Obamacare

The Obama administration’s remake of the U.S. health care system stands on three legs. One, it makes the purchase of insurance compulsory. Two, it doles out new entitlements via expanded Medicaid, subsidies, and certain coverage requirements. And three, it promises to control the growth of medical costs. These three parts differ in their implications and prospects. The first leg may give way altogether; the second is partially already in place; the third provides the rationale for centralized allocation of resources in health care. This summer the Supreme Court is to decide on the constitutionality of the 2010 Patient Protection and Affordable Care Act, which faces various challenges to its thousands of sections. Moreover the centerpiece challenge to the individual insurance mandate may invalidate other provisions as well. In fact the uncertainties extend well beyond the Supreme Court decision and its consequences. Not only the results of the 2012 presidential election but also congressional and state elections may result in changes to the law or to the way it is applied.

1 in 5 gay, bisexual men in U.S. cities has HIV

Nearly one in five gay and bisexual men in 21 major U.S. cities are infected with HIV, and nearly half of them do not know it, U.S. health officials said on Thursday.

Young men, and especially young black men, are least likely to know if they are infected with HIV, according to a study by the U.S. Centers for Disease Control and Prevention.

The study found that 28 percent of gay black men infected with HIV, compared with 18 percent of Hispanic men and 16 percent of white men. Black men in the study were also least likely to be aware of their infection, with 59 percent unaware of their infection compared with 46 percent of Hispanic men and 26 percent of white men. Age also plays a role. Among 18 to 29-year-old men, 63 percent did not know they were infected with HIV, compared with 37 percent of men aged 30 and older, the team reported in the CDC's weekly report on death and disease. "This alarming new data provides further evidence that prevention efforts for gay men have not been adequate to meet the growing epidemic and should be dramatically scaled up," said Carl Schmid of the nonprofit AIDS Institute.

The First Victims of Health Care Reform

As Democrats on the campaign trail do their best to drum up support for health care reform by touting the benefits that take effect this year, it's easy to forget that the full thrust of the Patient Protection and Affordable Care Act doesn't kick in until 2014. But by then, a few major players in the health care industry might have already experienced a real downside of the massive overhaul, so much so that they may no longer exist. Insurance agents and brokers and small insurance companies are among those who may have to scramble to stay afloat over the next few years. This is partly by design and partly an unintended consequence of a new law that is so sweeping, it will affect nearly every corner of an industry that accounts for one-sixth of the U.S. economy. Under the Affordable Care Act, beginning in January, plans sold to individuals and small groups must spend 80% of premiums on actual medical care (as opposed to administrative costs); the figure is 85% for large group plans. Plans that spend less will be required to send rebates to customers. The NAIC counted agent and broker commissions, which can make up 5% to 20% of premiums, in the administrative category. Most experts, therefore, predict these commissions will be on the chopping block as insurers scale back administrative expenses to comply with the new rules.

ObamaCare II

As Mr. Obama finished signing the bill, the first hand he shook was that of Marcelas Owens, an 11-year-old who has helped Democrats put a human face on the health care debate by talking about the death of his mother.

Mr. Obama is now speaking. “Today after all the votes are tallied, health insurance reform becomes law.”

Post Scriptum: The passage of the health care law shows that the US empire is declining because it illustrates the fact that people expect the state to take care of them. In their expansionary phase, empires force people to go out, seek risks and fend for themselves, Murrin said, reminding of the dismantling of the British empire after the war, when the National Health Service, which ensures universal health coverage in Britain, was created.

Obama's ex-doctor: Insurers 'screwing it up'

President Obama's former personal physician of 22 years, Dr. David Scheiner, has been very vocal on the issue of health insurance, particularly with his criticism of commercial insurers and how he feels they are meddling with the doctor-patient relationship.

You've said in interviews that insurers are making it increasingly difficult for doctors to do their jobs. Can you give some examples? I'll give you two. I have a patient with bipolar disorder whose psychiatrist is no longer in her insurance company's panel. She is heartbroken that the insurance company won't pay to let her see the doctor. I have another patient with obvious sleep apnea. I ordered a sleep study on him. The insurance company knows he needs it but has made life miserable for him. They are making him wait to get their approval, hoping he won't bother with it. Insurance companies are making it more difficult for doctors to get preauthorization for treatments because they are hoping it will discourage people from getting expensive treatments. Insurers also tell us what hospitals we can admit patients to and what subspecialists we can refer our patients to. They are telling me how to do my job.

