DENIS STAUNTON in Washington

US PRESIDENT Barack Obama has promised to overhaul the American healthcare system by the end of this year – without Republican support if necessary.

Speaking in Indiana after a town hall meeting to promote his economic policies, the president said he would prefer to sign a bipartisan healthcare Bill but it was not yet clear if negotiations with Republicans would prove fruitful.

“Sometime in September we’re going to have to make an assessment,” he told MSNBC. “I promise you, we will pass reform by the end of this year because the American people need it.”

Mr Obama told his audience in Elkhart, which experienced the sharpest unemployment rise in the US last year, that he would issue $2.4 billion in taxpayer grants to create electric cars and tens of thousands of jobs.

“For too long, we failed to invest in this kind of innovative work, even as countries like China and Japan were racing ahead,” he said.

“That’s why this announcement is so important – this represents the largest investment in this kind of technology in American history.”

Mr Obama identified energy, innovation, healthcare and education as the pillars of the new US economy he wants to build from the wreckage of the recession.

“Now, there are a lot of people out there who are looking to defend the status quo. There are those who want to seek political advantage. They want to oppose these efforts.

“Some of them caused the problems that we got now in the first place, and then suddenly they’re blaming other folks for it. They don’t want to be constructive. They don’t want to be constructive; they just want to get in the usual political fights back and forth,” he said to applause.

“But you and I know the truth. We know that even in the hardest times, against the toughest odds, we have never surrendered. We don’t give up. We don’t surrender our fates to chance. We have always endured. We have worked hard, and we have fought for our future.

“Our parents had to fight for their future; our grandparents had to fight for their future. That’s the tradition of America.

“This country wasn’t built just by griping and complaining. It was built by hard work and taking risks. And that’s what we have to do today.”

Republicans, who have opposed all Mr Obama’s key proposals, from the economic stimulus package to healthcare reform, see in the president’s declining popularity an opportunity to make gains in next year’s congressional elections.

“President Obama is now looking like a mere mortal, as opposed to someone who previously exceeded gravity,” said John Cornyn, chairman of the National Republican Senatorial Committee.

“I think there will be a significant number of voters who, leading up to 2010, will wonder if they voted for someone they didn’t get.”

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By JANE ZHANG

Federal health agencies, seeking to hand out stimulus funds to research the effectiveness of various medical treatments, said they will include projects that look in part at the cost of drugs and other treatments.

The approach — which was unveiled in a report to Congress this week by the Agency for Healthcare Research and Quality and the National Institutes of Health, both agencies under the Department of Health and Human Services — could provide more fodder to conservatives worried that the government might use the results of such studies to limit health care to consumers.

Administration officials have said they want to use stimulus funds to help doctors and patients choose more-effective treatments and ultimately, help rein in rising health-care costs. Democrats are considering including measures that would support such research as part of health-care legislation making its way through Congress.

The Agency for Healthcare Research and Quality, which has $300 million to spend on comparative research, mostly in the fiscal year starting Oct. 1, said it would increase funding to projects that focus on arthritis, cancer and 12 other conditions that are often costly to treat.

“This is unprecedented investment in helping clinicians and patients identify what’s the best for them in treatment,” said Carolyn Clancy, the agency’s director, in an interview.

The NIH, which is earmarked to spend $400 million in comparative-treatment studies over two years, will fund projects that include cost as a factor in their studies, said Richard J. Hodes, director of the NIH’s National Institute on Aging.

The NIH has received 1,800 research applications, but hasn’t figured out how many fall under the definition of “comparative effectiveness research,” Dr. Hodes said. The agency will award the first grants in August.

The two agencies don’t set policy, but their work helped officials running government programs such as Medicare, the insurance program for the elderly and disabled, decide which treatments to cover. Nicholas Papas, an HHS spokesman, said under the stimulus law, Medicare can’t use the research to deny coverage to patients.

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By Adriel Bettelheim

President Obama plans to huddle with his Cabinet and top advisers on Friday and Saturday to review lessons learned from his first six months in office. There’s bound to be some gnashing of teeth over the pace of the health care overhaul, and also some satisfaction over signs the economy is staggering back.

But based on his remarks at Wednesday’s town halls in Raleigh, N.C. and Bristol, Va., don’t expect a major recalibration of the administration’s message.

