The Senate got past the second filibuster on the compelling video game that is health-care reform, with one level left. While the final vote is theoretically scheduled for Christmas Eve, I saw Sen. Claire McCaskill on my teevee this morning saying that Republicans are trying to drag it out so that members won't be able to spend Christmas with their families.

Now, Claire, while I'm sympathetic to a point (yes, the Republicans are obstructionist scum), if this legislation is really a historic achievement (albeit one that will force many Americans to stretch their finances to the limit to comply), I don't especially care that your holiday schedule is mildly inconvenienced.

But that's just me!

The Senate cleared the second of three key procedural hurdles on President Obama's health-care legislation early Tuesday with another party-line vote, continuing the effort to pass the bill before Christmas.

All 60 members of the Democratic caucus supported the measure to finalize amendments to the health-care package, while 39 Republicans opposed it.

A third procedural vote is expected Wednesday, with final passage of the bill likely to come late Thursday -- Christmas Eve.

Although they lack any obvious way to torpedo the bill at this point, Republicans remain bitterly opposed to the legislation and have shown little indication that they are ready to relent in their increasingly negative standoff with Democrats.

On Monday, hours after a crucial 1 a.m. vote to end a Republican filibuster, the American Medical Association officially endorsed the legislation, while Democratic leaders defended the dealmaking that has brought the $871 billion package to the brink of passage.

Lacking the votes to block the bill, Republicans heaped scorn on the many concessions made to wavering Democrats in the quest to advance the package. GOP critics warned that support for the effort could mean the demise in 2010 of vulnerable incumbents, including Sens. Blanche Lincoln (D-Ark.) and Christopher J. Dodd (D-Conn.).

Oh, of course they're opposing it! But let's remember these are the most conservative, corporate trade groups in health care. And really, the more they oppose the buy-in, the more likely it is that it's a good idea:

Groups representing doctors and hospitals are coming out against the inclusion of a Medicare "buy-in" in the Senate health bill, The Washington Post reports. The groups joined Republicans in arguing "that a plan by liberal Democrats to allow uninsured individuals as young as 55 to buy into Medicare would be financially untenable and would jeopardize access to health-care services for millions of Americans."

The organizations, including the American Hospital Association, the Federation of American Hospitals and the American Medical Association, said the proposal would hurt their members because Medicare pays providers at a lower rate than private insurers. "Hospital representatives said the idea also would violate a deal they reached with the White House this year to give up $155 billion in Medicare payments over the next decade. The concession helped to lower the cost of a health-care package that promised hospitals a pool of at least 30 million newly insured customers" (Murray and Montgomery, 12/10).

Personally, I think they should be grateful to have jobs when 20% of the country is out of work. But some people just have no discretion.

USA Today: "Though the idea gained traction on Capitol Hill — and got a boost from President Obama — the outcry from the medical groups underscored the difficulty lawmakers are facing as they look for compromises that can win broad support for the Senate's bill, which would cost $848 billion in the first 10 years. 'Bringing more people into a system that doesn't work very well is not a good answer,' said Jeffrey Korsmo, executive director of the Mayo Clinic Health Policy Center. 'The current Medicare program is not sustainable'" (Fritze, 12/10).

No, it isn't. But as soon as we stop the massive fraud and abuses in Medicare Part D (you know, the private-sector plan?), it'll be much better.

The New York Times: "The American Hospital Association issued an action alert on Tuesday urging its members to oppose the plan and to call their senators’ offices. ... The Federation of American Hospitals also issued a bulletin ... 'Any Medicare Buy-In would invariably lead to crowd out of the private health insurance market, placing more people into Medicare,' the group said. 'It is critical that you contact your Democratic Senators today!'" (Pear and Herszenhorn, 12/9).

So they admit they like it when fewer people can actually afford health care.

