Las Vegas Review-Journal -

Feb. 23: Washington - Making a last-ditch effort to save his health care overhaul, President Barack Obama on Monday put forward a nearly $1 trillion, 10-year compromise that would allow the government to deny or roll back egregious insurance premium increases that infuriated consumers.

Posted Monday morning on the White House Web site, the plan would provide coverage to more than 31 million Americans now uninsured without adding to the federal deficit. It comes just four days before Obama's one-of-a-kind, televised health care summit with Democrats and Republicans.

Even with the latest changes, it's highly uncertain such an ambitious proposal can get through Congress. Republicans are virtually all opposed, and some Democrats who last year supported sweeping health care changes are having second thoughts in an election year. After a year in pursuit of what was once his top domestic priority, Obama may have to settle for a modest fallback.

Weeks ago, the president and congressional Democrats were on the verge of an historic step a long-sought remake of the nation's health care system after a half-century of unsuccessful attempts by scores of politicians. Then Republican Scott Brown stunned Washington with an upset win in the Massachusetts Senate race, denying Democrats their 60-seat majority and reversing any political momentum.

Determined to avoid facing voters empty-handed, Obama offered a fresh proposal based on Democratic-passed bills. The plan conspicuously omits a government insurance plan sought by liberals and viewed as a non-starter by conservatives and some congressional moderates. It includes Senate-passed restrictions on federal funding for abortion adamantly opposed by abortion foes as well as abortion rights supporters.

The new White House plan would give the federal government the power to regulate the health insurance industry much like a public utility. The Health and Human Services Department in conjunction with state authorities would be able to deny egregious premium increases, limit them or demand rebates for consumers.

Obama, who deferred to Congress on the specifics for more than a year, has finally put forward a detailed plan of his own. By and large, it follows the bill passed by Senate Democrats on Christmas Eve, with changes intended to make it acceptable to their House counterparts.

It would require most Americans to carry health insurance coverage, with federal subsidies to help many afford the premiums. Insurance companies would be barred from denying coverage to people with medical problems or charging them more.

The plan dramatically scales back a Senate tax on high-cost health insurance plans objected to by House Democrats -- and labor unions. Instead of raising $150 billion over 10 years, it would bring in just $30 billion, the administration said. A Medicare payroll tax increase on upper-income earners would help plug the revenue gap. For the first time, Medicare taxes would be assessed on investment income, not just wages.

Like the Senate bill, the Obama plan would create competitive insurance markets in each state for small businesses and people buying their own coverage. But it would strip out special Medicaid deals the Senate bill granted to certain states, gradually close the Medicare prescription coverage gap, make newly available coverage for working families more affordable.

Those changes move in the direction of the House bill. Estimated to cost about $1 trillion over 10 years, Obama's plan would be paid for by a mix of Medicare cuts, tax increases and new fees on health care industries.

Oversight of insurance companies has traditionally been a state responsibility. Obama's proposal for a new federal role calls for setting up a seven-member Health Insurance Rate Authority to monitor insurance industry practices and issue an annual report. States that beef up their consumer protection programs would be eligible for a share of $250 million in federal grants.

House Majority Whip James Clyburn, D-S.C., declined to say that House leaders have the votes now to pass the new plan, but said some of the concerns of House members were addressed by the changes Obama is proposing.

"So I do believe that there is more fertile soil today than when we first took this up," Clyburn said. Democrats, who now hold 255 of the House's 435 seats, drew only one GOP ally when the House passed its health care bill, 220-215, last November. Since then, one Democrat who voted for the bill has resigned, one has died and a third plans to leave office Feb. 28.

The Boston Globe -

Feb. 24: Washington - Democrats in Congress showed signs of enthusiasm for passing a health care bill yesterday after President Obama offered his own proposal Monday. But it remained far from clear whether they could muster enough votes to pass a bill, and the political focus remained on tomorrow's "summit" between Obama and congressional Republicans, which is threatening to become more of a showdown than a sober policy debate.

Republican leaders condemned the president's plan as a warmed-over version of the Democrats' previous bills, which attracted virtually no GOP support, and they called on the president to drop his threat of passing health care without the GOP if necessary.

The president has characterized tomorrow's meeting, which will be broadcast on television, as a good-faith effort to get Republicans and Democrats to cooperate on health care. But given the strong rhetoric from both sides before the event, it appears unlikely to produce any agreement.

