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			Thursday, March 5, 2009 News Clipping Archives *Maryland / Regional* Lawmakers to consider bill to cut Medicaid fraud (WBFF Fox 45) Tobacco funding in jeopardy (Annapolis Capital) Prince George's lawmakers say they were stiffed on stimulus (Prince George’s County Gazette) In Good Health — A shocking find that's on the rise (Prince George’s County Gazette) Detention Center quarantined after scare (Carroll County Times) Metro details a new Medical Center entrance (Prince George’s County Gazette) CareFirst unveils its version of a Universal Health Care bill (Daily Record) Docs seek gag orders to stop patients' reviews (Daily Record) Legislators, public against service fees for state workers (Cumberland Times News) *National / International* In Health Plan, Industry Sees Good Business (Washington Post) Free Antibiotics May Contribute to Drug Resistance, Officials Say (New York Times) The Voices of Kidney Disease (New York Times) *Opinion* Mental health system should get stimulus help (Prince George’s County Gazette) *Maryland / Regional* Lawmakers to consider bill to cut Medicaid fraud Associated Press WBFF Fox 45 March 05, 2009 00:02 EST ANNAPOLIS, Md. (AP) -- A panel of Maryland lawmakers will hear testimony on a bill that would authorize the state to sue people to recover funds and penalties from individuals who defraud Maryland's health care plan. The measure is backed by Maryland Department of Health and Mental Hygiene Secretary John Colmers and Maryland Insurance Administration Commissioner Ralph Tyler. State health departments officials say it would give Maryland the same authority as 22 other states to go after those who intentionally submit false Medicaid and other health care claims. The Maryland False Health Claims Act of 2009 is also part of Governor Martin O'Malley's 2009 legislative agenda. Testimony will be given on Thursday. Copyright 2009 WBFF Fox 45. Tobacco funding in jeopardy State cutbacks will reduce variety of county programs By Shantee Woodards Annapolis Capital Thursday, March 5, 2009 The state is doling out less money for anti-tobacco programs this year, which may cause the county Health Department to scale back its smoking-cessation efforts. Since 2000, the county has been using a grant from the state's cigarette-restitution fund to pay for a variety of free programs, including brochures, smoking-cessation classes and anti-smoking education programs in schools. Early estimates show funding for these programs could be reduced by nearly 70 percent. Officials said they wanted to make sure there was as little impact as possible on programs dealing with youth and communities. They don't expect to hear just how much money they'll receive until April. "We're hoping to sustain the programs that are community-based," Evelyn Stein, the Health Department's director of information and promotions, told the Conquer Cancer Advisory Council yesterday. "(But) the final bell has not rung. We do not know what the bottom line is going to be, but we do expect some reduction." The council has met twice a year since 2000 to develop cancer-prevention activities sponsored by the state's tobacco money. Members typically create an action plan for the upcoming year at the meetings, but they were unable to do so yesterday because of the financial uncertainty. The county health officer selects the participants who serve on the advisory council for two-year terms. The next meeting is set for September. The cigarette-restitution fund has three components: cancer prevention, tobacco control and minority disparities. Each county is given an amount based on a formula. In the past fiscal year, the county received $866,000 for tobacco-control programs. But this time, the amount the state has to distribute has declined. There is no money for funding the minority programs, and the tobacco-control funding has been reduced by $13.8 million, leaving slightly more than $4 million to distribute to counties, said Carlessia Hussein, director of the state's restitution fund. "Because of the deficit in the state and the nation, several reductions had to be made," Hussein said. "The hope is that the stimulus package that comes to the state could provide some relief, but there have been lots of cuts through all departments." At the meeting, department workers highlighted the changes they've made in the county through various programs. The percentage of adults who smoke has gone from nearly 30 percent in 2001 to slightly more than 15 percent in 2007, putting the county in line with state statistics. The goal is to get below 15 percent by 2010. "Part of the take-home message today is that we've come a long way … (but) we still have work to do," said Dr. Jinlene Chan, acting deputy health officer. "This doesn't mean we have to stop, we just have to work harder." Outside of the grant-funded programs, the department is able to provide free screenings for breast, cervical and colorectal cancer. This fiscal year, 118 people have received the screenings and cancer was detected in two of them, officials said. The county Police Department has its own tobacco-prevention program. Officers send minors into random businesses around the county to see if the clerks will sell them tobacco products. Last year, officers checked 71 businesses and found that 40 facilities made the sale to the minor. Violators are subject to a civil citation and a fine ranging from $25 to $50, Deputy Chief Emerson Davis said. "There is a huge turnover in a lot of these businesses," Davis said, adding that new employees