to volunteers, fishermen, clean-up workers and members of coastal communities, according to a new commentary by UCSF researchers who spent time in the region and are among the first to look into health problems caused by the oil spill.  The good news, the authors say, is that one of the risk factors, coastal air quality, is improving now that the oil leak has been stopped.

The commentary will be published online August 16th and in the September 8, 2010 issue of the Journal of the American Medical Association. 

The goal of the article is to inform physicians and coastal communities about the immediate and long-term health risks posed by toxic vapors, oil slicks, tar balls and contaminated seafood.  The authors hope to encourage community members to protect themselves and seek treatment if symptoms from oil contamination occur. 

“The oil spill in the Gulf of Mexico is well known as an ecological disaster, but what is less known is the risk to human health caused by oil contamination.  We want to reach the volunteers, clean-up workers, fishermen, medical specialists and community members with practical information about the impact to their health from these chemicals.  With correct information, we hope they can protect themselves and seek treatment if they don’t feel well,” said Gina Solomon, MD, MPH, senior author, director of UCSF’s Occupational and Environmental Medicine Residency and Fellowship Program and senior scientist with the Natural Resources Defense Council (NRDC) in San Francisco. 

Air quality, skin irritation, mental health and seafood safety are the primary areas of short and long term health concerns, according to the authors. The article cites health information collected from previous oil spills in Alaska, Spain, Korea and Wales, which report an increase in health effects such as respiratory problems, DNA alterations, anxiety, depression, post-traumatic stress disorder, psychological stress and self-reported neurological impairment in workers and local residents. 

In the early months of the Gulf oil spill, more than 300 individuals, most of whom were cleanup workers, sought medical attention for headaches, dizziness, nausea, chest pain, vomiting, cough and respiratory distress that might be consistent with chemical exposure, according to data collected by the Louisiana Department of Health and Hospitals. 

“Louisiana is making an effort to track health complaints,” said Solomon.  “But it is important to remember that these 300 reported cases are only from one state and only within a few months.  The Gulf Coast is a large region with many coastal communities, and it is imperative that we do whatever we can to help everyone impacted by this disaster.” 

The risk to air quality comes partly from volatile organic compounds that evaporate within hours after oil makes contact with water.  These chemical compounds can cause respiratory irritation, headaches, and nausea.  Other compounds released by the oil or by the chemicals used to disperse the oil include chemicals that can cause skin irritation, respiratory problems and damage to the central nervous system.

“Clinicians should be aware of and look for evidence of toxicity from exposures to oil and related chemicals,” study co-author Sarah Janssen, MD, PhD, MPH, assistant clinical professor at UCSF and senior scientist with the NRDC.  “Symptomatic patients should be asked about occupation and location of residence, and the physical examination should focus on the skin, respiratory tract, and neurological system.” 

To protect coastal community members from exposure to chemicals caused by the oil spill or its dispersants, the researchers advise the following measures:

1. Workers may need protective equipment such as hats, gloves, boots, coveralls, safety goggles, and even respirators in some areas;
2. Workers need to take breaks and drink ample fluids to prevent heat-related illness;
3. Avoid skin contact with tar or oil on beaches, marshland or in the water;
4. Do not fish in areas of known oil contamination or where there is visible oil;
5. Do not eat seafood that smells oily or strange; 
6. If there is a strong smell of oil outside and it makes you feel ill, go inside and adjust the air conditioner to recirculate air;
7. If you are feeling persistently ill, seek medical attention so your symptoms can be assessed and reported.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For further information, visit www.ucsf.edu.

Pet health care plans on a rise among the owners

A new kind of health care has now come into existence following the humanization of pets and the increased costs of veterinary care – pet health care.

Last years’ economic recession has resulted in cost-conscious consumers forced to keep a watchful eye on their budget to make ends meet. Many of them have cut down on purchases for themselves but pampering and caring for their beloved pets continues to be a top priority.

A result of this is a rise in the pet health insurance and veterinary discount plans. The number of cats, dogs and exotic animals insured in the country went up by 56 percent from the year 2003 to 2007. This data was revealed in a study done by the research group Packaged facts.