Obama continued to strenuously defend economic relief efforts launched in the aftermath of last fall’s financial crisis and lay some blame at the feet of former President George W. Bush. And he eagerly portrayed himself as a responsible steward of taxpayers’ money, to deflect persistent Republican charges that he’s incapable of controlling federal spending.

“I know that some critics in Washington think we’ve been slow to get these projects started,” Obama said in Raleigh, referring to work funded by the $787 billion economic stimulus package (PL 111-5). “They are saying we should have broken ground on all our highway projects on the first day. But everyone knows that’s impossible, especially because I wanted to be sure we did our homework and invested tax dollars only in those projects that actually created new jobs and jumpstarted our economy.”

Speaking in a state where the jobless rate is 11 percent, Obama said while there’s still much work left to be done to assure a complete recovery, “there is little debate that these steps, taken together, have helped stop our economic freefall.”

Obama also fired back at critics who blame him for running up the federal deficit, saying he inherited a $1.3 trillion shortfall. Without mentioning Bush by name, Obama said the staggering deficit was “a debt that is partially a result of two tax cuts that went primarily to the wealthiest few and a Medicare drug program, none of which was paid for.”

Finally, Obama continued to subtly recalibrate his health care message, casting the debate as one that revolves around curbing insurance companies’ less-savory business practices.

He outlined a series of consumer-protection measures aimed at preventing health plans from denying coverage to individuals who have preexisting medical conditions, dropping coverage for individuals who become seriously ill or charging unlimited out-of-pocket expenses. He also said the health overhaul would force the plans to pay for preventive care and routine checkups and remove arbitrary caps on the amount of coverage individuals can receive in a given year or in a lifetime.

Of course, many of these proposals aren’t major sticking points in the current debate. But talk about contentious stuff like public insurance options and how to pay for the overhaul should probably best be left to staff retreats and closed-door negotiating sessions on Capitol Hill.

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obama-defends-stimulus-health.html

By Kim Landers for The World Today

United States President Barack Obama is battling slumping poll numbers as he tries to counter the growing criticisms of his economic and health policies.

Mr Obama has used a prime time media conference to defend his campaign to overhaul America’s health system, calling it vital to pulling the economy back from the brink.

It was his 10th news conference since taking office six months ago and the timing was critical.

The President held it during prime time in the US to guarantee a national television audience. And he did it in a bid to convince Americans and the Congress to back his ambitious health care reforms.

“This debate is not a game for these Americans and they can’t afford to wait any longer for reform. They’re counting on us to get this done. They’re looking to us for leadership and we can’t let them down,” he said.

With the US in a deep recession, unemployment rising and the deficit ballooning, healthcare reform is set to be Barack Obama’s biggest test yet.

Forty-seven million Americans do not have health insurance but the President’s far reaching plans to bring affordable health care to all Americans have left many worrying who will foot the bill.

The growing public unease with his approach is partly due to an onslaught from his Republican critics and some within his own Democratic Party remain sceptical.

But Barack Obama says the time is right for a health care overhaul.

“I’m the President of the United States so I’ve got a doctor following me every minute which is why I say this is not about me,” he said.

“I’ve got the best health care in the world. I’m trying to make sure that everybody has good health care, and they don’t right now. “

‘Back from the brink’

America’s health care costs are a huge factor in the skyrocketing deficit and the President has also used his prime time media appearance to defend his economic policies.

“We’ve been able to pull our economy back from the brink,” he said

“We took steps to stabilise our financial institutions and our housing market and we passed a recovery act that has already saved jobs and created new ones.”

But six months after taking office Mr Obama’s popularity is fading. A Gallup poll shows his approval rating has dipped to 55 per cent.

The White House says they are “darn good numbers” but at the same point in his White House tenure George W Bush was on 56 per cent, Jimmy Carter was on 67 and Bill Clinton was on 41 per cent.

Bill Clinton was the last President to try and very publicly fail to reform health care.

Policy concerns

Darrell West is the vice-prsdsesident and the director of Governance Studies at the Brookings Institution. He is not marking Barack Obama’s six month report card too harshly.

“His poll numbers are starting to slip, unemployment is getting close to 10 per cent and Americans are starting to have a few doubts about some of the current directions of his policy initiatives,” he said.

