Healthcare

NYT Special Section on Health

Slow Ideas — Some innovations spread fast. How do you speed the ones that don’t?
by Atul Gawande
We yearn for frictionless, technological solutions. But people talking to people is still the way that norms and standards change.
(The New Yorker) … This has been the pattern of many important but stalled ideas. They attack problems that are big but, to most people, invisible; and making them work can be tedious, if not outright painful. The global destruction wrought by a warming climate, the health damage from our over-sugared modern diet, the economic and social disaster of our trillion dollars in unpaid student debt—these things worsen imperceptibly every day. Meanwhile, the carbolic-acid remedies to them, all requiring individual sacrifice of one kind or another, struggle to get anywhere. (29 July 2013)

“Why We Care” paints intimate portraits of why global leaders support access to reproductive health
To coincide with London Summit on Family Planning, Aspen global health and development and the United Nations Foundation unveil a groundbreaking book titled, “Why We Care.” The book provides a platform through which Global Leaders on Reproductive Health will focus international attention on the world’s hardest to reach women, who want access to voluntary contraception to build on the momentum set by the London Summit’s goals and commitments. Read more.  (11 July 2012)

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Esther Dyson: The HICCup Manifesto
(Project Syndicate) It is hard to find anyone in health care who does not believe that spending $100 now on healthy behavior – exercise and proper nutrition, counseling for pre-diabetics, risk monitoring, and so on – could yield more than $200 in reduced costs and improved outcomes later. The numbers are fuzzy, of course, and there are plenty of methodological caveats, but there is little dispute about the desirability of such an approach.
Instead of just complaining, I recently decided to create HICCup, the Health Intervention Coordinating Council, a self-appointed counseling service aimed at persuading local institutions to embrace a long-term perspective and launch a full-scale intervention in their communities. For practical reasons, there are a few guidelines – but anyone who wants to do this without following our rules is welcome to do so.
10 May
The U.S. health-care gouge
Two-thirds of personal bankruptcies are caused by huge medical bills, writes WILLIAM MARSDEN
(Canada.com) If you need a new hip or knee joint in the United States, it’s probably best not to hobble over to Monterey Park Hospital in California. They’ll try to skin you for at least $223,000 US. In fact, stay out of California altogether. Just over in Inglewood at the Centinela Hospital Medical Center the charge isn’t any better: a mere $220,800.
The best bet is to head for tiny Ada, Okla. There, the Chickasaw Nation Medical Center will fix you up for only $5,300.
This huge disparity is the same story for pretty well every medical procedure everywhere in the United States. Sticker prices are shockingly inflated and the differences are in many cases astronomical, according to a database of hospital medical charges made public by the White House this week.
30 April
Laura Tyson: America’s Healthy Path to Fiscal Health
Trends in the US budget reflect an inconvenient truth: If the growth of spending on health-care programs cannot be slowed, stabilizing the federal debt at a sustainable level will require deep cuts in spending on other priorities and increases in taxes on the middle class. The recent slowdown in the growth of health-care spending is a promising sign that America’s budgetary tradeoffs may turn out to be less difficult than expected.
(Project Syndicate) Over the last five years, the growth of health-care spending in the United States has slowed dramatically – to the lowest rate in the past 50 years. The slowdown is not a surprise. It is a predictable result of the recession and slow recovery that have left millions of Americans without health insurance and dampened household spending. …
As a result of the recession and lagging recovery, health-care spending has also slowed significantly since 2009 throughout the OECD. Indeed, for the first time on record, real health-care spending stalled on average in the OECD in 2010, as developed countries, reeling from budgetary constraints, clamped down on health programs. Growth in health-care spending was slower in every OECD country in that year, with the exception of Germany.
8 April
Canada loses out on drug pricing: UBC study
(Eureka) Health systems worldwide are increasingly negotiating secret price rebates from pharmaceutical companies and Canadians risk losing out on the deal.
“The pricing of medicines is now a game of negotiation, similar to buying a car at a dealership,” says Steve Morgan, an expert in health policy at the University of British Columbia. “There’s a list price equivalent to a manufacturer’s suggested retail price; and then there’s secret deals that everyone negotiates from there.”
In a study published today in the April issue of the journal Health Affairs, researchers interviewed policymakers from nine developed countries and analyzed practices for securing confidential manufacturers’ rebates.
They confirmed that almost all countries are now routinely negotiating rebates from drug companies as a condition of coverage under their health care systems. Manufacturers are promoting these rebates because the associated confidentiality clause ensures deals struck in one country don’t set precedent in others.
4 April

Dementia Cost, Already High, Is Projected to Double by 2040

(NYT) The most rigorous study to date of how much it costs to care for Americans with dementia found that the financial burden is at least as high as that for either heart disease or cancer, and is probably higher
Estimating the Soaring Price Tag and Other Costs of Dementia Care
(PBS Newshour) A new study by the RAND Corporation estimates the cost of dementia care as $41,000 to $56,000 anually per patient. Jeffrey Brown examines the findings and implications with Dr. Ronald Petersen, director of the Mayo Alzheimer’s Disease Research Center, and Dr. Richard Hodes, director of the National Institute of Aging.
1 April
Novartis loses landmark India patent case on Glivec, govt hails ‘historic’ SC verdict
India’s top court dismissed Swiss drugmaker Novartis AG’s attempt to win patent protection for its cancer drug Glivec, a blow to Western pharmaceutical firms targeting India to drive sales and a victory for local makers of cheap generics.
The decision sets a benchmark for intellectual property cases in India, where many patented drugs are unaffordable for most of its 1.2 billion people, and does not bode well for foreign firms engaged in ongoing disputes in India, including Pfizer Inc and Roche Holding AG, analysts said.