The Wall Street Journal: "The insurance industry's trade association, America's Health Insurance Plans, opposed the measure to fix companies' medical-loss ratios at 90%. Medical-loss ratios are closely watched measures of how many premium dollars companies spend on patient care versus administrative costs and profits." Insurers say it would be very difficult to reach and could hurt their abilities to "weed out fraud and run other programs designed to cut costs and improve wellness."

No, it's much better to have insurance companies knocking a half-million people at a shot off their rolls to keep the MLR low enough to pump up the stock. Okay, we've established what you are, we're only negotiating price.

Drug companies as well could see less money for medicines under the Medicare plan than what private insurers give them, the Journal reports (Johnson and Rockoff, 12/10).

Oh, boo hoo. See above comment about being grateful to have jobs.

They're released data from the earliest cases of swine flu deaths, showing that people over 50 who were admitted to the hospital were likelier to die. This has a different curve from seasonal flu deaths, where adult deaths are typically people over 80:

An analysis of more than 1,000 California patients hospitalized with H1N1 flu during the first four months of the pandemic found that infants were most likely to be admitted, and patients 50 and older were most likely to die once admitted.

In the first four months of the pandemic, H1N1, like the seasonal flu, was especially severe in older people, who are more likely to have underlying health conditions, says lead author Janice Louie, a public-health medical officer at the California Department of Public Health.

However, Louie says, unlike seasonal flu, older people are far less likely than children and young adults to contract the H1N1 flu in the first place. For that reason, the study won't lead the Centers for Disease Control and Prevention to add healthy older people to the list of priority groups for H1N1 vaccine, director Thomas Frieden told reporters Tuesday.

Of 1,088 patients hospitalized with H1N1 flu in California, 11%, or 118 patients, died, and 30%, or 340 patients, were admitted to intensive-care units, Louie and her co-authors report in today's Journal of the American Medical Association. In patients 50 and older, the death rate was up to 20%, compared with about 2% in hospitalized patients under age 18.

The study focuses on patients who were hospitalized between April 23 and Aug. 11. Whether H1N1, or swine flu, will eventually mutate and cause more severe illness is not yet known, Louie says: "Influenza is pretty unpredictable."

Nearly a third of all the hospitalized patients in her study were reported to have no underlying conditions, such as lung disease, associated with an increased risk of flu complications.

But a disproportionate number of them were obese, an observation that also has been made in other countries, the authors write. Obesity doesn't appear to be a risk factor for seasonal flu.

Of the 361 patients whose body mass index – or BMI, a number based on height and weight – was known, half were obese, and half of those patients were morbidly obese, defined as having a BMI over 39, or roughly 100 pounds overweight.

Either you get a mild case - or it almost kills you, and they still don't know why:

Swine flu is mild for most people, but some become so gravely ill that they require sophisticated techniques, equipment, and aggressive treatment in intensive-care units to survive, according to three new studies.

"This is the most severely ill that we've ever seen people," said Anand Kumar, lead author of one of the studies and ICU attending physician for the Winnipeg Regional Health Authority in Canada. "There's almost two diseases. Patients are either mildly ill or critically ill and require aggressive ICU care. There isn't that much of a middle ground."

Some of the patients Dr. Kumar and his colleagues saw were so sick they had to be saved with a technology similar to one used for patients undergoing heart bypass.

The studies of critically ill patients in Canada, Mexico, Australia and New Zealand, published online Monday in the Journal of the American Medical Association, suggest that intensive-care units could be stretched as a second wave of H1N1 swine flu builds in Northern Hemisphere countries such as the U.S.

American public-health and hospital officials have expressed concern that the country's intensive-care facilities may not be up to accommodating the swell of patients they could potentially end up with in large-scale outbreaks.

An advisory panel to President Barack Obama warned in August of one scenario in which as many as 300,000 patients could require intensive care, occupying between half and all of ICU beds in affected regions at the peak of infection. Such a scenario "could place enormous stress on ICU units, which normally operate close to capacity," the panel warned in a widely publicized report, which also said as many as 90,000 people could die of the disease.