You Have No Idea What Health Costs

The average health-care coverage for the average family now costs $13,375, according to Kaiser. Over the past decade, premiums have increased by 138 percent. And if the trend continues, by 2019 the average family plan will cost $30,083.

About 160 million Americans receive health coverage through their employers. In general, the employer picks up 73 percent of the tab. This seems like a good deal. In reality, that money comes out of wages.

Another 80 million Americans are on public plans, mainly Medicare and Medicaid. Those costs are paid by taxpayers. And about 46 million Americans are uninsured.

That's the dilemma for Washington wonks trying to fix this mess: They look at the numbers and see health-care costs crushing our economy, overwhelming our government, swallowing our wages. But the public isn't feeling it. Virtually no one cuts a $13,375 check for health care. Most pay 27 percent of it, or even less. The surest way to cut health-care spending would be to make people shoulder more of the burden directly, as opposed to hiding it in taxes and lost wages. But that's about as popular as a puppy pot roast.

ObamaCare

Fonte: aqui.

Obama universal healthcare

Fonte: aqui.

A América em dieta?

Vivemos tempos de depressão económica, ainda que sem ser em estado de violência. Por enquanto. Não é possível readaptarmo-nos a um novo ciclo de vida do planeta, sem uma dieta concreta por parte dos que gastam e consomem mais (sobretudo os 1.000 milhões de cidadãos do hemisfério norte).

O Presidente Obama emergiu numa época difícil, mas de outra forma, nunca teria chegado a Presidente! Quer Obama, atribuir a saúde para todos os Americanos, à semelhança do que se passa em vários países europeus, na mesma altura em que estes se sentem em presssão para reduzir a comparticipação dos Estados na saúde.

A quadratura do círculo. Pois. Vejamos as propostas da Dr. Maya Rockeymoore Cummings, para uma América mais saudavel:

• There is only one viable solution: ask Americans to lose weight and give them the tools to keep it off. The waistlines of Americans young and old are expanding and the costs of related chronic diseases—like Type 2 diabetes, heart disease, kidney disease and stroke—are exploding alongside the obesity epidemic. Our nation’s obesity problem is costing the country more than $117 billion per year in direct medical costs and indirect costs related to reduced worker productivity and absenteeism. And experts agree that rising rates of obesity-related chronic diseases are driving higher annual medical expenditures.
• we must create a primary prevention system on top of an expanded healthcare system that supports Americans in their effort to lose weight.
• the adoption of a wellness tax credit tied to wellness insurance utilization rates and health outcomes would create an economic incentive for Americans of all backgrounds to eat healthier and be more physically active.
• For decades, corporations have been encouraging their employees to participate in wellness programs as a way to reduce costs and enhance their bottom lines. The efficacy of this approach has been proven in the private sector, now we must give a broad base of American workers access to wellness services.
• The final part of the plan involves adopting and implementing community and school-based policies that support healthy eating and active living. Most Americans live in what researchers call “obesogenic environments” that encourage sedentary lifestyles and unhealthy eating.

Pois é, sem ser pessimista, não será em dois mandatos que isto acontecerá nos EUA. Pois é, Barack Obama não vai cumprir a sua promessa de "global healthcare coverage" for everybody!

Finalmente, é preciso ter em conta que cerca de 7.000 milhões de pessoas no planeta (sobretudo do hemisfério sul) não lutam ainda por uma saúde global, mas antes por um prato de arroz diário.

O maior desafio de Obama

O Presidente Obama tem uma capacidade de comunicação única. O Presidente Obama está perante o maior desafio dos EUA, desde a II Grande Guerra: tentar travar o declínio evidente dos EUA.

Uma das fontes de declínio Americano é sem dúvida, a imensa despesa em saúde e um consumismo elevadíssimo. Obama prometeu criar, se fosse Presidente, a chamada "global healthcare coverage". Vai ser tudo, menos fácil.