Jennifer Duffy is a senior editor with the Cook Political Report, an independent newsletter. She says any president who started with such high popularity has to endure some erosion.

“But what we’re really seeing here is not that so much that he’s becoming less popular but that voters have some concerns about his policy,” she said.

“They still like him. They just have concerns about health care. They have concerns about whether the stimulus package is working.”

President Obama has again stressed today that he inherited the worst recession in half a century.

But Ms Duffy says Americans seem keen to put talk of the past behind them and they are now grading the new President on how he is handling the economy, particularly the impact of his $2 trillion stimulus package.

“First of all Americans are pretty fond of instant gratification,” she said.

“The stimulus I think may be the very first example of that and I think the White House has tried to reset the expectations to a certain degree but in a number of states, especially in the mid-west, we have had failing economies much longer than other states. Asking for patience is a hard thing.”

As one commentator in the United States put it, the icy cool President Obama is finally starting to sweat.

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By Sheldon Alberts, Washington Correspondent, Canwest News Service

WASHINGTON — facing possible defeat on his signature domestic policy priority, President Barack Obama appealed on Wednesday for Americans to put aside fears about health care reform and back sweeping changes that include the creation of a government-run medical insurance program.

During a prime time news conference in which he linked passage of health care legislation to the nation’s overall economic stability, Mr. Obama also claimed his administration’s controversial US$787-billion stimulus package and financial industry bailouts had all but rescued the American economy from collapse.

“As a result of the action we took in those first weeks (in office), we have been able to pull our economy back from the brink,” Mr. Obama said.

The president’s declaration of victory in the fight to save the economy came amid a wave of recent criticisms that the stimulus has done little to stem the tide of job losses. It’s expected the U.S. unemployment rate could rise above 10% later this year.

“We still have a long way to go,” Mr. Obama acknowledged. “I’ll be honest with you – new hiring is always one of the last things to bounce back after a recession.”

With Congress now wavering on White House demands to pass a US$1-trillion-plus health care bill before the fall, Mr. Obama warned a failure to overhaul the system now will lead to ballooning costs and force millions of more Americans to lose their coverage over the next decade.

“If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket,” Mr. Obama said. “If we do not act, 14,000 Americans will continue to lose their health insurance every single day. These are the consequences of inaction.”

Answering Republican opponents who this week predicted the health care issue would be his “Waterloo,” Mr. Obama made a defiant prediction: “We will do it this year.”

Mr. Obama’s decision to spend precious political capital by making a personal health care plea to Americans – it was his fourth prime time press conference since taking office in January — came as the White House struggled to keep conservative Democrats from abandoning him on the issue.

The most contentious elements of the health plan include a proposal to pay for health reform by taxing the wealthiest Americans, and the politically risky idea of launching a publicly-run health insurance system that competes directly with U.S. private insurers.

Already, leaders of one key House of Representatives Committee have put off voting on a version of the legislation after admitting they lacked enough support from Republicans and Democrats to get it passed.

In the Senate, meantime, Democrats who control the committees crafting health care legislation say Mr. Obama’s August deadline for passage of a bill is too ambitious. They argue there is no need to rush, especially with Americans increasingly wary of the price tag.

“I think it’s important that there be pressure (from the president). Otherwise sometimes things tend to drift,” said Senator Kent Conrad, a North Dakota Democrat and a member of the Senate finance committee.

“But this is hard. There’s just no way around it.”

Countered Mr. Obama: “If you don’t set deadlines in this town, things don’t happen. The default position is inertia.”

The nervousness among some Democratic lawmakers has been triggered, in part, by a series of polls showing the country is not sold on Mr. Obama’s plan.

A Rasmussen survey released Wednesday showed just 44% of Americans in favour of health reform proposals – even though a detailed bill has yet to emerge from Congress – while 53% are against.

But Mr. Obama cast the U.S. health system as broken and increasingly unaffordable. Americans spend $2.5-trillion a year on health care and yet 47-million residents go without medical insurance.

Ballooning costs of existing government health programs – Medicare for Americans 65 and over, and Medicaid for the poorest U.S. citizens – are weighing down the federal balance sheet, Mr. Obama said.

“Let me be clear: if we do not control these costs, we will not be able to control our deficit,” he said.

