Low-hanging fruit.

Coffee Brown, University of New Mexico, Talk Radio News

The Alliance for Health Reform presented findings of recent pilot studies showing that major improvements in healthcare are possible now, even in advance of new technologies and structures.

Ed Howard, Alliance for Health Reform, said that less than two percent of hospitals have “fully integrated” Health Information Technology (HIT). Even as hospitals invest in hardware, software, and training, the systems won’t work unless everyone uses them, he said. Where HIT is used effectively, he finished, quality and cost control are measurably improved. In other words, HIT does deliver better, faster, less expensive care.

But only when its use is coordinated among providers (often called “Care Teams”), according to Carolyn M. Clancy, MD, Director of the Agency for Healthcare Research and Quality (AHRQ). When the Electronic Medical Record (EMR) merely recreates the chart as an electronic document, “it can actually allow us to make the same mistakes faster.”

She cited the Provnost Study showing that when computers helped to coordinate care among all of the caregivers, using checklists, prompts, and feedback, infected lines in the ICU were reduced nearly to zero.

Jon Rasmussen, Pharm. D., Chief of Clinical Pharmacy Cardiovascular Services, and Susan Kuca, RN, Cardiac Care Coordinator, described Kaiser Permanente’s intricately coordinated care. They said the program had reduced the risk of subsequent fatal heart attack by 88 percent if begun immediately after hospitalization, and by 73 percent even if started much later, such as when a patient with existing heart disease came into the system from elsewhere.

Greg Halvorson, Chairman and CEO of Kaiser Permanente Health Plan, said we are the only industrialized country without universal health care. He said healthcare can and should be both better and more affordable. Halvorson described a RAND study covering 5 million patients over 2 years that found 25 percent of care was wrong or harmful, implying that U.S. savings in healthcare from efficiency alone could be one-half to one trillion dollars.

Diabetics account for 30 percent of Medicaid dollars, yet their carewas rated as “right only eight percent of the time.”

Big deductibles had the opposite of their intended effect by causing beneficiaries to delay care too long, he said.

In the case of chronic care, one percent of patients use 35 percent ofthe dollars, and ten percent use 80 percent of total dollars. “Chronic
care is a team sport,” Halvorson said.

The consensus of the panel was that, even without a single new treatment or device, coordination of ongoing care could save billions
or trillions of dollars, while improving outcomes.

New policy for old drugs

Coffee Brown, University of New Mexico, Talk Radio News

Sens. Chuck Schumer (D-N.Y.), Susan Collins (R-Maine), Sherrod Brown (D-Ohio), and Mel Martinez (R-Fla.) announced the Promoting Innovation and Access to Life-Saving Medicine Act, to make generic alternatives available as “biologics” go out of parent.

Schumer joked that he couldn't make an acronym out of the initials, then explained biologics are drugs produced from living cells, (such as Premarin from horses, vaccines from killed or weakened microbes, Insulin from bacteria, or the anticipated results of stem cell research).

Collins said the act is needed because currently the FDA has no pathway to evaluate and approve this class of drugs. Many lifesaving biologics are long out of patent, but are still expensive because generics can’t get approved. “The price tag (for insulin) might well drop by as much as 25 percent,” she said.

Brown and Martinez agreed that there was strong bipartisan support for the act.

“We probably have four different opinions here about here on the best way to proceed on healthcare reform, but everyone agrees a prerequisite is to bring costs down," Schumer said.

The summary of the bill contained a clause limiting “exclusivity” (like a patent) to five years for the original molecule and three years for some modifications.

“The most fiscally irresponsible budget in American history"?

Coffee Brown, University of New Mexico, Talk Radio News

House Minority Leader John Boehner (R-Ohio), Republican Whip Eric Cantor (R-Va,), Rep. Paul Ryan (R-Wis.), and Rep. Mike Pence (R-Ind.) presented the broad outline of the Republican budget counter-proposal, stating that details would be forthcoming next week.
Boehner said the President’s proposal “spends, taxes, and borrows too much,” adding “I think it’s completely irresponsible. Our plan curbs spending, creates jobs, and cuts taxes, while controlling the debt.”

Pence called it “the most fiscally irresponsible budget in American history,” saying it calls for “more spending, more government, more bailouts.”

He said the “national energy tax” (Cap-and-Trade) would cost every American household more than $3,000 per year. The increase on marginal tax rates would fall most heavily on small business owners, he said. “We believe it is our obligation to offer a better solution if we are in disagreement,” he finished.

Cantor said the Republicans had presented an alternative stimulus plan and housing plan and were preparing an alternative energy plan as well. He accused the President of turning from a centrist campaign to “ambushing” and “strong-arming” Congress toward a “more ideological” agenda.

Ryan promised the details of the plan next Wednesday on the House floor, calling the president’s version “reckless and irresponsible. It’s a budget that doubles the national debt in 5 and 1/2 years, and triples it in ten and 1/2 years. It’s a budget that increases our national debt and our borrowing more than in all prior presidencies.”