[Editor's Note:  At least one Wednesday Nighter suggests that as  many patents for the most popular prescription drugs from the major pharmaceutical companies either recently expired or are set to expire there could be a 15% reduction in drug costs in Canada over the next decade, but that the real potential for these drugs lies in the soaring diabetes, hypertension, obesity and related health problems in populous emerging economies resulting from their rising middle classes adapting Western diets/habits, e.g. Just about all of Egypt’s middle class has high blood pressure and diabetes. New biopharmaceuticals, even if they are more effective, will likely not see significant uptake in emerging markets in the presence of viable, much more cost-effective traditional pharmaceuticals - especially when they are available at a fraction of the cost as generics. and that decisions against large pharmaceuticals trying to update their popular drugs to extend their patents in emerging markets matter. Decisions such as those in India will set a precedent for other populous, emerging economies.]

24 January
Dr Eric Topol on NBC News’ Rock Center: iPhone is the future of medicine
In a recent video on NBC News’ Rock Center, cardiologist Dr Eric Topol has revealed that the iPhone may well be the future of modern medicine.
In his interview, Topol appeared convinced that smartphone-enabled medical devices will bring down costs and revolutionise modern medicine, making it more efficient and more effective than ever before. He showcased a handheld ultrasound machine, and an iPhone-compatible EKG machine. It is devices like this that he believes will enable doctors to carry out procedures in primary care, or even at the home of patients.
3 January
Could polio soon meet the same end as smallpox?
Despite the recent murders of 16 health workers associated with anti-polio efforts in Pakistan, eradication of the disease appears “tantalizingly close,” writes Jeffrey Kluger. “Just 25 years ago, polio was endemic to 125 countries and would paralyze or kill up to 350,000 people — the overwhelming majority of them children — each year. Now the disease has been run to ground in just three countries: Afghanistan, Pakistan and Nigeria, and in 2012, it struck only 215 people worldwide,” Kluger writes. Time.com (1/3), Time.com/LightBox (1/3)