Mr. Obama has accused Republicans of fuelling public concern with misleading claims that his reforms would set the U.S. on a path to government-run, single-payer health care — with Canadian medicare being offered as the ‘socialized’ medicine Americans must avoid at all costs.

“What the heck do we want to become England or Canada for,” Rudy Giuliani, the former New York mayor and failed Republican presidential candidate, said Wednesday in a televised interview.

Mr. Obama dismissed the idea of a government takeover of health care, saying a public insurance system would complement, not replace, private companies.

“It will keep government out of health care decisions, giving you the option to keep your (private) insurance if you’re happy with it,” he said.

Other Republicans have cast the health care battle as their best chance to deal Mr. Obama, whose personal approval ratings have slipped under 60%, a crippling political blow just six months into his presidency.

“We need to put the brakes on this president. He’s been on a spending spree since he took office,” Senator Jim DeMint, a South Carolina Republican, told NBC’s Today Show.

“It’s not personal. But we’ve got to stop his policies … They’re loading trillions of dollars of debt onto the American people.”

Above article published on http://www.vancouversun.com/health/Obama+asks+Americans+aside+
health+care+fears/1817740/story.html

By Matthew DoBias

President Barack Obama moved to stem growing criticism of his blueprint to overhaul the U.S. healthcare system, warning a national audience not to “become consumed in the game of politics” and underscoring the potential benefits everyday individuals could reap under a wholly reformed system.

In a news briefing that focused almost entirely on healthcare, the president tried to put the focus on the personal rather than the political.

“My hope is, and I’m confident that, when people look at the cost of doing nothing, they’re going to say, ‘We can make this happen. We’ve made big changes before that resulted in a better life for the American people,’” Obama said.

Over the past three weeks, Obama’s push to fundamentally change how care is provided and paid for has come under attack from a bloc of fiscally conservative Democrats, stalwart Republicans and both right- and left-leaning interest groups.

Longtime policy shapers have begun to tie the president’s upstart reform efforts to one that failed spectacularly in the early 1990s. Such comparisons could prove to be as damaging as any legislative setback or missed deadline.

The president reiterated a pledge not to support any new taxes that would hit the middle class. His steadfast opposition to a tax on health benefits has rankled some lawmakers who had hopes of using such a levy to help defray the expected $1 trillion overhaul price tag.

“If I see a proposal that is primarily funded through taxing middle-class families, I’m going to be opposed to it,” he said. But, he added that he’s open to other tax proposals now being hashed out by congressional leaders.

And Obama also backed a measure that would give the Medicare Payment Advisory Commission expanded powers to enact many of its payment recommendations with limited chances for Congress to alter such proposals

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REG/307229963&AssignSessionID=173353830933946

Annie Reyes of Merizo said the Southern Regional Community Health Center has been a lifesaver for her family for decades.

“They’re good people; they do a good job here,” she said yesterday in the waiting room of the Department of Public Health and Social Services center in Inarajan after a doctor’s visit.

Not only are the staff friendly and competent, it saves the family from a long — and expensive — drive to see a doctor, added her husband, Joe Reyes.

More families will be able to be seen at the health center daily after an expansion project breaks ground next week.

An infusion of $718,000 through President Obama’s economic stimulus plan, announced, will help fund the expansion, said Dr. Tony Stupski, medical director and acting administrator for Public Health’s community medical centers in Inarajan and Dededo.

The stimulus plan, signed into law in February, set aside $1.5 billion to fund construction, renovation and equipment purchases at community health centers around the nation.

On Guam, it will help along a project to build a larger lab and pharmacy, more exam rooms, isolation rooms and storage at the 40-year-old Inarajan center, Stupski said.

“The whole idea of it is to increase access,” he said. “If you’ve ever been to the regional medical centers, you know sometimes it’s hard to get in. We’re just trying to expand the number of appointments we have and to see more people.”

The Inarajan center also will expand its emergency services offerings, Stupski added.

“It’s going to be set up so it can be used as an emergency center, so during typhoons people can go there,” he said.

The center provides services such as immunizations, women’s care, minor surgeries and wound repair, tuberculosis testing and therapy, STD and cancer screening, communicable and chronic disease care and community outreach.