Vejamos alguns detalhes desta "quadratura do círculo" de Obama:

• A Associação de Médicos dos Estados Unidos da América terminou hoje a reunião anual, em Chicago, sem definir uma posição sobre a reforma de saúde que o presidente Barack Obama pretende instalar. Os delegados da Associação, a maior do país com 250 mil membros, acordaram hoje apoiar alternativas ao actual sistema de saúde através de uma reforma mas não referiram nenhuma opção concreta.
• A opinião da Associação de Médicos é fundamental para o êxito ou fracasso da iniciativa de Obama, que pretende iniciar a reforma de saúde ainda este ano e que está a recolher apoios junto da indústria e dos críticos tanto republicanos como democráticos.
• A Associação, que rejeitou recentemente um plano público que concorria com as seguradoras privadas, comprometeu-se apresentar uma reforma de saúde que garanta a todos os norte-americanos uma cobertura dos serviços sanitários acessível e de qualidade.
• "A situação é insustentável para as famílias, as empresas e o governo. Os EUA gastam....quase 50 por cento a mais por pessoa do que o segundo país com maior despesa na saúde (...) Mesmo assim, temos cada vez mais cidadãos sem seguro, a qualidade do serviço tem-se deteriorado a população não está mais saudável", afirmou Obama.
• Obama pretende reduzir as despesas de saúde e alargar a cobertura dos cuidados médicos a 46 milhões de norte-americanos que continuam excluídos (cerca de 15 por cento da população).

Lembramo-nos logo daquele filme "Os Deuses devem estar loucos". E porquê? Porque, se Obama conseguir fazer esta reforma, ficará na História dos EUA ao lado de Roosevelt, Reagan ou Lincoln. De outra forma, vai ficar muito mal visto!

Aguardemos.

Nos EUA, os Deuses estão loucos

Quando lemos isto: Healthcare costs doubled from 1996 to 2006, and are projected to rise to 25 percent of GDP in 2025; 49 percent by 2082 if something does not change. Percebemos, que algo está muito errado na sociedade ocidental. Há com certeza muita gente equivocada, quando organismos públicos estimam que os custos com a saúde poderão representar cerca de 50% do produto de uma economia! Ainda que estejamos a imaginar o não tão longinquo ano de 2082!

Talvez porque estes organismos públicos apenas conjecturam cenários loucos, há alguém que sente necessidade de mudar as coisas: Reform of the U.S. healthcare system is vital this year because of growing costs and worsening care, the Health and Human Services Department said in a report on Monday.

É que os EUA atingem sempre cenários inimagináveis para os outros:

• The report points out that the United States spent $2.2 trillion on healthcare in 2007, or $7,421 per capita. Healthcare accounts for more than 16 percent of gross domestic product, nearly twice the average of other developed nations.
• "In spite of the vast resources invested, the health care system has not yet reached the goal of high-quality care," the report said.
• "Across 37 performance indicators, the United States achieved an overall score of 65 out of a possible 100," it said, citing the non-profit Commonwealth Foundation.

Do or die, parece ser a opção do Presidente Barack Obama.

Secretary of Health

Fonte: aqui.

A Governadora Kathleen Sebelius deverá ser apontada por Barack Obama, como nova Secretária da Saúde do governo dos EUA, conforme se refere aqui: President Barack Obama named Kansas Governor Kathleen Sebelius to help steer his $634 billion plan to provide every American with affordable medical coverage as head of the U.S. Health and Human Services Department.

Algumas das novas tarefas da futura Secretária da Saúde (equivalente à nossa Ministra da Saúde) e o respectivo background:

• Sebelius is a two-term Democratic governor who successfully pushed to expand subsidized health-care for children in her largely Republican state.
• The nomination ended almost a month of uncertainty over who would assist Obama in developing and promoting his health plan. His previous nominee, former Senator Thomas A. Daschle, withdrew after questions were raised about his back payment of taxes.
• Sebelius would also oversee the Food and Drug Administration, which polices the U.S. food supply and approves drugs, and the National Institutes of Health, which holds responsibility for medical research.
• Sebelius previously served as the Kansas insurance commissioner. She was the first commissioner to reject a proposed conversion of a nonprofit Blue Cross Blue Shield into a for-profit company, slowing the pace of such conversions nationally.
• Obama this week presented Congress with a budget that envisions spending $634 billion over 10 years to begin overhauling the health-care system.
• The $634 billion would be a “down payment” on the president’s pledge to make health care affordable and cover the 46 million uninsured. Obama proposed financing it with increased taxes on wealthy Americans and less government money for some drugmakers and health insurers.

Obama e o universal healthcare II

O Presidente Obama trouxe muita esperança. O Presidente Obama está em estado de graça. Aguardemos.

Uma das principais esperanças que Obama trazia, tinha que ver com os cerca de 45 milhões de Americanos excluídos de um serviço de saúde universal. Ainda assim, os EUA gastam cerca de 17% do seu PIB em saúde. Ou seja, Obama prometeu trazer serviços de saúde a quem não os tinha.