2012

Germany ‘exporting’ old and sick to foreign care homes
Pensioners are being sent to care homes in eastern Europe and Asia in an austerity move dismissed as ‘inhumane deportation’
(The Guardian) Growing numbers of elderly and sick Germans are being sent overseas for long-term care in retirement and rehabilitation centres because of rising costs and falling standards in Germany.
The move, which has seen thousands of retired Germans rehoused in homes in eastern Europe and Asia, has been severely criticised by social welfare organisations who have called it “inhumane deportation”.
But with increasing numbers of Germans unable to afford the growing costs of retirement homes, and an ageing and shrinking population, the number expected to be sent abroad in the next few years is only likely to rise. Experts describe it as a “time bomb”.
Germany’s chronic care crisis – the care industry suffers from lack of workers and soaring costs – has for years been mitigated by eastern Europeans migrating to Germany in growing numbers to care for the country’s elderly.
Increased life expectancy brings wellness concerns
People the world over are living longer, yet more young and middle-aged adults are suffering from diseases and conditions typically associated with wealthy nations — notably cancer, heart disease, diabetes and depression. The results of a five-year survey reveal that “[w]e are in transition to a world where disability is the dominant concern as opposed to premature death,” said Christopher J.L. Murray, who directed the study published Thursday in The Lancet. The New York Times (tiered subscription model) (12/13), The Washington Post (12/13), PRI’s The World (Boston) (12/13)
Universal health care now benchmark for global development
Universal health coverage was endorsed Wednesday by the United Nations General Assembly. “There have been lots of discussions of what health goals should be, for example on non-communicable diseases. This resolution gives weight to health systems as a whole and questions of equity. It ensures that universal health care stays on the agenda as one of the post-MDG goals,” said Ceri Averill of Oxfam. The Guardian (London) (12/13), The Guardian (London) (12/12)
10 December
A New Imperative for Healthier Cities
(The Atlantic) Collaboration among business, academic, and government leaders is oftentimes the key factor in making cities better places to live. And while local leaders often come together to discuss growth or infrastructure, shouldn’t they consider health care and social programs too?
By asking, how can we keep our citizens well, or how can we make our city a healthier place to live, communities can make dramatic strides working together. Some cities are starting to do this by creating new programs and services to improve the health of citizens. Others are focusing on the overall population, making their community a more desirable place to live and work. Either way, by providing ways to improve citizen health, smarter cities can attract new businesses and enhance quality of life for everyone.
1 November
Staunch Conservative J.D. Kleinke Makes Conservative Case For Obamacare
IF Mitt Romney’s pivots on President’s Obama’s health care reform act have accelerated to a blur — from repealing on Day 1, to preserving this or that piece, to punting the decision to the states — it is for an odd reason buried beneath two and a half years of Republican political condemnations: the architecture of the Affordable Care Act is based on conservative, not liberal, ideas about individual responsibility and the power of market forces.
29 October
Paul Krugman Medicaid on the Ballot
By any reasonable standard, this is a program that should be expanded, not slashed — and a major expansion of Medicaid is part of the Affordable Care Act.
Why, then, are Republicans so determined to do the reverse, and kill this success story? You know the answers. Partly it’s their general hostility to anything that helps the 47 percent — those Americans whom they consider moochers who need to be taught self-reliance. Partly it’s the fact that Medicaid’s success is a reproach to their antigovernment ideology
4 October
Paul Krugman: Romney’s Sick Joke
(Other News) … the fact is that everything Obama said was basically true, while much of what Romney said was either outright false or so misleading as to be the moral equivalent of a lie.
Above all, there’s this:
MR. ROMNEY: Let — well, actually — actually it’s — it’s — it’s a lengthy description, but number one, pre-existing conditions are covered under my plan.
No, they aren’t. Romney’s advisers have conceded as much in the past; last night they did it again.
I guess you could say that Romney’s claim wasn’t exactly a lie, since some people with preexisting conditions would retain coverage. But as I said, it’s the moral equivalent of a lie; if you think he promised something real, you’re the butt of a sick joke.
19 September
Arianna Huffington:  Just last week, a study was published by researchers at Rensselaer Polytechnic Institute which showed that the light from computer screens interfered with the body’s melatonin production, which helps govern our internal body clock and regulates our sleep cycle.
And, as I’ve pointed out before, sleep plays a vital role in decision-making. According to the Harvard Medical School’s Division of Sleep Medicine, lack of sleep was a “significant factor” or played a “critical role” in the nuclear accidents at Three Mile Island and Chernobyl, the wrecking of the Exxon Valdez, and the explosion of the Challenger space shuttle.
“Sleep deprivation negatively impacts our mood, our ability to focus, and our ability to access higher-level cognitive functions,” Harvard’s sleep doctors say. “The combination of these factors is what we generally refer to as mental performance.”  More
Cancer, diabetes must be among development goals
It’s a vicious cycle: Poverty contributes to noncommunicable diseases, and their effects worsen poverty, threatening sustainable development, write Johanna Ralston and Ann Keeling. NCDs were left out of the original Millennium Development Goals, but the four most prevalent NCDs — cancer, cardiovascular disease, chronic respiratory disease and diabetes — must be included among the sustainable development goals being debated, they write. The Guardian (London)/Poverty Matters blog (9/11)
31 August
Paul Krugman: The Medicare Killers
Paul Ryan’s speech Wednesday night may have accomplished one good thing: It finally may have dispelled the myth that he is a Serious, Honest Conservative. Indeed, Mr. Ryan’s brazen dishonesty left even his critics breathless. … The Republican Party is now firmly committed to replacing Medicare with what we might call Vouchercare. The government would no longer pay your major medical bills; instead, it would give you a voucher that could be applied to the purchase of private insurance. And, if the voucher proved insufficient to buy decent coverage, hey, that would be your problem.
28 August
Adverse Effects of Mining Industry Provoke Hard Questions for Medical Humanitarian Organizations
(ScienceDaily) — Increasingly humanitarian organizations will find themselves responding to health emergencies provoked by the adverse effects of mining and other extractive industries, setting up a potential clash to do with the core principles and values at the heart of humanitarian medicine, writes Philippe Calain from the humanitarian medical organization, Médecins Sans Frontières (MSF), in this week’s PLoS Medicine.
13 July
Hacking Health: Bottom-up Innovation for Healthcare
By Jeeshan Chowdhury, Sauvé Scholar 2011-2012
Technology Innovation Management Review
Abstract
Healthcare is not sustainable and still functions with outdated technology (e.g., pagers, paper records). Top-down approaches by governments and corporations have failed to deliver digital technologies to modernize healthcare. Disruptive innovation must come from the ground up by bridging the gap between front-line health experts and innovators in the latest web and mobile technology. Hacking Health is a hackathon that is focused on social innovation more than technical innovation. Our approach to improve healthcare is to pair technological innovators with healthcare experts to build realistic, human-centric solutions to front-line healthcare problems.
13 July
David (Kilgour): Despite its faults, Canada’s health care system remains better than America’s
vs.
David (T. Jones): At its best, U.S. health care is exceptional — but the battle isn’t over yet
London Summit offers crucial opportunities for women, health
The London Summit on Family Planning opened today and aims to prioritize and fund family planning globally, giving women “the tools to make critical decisions about the size of their families and the spacing of their pregnancies,” writes Nafis Sadik, whose United Nations roles include being a United Nations Foundation board of directors member. Also today, the U.K. pledged to double family-planning aid to about $280 million annually for eight years. Read more from the UN Foundation on supporting the Every Woman Every Child movement. Diplomatic Courier online (7/11), The Independent (London) (7/11), The Huffington Post (7/10), The New York Times (tiered subscription model) (7/9)
Then and now, GAVI reducing unnecessary deaths
The board chairman of the GAVI Alliance, Dagfinn Høybråten, discusses the potential for ending by 2035 deaths of children due to preventable diseases and conditions. The alliance has helped prevent more than 5.5 million unnecessary deaths, he said, and a program to vaccinate 250 million children through 2015 could save an additional 4 million lives. GlobalPost.com/Global Pulse blog (6/25)
8 June
Malaysian prince promotes protein pill to fight dengue fever
[the pill] starves mosquito larvae and could revolutionise the global dengue fight.
It is a fight that is intensifying: more than 2.5 billion people – about 40 per cent of Earth’s population – live in areas susceptible to the mosquito-borne virus, with up to 100 million infected annually, according to the World Health Organisation. Dengue kills 20,000 people worldwide every year, and its complexity – and what health advocates say is a lack of priority given the race to find cures for higher profile viruses such as AIDS – means a vaccine has proved elusive.
Global anti-polio effort is declared an emergency
The Global Polio Eradication Initiative has launched an emergency action plan to boost immunization against polio in Nigeria, Pakistan and Afghanistan, where the disease is endemic. …  some vaccination campaigns have been halted because of funding shortfalls. BBC (5/24)