During the renovation, the center won’t close, but some services, such as assistance programs, have been moved to other Public Health facilities, Stupski said.

The economic downturn and the rising cost of health care mean many more people around the country are depending on community health centers, Obama said earlier this year.

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Accessible-health-care–Stimulus-funds-will-expand-health-center

More than 50% of healthcare providers surveyed by IVANS do not believe the federal stimulus package will successfully encourage health IT adoption.

By Marianne Kolbasuk McGee InformationWeek

Although a majority of healthcare providers remain skeptical about how they’ll benefit by the federal government’s $20 billion stimulus program, many plan to forge ahead anyway, according to a report released this week.

About seven in 10 healthcare providers believe electronic medical records will have a positive impact on their businesses and patient care, but 80% say the lack of money is their biggest obstacle to deploying health IT systems, said the new report by IVANS, a supplier of EDI and network services to the insurance industry.

The nationwide, e-mailed survey of 508 healthcare providers — including hospitals, clinics, private medical practices, nursing homes, home healthcare organizations and medical billing companies — found that while nearly 40% plan to forge ahead with e-medical record deployments within the next 12 months, more than 50% of healthcare providers do not believe the federal stimulus package will successfully encourage health IT adoption.

Healthcare providers’ doubt appears to be rooted to several factor, most notably uncertainty about the specifics of the government’s eligibility requirements for receiving HIT-related rewards. Starting in 2011, the federal government is expected to begin awarding approximately $20 billion over the next five years, rewarding higher Medicare and Medicaid reimbursements to doctors and hospitals that demonstrate “meaningful use” of health IT.

However, the details of what will constitute “meaningful use” haven’t been worked out yet. The federal government is in the process of investigating and defining the scope of what “meaningful use” of health IT will qualify for the American Recovery and Reinvestment Act of 2009’s HITECH (Health Information Technology for Economic and Clinical Health) stimulus funding incentives. Just this week, a federal advisory panel — the HIT Policy Committee — unveiled some of its recommendations for the “meaningful use” definition.

“They’re on the right track,” said Clare DeNicola, IVANS CEO, of the HIT Policy Committee’s recommendation so far to the U.S. Dept. of Health and Human Services about the “meaningful use” definition. “It’s not about technology, it’s about the care — we can’t lose sight of that,” she said about the committee’s suggestions for how IT can be used for improving quality of patient care and public health.

Also fueling uncertainty among healthcare providers participating in the survey was this: Home healthcare providers and nursing homes were among the 508, healthcare providers polled. However, so far the HITECH federal stimulus legislations is vague on how those healthcare providers will participate in the new programs, despite the growing population of aging baby boomers who’ll likely increasingly require their services in coming years.

In fact, despite their skepticism and uncertainly about the government incentive programs, about four in 10 healthcare providers are planning to implement e-medical record systems over the next 12 months.

Many are already making investments in IT, including those that can help support e-medical record deployments, including wireless networks, business continuity technologies and connectivity to remote locations.

“Healthcare providers are wary but they are moving forward with technology innovations,” said DeNicola. “They’re not driven so much by the stimulus funds as they are in their belief that these technologies can help improve their businesses and patient care,” she said.

Finally, when survey participants were asked who should take the lead on driving adoption of healthcare IT to ensure its success, 47% of healthcare providers named themselves; 21% suggested the government should lead; 14% said healthcare insurers/payers should have that responsibility; and 18% were divided between industry associations and consumers leading the charge, according to the report.

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By KRISTEN WYATT
ASSOCIATED PRESS WRITER

COLORADO SPRINGS, Colo. — Homeless teenagers at a central Colorado shelter are feeling the effect of the government’s economic stimulus package. It’s the feeling of a dentist’s drill.

The 20 runaway youths living at the Urban Peak shelter had no regular dental care until this spring, when a $1.3 million stimulus grant to a community health center paid for a mobile dental and medical clinic to visit once a month. The residents now get medical and dental screenings, and cavities filled, right from their shelter’s parking lot.

“I knew my teeth needed to be fixed but I had no money,” says Michelle Daulton, 18, who has been living at the shelter for about four months and hadn’t seen a dentist since she was 13.

Now she’s had three chipped teeth repaired. “It was absolute and pure relief, I mean that,” she said.

