Best Recent Articles on Health Care Reform

Since I am way behind in my intended Blogs, here is a list highlighting recent articles and editorials on the hot topic of health care reform. The list starts with the most recently published, but they are all still quite current. These articles are all from The New York Times. Please send me suggestions for other ones.

• In “Drug Makers Raise Prices in Face of Health Care Reform” (11/15/2009), Duff Wilson wrote, “Even as drug makers promise to support Washington’s health care overhaul by shaving $8 billion a year off the nation’s drug costs after the legislation takes effect, the industry has been raising its prices at the fastest rate in years. In the last year, the industry has raised the wholesale prices of brand-name prescription drugs by about 9 percent, according to industry analysts. That will add more than $10 billion to the nation’s drug bill, which is on track to exceed $300 billion this year. By at least one analysis, it is the highest annual rate of inflation for drug prices since 1992. The drug trend is distinctly at odds with the direction of the Consumer Price Index, which has fallen by 1.3 percent in the last year. Drug makers say they have valid business reasons for the price increases. Critics say the industry is trying to establish a higher price base before Congress passes legislation that tries to curb drug spending in coming years […].”
• The editorial “Reform and Medical Costs” (11/14/2009) says that “Americans are deeply concerned about the relentless rise in health care costs and health insurance premiums. They need to know if reform will help solve the problem. The answer is that no one has an easy fix for rising medical costs. The fundamental fix — reshaping how care is delivered and how doctors are paid in a wasteful, dysfunctional system — is likely to be achieved only through trial and error and incremental gains. The good news is that the bill just approved by the House and a bill approved by the Senate Finance Committee would implement or test many reforms that should help slow the rise in medical costs over the long term.” The rest of this editorial provides an overview of the “the important proposals in the House and Senate bills.” The following issues are discussed: Cadillac Coverage, Simplified Forms, Electronic Medical Records, Reform of the Delivery System, Independent Commission, Managed Competition, a Public Plan, Comparing Treatments, Negotiating Drug Prices, and Malpractice Reform.
• In “America’s Defining Choice” (11/11/2009) Op-ed columnist Nicholas D. Kristof wrote, “President Obama and Congress will soon make defining choices about health care and troops for Afghanistan. These two choices have something in common — each has a bill of around $100 billion per year. So one question is whether we’re better off spending that money blowing up things in Helmand Province or building up things in America. […] So doesn’t it seem odd to hear hawks say that health reform is fiscally irresponsible, while in the next breath they cheer a larger deployment of troops in Afghanistan? Meanwhile, lack of health insurance kills about 45,000 Americans a year, according to a Harvard study released in September. So which is the greater danger to our homeland security, the Taliban or our dysfunctional insurance system? […] So where’s the best place to spend $100 billion a year? Is it on patrols in Helmand? Or is it to refurbish our health care system so that people like Sue don’t die unnecessarily every 12 minutes?”
• In “Trading Women’s Rights for Political Power”  (11/11/2009) Op-Ed contributors Kate Mitchelman and Frances Kissling wrote, “A GRIM reality sits behind the joyful press statements from Washington Democrats. To secure passage of health care legislation in the House, the party chose a course that risks the well-being of millions of women for generations to come. House Democrats voted to expand the current ban on public financing for abortion and to effectively prohibit women who participate in the proposed health system from obtaining private insurance that covers the full range of reproductive health options. Political calculation aside, the House Democrats reinforced the principle that a minority view on the morality of abortion can determine reproductive health policy for American women. […] The Democratic majority has abandoned its platform and subordinated women’s health to short-term political success. In doing so, these so-called friends of women’s rights have arguably done more to undermine reproductive rights than some of abortion’s staunchest foes. That Senate Democrats are poised to allow similar anti-abortion language in their bill simply underscores the degree of the damage that has been done. […]”
• In “Unhealthy America” (11/4/2009) Nicholas D. Kristof wrote, “The moment of truth for health care is at hand, and the distortion that perhaps gets the most traction is this: ‘We have the greatest health care system in the world. Sure, it has flaws, but it saves lives in ways that other countries can only dream of. Abroad, people sit on waiting lists for months, so why should we squander billions of dollars to mess with a system that is the envy of the world? As Senator Richard Shelby of Alabama puts it, President Obama’s plans amount to “the first step in destroying the best health care system the world has ever known.’ That self-aggrandizing delusion may be the single greatest myth in the health care debate. […] The United States ranks 31st in life expectancy (tied with Kuwait and Chile), according to the latest World Health Organization figures. We rank 37th in infant mortality (partly because of many premature births) and 34th in maternal mortality. A child in the United States is two-and-a-half times as likely to die by age 5 as in Singapore or Sweden, and an American woman is 11 times as likely to die in childbirth as a woman in Ireland.[…]”