often don't know about the compliance checks. "With alcohol (checks), we can actually go after their license." Copyright 2009 Annapolis Capital. Prince George's lawmakers say they were stiffed on stimulus Council upset that only one transportation request was granted By Daniel Valentine Prince George’s County Gazette Thursday, March 5, 2009 Prince George's County Council members said Feb. 26 they are dismayed that state officials only approved $1 million in transportation money from a $400 million wish list they had for road funding from the recent federal stimulus. "This is sick. This is ridiculous. This is very disrespectful to Prince George's County," said Councilman Tony Knotts (D-Dist. 8) of Temple Hills at a committee hearing to discuss how the county fared in the recent aid package. At the meeting, Public Works Director Haitham A. Hijazi told the group that almost none of the county's priorities were funded under the $3.7 billion Maryland received from this month's federal stimulus. The state share, which is being funded over the next three years, was part of a $787 billion package Congress passed to revitalize the tanking economy. In addition to about $2.1 billion for roads and bridges, the money will go toward health care, building renovations and schools. County officials had high hopes for the package, which they had wanted to balance deep cuts the state made to transportation projects last fall. At the time, state officials cut $205 million to Prince George's County for roads, making up nearly 60 percent of the total highway cuts to Maryland's Transportation Master Plan. The next-hardest hit was Howard County, which saw its funding slashed by $79 million. In November, county officials met with Gov. Martin O'Malley (D) to ask that Prince George's be made a priority if transportation money became available. The promises never materialized, council members said. "What we need is a good old-fashioned protest. Prince George's County has just been totally disrespected," said Councilwoman Andrea Harrison (D-Dist. 5) of Springdale. "This is a beating we're taking. That's really what it is. It's a beating." Department spokesman Jack Cahalan said the $365 million worth of state projects in this round are all for repaving, bridge repair and other quick fixes to the highway system. They were selected to meet specific requirements laid out by the federal government, including a mandate that work must begin within 120 days. Council members said Prince George's had given the state a list of what it deemed "potentially-qualified road project stimulus requests," which listed 16 items totaling $400 million. Hijazi told council members that the state only granted one of their requests in the recently-announced package – about $1 million to replace three county transit buses. Prince George's had asked for $7.7 million for bus replacement. Hijazi also said state officials ignored two high priority road projects: a $66 million road to improve access to the Branch Avenue Metro and $130 million to build a new interchange at Suitland Parkway and Pennsylvania Avenue. "We don't have any more friends up there. I've been yelling, screaming, hollering," Hijazi told the group. "We've got at least two shovel-ready projects. … We know it. The state knows it." Hijazi acknowledged that though the county's priorities were not fielded in the first phase of funding, many Prince George's roads and bridges will still be fixed under the stimulus. The Maryland Department of Transportation plans to spend about $30.8 million to repair state-owned roads and bridges in Prince George's and to build a $2.9 million upgrade of the Laurel MARC train station in the next year. "The goal here was to move these projects quickly," said Cahalan, who noted that the state still has another $620 million in transportation money to distribute in the next few months. "There will be discussions," he said. Council members saw it differently, and said they plan to write letters expressing their displeasure. "This is about the state being greedy. Being a hog," said Councilman Thomas E. Dernoga (D-Dist. 1) of Laurel. "They're taking care of their house and getting it in order." Projects like the Suitland Parkway Interchange weren't funded anywhere in the state, Cahalan said, which focused on smaller work that will employ construction crews immediately to get the economy going. "There are no single large projects that are on this to date," he said. "The goal of these projects was to get more repairs out on the street, to employ more people across the state. You don't see a $130 million project like Suitland Parkway anywhere in the state." Other council members said Prince George's share was much less than other areas of Maryland. "Baltimore city got $65 million for hybrid buses," said Councilwoman Ingrid Turner (D-Dist. 4) of Bowie, who called the Laurel MARC station project "a crumb." Thursday's complaints continue a long tradition of disputes between local officials and the state about funding. For years, Prince George's County officials have said that the state doesn't provide the county with the resources it needs. "There's always been concerns about getting our fair share from the state," said Council Chairwoman Marilynn M. Bland (D-Dist. 9) of Clinton. "It would be different if this came along and the state had always treated us fairly." Copyright 2009 The Gazette. In Good Health — A shocking find that's on the rise By Ashley Andyshak Prince George’s County Gazette Tuesday, March 3, 2009 Warning: this column is not for the faint of heart (or stomach). We've