2011

Gates Foundation funds a dozen unusual disease treatment ideas
The Bill & Melinda Gates Foundation has awarded a dozen scientists $1 million each in funding over the next five years to further explore unusual approaches to combating malaria and other global public health concerns. Adapting a microwave to identify and target the presence of iron in a bid to wipe out the malaria parasite is one of the ideas selected to receive a grant from more than 500 that initially received a smaller amount of funding. Bloomberg Businessweek/The Associated Press (7/13)
UN Foundation partners to transform mHealth
In an interview, the chief executive officer and co-founder of DataDyne, which creates Web and mobile software for the global health and international development community, cites the partnership between the United Nations Foundation and Vodafone Foundation — which provided funding and communications support — as essential to the success of the social startup. “Obviously, the funding was important, and we wouldn’t have been able to do anything without that, but almost as important was their help in getting the word out about what we were creating,” said Joel Selanikio. The Guardian (London) (5/27)
25 May
Medicare has a lemons problem
(The Economist) THERE are many problems with Paul Ryan’s budget and his plans for Medicare, but for Democrats, one is paramount: it is unpopular. His proposal initially put Democrats on the back foot, but within days they took heart as press commentary and polls turned negative.
Both parties have, somewhere inside them, a serious proposal to reform Medicare. If they thought they could be elected by offering such a plan, they would do so. But any serious attempt to reform Medicare is going to be unpopular because it will cost the elderly something, and the elderly are on the way to becoming 30% of the voting population. Thus, the opposing party is inevitably going to use such a proposal to kill the other at the next election without advancing an alternative. And since both parties know this, the only Medicare plans they offer voters will be lemons.
16 May
The Need for Greed
In the Republican budget plan proposed by Representative Paul Ryan, it’s the I’ve Got Mines vs. The Left Behinds.
(NYT) … in order for the Republican plan to turn Medicare, one of most popular government programs in history, into a much-diminished voucher system, the greed card had to work.
The plan’s architect, Representative Paul Ryan of Wisconsin, drew a line in the actuarial sand: Anyone born before 1957 would not be affected. They could enjoy the single-payer, socialized medical care program that has allowed millions of people to live extended lives of dignity and decent health care.
And their kids and grandkids? Sorry, they would have to take their little voucher and pay some private insurer nearly twice as much as a senior pays for basic government coverage today. In essence, Republicans would break up the population between an I’ve Got Mine segment and The Left Behinds.
George Monbiot writes (blisteringly) on the transformation of Britain’s NHS
A Death Foretold
Why have successive governments been waging war on one of the world’s best health systems?
This programme [proposed by PM David Cameron] seeks to model one of the most efficient and cost-effective health services in the world – the NHS – on one of the least: the US system. The OECD’s figures show that healthcare in the US costs $7,500 per person per year. The OECD average is $4,500. In the UK it costs $3,500. Yet while the US system is plagued with fraud and lawyers, while it overtreats the rich and dumps the poor in the street, the NHS came out top of the countries surveyed in the journal Health Affairs on most measures of public confidence and public access. The US came bottom. As Major did with the railways, Cameron wants to take a functioning system and smash it into chaotic fragments.
Chan: Time to reform WHO
The World Health Organization is instituting cost-saving and efficiency measures as a reflection of global economic realities that caused a significant drop in voluntary contributions by United Nations member states. WHO Director-General Margaret Chan says the cutbacks present an opportunity for the organization to undertake reform to better represent a mandate that as changed significantly over the past decade. Google/Agence France-Presse (5/16)
7 February
Health Care Showdown: Obama Administration Calls Out GOP Governors
The Obama administration is showing political tough love with Republican governors who criticized both the constitutionality and funding of the president’s signature health care legislation.
On Monday, Press Secretary Robert Gibbs called out GOP leaders who were bemoaning the law — and threatening to ignore its provisions — while still taking the funds needed for implementation.
19 January
House votes to repeal health-care reform: What happens now?
(CSM) Though the House has repealed health-care reform, it won’t be repealed by the Senate, meaning the effort is virtually dead. But House Republicans can still try to dismantle the law by other means.