The patients analyzed in the three JAMA studies deteriorated very rapidly after entering the hospital, quickly progressing to respiratory failure, shock, and organ dysfunction and failure. They spent prolonged periods on mechanical ventilators, and some required frequent "rescue therapies," or treatment to save them from life-threatening conditions.

Continue reading »

And the racism keeps on coming.

The election of our first black president has brought with it a strange proliferation of online racism among conservatives.

And we've got the latest example.

On Sunday night, Dr. David McKalip forwarded to fellow members of a Google listserv affiliated with the Tea Party movement the image below. Above it, he wrote: "Funny stuff."

Now, Tea Party activists trafficking in racist imagery are pretty much dog bites man. But McKalip isn't just some random winger. He's a Florida neurosurgeon, who serves as a member of the American Medical Association's House of Delegates.

He's also an energetic conservative opponent of health-care reform. McKalip founded the anti-reform group Doctors For Patient Freedom, as well as what seems to be a now defunct group called Cut Taxes Now. Last month he joined GOP congressmen Tom Price and Phil Gingrey, among others, for a virtual town hall to warn about the coming "government takeover of medicine." And in a recent anti-reform op-ed published in the St. Petersburg Times, McKalip wrote that "Congress wants to create larger, government-funded programs for health care and more bureaucracy that ration care and impose cookbook medicine."

I wonder how his African American patients have recovered after he treats them?

Robert Reich was out beating the drum yesterday, speaking on "This Week" and posting this piece in Salon:

If you want to save universal healthcare, you must do several things, and soon:

1. Go to the nation. You're not only a powerful orator; you're also capable of motivating, energizing, and mobilizing the American public. You must go on the road -- building public support by forcefully making the case for universal health care everywhere around the country. The latest Wall Street Journal poll shows that three out of four Americans want universal healthcare. But the vast majority don't know what's happening on the Hill, don't know how much money the medical-industrial lobbies are spending to defeat it, and have no idea how much demagoguery they're about to be exposed to. You must tell them. And don't be reluctant to take on those vested interests directly. Name names. They've decided to fight you. You must fight them.

This is the president's biggest weakness. Please, more drama, Obama!

2. Be LBJ. So far, Lyndon Johnson has been the only president to defeat the American Medical Association and the rest of the medical-industrial complex. He got Medicare and Medicaid despite their cries of "socialized medicine" because he knocked heads on the Hill. He told Congress exactly what he wanted, cajoled and threatened those who resisted, and counted noses every hour until he had the votes he needed. When you're not on the road, you have to be twisting congressional arms and drawing a line in the sand. Be tough.

3. Forget the Republicans. Forget bipartisanship. Universal healthcare can pass with 51 votes. You can get 51 votes if you give up on trying to persuade a handful of Republicans to cross over. Eight years ago George W. Bush passed his huge tax cut, mostly for the wealthy, by wrapping it in an all-or-nothing reconciliation measure and daring Democrats to vote against it. You should do the same with healthcare.

4. Insist on a real public option. It's the linchpin of universal healthcare. It's one thing to give up on single payer, and say that a public option is the best feasible alternative. But further compromise would essentially gut any healthcare plan. Don't accept Kent Conrad's ersatz public option masquerading as a "healthcare cooperative." Cooperatives won't have the authority, scale, or leverage to negotiate low prices and keep private insurers honest.

5. Demand that taxes be raised on the wealthy to ensure that all Americans get affordable healthcare. Not even a real public option will hold down costs enough to make healthcare affordable to most American families in years to come. So you'll need to tax the wealthy. Don't back down on your original proposal to limit their deductions. And support a cap on how much employee-provided healthcare can be provided tax free. Yes, you opposed this during your campaign. But you have no choice but to reverse yourself on this. These are the only two big pots of money.