all read stories about people dealing with tapeworms and other parasites before, but the worms have always been in the stomach or other lower digestive organs. So my newsroom colleagues and I were shocked last week when we saw a story about an Arizona woman who had a worm removed from her brain after days of increasing fatigue. And we were even more shocked when we read that 10 percent of all emergency room seizure cases in the southwestern U.S. are caused by brain worms, according to the National Institutes of Health. Brain worms, like other parasites, are typically found in people living in developing countries like India, China and parts of Central America. However, Dr. Peter Nakaji, who treated the Arizona woman, told news outlets that he has removed more brain worms this year than in any past year. The cycle begins when someone eats pork infected with the tapeworm cysticercosis. In the infected person's stomach, the worm lays eggs that are released each time the person uses the bathroom. Lesson one: cook pork thoroughly. If an infected person doesn't wash his or her hands after using the bathroom, the eggs can be spread to others and can travel through the new victim's bloodstream to the brain. Lesson two: wash your hands before touching your eyes, mouth or nose, or before eating or preparing food. You never know what you're going to pick up. For information on parasite prevention, visit cdc.gov/ncidod/dpd/index.htm. Copyright 2009 The Gazette. Detention Center quarantined after scare By Jennifer Jiggetts Carroll County Times Thursday, March 5, 2009 The Carroll County Detention Center quarantined parts of the building Wednesday because a man who was arrested might have had meningitis. Warden George Hardinger said Kevin Mark Brooks, of Washington Lane in Westminster, was brought into Central Booking Wednesday morning. Hardinger said he was charged with three counts of failure to stop at a stop sign, negligent driving and driving with a suspended license. Brooks was also charged with attempting to elude police. Brooks, 50, saw the nurse at the Detention Center earlier that morning and was later released that afternoon, Hardinger said. Brooks later collapsed while walking along a county road. He was taken to a hospital and pronounced dead. Hardinger said that since Brooks’ body temperature was elevated, hospital officials think that he may have died from meningitis. That evening, Hardinger ordered anyone who was in the Detention Center to stay. Evening visiting hours were canceled and prisoners were not relocated. “We had to immediately do it,” Hardinger said. “We aired on the terms of caution by not letting people leave. The Central Booking and lobby areas were cleaned because Brooks were at those areas, Hardinger said. Sykesville resident Kathy McGehrin was at the center Wednesday afternoon. She later learned about the contamination alert that evening. “I thought, ‘Am I contaminated?’” she said. “I was afraid of my own health.” If Brooks tests positive for meningitis, Hardinger said, those who came in contact with him will have to take medication. Hardinger said he will be notified of Brooks’ meningitis status today. Reach staff writer Jennifer Jiggetts at 410-857-7873 or jennifer.jiggetts@carrollcountytimes.com. Copyright 2009 Carroll County Times. Metro details a new Medical Center entrance Plan to add tunnel, elevators could cost up to $60 million By Andrew Ujifusa Prince George’s County Gazette Wednesday, March 4, 2009 Building a new entrance to the Medical Center Metro station that would include a tunnel under Rockville Pike and two sets of elevators is "the best solution" for upgrading the station, according to a Washington Metropolitan Area Transit Authority official. The option, the newest from WMATA, includes elevators on both sides of Rockville Pike down to the Metro fare gates, as well as a shallow pedestrian walkway under the road that would allow easier access for people walking between the current Metro station and the National Naval Medical Center, across the street from the National Institutes of Health. The option would cost $46 million to $60 million according to WMATA estimates. In a presentation to the Base Realignment and Closure Implementation Committee Meeting on Feb. 24, WMATA officials said the combination of the tunnels and elevators would probably be most attractive to Navy Med employees, visitors and residents seeking to cross Rockville Pike, although the report did not contain an official recommendation. "That actually is the best solution for everyone for pedestrian access," said Bill Gallagher, a WMATA architect. Committee members called this the "Cadillac" option and worried about whether it could get the necessary funding. Members of the BRAC committee, which includes representatives from Bethesda neighborhoods and businesses as well as NIH, have vigorously supported a new Metro entrance, saying it is crucial for providing access for the higher number of daily commuters and visitors who will be traveling to the Navy Med campus when the Walter Reed National Military Medical Center is scheduled to open there in September 2011. In its Feb. 24 presentation, WMATA projected that in 2020, 6,120 employees and visitors will walk to Navy Med from the Medical Center Metro every day. NIH will receive 6,900 daily employees and visitors from the Metro, while 3,135 local residents are projected to use the station every day. "That's why we make so much noise. That's a lot of people," said Ilaya Hopkins of the East Bethesda Citizens Association. Other past proposals from WMATA