According to data provided by the American Pet Products Association, dogs led the pack in 2008 with 2 million insurances, followed by cats with about 900,000 of them being insured.

These figures are expected to rise due to the current widespread perception of dogs, cats and other pets as family members. The present statistics account for only 3 percent of all dogs and 1 percent of all cats.

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This is the transcript of my recent podcast interview on how health reform is affect Flexible Spending Accounts.

David Williams:            This is David Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Jody Dietel.  She is president and Chair of the Special Interest Group for Inventory Information Approval Systems Standard (SIGIS).  Jody, it’s nice to speak with you today.

Jody Dietel:            Thank you.  Nice to speak with you.

Williams:            Starting with the basics, what is an FSA?

Dietel:            A Flexible Spending Account or FSA is one of several consumer directed accounts whereby employees can set aside some pre-tax dollars to pay for out of pocket health care expenses that they already know they have. These include office visit co-payments, prescription drug co-payments, over-the-counter medications, dental, vision –all sorts of expenses.

Williams:            Have FSAs been well utilized?

Dietel:            Yes, there are about 35 million households with Flexible Spending Accounts today. Yet I would say it’s also an underutilized benefit.  Many employees have the opportunity to participate but for whatever reason it’s just an underutilized benefit much like 401K was in the early years.

Williams:            The new health reform law is quite sweeping in its scope. Although most people focus on big topics such as mandates to purchase insurance and medical loss ratio requirements, I understand that there are some changes afoot for FSAs as well.  Can you explain those?

Dietel:            The Affordable Care Act does impact many of the consumer directed accounts. The changes that I’m going to describe first also affect employer funded Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs) as well. The Affordable Care Act requires that beginning January 1st, any purchases for over-the-counter drugs and medicines will require a physician’s prescription in order to be covered under a health care Flexible Spending Account or other types of consumer directed accounts.

The wording is very specific, yet we’re looking for additional guidance from Treasury.  We can’t really believe that they meant a prescription with a capital “P,” which would have to be filled by the pharmacist. That kind of thing would really add a burden to the health care system. We think they mean a Black’s Law Dictionary definition of a physician directive.  In other words I have acid reflux and so my doctor tells me to take Prilosec OTC on a daily basis or something like that.

Williams:            I suppose in the worst case it could mean that you pick up that over-the-counter product from the shelf and then actually take it back to the pharmacist. The impact could be that an over-the-counter product becomes essentially a behind-the-counter product.

Dietel:            Assuming Treasury guidance is reasonable –and we expect it will be–   I think it’s more likely that before you buy an OTC medicine or drug that you want to have covered under one of these consumer directed accounts or your health plan, you’ll need to just make sure that you’ve talked to your doctor about it.

It will have to be made clear that you have a specific condition and they’ve told you to take or consume that particular OTC item to address the condition that you have.  So we’re looking for it to be not an onerous thing.  I think that putting OTC drugs and medicines behind the counter doesn’t make sense.  It would add a layer of complexity that wouldn’t be reasonable in the system.

Williams:             What’s the logic for introducing this change though in the first place? Even if it’s not onerous it still is an additional step and an additional cost and an additional thing for people to do.

Dietel:            That’s a very good question.  The only thing we’ve been able to understand during our extensive conversations on The Hill is that everyone needed to chip in some money to pay for health care reform. This was viewed as a way to raise about $5.4 billion over ten years. That’s assuming that consumers don’t follow the directive to get their physician to direct them to take their medicine.  We think the figure is overstated, but I think that’s simply a revenue grab to pay for health care reform.

Williams:            Now at the nitty gritty level, what impact does this have in terms of how a pharmacy sets things up or how somebody is administering the benefit?  What are the downstream issues?

Dietel:            That’s a really great question. The SIGIS Association, the Special Interests Group for IIAS Standards is really concerned about this change because over the past several years the IRS has issued guidance that allows for the use of a debit card in many of these consumer directed accounts. Today, in most cases, consumers can go to the drug store or their supermarket, purchase an over-the-counter item (an over-the-counter medicine or drug), and that item is automatically paid for with a debit card.  Funds come directly out of their account and in most cases there is no further need for substantiation.