26 December 2010
Obama Returns to End-of-Life Plan That Caused Stir
Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.
Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ bill would allow the government to cut off care for the critically ill.
22 December
Senate Passes 9/11 Health Bill as Republicans Back Down
Legislation providing $4.3 billion received unexpected support 12 days after Republicans had blocked a more expensive version from coming to a vote.
After years of fierce lobbying and debate, Congress approved a bill on Wednesday to cover the cost of medical care for rescue workers and others who became sick from toxic fumes, dust and smoke after the 2001 attack on the World Trade Center.
13 August
Sharing of Data Leads to Progress on Alzheimer’s
(NYT) In 2003, a group of scientists and executives from the National Institutes of Health, the Food and Drug Administration, the drug and medical-imaging industries, universities and nonprofit groups joined in a project that experts say had no precedent: a collaborative effort to find the biological markers that show the progression of Alzheimer’s disease in the human brain.
Now, the effort is bearing fruit with a wealth of recent scientific papers on the early diagnosis of Alzheimer’s using methods like PET scans and tests of spinal fluid. More than 100 studies are under way to test drugs that might slow or stop the disease.
18 July
Insurers Push Plans That Limit Choice of Doctor
As the Obama administration begins to enact the new national health care law, the country’s biggest insurers are promoting affordable plans with reduced premiums that require participants to use a narrower selection of doctors or hospitals. The last time health insurers and employers sought to sharply limit patients’ choice was back in the early 1990s, when insurers tried to reinvent themselves by embracing managed care. Instead of just paying doctor and hospital bills, insurers also assumed a greater role in their customers’ medical care by restricting what specialists they could see or which hospitals they could go to.
The concept was largely abandoned after the consumer backlash persuaded both employers and health plans that Americans were simply not willing to sacrifice choice.
15 June
This remarkable documentary “Obama’s Deal” from PBS’ Frontline stands out for the scope of the awfulness of virtually all who were involved in the multiple scuttling of the Obama health reform legislation.
“On March 23, 2010, after a bruising year of debate, negotiation and backlash, President Barack Obama finally signed the health reform bill that he had promised more than a year before. But at what cost to his popularity and to the ideals of bipartisanship and open government that he’d campaigned on?
In Obama’s Deal, veteran FRONTLINE producer Michael Kirk takes viewers behind the headlines to reveal the political maneuvering behind Barack Obama’s effort to remake the American health system and transform the way Washington works. Through interviews with administration officials, senators and Washington lobbyists, Obama’s Deal reveals the dramatic details of how an idealistic president pursued the health care fight — despite the warnings of many of his closest advisers — and how he ended up making deals with many of the powerful special interests he had campaigned against.”
15 April
Mark B. McClellan, Director, Engelberg Center for Health Care Reform: Better Health Care at Lower Costs: Real Health Care Reform
(Brookings Institute) The passage of comprehensive health care reform legislation presents tremendous opportunities to improve the way that America’s health care system works. Reforms to expand coverage hold the potential to help millions of Americans. But in order to sustain this coverage and assure it provides access to innovative care, we need to focus on helping all Americans get the best care, not just better coverage.
13 April
Baffled by Health Plan? So Are Some Lawmakers
(NYT) The confusion raises the inevitable question: If they did not know exactly what they were doing to themselves, did lawmakers who wrote and passed the bill fully grasp the details of how it would influence the lives of other Americans?
The law promises that people can keep coverage they like, largely unchanged. For members of Congress and their aides, the federal employees health program offers much to like. But, the report says, the men and women who wrote the law may find that the guarantee of stability does not apply to them.
10 April
Under Fire for Abortion Deal, Stupak to Retire
Mr. Stupak, a nine-term incumbent, has been under intense pressure from anti-abortion groups and others since the health care bill passed last month. At his request, President Obama signed an executive order outlining the prohibitions against the use of federal funds for abortion. But anti-abortion groups dismissed the executive order and pledged to defeat Mr. Stupak, whom they had once championed.

We were not alone in our bewilderment regarding what the President had signed when. The intrepid Tony Deutsch queried his friend Professor Hal Waller of McGill: “A few days ago there was a much-publicized signing ceremony of the health-care bill at the White House. Now I discover that yesterday Congress passed another piece of what seems to be the same legislation, and sent it to the President. My, obviously mistaken, impression was that the legislation had to be complete before the President could act on it. (Under the British system Royal Assent has the effect of proclaiming the legislation as law of the land.) Could you possibly enlighten me as to what appears to be the U.S.practice?”
The prompt answer was – and is -
“Normally a bill is taken up separately by the two houses of Congress. In the course of its route through each house there are many changes made (basically amendments). The result is that for any consequential bill the two houses produce two somewhat different versions. In order for a bill to become law it must be signed by the president. But he can only sign a bill that has been passed in identical versions by the two houses. So the usual practice is to set up a conference committee for each such bill. The committee consists of representatives from both parties in each house and reflects the majority party’s weight. This committee has broad powers to combine the two versions into one bill. It can add or delete anything, compromise between the two versions, etc. Eventually the representatives of the two houses on the committee have to concur on a joint version (the conference report). This joint version is then sent back to each house for an up or down vote (i.e., no amendments on the floor). If it passes both houses then it has passed in identical form and can be sent to the president for signature. That’s the normal procedure.
What happened with the health care bill was a sharp departure from the normal procedure. In November and December the two houses had passed different versions of the bill. But once Scott Brown won in Massachusetts, the Democrats no longer had the votes to shut down a Senate filibuster. The Republicans would have filibustered any conference report because they were opposed to any bill. So the Democrats had to go around this obstacle and not set up a conference committee. Instead they sent the Senate version to the House, where it was passed last Sunday night without any changes. That was the bill (passed in identical form by both houses) that the president signed on Tuesday. However, the House Democrats had insisted that there were changes needed in the Senate bill. In exchange for the House’s willingness to pass the Senate bill, the Senate agreed to accept some amendments, in the form of a separate bill. This separate bill was officially handled as a budget reconciliation measure. Under Senate rules such bills are not subject to filibuster. So the House passed the reconciliation bill on Sunday night and sent it to the Senate. The Senate finally passed it on Wednesday, albeit with a couple of small amendments. So it went back to the House, which passed the amended version. That was then sent to the president [to sign]. That completes the legislative process on this matter!