include a pedestrian bridge over the road ($12 million) and a shallow tunnel under the road connecting to elevators near the current Metro entrance ($16 million to $30 million). No engineering or construction schedule has been created for the project and no funding source has been identified. The Defense Access Roads program funded by the Department of Defense, as well as $1.5 billion in newly-available federal money for transportation projects that must be spent by the end of the 2011 fiscal year, are possible funding options. "This evaluation is not the beginning of an actual project," said Phil Alperson, Montgomery County BRAC coordinator. Alperson also announced that U.S. Rep. Christopher Van Hollen Jr. (D-Dist. 8) secured $3 million for the four BRAC-affected intersections near Navy Med in a 2009 fiscal year spending bill, although the bill still requires Senate action. These four intersections include Rockville Pike and Jones Bridge Road, Rockville Pike and West Cedar Lane, Old Georgetown Road and West Cedar Lane, and Connecticut Avenue and Jones Bridge Road. Ed Krauze of the Bethesda Parkview Citizens Association, meanwhile, expressed concern that a Montgomery County project to repair the Cedar Lane bridge over Rock Creek between the Capital Beltway and Beach Drive would conflict with BRAC-related work at Rockville Pike and West Cedar Lane performed by the State Highway Administration. The bridge repair project, estimated to cost between $2.1 million and $2.7 million, is expected to take place between fall 2010 and fall 2011. It could include closure of the bridge, which is located about half a mile from the intersection. "There doesn't seem to be any coordination," Krauze said, noting that he had spoken with the county's engineer for the project. SHA official Andy Scott said state and county engineers are in constant contact and would work to avoid creating conflicts between the two projects. Copyright 2009 The Gazette. CareFirst unveils its version of a Universal Health Care bill By Richard Simon Daily Record Wednesday, March 4, 2009 ANNAPOLIS — Legislators and representatives from CareFirst BlueCross BlueShield unveiled companion bills Wednesday aimed at providing health care for more than 800,000 Maryland residents who are uninsured, the second piece of legislation of its kind introduced this session. Titled the Health Care Affordability Act, Senate Bill 515 and House Bill 860, sponsored by Sen. Thomas M. Middleton, D-Charles, and Del. Peter A. Hammen, D-Baltimore City, respectively, would require Maryland residents to obtain insurance and employers to offer coverage for their workers. Organizers said they hope that the “Healthy Maryland” plan will offer health coverage to every Maryland resident regardless of health status or pre-existing conditions. Massachusetts is the only state that has successfully passed universal health care legislation. Organizers said 75 percent of the money that would fund the program would come from premiums. Chet Burrell, CareFirst president and CEO, said the Healthy Maryland program could be self-sustaining for as many as 10 years from premiums, which could range from as little as $25 per month to a little more than $250 per month for the average member, depending on the subscriber’s income. The Senate bill was discussed in the Senate Finance Committee Wednesday afternoon, and is seen as a starting point, according to experts familiar with the situation. “We’re just at the beginning of this, and we look forward to working through the spring, the summer and into the fall on really examining what the issues are and what the best approaches might be with the idea so that when we reach the fall, perhaps by clarifying language in the legislation, an entire bill can be put together that best fits what Maryland’s needs are,” said Burrell, who added that it’s an issue that will not go away. The other universal health care plan, called the Maryland Citizens’ Health Initiative, was first proposed by Vincent DeMarco of Maryland Health Care for All in November. DeMarco’s plan has been introduced in both the Senate and House through Senate Bill 813 and House Bill 951. The Senate bill, sponsored by Sen. Verna L. Jones, D-Baltimore City, is scheduled to be heard on March 18. DeMarco, who testified before the Finance Committee Wednesday, said he is thrilled that there are two universal health care bills that have been presented. “We have talked and we’re thrilled that they are doing what they are doing,” DeMarco said. “As [Middleton] said, nothing is going to pass this year, but we are building for the future.” In a statement read to the committee, DeMarco strongly urged lawmakers to look closely at both SB 813 and SB 515 so that the parties can work together toward the common goal of quality, affordable health care for all Marylanders. Although the bills have many similarities, DeMarco’s Health Care Affordability Act differs from CareFirst’s Healthy Maryland Act in that one of the former’s primary sources of funding is from business contributions through a 2 percent payroll tax. DeMarco said premiums would decrease as a result. Health care leaders expect a continuing debate on both bills heading into next year’s General Assembly and foresee universal health care as a top issue in 2010. “There’s a lot of work to be done,” Burrell said. Copyright 2009 Daily Record. Docs seek gag orders to stop patients' reviews Associated Press Daily Record Thursday, March 5, 2009 The anonymous comment on the Web site RateMDs.com was unsparing: "Very unhelpful, arrogant," it said of a doctor. "Did not