Women’s Reproductive Rights Should Not Be the Price to Pay for Health Care Reform

Is passage of the House of Representatives health care reform bill a step forward or backward towards real health reform? On the one hand I am encouraged that something passed (albeit by a tiny margin), on the other I am dismayed about the right-wing compromises that were made to to buy passage. Not surprisingly, women’s rights are thrown away as cheap bargaining chips. Health insurance companies and religious conservatives are the winners, while all sorts of people are left out in the cold.

According to the editorial “The Ban on Abortion Coverage” (The New York Times 11/9/2009),

When the House narrowly passed the health care reform bill on Saturday night, it came with a steep price for women’s reproductive rights. Under pressure from anti-abortion Democrats and the United States Conference of Catholic Bishops, lawmakers added language that would prevent millions of Americans from buying insurance that covers abortions — even if they use their own money.

The restrictions would fall on women eligible to buy coverage on new health insurance exchanges. They are a sharp departure from current practice, an infringement of a woman’s right to get a legal medical procedure and an unjustified intrusion by Congress into decisions best made by patients and doctors.

The anti-abortion Democrats behind this coup insisted that they were simply adhering to the so-called Hyde Amendment, which bans the use of federal dollars to pay for almost all abortions in a number of government programs. In fact, they reached far beyond Hyde and made it largely impossible to use a policyholder’s own dollars to pay for abortion coverage. […]

And women’s rights are not the only thing that got lost along the road to passage. Here is a handy little list “Six Smart Progressive Complaints About House Health Bill” from John Nichols’ The Beat blog ( The Nation, 11/09/2009).

The Affordable Health Care for America Act was approved by the U.S. House Saturday night with overwhelming support from progressive Democrats who serve in the chamber and from a president who was nominated and elected with the enthusiastic support of progressive voters. But that does not mean that informed and engaged progressives are entirely enthusiastic about the measure. In fact, some are openly and explicitly opposed to it […]

Key interest groups […] argue that the bill is not the cure for what ails the U.S. health care system. Indeed, they suggest, the bill as it is currently constructed could make a bad situation worse. Many sincere progressives in the House, and outside of it, chose to back the bill as the best that could be gotten. Others supported it on the theory that flaws could be fixed in the Senate and in the reconciliation of the House and Senate bills. But those repairs will only be made if activists are conscious of what ails this bill.

For that reason, even supporters of the House legislation would be wise to consider the criticisms of it by groups that advocate for the rights of women, patient advocates, unions and some of the most progressive members of the House. Here are six smart progressive complaints about the House bill:

1. FROM THE NATIONAL ORGANIZATION FOR WOMEN: “This Bill Obliterates Women’s Fundamental Right to Choose” […]

2. FROM THE CALIFORNIA NURSES ASSOCIATION: This Bill Fails to Control Costs […]

3. FROM CONGRESSMAN ERIC MASSA: “This Bill Will Enshrine in Law the Monopolistic Powers of the Private Health Insurance Industry” […]

4. FROM PLANNED PARENTHOOD’S CECILE RICHARDS: This Bill Embraces Religious-Right Extremes […]

5. FROM CONGRESSMAN DENNIS KUCINICH,: This Bill Worries About the Health of Wall Street, Not America […]

6. FROM “SICKO’S” DONNA SMITH: The Bill Does Not Cure What Ails Us […]

And for those of you who favor the multimedia approach, check out GRITtv: American Sickos: Will The Current Bills Help?

Actors Make a Video Plea to Protect Health Insurance Companies’ Profits

In the “Protect Insurance Companies PSA” video (funded by MoveOn.org and posted at FunnyorDie.com) several well-known actors make a heart-felt  plea to help insurance companies keep their high profits. Who needs health care reform when these needy companies are making such healthy profits? Aren’t they so much more deserving than the rest of us? Very inspirational! And just like the actors in the video, I am also not being sarcastic.