The parties remain miles apart on health care: Most Democrats want to see a comprehensive bill that makes significant progress toward providing insurance for nearly 50 million Americans without coverage; Republicans want to focus on smaller steps to lower health care costs.

Republicans are furious that, even as Obama is ostensibly offering Republicans an olive branch, some Democrats are plotting ways to bypass the GOP altogether using budget reconciliation, a parliamentary procedure that lets bills pass the Senate by a simple majority, circumventing a filibuster by the minority party.

"It seems to me that until the Democratic leaders take reconciliation off the table, it will be very hard to believe they intend to engage us," said Senator Jon Kyl, Republican of Arizona. He added that reconciliation "was never designed for a large, comprehensive piece of legislation such as health reform."

Senate majority leader Harry Reid, Democrat of Nevada, retorted that Republicans should "stop crying" about using reconciliation. The procedure was used to pass President Bush's tax cuts this decade, a welfare overhaul in the 1990s, and President Reagan's tax cuts in the 1980s.

The plan Obama put forward on Monday was based largely on agreements Democratic leaders had made in trying to resolve differences between the House and Senate bills before Jan. 19, when Massachusetts voters elected Republican Scott Brown to fill the seat of the late Edward M. Kennedy.

Brown's election deprived Democrats of the 60-vote majority required to pass a compromise health care bill without the GOP's help. House Democrats met at noon yesterday to review the president's proposal, and afterward House Speaker Nancy Pelosi said the president's plan had been well received. House Energy and Commerce Committee chairman Henry Waxman appeared encouraged after the meeting and said he thought Democratic leaders were "very close" to getting majorities in the House and Senate behind a bill.

US Representative Jim McDermott, a Washington Democrat, said members are beginning to realize that whatever passes can be adjusted later and that major pieces won't take effect for years. "There's no surprises left in this whole process," he said. "It's now just a matter of moving the pieces around till it makes sense as a bill to 218 people."

But several moderate Democrats sounded less confident. House majority leader Steny Hoyer, in his weekly briefing with reporters, declined to say much about the president's plan, adding at one point that Democrats "may not be able to do it all." Two other prominent moderate Blue Dog Democrats in the House, Baron Hill of Indiana and Jason Altmire of Pennsylvania, also declined to comment on the president's proposal.

Republicans say they hope to persuade Americans watching tomorrow's televised summit that their approach is the right one. Senator Lamar Alexander, Republican of Tennessee, ticked off the GOP goals: Providing help for small businesses; allowing people to buy insurance across state lines; reducing frivolous lawsuits against doctors; reducing waste, fraud, and abuse in Medicare and Medicaid; and expanding health savings accounts.

"We think we should first...go step by step, reducing costs, and by doing that allow more people to buy insurance, because it will cost less," he said.

He said Democrats have rejected the GOP ideas, but in fact a number of them have been incorporated into the Democratic bills, for example, Obama's plan includes ideas for reducing fraud in government programs; and the Senate bill would establish a national private health insurance plan and provide tax credits for small businesses.

Democrats argue the Republicans' proposals would help insure only a tiny fraction of the 30 million people the Democratic proposals would. Senator Dick Durbin, Democrat of Illinois, said enough Democrats voted for the House and Senate bills late last year to throw their support behind a final compromise.

"A lot of members have said, listen, I fought the battle, I took the bullet," he said. "For goodness sakes, let's have a bill at the end of the day. Let's not end up empty-handed."

Las Vegas Review-Journal -

Feb. 25: Dr. Dipak Desai, who ran the Southern Nevada clinics linked to a major hepatitis C outbreak, has surrendered his license to practice medicine in Nevada.

The Nevada State Board of Medical Examiners on Wednesday unanimously voted to accept the surrender of Desai's license, an action that the board's interim executive director, Douglas Cooper, described as "absolute and irrevocable."

"It is a reportable action to the National Practitioner Data Bank," Cooper said, noting that other states generally do not allow physicians to practice in their jurisdictions after such a move is taken.

Cooper said the board acted after receiving a Feb. 5 affidavit from Desai's attorney, Kim Mandelbaum, that said he was not "competent to safely practice medicine due to physical and mental impairments arising from a series of strokes."

Mandelbaum, who notified the board in July that her client had a stroke, could not be reached Wednesday for comment. Health officials have definitively linked nine contracted cases of hepatitis C to Desai's clinics and have said an additional 106 cases were "possibly linked."