listen and cut me off, seemed much too happy to have power (and abuse it!) over suffering people." Such reviews are becoming more common as consumer ratings services like Zagat's and Angie's List expand beyond restaurants and plumbers to medical care, and some doctors are fighting back. They're asking patients to agree to what amounts to a gag order that bars them from posting negative comments online. "Consumers and patients are hungry for good information" about doctors, but Internet reviews provide just the opposite, contends Dr. Jeffrey Segal, a North Carolina neurosurgeon who has made a business of helping doctors monitor and prevent online criticism. Some sites "are little more than tabloid journalism without much interest in constructively improving practices," and their sniping comments can unfairly ruin a doctor's reputation, Segal said. Segal said such postings say nothing about what should really matter to patients - a doctor's medical skills - and privacy laws and medical ethics prevent leave doctors powerless to do anything it. His company, Medical Justice, is based in Greensboro, N.C. For a fee, it provides doctors with a standardized waiver agreement. Patients who sign agree not to post online comments about the doctor, "his expertise and/or treatment." "Published comments on Web pages, blogs and/or mass correspondence, however well intended, could severely damage physician's practice," according to suggested wording the company provides. Segal's company advises doctors to have all patients sign the agreements. If a new patient refuses, the doctor might suggest finding another doctor. Segal said he knows of no cases where longtime patients have been turned away for not signing the waivers. Doctors are notified when a negative rating appears on a Web site, and, if the author's name is known, physicians can use the signed waivers to get the sites to remove offending opinion. RateMd's postings are anonymous, and the site's operators say they do not know their users' identities. The operators also won't remove negative comments. Angie's List's operators know the identities of users and warn them when they register that the site will share names with doctors if asked. Since Segal's company began offering its service two years ago, nearly 2,000 doctors have signed up. In several instances, he said, doctors have used signed waivers to get sites to remove negative comments. John Swapceinski, co-founder of RateMDs.com, said that in recent months, six doctors have asked him to remove negative online comments based on patients' signed waivers. He has refused. "They're basically forcing the patients to choose between health care and their First Amendment rights, and I really find that repulsive," Swapceinski said. He said he's planning to post a "Wall of Shame" listing names of doctors who use patient waivers. Segal, of Medical Justice, said the waivers are aimed more at giving doctors ammunition against Web sites than against patients. Still, the company's suggested wording warns that breaching the agreement could result in legal action against patients. Attorney Jim Speta, a Northwestern University Internet law specialist, questioned whether such lawsuits would have much success. "Courts might say the balance of power between doctors and patients is very uneven" and that patients should be able to give feedback on their doctors' performance, Speta said. Angie Hicks, founder of Angie's List, said her company surveyed more than 1,000 of its consumer members last month, and most said they had never been presented with a waiver; 3 percent said they would sign one. About 6,000 doctors reviewed on the Angie's List site also were asked to comment. Only 74 responded, and about a fifth of them said they would consider using them. Lenore Janecek, who formed a Chicago-based patient-advocacy group after being wrongly diagnosed with cancer, said she opposes the waivers. "Everyone has the right to speak up," she said. While she's never posted comments about her doctors, she said the sites are one of the few resources patients have to evaluate physicians. The American Medical Association has taken no position on patient waivers, but President Dr. Nancy Nielsen has said previously that online doctor ratings sites "have many shortcomings." Online doctor reviews "should be taken with a grain of salt, and should certainly not be a patient's sole source of information when looking for a new physician," she said. Dr. Lauren Streicher, a Chicago gynecologist, got a glowing recent review on Angie's List, but also remembers a particularly snarky rating from a patient angry about getting brisk treatment after arriving 30 minutes late to her appointment. She said she sympathizes with doctors who ask patients to sign a waiver. Streicher said she has seen shoddy doctors praised online who she would not trust "to deliver my mail much less my baby." Conversely, bad reviews can destroy good doctors' careers, she said. "Are there bad doctors out there? Absolutely, but this is not a good way to figure it out," Streicher said. On the Net: Medical Justice: http://www.medicaljustice.com Angie's List: http://www.angieslist.com RateMDs: http://www.ratemds.com Copyright 2009 Daily Record. Legislators, public against service fees for state workers By Kevin Spradlin Cumberland Times-News Thursday, March 5, 2009 CUMBERLAND - A representative of the District 1 legislative delegation said public sentiment is “probably 5-to-1 overwhelmingly against” the Fair Share Act. Kim McMillan, district administrator for Sen. George Edwards, said Wednesday