Food for Thought About Health Care Reform in a Book and a Song

Here are a couple of suggestions for those of you who might want to hear or read more about health care reform and related matters. A good friend of mine led me to check out Paul Hipp‘s sarcastic song, “We’re number 37” inspired by the World Health Organization (WHO)’s ranking of nations around the world. If you want to fact-check the song go to this article on PolitiFact.com truth-o-meter “The US ranks 37th in the world for health care.”

Abigail Zuger’s review (“One Injury, 10 Countries: A Journey in Health Care,” The New York Times, 9/14/2009) of T. R. Reid’s new book, The Healing of America, convinced me to buy it (my local library’s waiting list for this book seemed too long). I haven’t read it yet but according to Zuger and others (see the San Francisco Chronicle 09/23/2009 review “A Global Quest for Better, Cheaper, and Fairer Health Care“), it seems like a “must read.” Here are some excerpts from Zuger’s review.

[…] a chronic shoulder problem offered the opportunity for an unusually well-controlled experiment: Mr. Reid decided to present his stiff shoulder for treatment around the world. One shoulder, 10 countries. Admittedly it’s a gimmick, but what saves the book from slumping into a sack of anecdotes like Michael Moore’s 2007 documentary “Sicko” is a steel backbone of health policy analysis that manages to trap immensely complicated concepts in crystalline prose.“The Healing of America” blends subjective and objective into a seamless indictment of our own disastrous system, an eloquent rebuttal against the arguments used to defend it, and appealing alternatives for fixing it.

Mr. Reid starts with a methodical clarification of terms. First: universal health care. Far from a single socialized system, the various plans other countries use to cover all their residents are quite distinct. Some are as private as our own, and most offer considerably more in the way of choice.

In Japan, and many European countries, private health insurers — all of them nonprofit — finance visits to private doctors and private hospitals through a system of payroll deductions. In Canada, South Korea and Taiwan, the insurer is government-run and financed by universal premiums, but doctors and hospitals are private. In Britain, Italy, Spain and most of Scandinavia, most hospitals are government-owned, and a tax-financed government agency pays doctors’ bills. In poor countries around the world, private commerce rules: residents pay cash for all health care, which generally means no health care at all.

Similarly, what Americans often consider a single unique system of health care is an illusion: we exist in a sea of not-so-unique alternatives. Like the citizens of Germany and Japan, workers in the United States share insurance premiums with an employer. Like Canadians, our older, destitute and disabled citizens see private providers with the government paying. Like the British, military veterans and Native Americans receive care in government facilities with the government paying the tab. And like the poor around the world, our uninsured pay cash, finagle charity care, or stay home.

Our archipelago of plans means that those safe on a good island with good insurance can be delighted with the system, even as millions of invisible fellow citizens tread water or drown offshore. It means that those on a mediocre island are stuck there. It also means that not one single piece of the infrastructure — like record keeping, drug pricing and administrative costs — can be streamlined across islands in any meaningful way. Hence the expense, the inequity and the tragedy.

But the comparative merits of different orthopedic philosophies are secondary here: Mr. Reid’s attention is focused on a meticulous deconstruction of the history and philosophy of the policy decisions behind them. Among health policy narratives, this book’s clarity, comprehensiveness and readability are exceptional, and its bottom line is a little different from most. Instead of rationalization and hand-wringing, Mr. Reid offers an array of possible solutions for our crisis.[ …]

What You Should Know About Government and Health Care Reform

Here are some invigorating readings for those of us who are worried and confused about rumors that real health care reform will die an early death. I think that the piece about Roosevelt should be mandatory reading for the Obama administration. Consensus is great in theory, but those of us in the majority who voted for President Obama were definitely not voting for Republican policies and their pro-big-business, anti-government ideas.

In “The Real Town Hall Story” (The Washington Post 9/3/2009)  E. J Dionne Jr. pointed out that,

Health-care reform is said to be in trouble partly because of those raucous August town-hall meetings in which Democratic members of Congress were besieged by shouters opposed to change. But what if our media-created impression of the meetings is wrong? What if the highly publicized screamers represented only a fraction of public opinion? What if most of the town halls were populated by citizens who respectfully but firmly expressed a mixture of support, concern and doubt? There is an overwhelming case that the electronic media went out of their way to cover the noise and ignored the calmer (and from television’s point of view “boring”) encounters between elected representatives and their constituents. It’s also clear that the anger that got so much attention largely reflects a fringe right-wing view opposed to all sorts of government programs most Americans support. [….]