Vejamos, o que nos dizem as últimas notícias:

• President Barack Obama will ask Congress to set aside $634 billion over 10 years to help pay for an overhaul of the nation’s health-care system.
• About half the money will come from cost cuts in the Medicare and Medicaid programs and the other half from tax provisions.
• The tax changes would limit deductions for wealthy tax payers.
• “The cost of our health care has weighed down our economy and the conscience of our nation long enough,” Obama told a joint session of Congress.
• Obama has set a goal of reducing the nation’s spending on health care and getting more of the nation’s uninsured covered.

Disse o Poeta, que "o sonho comanda a vida". Contudo, não acreditamos em milagres, sejam de que tipo forem. No país em que se gasta mais em serviços de saúde, o Presidente Obama quer aumentar o nível de serviços aos que não os têm, e simultaneamente reduzir os custos globais de saúde.

A quadratura do círculo!

Obama e o universal healthcare

Fonte: aqui.

O Presidente Obama criou uma onda de novidade. Mesmo, uma aura de grandiosidade. "Yes, we can". Todos, ricos e pobres, pretos e brancos, velhos e novos, podem alcançar o "american dream".

Obama questionou sobretudo que "a América não poderia aceitar que cerca de 46 milhões de cidadãos não tivessem cobertura de saúde", dado que não tinham dinheiro para suportar um seguro de saúde.

Azar, Presidente Obama, logo o Secretário da Saúde (equivalente ao nosso Ministro da Saúde), escolhido por Obama, haveria de lhe deixar mais um amargo de boca: When President Obama nominated former Senator Tom Daschle to be his secretary of health and human services, it seemed to be a good choice.

Mas, afinal: Unfortunately, new facts have come to light — involving his failure to pay substantial taxes that were owed and his sizable income from health-related companies while he worked in the private sector — that call into question his suitability for the job. We believe that Mr. Daschle ought to step aside and let the president choose a less-blemished successor.

Pois é, a moral e a ética está pelas ruas da amargura, por todo o lado. E Obama aguentará tanta falta de ética e de moral na política e nos negócios?

Os orçamentos da saúde

A despesa em saúde representa cerca de 10% do PIB da generalidade dos países desenvolvidos (nos EUA, já representa quase 18% do PIB). É muito? É pouco? Há pessoas que dizem que a saúde não tem preço! Será que não tem? Será que não tem que se impor um limite aos gastos com a saúde?

Vejamos o que por aqui se escreve:

• The American hospital is a 19th-century cottage industry in the postmodern world. The problem is not medical or technological.
• The first problem is correcting wasteful and dangerous management practices before extending coverage to more patients. Knowledge exists to transform every hospital in the country to deliver higher quality care and in so doing substantially reduce costs and save lives.
• Extending health care to more people without correcting the antiquated delivery system doesn’t make sense.
• In fact, two large hospitals systems — in Pittsburgh and across the Midwest — cut costs in half and significantly reduced hospital-acquired infections and medical and medication errors.
• This solution of continually improving patient care was based on the Toyota management system. The hospital managements created an environment — without blame — where their employees could learn and practice continual improvement of their processes, systems and themselves in pursuit of “perfect patient care.”

O próximo Presidente dos EUA, Barack Obama, prometeu uma cobertura de saúde alargada, tendo em vista dar mais saúde àqueles que não têm dinheiro para comprar uma apólice de seguro de saúde. Mas, como se diz acima, se alargar a cobertura de saúde, sem racionalizar custos, vai apenas transformar um grande problema, na falência do Estado Americano!

Michelle Obama

Fonte: aqui.

A uma semana da posse do marido, Michelle Obama decidiu abandonar seu emprego no hospital de Chicago (Illinois, norte dos Estados Unidos), onde trabalhava há seis anos, para se dedicar totalmente a sua futura função de primeira-dama dos Estados Unidos, anunciou nesta segunda-feira o próprio centro de saúde.

A advogada Michelle Obama, que se tornará a nova primeira-dama americana no dia 20 de janeiro, ocupava desde 2005 o cargo de vice-presidente para assuntos externos e comunitários do hospital, onde começou a trabalhar em 2002.

Obama’s Efforts to Quit

Fonte: aqui.

Franklin D. Roosevelt smoked cigarettes, and John F. Kennedy and Bill Clinton occasionally smoked cigars. Gerald R. Ford preferred a pipe.