30 March
The Last Piece in Place
In Alexandria, Va., President Obama on Tuesday signed into law the final piece of the Democrats’ health care overhaul.
Insurers to Comply With New Rules for Children
Under pressure from the White House, health insurance companies said on Tuesday that they would cover children with pre-existing conditions.
26 March
At last: Final health care measure heads to Obama
Yearlong struggle to pass health care overhaul ends as Democrats send final piece to Obama
(Yahoo! Finance)The last legislative chapter in the wrenching debate came Thursday night when the Democratic-controlled House passed, for the second time, a package of fixes to the bill that Obama had signed two days earlier. The measure includes better benefits for older people and low-income and middle-class families.
Taken together, the two bills extend coverage to 32 million uninsured Americans and aim to crack down on unpopular insurance industry practices, such as denying coverage for people with medical conditions, and to reduce federal deficits by an estimated $143 billion over a decade.
Most Americans would be required to buy insurance for the first time or face penalties if they refuse.
The second of the two bills also presented Obama with another victory, stripping banks and other private lenders of their ability to originate student loans in favor of a system of direct government lending.
Obama was expected to sign the measure early next week.
25 March
But, wait a minute! Senate Passes Set of Changes to Health Care Overhaul
After running through an obstacle course of Republican amendments and procedural objections, the Senate on Thursday afternoon approved of a package of changes to the Democrats’ sweeping health care overhaul, capping a bitter partisan battle over the most far-reaching social legislation in nearly half a century.
24 March
After Health Vote, Threats on Democrats
Democratic lawmakers have received death threats and been the victims of vandalism because of their votes in favor of the health care bill, lawmakers and law enforcement officials said Wednesday, as the Congressional debate over the issue headed toward a bitter and divisive conclusion.
Bill Boyarsky: A Healthy Start … With Loopholes –
Now that President Barack Obama has signed health reform into law, insurance industry lobbyists will turn their attention to trying to cripple it. This will be done under the pretense of improving the reform proposal—or, as they say in the lobbying business, loving the law to death.
23 March

Obama Signs Health Care Overhaul Bill, With a Flourish
With the strokes of 20 pens, President Obama signed his health care overhaul — the most sweeping social legislation enacted in decades — into law on Tuesday during a festive, at times raucous, White House ceremony.
Despite the president’s signature, the legislative work on the measure is not over, nor is the intense partisan fight over it. Republicans are already vowing to repeal the bill. And the legislative battle will flare anew in the Senate on Tuesday, where lawmakers are set to take up a package of changes to the measure under the parliamentary procedure known as reconciliation.

Obama on Health care – Presidential campaign 2008
Obama believes that the federal government should provide health care for everyone. He also feels that we need to increase competition in the insurance and pharmaceutical markets and advocates better funding for AIDS research and prevention. “Too many hard-working Americans cannot afford their medical bills, and health-related issues are the number one cause for personal bankruptcy. Promoting affordable, accessible, and high-quality health care is a priority.”

Atul Gawande: Five Rules – Harvard Medical School Commencement address (June 9, 2005)
Dr. Atul Gawande’s Commencement Address, Harvard School of Public Health, June 2009

We have arrived, I think, at a difficult point in human history. For millennia, before this moment in time, we had little knowledge of what to do to improve and sustain the health of human beings. We lived in ignorance. The average longevity of a person was under 40 years. The body, and how it failed, was largely a mystery.
The 20th century, however, brought an age of remarkable discovery. In the last century, scientists have come to recognize more than 60,000 different diseases and disorders that can afflict the human body — 60,000 different ways the human body can fail. And they have discovered methods of prevention and treatment for nearly all of them — if not to cure them, then at least to alleviate their worst harm and misery.
That knowledge has ranged from how to construct sewage systems well, to how to provide intensive care technologies. And that knowledge is continuing to grow. But having discovered so much, we have hit, in this new century, a new problem — how to actually deliver on all that has been learned.