In “Roosevelt: The Great Dividier” (The New York Times 9/2/2009) Jean Edward Smith commented that,

PRESIDENT OBAMA’S apparent readiness to backtrack on the public insurance option in his health care package is not just a concession to his political opponents — this fixation on securing bipartisan support for health care reform suggests that the Democratic Party has forgotten how to govern and the White House has forgotten how to lead. This was not true of Franklin Roosevelt and the Democratic Congresses that enacted the New Deal. With the exception of the Emergency Banking Act of 1933 (which gave the president authority to close the nation’s banks and which passed the House of Representatives unanimously), the principal legislative innovations of the 1930s were enacted over the vigorous opposition of a deeply entrenched minority. Majority rule, as Roosevelt saw it, did not require his opponents’ permission. […]

Roosevelt hived off the nation’s economic elite to win the support of the rest of the country. The vast majority of voters rallied to the president, but for a small minority he was the Devil incarnate. Few today remember the extent to which Roosevelt divided the nation. […]

Roosevelt understood that governing involved choice and that choice engendered dissent. He accepted opposition as part of the process. It is time for the Obama administration to step up to the plate and make some hard choices. Health care reform enacted by a Democratic majority is still meaningful reform. Even if it is passed without Republican support, it would still be the law of the land.

In “Health Care That Works” Nicholas D. Kristof (The New York Times 9/2/2009) wrote that,

Here’s a paradox. Health care reform may be defeated this year in part because so many Americans believe the government can’t do anything right and fear that a doctor will come to resemble an I.R.S. agent with a scalpel. Yet the part of America’s health care system that consumers like best is the government-run part. Fifty-six to 60 percent of people in government-run Medicare rate it a 9 or 10 on a 10-point scale. In contrast, only 40 percent of those enrolled in private insurance rank their plans that high. Multiple surveys back that up. For example, 68 percent of those in Medicare feel that their own interests are the priority, compared with only 48 percent of those enrolled in private insurance.

In truth, despite the deeply ingrained American conviction that government is bumbling when it is not evil, government intervention has been a step up in some areas from the private sector.  Until the mid-19th century, firefighting was left mostly to a mishmash of volunteer crews and private fire insurance companies. In New York City, according to accounts in The New York Times in the 1850s and 1860s, firefighting often descended into chaos, with drunkenness and looting. So almost every country moved to what today’s health insurance lobbyists might label “socialized firefighting.” In effect, we have a single-payer system of public fire departments. We have the same for policing. If the security guard business were as powerful as the health insurance industry, then it would be denouncing “government takeovers” and “socialized police work.”

Throughout the industrialized world, there are a handful of these areas where governments fill needs better than free markets: fire protection, police work, education, postal service, libraries, health care. The United States goes along with this international trend in every area but one: health care. The truth is that government, for all its flaws, manages to do some things right, so that today few people doubt the wisdom of public police or firefighters. And the government has a particularly good record in medical care. Take the hospital system run by the Department of Veterans Affairs, the largest integrated health system in the United States. It is fully government run, much more “socialized medicine” than is Canadian health care with its private doctors and hospitals. And the system for veterans is by all accounts one of the best-performing and most cost-effective elements in the American medical establishment.[….]

Here is a nice figure from the Nationaljournal.com post “Who’s Afraid of Public Insurance?” (6/29/2009)  that shows how the public give significantly higher approval ratings to public health plans compared with private insurance. And if you really can’t sleep check out “Easy Reading HR 3200 and Health Reform.”

There Is Nothing to Fear From a Public Health Insurance Option

Much has been written to assuage fears of a public health insurance option, but even more has been said and written to demonize and vilify it.  So here I highlight another article that tries to stem the flow of misinformation and fear mongering. Barbara W. Gold (a pediatrician) and Stephen F. Gold (an attorney) wrote this brief and to the point opinion piece, “Public Option Not The Enemy” (The Philadelphia Inquirer 08/25/2009).

Why have the words public option caused so much furor and fear in the health debate? The reality is that the United States has had public options in health care for more than 40 years. Currently, Medicare covers 44.8 million elderly and disabled Americans, while Medicaid programs cover 58.7 million low-income adults, children, elderly, and disabled people. In addition to these, the Department of Veterans Affairs, school health services, workers’ compensation, and state and local government programs further swell the ranks of those covered by various public options today.