during a legislative committee meeting at the Allegany County Chamber of Commerce that Edwards and Delegates LeRoy Myers and Wendell Beitzel are emphatically against Senate Bill 264 and its companion, HB 298. The bill would permit American Federation of State, County and Municipal Employees to collect a service fee from thousands of state employees. Union officials feel the fee is fair because those employees benefit from the collective bargaining process without paying union dues. If passed, the bill would allow AFSCME to negotiate a service fee to be paid by those employees, but the workers would not become members of the union by paying the fee nor would they have full voting rights. Delegate Kevin Kelly supports the initiative, noting state employees wanted collective bargaining 10 years ago. They earned that right, he said, and AFSCME overwhelmingly won an election to represent certain state workers at the bargaining table. "I think you're obligated to pay something for collective bargaining," Kelly said. "It's only fair." Debbie Pappas, president of the Allegany County Teachers Association, said her organization also supports the bills. Pappas told committee members that service-fee paying teachers pay approximately $150 less per year than union members and they cannot vote on a contract. Full members pay approximately $570 per year, about $10 a week. McMillan said public sentiment to the local lawmakers’ offices, expressed through e-mails and telephone calls, is largely against the fee because people see it as unfair. Constituents are claiming they can’t afford more money to be taken out of their paychecks when economic conditions already are difficult. One committee member referred to the legislation as the union’s economic stimulus package. Contact Kevin Spradlin at kspradlin@times-news.com. Copyright © 1999-2008 cnhi, inc. *National / International* In Health Plan, Industry Sees Good Business Lure of New Customers Creates Unexpected Support for Obama By Dan Eggen and Ceci Connolly Washington Post Thursday, March 5, 2009; A01 Just four months ago, the pharmaceutical industry was prepared for the worst. Drugmakers feared that Barack Obama would press for price controls on prescription drugs and readied plans for a multimillion-dollar ad campaign against the idea. Instead, Obama chose a more modest approach after becoming president, proposing to extract bigger discounts on medications bought through Medicaid. The plan could save the drug companies billions a year compared with price controls. "This is a great start," said W.J. "Billy" Tauzin, a former House member from Louisiana who now runs the Pharmaceutical Research and Manufacturers of America (PhRMA), referring to Obama's health-care plan. "There are things we don't like about it. But there's time to discuss all that." Obama's opening gambit to dramatically expand the health-care system has attracted surprising notes of support from insurers, hospitals and other players in the powerful medical lobby who are set to participate in an unusual White House summit on the issue this afternoon. The lure for the industry is the prospect of tens of millions of new customers: If Obama succeeds in fulfilling his pledge to cover many more Americans, those newly insured people will get checkups, purchase medicine, undergo physical therapy and get surgeries they cannot afford today. To start the process, Obama has proposed a $634 billion health-care reserve fund that would be partially paid for with targeted cuts in payments to insurers, doctors, hospitals, drugmakers and other providers, and he has vowed to fight attempts to water down the package. The unstated intention of Obama's approach is to dole out the pain in small, easier-to-swallow bites to minimize opposition, White House aides say. Under the president's plan, hospitals, doctors, drugmakers, insurance companies and wealthy seniors -- all of whom will be represented at today's summit -- would sacrifice. But if the system was calibrated properly, no one would lose too much. Not everyone is happy, of course, and lobbyists and health-care experts warn that major obstacles lie ahead. The seniors lobby AARP, for example, opposes Obama's recommendation to raise Medicare prescription premiums on wealthy retirees. Major insurers also dislike his proposed overhaul of the Medicare Advantage program, which markets managed-care plans to seniors, while home-care providers object to cuts to their Medicare reimbursements. Former Columbia/HCA executive Richard L. Scott has launched a nonprofit group called Conservatives for Patients' Rights, which promises a $20 million multimedia ad campaign warning that the country is hurtling toward socialized medicine. Scott, who was pushed out of Columbia/HCA in the 1990s and now runs a chain of Florida urgent-care clinics, said in an interview that he has put up $5 million of his own money to kick-start the effort, with hopes of building a grass-roots campaign. "Imagine waking up one day, and all your medical decisions are made by a central national board," Scott says in the group's first radio ad, which warns of "a system like England or Canada, where national boards make your health-care decisions and waiting lists reign supreme." But overall, the tone of the debate so far is strikingly different from that in the early 1990s, when well-funded lobbying groups united to crush President Bill Clinton's health-care proposal. "I'm very encouraged by what's going on now," said Bill Gradison, a former head of the Health Insurance Association of America, which funded the "Harry and