It's Not So Much What You Spend As What You Know

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

Several programs based on knowledge and teaching, rather than intensive funding, have proven effective in test communities, according to Wayne H. Giles, MD, MS, of the Centers for Disease Control (CDC).

The CDC has promoted programs like giving flu shots at voting sites, inspecting the homes of the elderly for trip-and-fall hazards, and educating patients to ask the right questions at clinic visits.

Substantial gains resulted in markers like the percentage of at-risk individuals getting flu shots, safer homes, and better blood sugars.

Giles noted that it's not enough to tell communities they need safe places for people to walk and exercise; action plans, "step by step cookbooks," are available online free through the CDC (http://apps.nccd.cdc.gov/DACH_CHAPS/Default/LinksResourceType.aspx?topic=7) and HHS(http://www.communityhealth.hhs.gov/homepage.aspx?j=1). These resources have proven effective and are intended for use by communities all over the country looking for low cost ways to improve the health of their members, Giles told the National Advisory Committee On Rural Health and Human Services.

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.

22 Democratic Members of Congress join to form Populist Caucus

Representative Bruce Braley (D-Iowa),, announced the formation of the new Populist Caucus. It is aimed at protecting and expanding the middle class. "This is the moment, and the time is right to form the populist caucus because many of us feel that the needs of the middle class are being ignored or not been given the proper attention."

Rep. Peter Welch (D-VT) said that this country has been founded on the proposition that people who want to work hard to get into the middle class can make it, and that those who are in the middle class can work to do better. "We have never seen, since the 1920's, the greatest disparity of wealth that we have had in this country. And it's shocking, it's unconscionable, and it's wrong. And many Americans have a sneaking suspicion that part of the reason is that Congress has lost its way." He said it is time for Congress to start advocating for the middle class, which is what the caucus intends to do.

"As we move forward and debate the policies that will hopefully rebuild this economy and re-build the middle class in this country, we will lean heavily on the lessons that we've learned over the last ten years or so and work again to make this an economy that works for everyone," said Rep. John Yarmuth (D-KY).
In order to strengthen the middle class, the caucus outlined 6 issues that they plan to focus on: creating good jobs and a secure retirement, cutting taxes for the middle class, affordable and quality for healthcare, quality and affordable education, fair trade, and protecting consumers.

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.