A Futuristic Grid and Fossil Gas are Energy’s New Pillars

Coffee Brown University of New Mexico, for Talk Radio News Service

During two energy conferences in Washington, DC, Secretary of Energy Dr. Steven Chu said that a new, expanded, robust, and smart electric grid is the big ticket item for his department in the just-signed stimulus bill (American Recovery and Reinvestment Act).

We are moving away, he said from locally produced power in pursuit of alternative energies, such as wind and solar, which are favored by geography in sparsely populated areas. As energy is produced in a fluctuating pattern due to local weather, and then sent farther away, a computerized grid which can direct, even out, monitor and store power will be needed. This coordination will extend even to homes, where fluctuations in use or peak draws can be managed to limit brown- and black-outs. he described circadian pricing, rewarding users who shift usage away from peak hours, and buy-back credits for homes which actually produce power as examples of smart distribution at the home level.

Chu noted that the new grid could be a target, so robust design was a security priority.
While wind power is as high as 20 percent in some areas, it is only three percent of overall production, and will need to mature and expand over a decade or more to compete on a cost-per-kilowatt basis.

Chu has made a priority of streamlining funding of shovel-ready projects, which were facing delays of up to two years for approval.

At the second conference, chaired by Senate Majority Leader Harry Reid, and attended by entrepreneur and hedge fund manager T.Boone Pickens, the question of new regulatory agencies came up, as power distribution became less regional and more interconnected. Reid said that he thought it could be handled administratively.

Pickens said that there are vast reserves of natural gas at several fields in the U.S., far more than would be needed to bridge the gap to non-carbon pumping energy production. Trucks, he said, can never run on batteries but can easily be converted from gasoline to natural gas, which is 30 percent cleaner and would create many American jobs and businesses.

Chu concluded by saying that carbon capture and climate change are important topics that will be addressed in later stages of the program.

In Health Care Reform, We Don't Know What Works, But We know What Doesn't

In Health Care Reform, We Don't Know What Works, But We know What Doesn't

Coffee Brown,MD, University of New Mexico, for Talk Radio News Service


 
 "We just have to try some of these, knowing some of them will fail," Director Douglas W. Elmendorf, Director of the Congressional Budget Office, told Senate Budget Committee Chairman Sen. Kent Conrad (D-ND). Elmendorf reinforced Conrad's statement that healthcare costs will rise from 16 percent of the GDP to 20 percent if nothing is done. One dollar out of five would then go to healthcare in 2020, and the total Medicare-Medicaid burden would rise to 52 Trillion dollars over the next 75 years if nothing were done and if that money existed, according to both Conrad and Elmendorf. This would occur within the lifespans of most of the children who are alive now.
Elmendorf told the Senate Budget Committee, that none of the projections in the CBO's report on the costs of medical reform are certain, that some are much more speculative than others, and that there is simply  no way to know ahead of time which strategies will be most cost effective.
The most promising way to pay for some form of universal healthcare access,Elmendorf said, would be to completely or partially roll back tax credits for employer and personal health insurance premiums. "That saves the government money, but the cost is transferred to individuals," he said.
To achieve universal health coverage, it will be necessary to pool risks and to enforce and subsidize health insurance mandates, he said.
Medical insurance premiums increased by 78 percent during the same period,( 2003-2007) that wages increased 19 percent. So long as medical costs rise faster than wages, more of every dollar will go into medical care.
Chairman Conrad then pointed out that we pay almost twice as much, 8,300 dollars per person per year, as any other nation, yet we rank below 20th on international quality scales. Even within the U.S., he pointed out, the regions that spend the least tend to have the best outcomes. Clearly, he said, higher cost does not equal higher quality. To save healthcare, we need to put less, rather than more money into it, though he accepted that there may be transition costs.

House Republicans Contend That H.R.2 is Not Bipartisan, Democrats Disagree

Coffee Brown, University of New Mexico, for Talk Radio News Service



In Wednesday's statements prior to voting, Republicans led by Pete Sessions (R-TX) complained that they had been effectively shut out of any debate over the provisions of H.R. 2: Children's Health Insurance Program Reauthorization Act of 2009. They said the 40 percent of House members who were Republicans and the 12 percent who are freshmen (Note: this appears to double count 22 out of 54 freshmen), were not included in the drafting of the bill’s provisions.

Democrats, led by Jared Polis (D-CO) countered that the original bill was co-sponsored by Republicans and the extension was passed twice with overwhelming bipartisan support already, only to be vetoed by then-president Bush. Since there are no substantive changes, they said, this bill is bipartisan.
Republicans stated that they want to pass an extension of the existing bill, but not an expansion.
The current version, they feel, invites fraud by removing the proof-of-citizenship requirement. It expands coverage to families with much higher incomes than before, up to 80 thousand dollars, by raising the qualifying threshold from twice the poverty level to three times that, and by waiving some forms of income from consideration. This, in turn means that the four million new enrollees will include about 2.4 million who are actually privately ensured now. S-CHIP should not compete with private insurance because public healthcare pays only 30-50 percent of market, making providers reluctant to see such patients, thereby reducing access and lowering quality.