Throughout the current health-care debate, facts and data about the public option have been in short supply. But from the latest government data, we know:

Nearly half of current health spending is public. Private health-care spending, which includes all private insurance and out-of-pocket expenditures, accounts for only 54 percent of the nation’s total health-care spending. The remaining 46 percent is public – primarily by Medicare and Medicaid, but also other public health programs, including Veterans Affairs and workers’ compensation. This ratio has remained relatively constant since the early 1980s. The “public option,” in other words, has been a reality of our health system for some time, and it has not eliminated private insurance. Since 1982, health-care spending has consumed more and more of our gross domestic product. But private and public spending have increased at roughly the same rate relative to gross domestic product.

Medicare covers an expensive population. Its enrollees are older and more disabled than those covered by the private health insurance market. The current debate has ignored the fact that Medicare’s beneficiaries are a more expensive group than the beneficiaries of private health-care spending.

Even though Medicare’s beneficiaries are costlier than the private market’s population, Medicare’s average annual cost increases have been far less than those of private health insurance companies since 1997. For example, from 2002 to 2007, Medicare spending increased 4.9 percent a year, but private health insurance increased 7.8 percent.

Enrolling more people in Medicare – for example, by extending the coverage to ages 60 to 64 by 2011, ages 55 to 59 by 2012, and so on – would not significantly increase overall health-care spending, because people in these cohorts do not consume nearly as much health care as those already covered by Medicare.

Medicare has had some success containing costs. Because it has more unified purchasing power than any single health insurance company, Medicare has kept its costs from growing as quickly as private insurers’.

Since the goal of reform should be to contain costs while providing health care to as many people as possible, we should focus on where the costs are. In 2008, Medicare spent 45.8 percent of its $281 billion in expenditures on hospitalizations. Figuring out how to control these hospital costs is the key, and no single private insurance company has the clout to address this with 6,000 hospitals. Only a public option will give us the ability to address this on a national scale.

Is the High Cost of New Cancer Drugs in the U.S. Justified?

Nick Mulcahy’s Medscape Medical News piece “Time to Consider Cost in Evaluating Cancer Drugs in United States?” (7/14/2009) offers an interesting discussion on the increasing high cost of new cancer medicines. Most government, academic, and industry experts interviewed in this piece felt that this “spiraling” cost  “is not sustainable.” Mulcahy explains that,

Oncology drugs are now the best-selling class of drug, having surpassed lipid regulators. Last year, oncologic drugs had annual sales in the United States of $19.2 billion, according to figures from IMS Health (Plymouth Meeting, Pennsylvania). Sales have increased more than 4-fold in the past 10 years, from less than $5 billion in 1998 to the current level. Newer anticancer agents are particularly expensive. Most of the cancer agents (> 90%) approved by the Food and Drug Administration (FDA) in the past 4 years cost more than $20,000 for a 12-week course of therapy, writes Tito Fojo, MD, the lead author of a new essay about the cost of cancer drugs published online June 29 in the Journal of the National Cancer Institute. Such big price tags have produced sticker shock among clinicians and at least 1 industry executive. […]

“There is a shocking disparity between value and price, and it’s not sustainable,” said Roy Vagelos, MD, at the 2008 annual meeting of the International Society for Medical Publication Professionals, according to cnbc.com. Dr. Vagelos is a former chief executive at Merck and the current chair of 2 biotech companies, Regeneron and Theravance. […]

In the essay, Dr. Fojo, who eventually enlisted bioethicist Christine Grady, PhD, from the National Institutes of Health, in Bethesda, Maryland, as a coauthor, reviews the “marginal benefits” that a number of high-priced agents produce in terms of survival. He highlights cetuximab for NSCLC, which costs $80,000 for an 18-week course but provides only the above-mentioned 1.2 months of additional survival.