Legal and Political Fights Loom
President Obama plans to open a new campaign this week to persuade skeptical Americans that the bill holds immediate benefits for them and addresses the nation’s shaky fiscal condition. Republicans said they would seek to repeal the measure, challenge its constitutionality and coordinate efforts in statehouses to block its implementation.
“The Moderate Republican: An Endangered Species” — Boy, the Republicans know how to make Barack Obama look good. What are they going to do now, threaten to repeal a law that forces insurance companies to cover the sick? Or block the provision that allows you to keep your out-of-work kids on your policy until they are 26?
Times Topics: Health care reform:
Mr. Obama and the Democratic leaders of Congress have appeared to be on the verge of victory before. On Nov. 7 2009, handing Mr. Obama a hard-fought victory, the House approved a sweeping overhaul of the nation’s health care system by a vote of 220 to 215. The Senate passed an $871 billion bill on Dec. 24.
But even as the House and Senate worked to merge their bills, their fate was put in jeopardy on Jan. 19, 2010, by an upset Republican victory in a special election to fill the Senate seat in Massachusetts held for decades by the late Senator Edward M. Kennedy. That outcome deprived the Democrats of the 60th vote needed to block a Republican filibuster, and threatened to change the political calculus for wavering supporters in both houses.
After weeks of strategizing and a one-day bipartisan “summit” organized by the White House, on March 3 President Obama began a final push for passage, making clear that he favored using a procedural maneuver called budget reconciliation to avoid a Republican filibuster in the Senate and allow passage of revisions to the original bill with a simple majority.
The House’s March 21 passage of the bill that was adopted by the Senate on Christmas Eve marks the first step of the Democrats’ plan. Mr. Obama is expected to sign that underlying measure quickly. But the House also approved a set of changes in a separate reconciliation bill, which Senate leaders have promised to pass. The reconciliation package would effectively smooth out some of the differences between the House and Senate versions. Mr. Obama would then sign that package, and he has also promised to issue an executive order “to ensure that federal funds are not used for abortion services.”
22 March
Marc Ambinder: Republicans in Disarray
A week ago, Republicans were united and on the verge of completely commanding the political narrative between now and November. Now, with their entire strategy having been upended by the Democratic health care victory, the party is in disarray.
There is no fallback on health care — none — except to call for repeal, as conservative House lawmakers and congressional candidates have already begun to do. But what to repeal? The “bad” stuff — tax increases and such — kick in later. Most everyone who will feel reform’s touch within the next year or so will get benefits, be it in the form of not having their coverage rescinded, or be it a $250 rebate check from the government. Today, Senate Majority Leader Mitch McConnell acknowledged as much by refusing to say whether Republicans actually would move to repeal legislation, or parts of it, if they manage to take control of the Senate.
New health care bill pros and cons: Will it cut costs?
(CSM) The Congressional Budget Office says the new health care bill will be deficit neutral. But economists aren’t sure. What are the financial pros and cons of the bill?
Hammering home reform
Barack Obama’s health reforms cross the most important threshold
(The Economist)The heart of the new reform is a restructuring of America’s deeply flawed insurance market. Insurers would face tough new regulations forbidding such practices as dropping customers with “pre-existing conditions” (real or trumped up), lifetime coverage caps and other cruel practices. In return, though, they would enjoy a vast expansion of the country’s private insurance market. Some 32m of the country’s 49m or so uninsured would be required to get insurance, starting in 2014; and the poorer ones will be given subsidies for doing so.
Paul Krugman: Fear Strikes Out
In the debate leading up to the victory for health care reform, President Obama urged lawmakers to do what is right, while opponents relied on fear and cynicism.
US House approves healthcare overhaul
(The Independent) In a late-night 219-212 vote, House Democrats approved the most dramatic US health policy changes in four decades.
U.S. House passes health care reform bill
The House of Representatives voted 219-212 to pass the a bill to reform the U.S. health insurance system. The reforms, which include income-based subsidies for the purchase of health insurance and an expansion of Medicaid, are expected to provide near-universal health coverage. The New York Times (free registration) (3/22) , The Wall Street Journal (3/22)
21 March
House Approves Health Overhaul, Sending Landmark Bill to Obama
Congress gave final approval to legislation that would provide medical coverage to tens of millions of Americans and remake the U.S. health care system along the lines proposed by President Obama.
Why this moment matters
James Fallows (The Atlantic) For now, the significance of the vote is moving the United States FROM a system in which people can assume they will have health coverage IF they are old enough (Medicare), poor enough (Medicaid), fortunate enough (working for an employer that offers coverage, or able themselves to bear expenses), or in some other way specially positioned (veterans; elected officials)… TOWARD a system in which people can assume they will have health-care coverage. Period.
That is how the entire rest of the developed world operates, as noted yesterday. It is the way the United States operates in most realms other than health coverage.
17 March
Obama Delays Trip as Report Aids Final Push on Health Care
As House Democrats geared up for a possible vote on Sunday to pass health care legislation, the Congressional Budget Office issued an analysis allowing them to point to significant cost savings in the decades ahead, and President Obama postponed a planned trip to the Pacific to keep pressing for approval.
12 March
Paul Krugman: Health Reform Myths
… reform still has to run a gantlet of misinformation and outright lies. So let me address three big myths about the proposed reform, myths that are believed by many people who consider themselves well-informed, but who have actually fallen for deceptive spin.