The pamphlet accompanying the announcement was 18 pages long and contained no specifics, but outlined broad policies, such as promoting nuclear power, encouraging enrollment in private insurance plans, reducing spending, reducing taxes, liberalizing exploration for oil in areas currently protected for environmental reasons, and ending “bailouts.”

"Spending money I haven't made yet for things I don't want."

Coffee Brown, University of New Mexico, Talk Radio News

Paul Ryan (R-Wis.) said, “The president is proposing to increase our national debt more than all prior 43 presidents combined,” adding $2.3 trillion more “to the national debt in higher deficits” than his own budget office stated.

Ryan said the budget increases taxes and spending. “But what’s so galling about this – we read today the Chinese are talking about a new currency, the Russians are talking about a new currency. We are debasing the value of the American dollar by borrowing way beyond our means,” he said.

“We are consigning our next generation to an inferior standard of living,” Ryan said.

He estimates the national debt will double in six years and triple in ten.

Dan Mitchell, senior fellow at the CATO Institute, a libertarian think tank, said, “That’s just the tip of the iceberg, because … we have trillions and trillions of unfunded liability for entitlement programs, … tens of trillions of dollars of unfunded liabilities in the future. We are in effect on a path to become the next Argentina.”

That other countries would consider a reserve currency other than the dollar is, he says, “a referendum that we are on the wrong track.”

Rep. Jim Jordan (R-Ohio), Chairman of the Fiscal Responsibility Task Force of the Republican Study Committee, said that one of the elements of greatness is the willingness of one generation to sacrifice for the next. The next generation, he said, will never be able to repay this debt.

He quoted Sen. Judd Gregg (R-N.H.) as saying this budget would bankrupt the country.

Rep. Marsha Blackburn (R-Tenn.) said “One of my constituents said it best, ‘I am tired of Congress spending money I haven’t made yet for things I don’t want.’ When you look at the push for nationalizing healthcare, when you look at the cap-and-tax scheme (Cap-and-Trade), this is what people are afraid is going to pile on more and more debt.”

“I look at this as being economic abuse of (her grandchildren’s) future,” she said.

Rep. Gregg Harper (R-Miss.) said, ”When you find out you’ve dug yourself a hole, you should quit digging, but we’ve brought in heavy machinery, and we’re making the hole so deep that we’re not going to be able to get out of it.”

“We tell our children we can’t afford to get everything,” he said, and now the children, the public, are telling the parents, the legislators, “We don’t really have to have that.”

Three Keys to Recovery

Coffee Brown, University of New Mexico, Talk Radio News

“The annual budget process is really the truest test of priorities that the President and Congress engage in,” said Sen. Patty Murray (D-Wash.), as she, Sen. Bernie Sanders (D-Vt.), and Sen. Jeff Merkley (D-Ore.) met to define what those priorities are for the Senate Democrats. “We want to put the middle class first by cutting taxes and making key investments to bring this country out of this recession,” she said. The three then defined what those key investments are.

Murray spoke for education, “To revive the American economy and compete in this global economy, we have to expand educational opportunities for all Americans. Investing in education is one of the most certain ways to prepare a skilled and ready workforce.”


She introduced Jaim Foster, a second grade teacher from Alexandria, Va., who described teachers facing cutbacks and uncertain employment, as well as increased responsibilities as school nurses also were cut.

Sanders said, “For decades, politicians have been giving speeches about the need for energy independence.” We send hundreds of billions of dollars a year” out of the U.S., often to more or less unfriendly countries. “Finally the American people have said ‘enough is enough, we have got to do something real,’” he said. “The time is now to break our dependence on fossil fuel, and that is what we are going to do.”

He said the expert consensus is that we must address climate change, and that we are already seeing its effects. The budget will create “millions of good paying American jobs as we move to new kinds of energy,” he said, citing geothermal, wind, solar, and biomass.

He introduced James Walker, President, American Wind Energy Association, who said the industry went from $700 million in 2004 to $17 Billion in 2008, creating over 85,000 jobs. When it reaches its projected potential of 20 percent of our total energy needs, it will be the equivalent of removing 140 million cars, and will have created over 500,000 jobs, he said.

Merkley took healthcare. “I think everyone understands how broken healthcare is,” he said, citing 50 million uninsured, many more who are under-insured, and families whose top concern is "whether or not
they can maintain health insurance". “The stress is continuous,” he said.

Merkley said that “every single year, double digit increases” in premiums cause more small businesses to stop offering health insurance. He said even larger businesses are now advocating for change.


Sanders finished with, “Ask Sen. (Judd Gregg (R-N.H.)) if he still supports the repeal of the estate tax, which would give one trillion dollars to the wealthiest three tenths of one percent. That’s OK, but when you fund energy, when you fund healthcare, when you fund education, when you put Americans to work to improve the quality of life for our families, somehow that’s a terrible idea.”