Wednesday's action will have no effect on a criminal investigation under way, Clark County District Attorney David Roger said. "A defendant's competency can be an issue at time of trial, but it's premature to discuss it at this point," Roger said.

Last month, Roger said prosecutors planned to take the hepatitis outbreak case before a grand jury in the "near future" to consider potential charges, but he would not identify possible targets. On Wednesday, he said prosecutors had yet to present the case to a grand jury.

In July, attorneys for Desai, 59, told the medical board that a stroke had made him incapable of recognizing a wristwatch. Medical tests were performed to determine whether Desai could help attorneys in malpractice charges brought against him by the board. Las Vegas clinical neuropsychologist Thomas Kinsora found that Desai was "squarely on the borderline with regard to his ability to assist counsel," board records show. Desai, said Kinsora, was "likely acceptably competent, but certainly not optimally competent."

Cooper said it is "very possible" that the board took Kinsora's evaluation into account when voting to accept the surrender of his license. Last summer, a longtime acquaintance of Desai told the Review-Journal that the physician suffered a stroke in 2007 during a flight to India. He had to be taken off the plane in Taiwan when flight attendants noticed that he continually was talking and stuttering, the acquaintance said.
The surrender of the gastroenterologist's license, Cooper said, will not preclude the board from proceeding on a pending disciplinary complaint.

Desai came under scrutiny in February 2008 when the Southern Nevada Health District linked several cases of hepatitis C to the Endoscopy Center of Southern Nevada on Shadow Lane, where Desai was majority owner.

Cooper said that if the board finds Desai guilty of malpractice, that fact also will be noted to national authorities. Such a finding would carry more weight with medical officials who might be evaluating Desai's reputation than a voluntary license surrender, he said.

In 2008, health officials notified 40,000 former patients about possible exposure to blood-borne diseases because of unsafe injection practices at the Shadow Lane clinic. More notifications followed to patients of a sister clinic, Desert Shadow Endoscopy Center.

Investigators said the outbreak resulted from nurse anesthetists reusing single-dose medicine vials among patients. Clinic staff told health investigators they were ordered by administrators, principally Desai, to reuse supplies and medications to save money.

Associated Press -

Feb. 23: Washington - Senate Majority Leader Harry Reid is pressing to extend unemployment benefits and health insurance subsidies for the jobless through December as he and Republicans try to clear leftover Senate business.

Reid also hopes to keep helping cash-strapped states with their Medicaid budgets, he said Tuesday on the Senate floor. Taken together, these proposals would cost in the range of $100 billion.

The Nevada Democrat is in talks with GOP leader Mitch McConnell of Kentucky over what to include in catchall legislation to help the long-term unemployed, extend several expired tax breaks and prevent doctors from suffering a big cut in their Medicare reimbursements.

The measure would cost more than the jobs bill the Senate is scheduled to approve on Wednesday. It mostly clears up business left unfinished because of last year's health care debate.

There is nothing new in the emerging measure to spur job growth. Instead, it would extend provisions that senators in both parties say have generally been helpful to the economy.

Facing a Feb. 28 deadline, Reid hopes to pass two measures, one as soon as possible. The first includes a 30-day extension of several of soon-to-expire provisions such as jobless aid, parts of the Patriot Act and prevention of cuts in Medicare payments to doctors.

Reid and McConnell were discussing the parameters of the second — a broader, longer-term measure — in a private conversation on the Senate floor. A top Reid aide could be overheard suggesting a full-year extension of unemployment insurance and a 65 percent health insurance subsidy for the unemployed through the federal COBRA program.

There is no agreement on how to proceed on the broader measure, said Minority Whip Jon Kyl, R-Ariz., who said Republicans are concerned about the high cost of the aid to the unemployed. An earlier bipartisan proposal would have extended the aid through May 31 instead of through the end of the year as proposed by Reid.

Kyl added that the proposal to give more Medicaid help to the states took Republicans by surprise. The nation's governors are lobbying strongly for the help.

The most costly piece of the measure would continue to provide additional weeks of benefits to jobless people whose unemployment insurance would otherwise expire. They have been extended several times by Congress since June 2008. The core benefit is 26 weeks, with up to 20 additional weeks in states with high unemployment.

The Reid aide also proposed extending for another six months a provision of last year's economic stimulus bill in which the federal government pays a higher share of costs for the state-federal Medicaid health care program for the poor and unemployed. The Medicaid help mirrors an Obama administration proposal to give states about $25 billion to help with their Medicaid budgets.