Dr. Fojo cites multiple examples of cancer drugs with high costs and marginal benefits, including bevacizumab (Avastin, Genentech) for metastatic breast cancer (provides progression-free survival improvement but no increase in overall survival; estimated total cost of therapy, $90,816). Nevertheless, a health economist who agrees that these cancer drug prices are not sustainable says, “There is too much blame on pharmaceuticals for rising healthcare costs in general.” Attention should also be paid to the overall cost of cancer care, suggested Shelby Reed, PhD, from Duke Clinical Research Institute, in Durham, North Carolina. […]

In their essay, Drs. Fojo and Grady make a number of proposals for cancer drug–expenditure reduction and improvement in treatment decision-making. The purpose of the proposals is to get oncologists to discuss change. […] The [lead]  proposal: a UK-style spending threshold for cancer drugs in the United States. […] In their proposal, Drs. Fojo and Grady propose that an American threshold for anticancer drugs be set at $129,000, which is the cost of a QALY in patients treated with renal dialysis. Dr. Fojo said that dialysis was an appropriate comparator. The threshold would apply to federal reimbursement of cancer drugs such as that from Medicare. […]

In interviews with experts, Medscape Oncology found support for the idea of a UK-style spending threshold for cancer drugs but little belief in the political possibility of its enactment. […]

Ultimately, the United States may not have the appropriate kind of healthcare system to implement a cost-effectiveness type of approach to evaluating drugs, including cancer drugs, said another expert.

“These approaches tend to be more common in ‘single-payer’ systems, like those with a public healthcare system or nationally coordinated health insurance,” said Michael Drummond, PhD, from University of York, in the United Kingdom, and the former president of the International Society of Pharmacoeconomics and Outcomes Research. Currently, “about 25 to 30 countries” employ cost-effectiveness analysis in their review of drugs, he told Medscape Oncology. […]

The high cost of drugs is part of the equation that threatens quality of cancer care in many areas of the country, says COA president Patrick Cobb,MD, who is also a partner in Hematology-Oncology Centers of the Northern Rockies, in Billings, Montana.

“The increasing cost of drugs, declining Medicare reimbursement, and current financial crisis have created a ‘perfect storm’ that jeopardizes community cancer clinics, where most Americans with cancer are treated,” he said in a press statement. Dr. Saltz sees a change coming in cancer drug prices. “There is not enough money to pay for what we are doing. However, I don’t think the price drop will be a well-thought-out event,” he said, adding that the drop may come only if the cancer care system nears a “total collapse.”

Worrisome Growth of Obesity in the US in the Past Decade

This chart from the Economist.com (7/13/2009) “Obesity in America: Battle of the Bulge” illustrates the growth of obesity in the US from 1998 to 2008. Colorado seems to be the skinniest state. According to the Economist.com ,

IT MAY be time to hide the cookie jar. Over 26% of Americans are obese, with a weight to height ratio or body mass index of over 30, according to the Centres for Disease Control and Prevention, a government body. Over the past ten years, waistlines have expanded in every state. In 1998 most states had a relatively trim population, with fewer than a fifth of adults obese. But since then the scales have tipped in the other direction. Now at least a quarter of adults in 32 states are obese. Mississippi is the fattest of all, with a third of its residents considered obese.

Don’t Succumb to Republican Fear Mongering of a Public Health Plan Optio’t

Americans United for Change is spreading this sardonic video to promote the message that people (including our elected representatives) should not be scared of real health care reform. It’s very funny how the government bureaucracy “bogeyman” message is repeated over and over by scaremongers, as if that could possibly be any more aggravating (or terrifying) than the private health insurance bureaucracy that most of us have to contend with!

For the more literary types, the recent New York Times editorial, “A Public Health Plan” (6/20/2009) provides another eloquent argument to support the public plan option.

As the debate on health care reform unfolds, no issue has caused such partisan rancor — and spawned such misleading rhetoric — as whether to create a new public insurance plan to compete with private plans.  The nation already has several huge public plans, including Medicare for the elderly (once reviled by conservatives, it is now only short of the flag in its popularity) and Medicaid for the poor. Now the issue is whether to establish a new public plan to encourage more competition among health insurers and provide Americans with an alternative.

Most Democrats and some Republicans have already accepted the need to create one or more health insurance exchanges where individuals without group coverage and possibly small businesses could buy insurance policies. Some proponents hope that big businesses could enroll their workers as well. […]

What Republicans are adamantly opposed to is the idea of adding a public plan to that exchange. They portray it as a “government takeover” of the health care system, or even as socialized medicine. Those are egregious mischaracterizations. There is no serious consideration in Congress of a single-payer governmental program that would enroll virtually everyone. Nor is there any talk of extending the veterans health care system, a stellar example of “socialized medicine,” to the general public.