From the Colorado homeless shelter to rural Pennsylvania clinics that can accept new patients, health centers that serve the poor are among the first places the federal stimulus package is being spent.

The stimulus law sets aside $2.5 billion for free and low-cost health clinics, and a big chunk of it - about $500 million - is already being spent. The White House has promised another burst of money this summer.

“This has really been a boost for us,” said Bob DeFelice, CEO of First Choice Community Health Care. “It’s allowed a level of stability in some very difficult times.” DeFelice’s group runs nine community health clinics around Albuquerque, N.M., and used a $703,000 grant to hire two physicians and four support staffers.

Health clinic executives say the money will allow them to keep their doors open as the rolls of uninsured patients grow. An estimated 64 million people use rural health clinics, a number that is expected to rise as people lose their jobs and health insurance.

“We’re seeing more and more people,” said Edward Michael, president of the Rural Health Corp. in Wilkes-Barre, Pa. The six-clinic group in northeastern Pennsylvania had no room for new patients until it received a $311,000 grant in April. Now, Michael says, his clinics can expand from seeing 18,000 patients last year to 19,000 this year.

“You know, we weren’t there back in the Depression, so we never experienced being back in the ’30s standing in line for food, standing in line for a doctor,” Michael said. “This money is really going to prevent a lot of long-term hardship.”

The health clinic grants are one-time boosts, not long term health care fixes. The stimulus won’t make up for a lack of doctors in poor and rural areas, a shortage the Association of American Medical Colleges says is growing and could reach 159,000 doctors by 2025.

“I look at the stimulus bill as one step to health care reform,” said Maggie Elehwany, vice president for government affairs and policy at the Washington-based National Rural Health Association. “It isn’t everything.”

While Congress considers a health care overhaul, clinic workers hope just to keep up with basic needs such as vaccinations and exams.

“I can’t imagine not having the stimulus money right now because we wouldn’t be able to do any of this,” said Nicole Noll, who drives the mobile health clinic to the teen homeless shelter and rural elementary schools.

The van was provided by Ronald McDonald House Charities. But stimulus money pays for Noll, the doctors and the dentists.

Far more than a brighter smile can be at stake in dentistry. In Maryland, a 12-year-old boy whose Medicaid coverage had lapsed, Deamonte Driver, died in 2007 after bacteria from the abscess of an aching tooth spread to his brain. An $80 tooth extraction might have saved his life.

“I’m so glad they did this,” Michelle Daulton said. “My parents were cheap. They never took me to the dentist. And when you don’t have any money, your teeth, you just leave ‘em alone. Not anymore.”

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http://www.seattlepi.com/national/1110ap_stimulus_health_clinics.html

President Obama believes one of the most effective ways to reduce health care costs is to go paperless. Children’s Mercy Hospital is one of a growing number of hospitals relying on electronic records, but recent studies found only nine percent of US hospitals and about 25 percent of doctor offices have gone to electronic records.

Everyone agrees that’s the trend but not everyone agrees it’ll save money and improve patient care.

Kansas City’s Internal Medicine Clinic moved to electronic medical records four years ago.

“We have everything, if we want to look at a lab, we push a button,” Dr. Marianne Hudgins said.

The administrative staff has shrunk by 5 and the clinic is adding a new doctor, but it’s patient quality that really impresses Dr. Hudgins.

“I think one of the beauties of this is that if it’s 2:00 in the morning and I get that call, I jump on my computer and I know everything about that patient,” Dr. Hudgins said.

Another obvious advantage of going paperless is more space, that become exam rooms.

“There are some benefits to the old paper way of doing it such as you can go through a 200 page chart in a matter of a minute,” Dr. Scott Kuennen with the Clay Platte Family Medicine Clinic said.

Dr. Kuennen’s clinic has plans to go electronic, but not until it absolutely has too.

“You’ll save money, in the sense that you’ll have less staff, you’ll be more efficient, not the case with anybody I’ve ever talked to,” Dr. Kuennen said.

He said the upfront costs are huge and adds too often doctors and hospitals aren’t on the same computer system until they are, he prefers paper.

The Obama administration is offering stimulus money to partially reimburse doctors who go electronic. One of the biggest benefactors could be Kansas City-based Cerner.

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-paperless-records,0,7058639.story