Louise" ad campaign that helped torpedo the Clinton plan. "My impression is that there's been a real openness to reach out to diverse interests, not leaving anyone out -- which is how a lot of people felt back in the 1990s. . . . They seem to have learned the lessons of what not to do this time." Obama has made overhauling health care a centerpiece of his young presidency, with the stated goal of assembling a broad reform package by the end of the year that would push the nation closer to universal coverage. The number of Americans without health insurance is now estimated at 46 million. The president has cast the effort as a fiscal priority amid the economic crisis, calling it "a historic commitment to reform that will lead to lower costs and quality, affordable health care for every American." Rather than single out any one player in health care, Obama's plan would inflict "flesh wounds" on virtually every major stakeholder, said Nancy Chockley, president of the National Institute for Health Care Management, a nonprofit group funded largely by Blue Cross Blue Shield. The key, she added, is that none of the wounds would be fatal. "You look down the list, and no one's going to be happy," Chockley said. "But nothing is a lay-down-the-gauntlet" style attack. Melody C. Barnes, Obama's domestic policy adviser, said: "The important outcome for everyone is reduced costs. We all have to put something down on the table." Keeping the major players on board could be crucial to Obama's success. The health-care sector is one of the mightiest political forces in Washington, spending nearly $1 billion on lobbying and contributing $162 million to candidates of both parties over the past two years, according to the Center for Responsive Politics. Obama's presidential campaign received nearly $19 million from health-care companies and their employees. For the industry, expanded coverage could open up huge new markets. As drug companies learned when President George W. Bush and Congress created a new Medicare prescription drug benefit in 2003, "long-term success is built on market share," said Chris Jennings, a former Clinton health adviser. "Expansion of coverage certainly creates a variety of opportunities for the private sector," said Sen. Ron Wyden (D-Ore.). The prospect of that new business is one way to "keep the powerful interests" at the bargaining table, he added. Hospitals and physicians would also win significant reprieves under Obama's initial proposal. The president would leave untouched $20 billion in annual payments for hospitals that care for large numbers of uninsured patients, focusing instead on more modest cutbacks for doctors and hospitals that do not meet certain quality standards. His plan also includes budget language that would spare doctors a 21 percent reduction in pay next year and 5 percent cuts in future years. Karen Ignagni, president and chief executive of America's Health Insurance Plans, said members of the insurers group are deeply concerned about Obama's proposal to switch the Medicare Advantage program to a competitive bidding process, arguing that it would force seniors to bear a disproportionate share of the costs. The administration says the change would save $175 billion over the next decade. But Ignagni, who will attend today's summit, also said her group is willing to make sacrifices to reach an agreement. "The coin of the realm for 2009 is not the old-fashioned playbook of ads and 30,000-feet campaigns," she said. "The coin of the realm is for stakeholders to come to the table with real proposals and solutions." Another major challenge could come from the AARP, which strongly objects to making wealthy seniors pay higher premiums for drug coverage. "Asking seniors to pay more is not a solution to the skyrocketing costs of prescription drugs," said spokesman Jim Dau. "Rather than shift more costs to seniors, AARP urges more focus on lowering soaring drug-cost increases." William Dombi, a vice president of the National Association for Home Care and Hospice, complained that his relatively small sector is being hit inordinately hard by Obama's proposal to slash $37 billion in Medicare payments that the president says are bloated. "Because the others are bigger, they have greater entree and greater influence," Dombi said. "That's why they're not complaining -- they don't have anything to complain about." Drew Altman, head of the Kaiser Family Foundation, said the debate "will get a lot tougher" in the months ahead. "We're still more in the happy-talk stage of health reform," he said, adding: "In Washington, there is a machine set up to fight every fight. No battle goes unfought." Research editor Alice Crites contributed to this report. Copyright 2009 Washington Post. Free Antibiotics May Contribute to Drug Resistance, Officials Say By Tara Parker-Pope New York Times Thursday, March 5, 2009 Pharmacies around the country are offering free antibiotics to cash-strapped consumers, but public health officials say the incentives send the wrong message and could worsen the problem of drug resistance. Last week, the Centers for Disease Control and Prevention sent out letters to several pharmacies urging them to promote responsible use of antibiotics to their customers. Currently, several pharmacies including Giant Food Stores, Stop & Shop, Wegmans Food Markets, Publix, Meijer and ShopRite are offering free antibiotics to customers who have a prescription from their doctor. “We don’t want to discourage companies from providing low-cost medications to their consumers,” said Dr. Lauri Hicks, medical