The debate is really over whether to open the door a crack for a new public plan to compete with the private plans. Most Democrats see this as an important element in any health care reform, and so do we. A public plan would have lower administrative expenses than private plans, no need to generate big profits, and stronger bargaining power to obtain discounts from providers. That should enable it to charge lower premiums than many private plans. It would also provide an alternative for individuals who either can’t get adequate insurance from private insurers or don’t trust the private insurance industry to treat them fairly. And it could serve as a yardstick for comparing the performance of private plans and for testing innovative coverage schemes.

Unfortunately, many Senate Democrats are so desperate to find a political compromise with Republicans — or so bullied by the rhetoric — that they are in danger of gravely weakening a public plan, or eliminating it entirely. That would be a mistake.

[…] The prospect of competing with a government plan terrifies the private insurers. But in our judgment, if that many Americans were to decide that such a plan is a better deal for them and their families, that would be a good thing. Innovative private plans that already deliver better services at lower costs would survive. Inefficient private plans would wither.

[…]  We continue to believe that a public plan would be desirable. Surveys by the Commonwealth Fund have found that Medicare beneficiaries report fewer problems obtaining medical care, less financial hardship due to medical bills, and higher satisfaction with their coverage than do workers insured by private employers. […]

As a self-employed, tax-paying citizen relying on my spouse’s health insurance policy, I certainly support the creation of a competitive, publicly-funded health plan.

Reasons for Breast Reduction Surgery

I know a few women who had breast reduction surgery to ease the discomfort of being overly endowed. I read with interest physician Jennifer Walden’s Medscape Blog “The Case of Tennis Star Simona Halep: Why Do Women Seek Breast Reduction Surgery?: Medscape Connect”  (posted 6/12/2009). I think that this is useful information for other women who might be considering it and for the people (probably, mostly of the male persuasion) who might think that it’s a crime against nature. Walden said,

London press release on May 29th went like this: “Junior French Open champ Simona Halep is set to undergo a surgery to reduce her 34DD boobs. The 17-year-old feels they are a disadvantage and has vowed to have a reduction later this year. “The breasts make me uncomfortable when I play,” the Sun quoted her as saying.”It”s the weight that troubles me – my ability to react quickly,” she added. However, fans of the Romanian tennis player didn’t seem too happy with her decision. They flocked to sign an online petition: Save Simona Halep Boobs. One stormed: “It will be a crime against nature.”

Simona Halep, as you may or may not know, is from Romania and is a budding Junior tennis player. She is ranked #258 in the world. She won the Junior French Open tennis tournament in 2008, and although not yet fully developed as a professional, she reached the second round of the qualifiers for the Senior French Open in 2009. In May 2009 she received widespread media attention all over the world for expressing her desire to go through breast reduction surgery in order to perform better on the tennis court. I found it surprising to read on blogs and sports pages online how much fans and readers did not understand the purpose and benefit of breast reduction surgery. Comments ranged from disgust to outrage to frank misunderstanding of what the indications and outcomes are for breast reduction surgery.

Constant back and neck pain, gouges in your shoulders from bra straps, difficulty with clothing fit, and deteriorating posture and an inability to participate in certain activities rank among the common complaints of women with large breasts. Breast reduction surgery (reduction mammaplasty) may help relieve these symptoms. As technology advances, more women are seeking consultations from plastic surgeons to discuss options for adjusting their breast sizes to a healthier and more comfortable level. According to the American Society of Plastic Surgeons, more than 104,000 breast reduction surgeries were performed in 2006. Breast reduction is often considered a medically necessary treatment due to its interference with the activities of daily life and physical symptoms, so third party payors and referrals from primary care physicians are often involved. […]

Women can have breast reduction surgery at any age, but it’s generally advisable to wait until you’re at least age 17 or 18, by which time your breasts are likely to be fully developed. However, sometimes surgery is performed in teens who suffer significant emotional and psychological effects of having too-large breasts (called juvenile breast hypertrophy).  Patients are often advised that if they want children and wish to breastfeed, they may consider postponing breast reduction surgery until afterwards. Changes to breast tissue during pregnancy could alter your surgical results. Also, after the surgery, breast-feeding may be difficult. […]

According to MayoClinic.com “Breast Reduction Surgery: Decrease Breast Size, Ease Discomfort” indications for breast reduction surgery include:

• Chronic back, neck, and shoulder pain
• Poor posture
• Skin rash under the breasts
• Deep grooves in the shoulders from bra strap pressure
• Restricted levels of activity
• Low self-esteem
• Difficulty wearing or fitting into certain bras and clothing