6. Put everything else on hold. As important as they are, your other agenda items -- financial reform, home mortgage mitigation, cap-and-trade legislation -- pale in significance relative to universal healthcare. By pushing everything at once, you take the public's mind off the biggest goal, diffuses your energies, blur your public message, and fuel the demagogues who say you're trying to take over the private sector. You have to win this.

Just try to remember: The AMA only represents a mere percentage of doctors. More doctors want single payer than don't. In the meantime, more on the proposed reform from Kathleen Sebelius:

As debate gets under way over Obama's initiative to revamp health care, Republican opposition has centered on one of the key pillars of the president's proposal: the so-called public option — a publicly funded insurance plan that would likely compete against private insurers.

A public health insurance plan, Sebelius said, will put pressure on private insurers to keep costs competitive. "And that's a good thing," she says. "I think that's a good thing for the American public. Medicare right now has lower overhead costs than private insurers."

Republicans argue that upward of 100 million Americans would opt out of private insurance in favor of a public plan if such a plan were available. That figure comes from a study by the Lewin Group, a consulting group owned by Ingenix, a subsidiary of UnitedHealth Group, but it is a selective representation of the study's findings.

Big surprise there, huh!

"The whole idea of the public option has been difficult, in part, because some of the opposition has described it as a potential for a, you know, draconian scenario that was never part of the discussion in the first place," Sebelius says. "So, disabusing people of what is not going to happen is often difficult, because there's no tangible way to do that."

The American Medical Association voted Monday to put its weight behind legislative initiatives around the United States that would require pharmacies to fill legally valid prescriptions in the wake of recently publicized refusals by pharmacists opposed to dispensing the morning-after contraceptive.

If the pharmacist or pharmacy has objections, they should provide an "immediate referral to an appropriate alternative dispensing pharmacy without interference," according to the resolution passed Monday by the AMA's policymaking House of Delegates...read on

Now read LifeSite.com's article: American Medical Association Targets Catholic and Pro-Life Pharmacists for Extinction : The American Medical Association is backing a proposal that would force pharmacists to dispense abortifacients like the morning-after emergency abortion and birth control pill or refer to another pharmacist to have the prescriptions filled.

They also say: The Pharmacists for Life International (PFLI) web site describes their view of the morning-after emergency abortifacient: “Any medically educated person should be given to understand that this regimen works primarily by preventing the implantation of an already fertilized egg. This is not contraception.”

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If its not contraception wingnuts then what is it? Contraception prevents pregnancies by not allowing eggs to be fertilized. Am I missing something here? They should be behind the Plan B pill one hundred percent. It would be in line with their beliefs exactly. What does a condom do? Are these pro-life fools against selling condoms? I feel a new letter coming on.

via ctx3

"... On NPR this morning I was listening to his interview with Diane Rehm and he was discussing his bankruptcy bill that is being debated in the House. He was drawing a comparison between credit card companies and alcoholic drink companies. His line of comparison was that we do not blame the company that made the alcohol when a person is weak and becomes an alcoholic while a credit card company can get blamed for the misuse of credit when a person is weak and uses their credit card too much."

Memo to Grassler, in 1956 the American Medical Association declares alcoholism an illness. In Physician's News Digest they talk about handling that disease. If Sen.Grassely draws the analogy of credit card debt to alcoholism, then aren't these people suffering from a disease? Shouldn't they be treated like people with an illness, and not a weakness? I can't go a day without getting a credit card offer in the mail with a huge credit line, low interest rate, and those cute, preprinted checks with my name plastered across them. (a huge cause of identity theft) Isn't that like sending an alocholic a bottle of hooch in the mail every day and expect that person not to drink it? Of course this bill does not address the credit card companies culpability in credit card abuse.

Our overall concern is that this isn't a balanced bill," said Travis Plunkett, spokesman for the Consumer Federation of America, a nonprofit consumer research and advocacy group. "There isn't a single curb on abusive lending practices by credit card companies in these bills."