Several states are using S-CHIP to cover adults, they added. The net effect, according to Steven King (R-IA), will be to raise the true cost from the projected $3.85 Billion to over $15 billion. Cigarette taxes are not going to be nearly enough to pay for that, especially if smoking rates continue to fall.
Sessions reminded Democrats of their own criteria for the bill, saying, "This is neither cost effective nor common sense."
Democrats said caring for children should be the nation's first priority. They pointed out that children born here are citizens regardless of their parents' status, and children have no say in their own socioeconomic circumstances.
Healthcare dollars are cost effective, they said, because they ensure healthy workers and help reduce the high costs of under-managed chronic disease and of avoidable emergency department visits. The younger we begin preventive care, the greater the return on the investment. Healthcare also generates high quality, lasting jobs.
In the words of Alan Grayson (D-FL), "Choose life."

The measure passed, with 30 Republican votes, 183 to 89.

The High Cost of Doing Nothing

Coffee Brown, MD, University of New Mexico, for Talk Radio News Service

For each increase of one percent in the unemployment rate, the number of medically uninsured goes up by approximately 1 million, according to Professor Jeanne Lambrew, Deputy Director of the new White House Office of Health Care Reform. Unemployment and medical debt in turn, increases foreclosures, she stated while addressing the National Health Policy Conference in Washington D.C., speaking at the National Health Policy Conference.
The coming spike in the uninsured will trigger a provision in the recovery act to subsidize 65 percent of cobra payments. When workers lose their jobs, they usually lose their insurance as well. By law, they can continue their former plan for six months by paying the entire premium plus two percent. This is about 80 percent of typical unemployment benefits, rendering it unaffordable for most. It may be wise to offer medicare as a less expensive, longer-lasting alternative, Lambrew said.
She also expressed concern over medical error rates that are higher in America than in peer nations. Health reform is needed to address these problems and the healthcare workforce shortage as well. This in turn will create lasting jobs, and cash flow within communities, she concluded.


Robert Berensen said that there is no longer any significant debate about the need for healthcare reform, now it’s about the form of the healthcare delivery system itself. The effort to reform the system has been gridlocked for 30 years, he said.
Paul Wallace, M.D., spoke for Kaiser Permanente and Glenn Steele, M.D., spoke for the Geisinger Health System. They described private sector innovations aimed at increasing efficiency, such as varying pay structures to improve healthcare benchmarks. The most important of these was getting caregivers to adopt electronic records. This measure speeds flow, reduces redundancy and reduces errors by making sure that the patient’s history is up-to-date at each visit, even when they cannot see their usual provider.
Both physicians emphasized the importance of a patient “care home”, a clinic and staff who know the patient well. This practice, the modern equivalent of the family doctor, is increasingly common as states experiment with ways to reduce costs and increase patient satisfaction. Results reported at several recent conferences have been very positive.

Sen. Max Baucus, D-Mont., at the National Health Policy Conference, said there are several good reasons for healthcare reform right now.
First, he said, the cost of doing nothing has become greater than the cost of doing something. Prices were rising faster than inflation even before the crash, he said. By 2014, half of U.S. households will be spending 45 percent of their total incomes on health insurance premiums.
Second, the current system is failing. Costs are higher and quality markers are lower than for other industrialized nations. Medical errors are killing tens of thousands of us a year, largely due to poor Health IT systems, which are now a major item in the recovery package.
Third, there is an unprecedented degree of bipartisan and even industry support.
Baucus concluded with the statement that the first priority has to be changes that create economic stimulus, and the second needs to be speed, while the momentum is favorable. The problem, he said, is that we also have an economic crisis, two wars, and an oil-dependence crisis competing for the attention of congress and the president.

Health care transforms, Gingrich gives thoughts

Newt Gingrich, former Speaker of the House of Representatives, participated in the Center for Health Transformation's Healthcare that Works presentation at the Washington Press Club.
A panel of speakers presented data on the need for robust and universal computerized medicine for safety and cost savings. Gingrich said government could save much more by promoting private sector best practices than by just funding benefits.
Merrill Mathews, PhD, said centralized accounting could combat fraud totaling billions of dollars annually. He said the private sector has much better control of this, and should be the model.
Brandon Savage, MD, of GE Healthcare, said electronic patient records Could be modeled on ATM software which already provides fast access no matter where the user is, while remaining secure. Gingrich added that such records could monitor medical errors, medicine conflicts, allergies, etc.

According to Donald Doak, EBSCO Publishing, 40 thousand to 90 thousand lives a year might be saved . He also said Evidence based (objective, statistically supported best practices) medicines is derived from, and distributed by, networked databases.
Gingrich said that he had tried to encourage electronic medical information reforms under Bush for six years; now they are part of Obama's package.
In a broader concluding statement, Gingrich also proposed tripling NSF funding, based on a "generational investment strategy": the payoff is huge, but delayed. "My biggest mistake as Speaker was not doing that."
Dr. Rita Colwell, former director of the National Science Foundation, endorsed Gingrich's estimate of needed funding.

The entire presentation will be available as a video at www.healthtransformation.net