So this change under the Affordable Care Act is really three steps backwards.  Essentially what it means is that you will no longer be able to use your card to purchase these items because the card doesn’t know whether or not you’ve had a discussion with your doctor and they’ve given you some sort of written directive or prescription to take the over-the-counter drug and medicine.  It’s also important to note that this really only affects about 35% of the items that are considered over-the-counter items.  So you can still buy Ace bandages, Band-Aids, gauze pads, reading glasses, wheel chairs.  There is a whole host of over-the-counter items and again about 65% of the list that is in existence today will still be available for the cards’ use.

Williams:            Okay but now you’re going to have to split up your order.  You’re going to have some things that you can still use your card for but then you’re going to have to take money out of your pocket and go through reimbursement like in the olden days?

Dietel:            Yes, that’s correct.

Williams:            So you also mentioned I think January 1st as a time for implementation here.  Will people be ready in time for that?

Dietel:            Actually no.  In fact, we’ve talked to the Treasury Department and issued a letter that requests a delay or basically a non-enforcement period.  January 1st is a horrible time of year for the retail community. Many of our members are merchants. Essentially this rule asks them to, overnight, December 31st to January 1st at the busiest retail season of the year, during a time where many retailers have historically had a blackout period against IT changes, to make this really substantial change.

So we’re asking Treasury and the IRS to consider the impact on the retailers and the economy. Despite our best communication efforts, I think that participants are going to be very confused, because essentially, something that they purchased with their card on December 31st will no longer be able to be purchased on January 1st.  We know the retailers won’t be able to consistently apply that and so even worse, a participant’s experience will differ from retailer to retailer unless we get this extensive guidance from Treasury and some relief from the arbitrary date of January 1st.

Williams:            It does sound like a mess.  Do you have any sense yet of whether Treasury is sympathetic to your arguments and whether they can actually do anything about it even if they are?

Dietel:            I’m not sure that there is anyone who has a real sense.  I can tell you that they’re very interested and empathetic to our concerns.  We have had telephone conversations with them following our letter and I think that arguments that we made were sound and were really appreciated by the Treasury folks. The only word on the street is that we’ll see guidance sooner rather than later, whatever that means. We’re hopeful that that does mean in the next three or four weeks or so.

Williams:            What should employers and consumers be doing now?

Dietel:            I think that employers definitely need to start communicating with participants that there is a change.  About five or six years ago the change to allow over-the-counter drugs was made because these drugs are considered safe by the Food and Drug Administration.  In many cases it’s far less expensive for consumers to self-medicate through the over-the-counter process without the prescription drug/pharmacist process. And it’s certainly far cheaper for our health care system.

We need to start communicating with consumers today that there is a change on the horizon, that we are expecting additional guidance and that we’ll get that guidance out to them as soon as possible. But I think we’re in for a wild ride over the next few months until the end of the year and then when this change really takes place.

Williams:            If you look ahead another year or two when this transition has passed one way or the other, do you expect that FSAs will have an ongoing role under health reform or will they gradually fade off?

Dietel:            I really believe that Flexible Spending Accounts and other consumer directed accounts are part of the solution and not part of the problem.  Every single person’s health status and health needs are different and the reality is that under the Affordable Care Act there still are substantial out of pocket costs and cost sharing with participants.

The Flexible Spending Account is one of the only tools that puts the participant in the driver’s seat.  Milton Friedman, a noted Nobel Prize winning economist said, “No one spends someone else’s money as carefully as they spend their own.”  And so the whole idea is personal engagement, personal responsibility –that you and I can control much of our health care costs in America because of our own health status and taking better care of ourselves.  What we’ve found is that people who participate in a Flexible Spending Account or other consumer directed account actually have lower health care costs, have better compliance with treatment regimes and are healthier people. So I believe they have a very, very strong role in solving the health care ills of our country.

Williams:            I’ve been speaking today with Jody Dietel about Flexible Spending Accounts and some of the changes that are coming under health reform sooner rather than later.  Jodie, thanks very much for your time.

Dietel:                        My pleasure, thanks David.

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