director for the C.D.C.’s “Get Smart Program,” which offers educational materials about appropriate antibiotic use. “If a patient believes that they can get an antibiotic quite easily or for free, then it may increase the pressure on health care providers to prescribe it.” The generic antibiotics included in the free programs are relatively inexpensive compared to other drugs, in part because they typically are used for limited periods and are not refilled. Pharmacies have adopted the programs to promote customer loyalty and compete for the business of major retailers like Wal-Mart. Last year, the centers also sent letters to major retailers who were promoting low-cost drug programs, urging them to educate customers about drug resistance. But the agency says some of the pharmacies that are giving away antibiotics have linked the offers to the cold and flu season, prompting the agency to send a new round of letters. Colds and flu are viral-borne and should not be treated with antibiotics, doctors say. “Most of the infections during cold and flu season and most times are due to viruses and not the result of bacteria, so antibiotics don’t work,” said Dr. Neil Fishman, chairman of an antimicrobial resistance work group for the Infectious Disease Society of America and an infectious disease specialist at the University of Pennsylvania. “This is exactly the time we don’t want to encourage antibiotic use.” Jamie Miller, public affairs manager for Giant Food, said the company had dropped the references to cold and flu from its marketing campaign, and was reviewing the C.D.C.’s concerns. “We trust that doctors will write prescriptions for antibiotics based on the best interests of their patients,” Mr. Miller said. Jeanne Colleluori, a spokeswoman for Wegmans Food Markets, said the company in February published information on its Web site, in advertising circulars and e-mail messages to customers about responsible antibiotic use and appropriate cough and cold treatments. Ms. Colleluori said that Wegmans would continue the giveaways until its scheduled end date of April 30, but that the company was planning to distribute the centers’ educational materials in its pharmacies. The Infectious Disease Society of America said the pharmacies would be providing a more important public service if they gave free flu shots. “If you give antibiotics away, it sort of implies that we should use them rather freely,” said Dr. Anne Gershon, an infectious disease specialist and president of the infectious diseases society. “Giving away antibiotics could lead to stockpiling of drugs. We need to control antibiotic use very carefully, because more and more bacteria are becoming resistant to antibiotics.” Copyright 2009 The New York Times Company. The Voices of Kidney Disease Well - on Health By Tara Parker-Pope New York Times Thursday, March 5, 2009 More than 26 million Americans — that’s one in nine adults — have kidney disease. Millions more are likely to develop the disease, but most of us don’t know we’re at risk. People with diabetes, hypertension and a family history are all at risk of kidney disease. African Americans, Hispanics, Pacific Islanders, Native Americans and people over 65 are also at increased risk. The National Kidney Foundation has an excellent Web site with information as well as a quiz testing your knowledge. But to really understand how kidney disease affects your life, listen to the latest Patient Voices by my colleague Karen Barrow. You’ll hear from six men and women who have undergone transplants and treatments like dialysis as a result of kidney disease. “Chronic kidney disease is an epidemic. It’s growing in huge numbers, and people aren’t realizing that modification of their diets and being on top of your hypertension and diabetes could save you from dialysis, could save your kidneys,” says Anna Bennett, 42, who lives in the Bronx. “It’s a shocking, life changing, amazing thing to get a phone call saying someone is giving you a body part you can’t live without.” Click here to listen to all the voices of kidney disease. Copyright 2009 The New York Times Company. *Opinion* Mental health system should get stimulus help Prince George’s County Gazette Thursday, March 5, 2009 Despite the fact that Maryland is poised to receive billions of dollars in federal stimulus funding, including $1.63 billion in Medicaid matching funds, the state Mental Hygiene Administration's budget is facing unprecedented cuts. The MHA budget has already absorbed $19.5 million in cuts so far this year. More people are in need and entitled to receive public mental health services as Medicaid enrollment continues to climb. The MHA has been ordered to curtail spending so that this year's projected budget deficit of $10 million is erased by June 30 and cuts are planned for 2010 as well. The state is implementing the required cost containment in such a manner where Maryland's fragile network of community mental health providers and the non Medicaid eligible working poor will end up bearing the brunt of these cost containment actions over the next four months and will continue to suffer next fiscal year as well. I would encourage anyone who is interested in ensuring the strength and viability of community mental health services in Maryland [to] join me in recommending that [the] governor utilize a very small amount of the federal stimulus funds Maryland will soon receive to shore up our fragile public mental health system. Scott K. Birdsong Laurel Copyright 2009 The Gazette. BACK TO TOP


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