Reid dropped the help for the unemployed from the jobs bill. Republicans were unhappy Reid had also discarded an extension of more than 40 expired tax breaks they wanted in the bill. A trimmed-down version of the jobs bill advanced on a bipartisan 62-30 vote Monday to end a GOP filibuster.

Las Vegas Review-Journal -

Feb. 20: Clark County District Judge James Bixler on Wednesday dismissed a lawsuit the attorney general's office filed against major drug companies over allegations that hormone treatments damaged the health of Nevada women.

The case never reached substantive issues because Bixler agreed with defendants Wyeth Pharmaceuticals, Pfizer Inc. and Pharmacia & Upjohn Co. that Nevada's four-year statute of limitations had expired by the time the lawsuit was filed in November 2008.

The judge ruled that the state waited too long to file the lawsuit. Key to the decision was the determination of when the plaintiff first should have known about problems with the hormone treatment drugs and thus when the statute of limitations started ticking.

Nevada is the only state to have filed a lawsuit over the marketing of hormone therapy drugs.

The drug companies were accused of selling hormone replacement therapy drugs, including Premarin, Cycrin and Prempro, to women coping with menopause symptoms, such as mood swings, hot flashes and night sweats.

The lawsuit, filed by attorney Peter Wetherall in cooperation with the Attorney General's office, claimed that the hormone treatments posed "substantial health risk with little or no corresponding benefit." It mentioned risks including breast and ovarian cancer, heart attacks, strokes and auto-immune diseases.

The state claimed the drug companies violated the Nevada Deceptive Trade Practices Act and sought damages and restitution.

Associated Press -

Feb. 23: Chicago - American doctors have steadily cut their work hours over the past decade, a new study finds, something that experts say may only worsen the U.S. health care situation.

It's not that doctors are terrible slackers. Average hours dropped from about 55 to 51 hours per week from 1996 to 2008, according to the analysis, appearing in Wednesday's Journal of the American Medical Association.

That's the equivalent of losing 36,000 doctors in a decade, according to the researchers. And it raises policy questions amid a looming primary care doctor shortage and Congress considering an expansion of health insurance coverage that would mean more patients.

The decline in hours "occurred among all groups of physicians young, old, men, women, residents and nonresidents and it didn't occur in other occupations," said lead author Douglas Staiger, an economics professor at Dartmouth College.

"Something has been discouraging physicians from working the long hours they used to work," he said. Work-hour limits for residents, or doctors in training, were introduced in 2003 and brought down the average. But when researchers removed the resident doctors from the analysis, they still found a nearly 6 per cent decline in work hours.

Growing numbers of women in the profession contributed to the decline in hours, but they weren't a big driver of the trend, Staiger said. Payment issues may have played more of a role. The overall decrease in hours coincided with a 25 per cent decline in pay for doctors' services, adjusted for inflation. And when the researchers looked closely at U.S. cities with the lowest and highest doctor fees, they found doctors working shorter hours in the low-fee cities and longer hours in the high-fee cities.

Greater competition and more managed care in the low-fee cities may provide a clue to why doctors are working fewer hours. "It's not so much the fees as the hassle factor," said Dr. Robert Perlmuter, a Chicago internist, who works 60 hours a week. He told about a recent problem with a pharmacy benefit manager. A series of faxes and phone calls got conflicting answers about which of three types of insulin the patient's plan would cover. By the time it was sorted out, "the patient missed insulin for a day."

"There's so much oversight for what we do, so many people we have to answer to and so little of it improves care, it's just driving us all crazy," Perlmuter said. The researchers based their analysis on data from U.S. Census Bureau household surveys. The data included self-reported hours from about 27,000 doctors. The study was supported by a grant from the National Institute on Aging.

"This really presents a problem for us as a country as we strive to maintain a sufficient primary care work force," said Dr. Ann O'Malley of the nonpartisan Center for Studying Health System Change, which has found declines over the past decade of about two hours per week in doctor work time.

The centre's surveys add a piece to the puzzle. They've found overall work hours for primary care physicians and medical specialists declining, but hours worked by surgeons remaining stable, said O'Malley who wasn't involved in the new study.

On top of that, fewer medical students are choosing primary care and more are pursuing higher paying specialties. Paying primary care doctors for the time they spend co-ordinating care, such as talking to other doctors and avoiding duplicative tests, could help, she said.