7 March
Frank Rich: The Up-or-Down Vote on Obama’s Presidency
Now that we have finally arrived at the do-or-die moment for Obama’s signature issue, we face the alarming prospect that his presidency could be toast if he doesn’t make good on a year’s worth of false starts. And it won’t even be the opposition’s fault. If too many Democrats in the House defect, health care will be dead. The G.O.P. would be able to argue this fall, not without reason, that the party holding the White House and both houses of Congress cannot govern. .
25 February
Obama dominates the room at healthcare summit
(Reuters) – It was a unique insight into President Barack Obama’s management style.
Obama dominated the debate during Thursday’s nearly seven hour cross-party summit on healthcare, always in command not only of the room but also of the most intricate policy details, as he personally rebutted every point he disagreed with.
His tone was at times professorial, occasionally combative and at one point even dismissive of his 2008 rival for the presidency, Republican Senator John McCain.
It remains to be seen if the American public was more convinced by Obama’s detailed exposition of policy or the Republicans’ more visceral argument against an expansion of Washington’s powers.
What is certain is that there was little progress toward generating a greater bipartisan consensus around a reform of the mammoth healthcare industry.
9 November 2009
U.S. health care reform ‘two steps away’
… U.S. health care reform ‘two steps away’. Obama ‘confident’ Senate will pass legislation.
19 October
US Healthcare Reform Myths and Realities
(Conference Board of Canada) The debate raging over healthcare reform in the United States has taken a number of bizarre twists and turns that has [sic] come as a shock to many Canadians observing the unfolding drama. The Canadian healthcare system has been dragged into the debate as critics of government-run healthcare point to the deficiencies in our system as evidence concerning the damage that the public option brings with it. Apparently a publicly run system like ours can lead to the creation of death panels that can determine who lives and dies, according to Sarah Palin and other Republicans. Little is said about the fact that Canada has a higher life expectancy than the United States.
13 October
Health care reform clears a Senate hurdle
(MSNBC) Nearly nine months after the president pledged in his Inaugural Address to tackle health care, legislation to expand coverage to millions who lack it has now advanced further than President Bill Clinton’s ill-fated effort more than a decade ago — or any other attempt in more than a generation.
7 October
CBO: Health care bill to cost $829 billion
(MSNBC) Budget experts say proposal would cover 94 percent of Americans
The Congressional Budget Office added that the measure would reduce federal deficits by $81 billion over a decade and probably lead to “continued reductions in federal budget deficits” in the years beyond.
16 September
Max Baucus releases health care bill
(Politico) Introducing a health care reform bill without the bipartisan support he had sought, Senate Finance Committee Chairman Max Baucus on Wednesday defended a series of concessions to Republicans in the $856 billion plan that have drawn sharp criticism from Democrats.
The bill forces insurance companies to change the way they do business, such as prohibiting them from dropping or denying coverage based on preexisting conditions. To force competition with private insurers, the Montana Democrat chose creating nonprofit consumer-owned cooperatives over the public insurance option, which most Democrats prefer.
13 August 2009
Palin doubles down on ‘death panels’
(Politico) Former Alaska GOP Gov. Sarah Palin defended her claim that the Democratic health care proposal would create “death panels” in a statement Wednesday night slamming President Barack Obama.
“Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly and the disabled would suffer the most under such rationing; and that under such a system, these ‘unproductive’ members of society could face the prospect of government bureaucrats determining whether they deserve health care”.
26 March 2009
(TIME) Max Baucus Is Mr. Health Care
Baucus has been surprising almost everyone, most notably by the zeal with which he is tackling what could be the toughest challenge of all: overhauling the health-care system to provide coverage for the more than 45 million Americans who lack it and to bring soaring costs under control. Indeed, Baucus’ proposal, unveiled in an 89-page white paper eight days after the election, was even more ambitious than Obama’s, adding a requirement that individuals who are not covered by their employers purchase their own health insurance, much as car owners must carry auto insurance. Max Baucus Health Reform White Paper

Presidential campaign 2008 – Barack Obama on the issues
(Washington Post) Do you have a plan to make health care more accessible to Americans? If so, how would you do it?
(Barack Obama) Every American has the right to affordable, comprehensive and portable health coverage. My plan will ensure that all Americans have health care coverage through their employers, private health plans, the federal government, or the states. My plan builds on and improves our current insurance system, which most Americans continue to rely upon, and creates a new public health plan for those currently without coverage. Under my plan, Americans will be able to choose to maintain their current coverage if they choose to. For those without health insurance I will establish a new public insurance program, and provide subsides to afford care for those who need them. My plan includes a mandate that all children have health care coverage and I will expand eligibility for the Medicaid and SCHIP programs to help ensure we cover all kids. My plan requires all employers to contribute towards health coverage for their employees or towards the cost of the public plan. Under my plan a typical family will save $2,500 each year. We will realize tremendous savings within the health care system from improving efficiency and quality and reducing wasted expenditures system-wide. Specifically, these savings will result from investments in health information technology, improvements in prevention and management of chronic conditions, increased insurance industry competition and reduced industry overhead, the p