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The $787 billion economic stimulus package that was signed into law last week includes one or two health-related measures that haven’t been widely publicized, but which are no less important for it.

One of these is the $1.1 billion that has been assigned for a study to compare the effectiveness of a large number of medical treatments, drugs, surgeries, and other current standard medical procedures and devices. A council of fifteen federal employees will be set up to coordinate the research and advise the President and Congress on where the money would best be spent.

The program is a response to growing concerns that doctors have little solid evidence on which to base the value of many of the treatments that are currently considered standard.

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Japan’s overcrowded, understaffed hospitals are in danger – and so are the people who rely on those hospitals when they need emergency medical care. An elderly Japanese man who sustained head injuries after being struck by a motorcycle waited ninety minutes in an ambulance – while paramedics phoned fourteen different Tokyo hospitals, trying to find a hospital that would accept the man for treatment. All the hospitals refused to admit the injured man, saying they lacked the equipment and staff needed to treat him. The paramedics arrived at the accident site just a few minutes after the 69-year-old man was injured, but ninety minutes and fourteen hospitals later, the man died just a short time after paramedics finally located a hospital that would accept him for treatment. The man died from the shock caused by the loss of a large amount of blood – a condition which the man might have survived if he had received treatment earlier.

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The big healthcare news from the Obama administration over the last few weeks has been that the State Child’s Health Insurance Program will be expanded, but another SCHIP-related change that happened around the same time hasn’t received as much attention.

This change is a reversal of enrollment rules imposed in August 2007 by the Bush administration. Controversial at the time, the new rules made it much more difficult for states to allow certain families to use SCHIP. For families whose income totaled more than 250% of the federal poverty line (that equates to around $50,000 per year for a family of four), it suddenly became all but impossible to use SCHIP. Several states actually sued the federal government over this change, including Maryland, Illinois and Washington.

In May 2008, Bush relented a little by reducing the income restriction to around 200% of the federal poverty line, or about $40,000 per year for a family of four.

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The close ties between doctors and the drug industry are long-standing, but recently health policy experts have been saying that it’s about time those ties were cut. Over the years, many reports of drug companies providing financial and material perks for doctors has caused an erosion of public trust in medical professionals – and experts say that to repair that particular problem, it’s time for doctors to cut ties with the drug companies that provide the kick-backs.

A series of comments made by health policy experts in the British Medical Journal elaborate on the issue, saying that doctors might have to give up the freebies to win back public trust. From inexpensive prescription pads and pens to seminars at luxurious hotels, there are plenty of rewards for doctors who cultivate good relationships with drug companies.

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After being accused of overcharging millions for health care insurance, one of America’s biggest insurers has agreed to a $50 million settlement pay-out.

Hundreds of people made complaints about charges made by Oxford Insurance, and its parent company UnitedHealth Group. The parent company claims that its reimbursement rates are based on “independent research from across the health care industry,” but an investigation by the New York Attorney General’s office revealed that it’s actually Ingenix, a research firm owned and operated by UnitedHealth Group, that supplies the data.

This isn’t just a case of conflict of interest, however – it gets much worse.

According to New York Attorney General Andrew Cuomo, Ingenix has been manipulating the data, allowing UnitedHealth Group’s Oxford Insurance to pay less for reimbursement of its customers.

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Early in January, the California High Court banned emergency room doctors from directly billing insured patients, after their HMOs refused to pay their emergency medical care bills. The High Court has decided that doctors should not be allowed to take up the issue with patients if they believe they’ve been shortchanged by the patient’s HMO.

This new ruling affects around 21 million people, providing them with protection if they are treated by emergency room doctors who are not covered by their HMO plan.

The issue centers around a practice called balance billing. Sometimes, HMOs don’t cover the entirely of an emergency treatment bill, typically because the doctor used by the policy holder isn’t covered by the HMO’s plan. In these cases, the doctor concerned normally directly bills the patient who received the treatment.

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The Consolidated Omnibus Budget Reconciliation Act (COBRA) was approved by the federal government in 1985, but in the intervening 23 years thousands of Americans have found that the scheme isn’t as useful as it seems. Now, with the economic crisis putting millions out of work, the failings of COBRA are beginning to be revealed, in all their dubious glory.

Under COBRA, workers who lose their jobs can still retain the employer healthcare that job provided. They can retain the healthcare for up to eighteen months, but they must pay for the full price of upkeep once their employment terminates. While employed, they pay only a portion of the premium, with their employer footing the bill for the remainder. But after their employment is terminated, they’ll pay both shares.

It sounds like a great idea – and it works in theory – but the reality is that to maintain their healthcare after losing their jobs, the average worker must pay as much as 30% of their unemployment check. When a family, rather than a single person is involved, that figure can rise to an astonishing 84%.

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Universal healthcare could be useful in more ways than one. With more than half a million jobs lost in America in November (the biggest decline in a single month in more than thirty years), the country is in dire straights. Nearly 7% of the nation is wholly unemployed, and a total of 12.5% are either unemployed or barely working. That’s 19.3 million Americans who have little or no work.

The incoming administration is preparing a stimulus package to be introduced in the New Year, intended to get the economy ticking over again by investing billions in infrastructure. The package may include upgrading school buildings, upgrading public buildings to improve energy efficiency, building of bridges and roads, extending the reach of broadband internet, and improving electronic record keeping for medical billing.

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AARP (formerly the American Association of Retired Persons, but now known more commonly by its acronym) is a non-profit, non-government interest group which, according to its web site mission statement, is “dedicated to enhancing quality of life for all as we age,” by providing “a wide range of unique benefits, special products, and services for our members.” AARP acts as a member advocate, and is a powerful lobbying group. It also sells insurance, investment products, and endorses certain insurance companies.

Sounds good, yes? But by virtue of its habit of endorsing insurance companies, AARP has recently come under fire. The Kaiser Family Network recently revealed that AARP’s endorsements don’t come cheaply – 43% of the revenue the supposedly non-profit, independent advocacy group collected in 2007 came from royalties and fees the organization took from insurance companies – as payment for endorsements.

Doesn’t sound too much like consumer advocacy, does it.

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Barack Obama, our new President-elect, used an ambitious health care reformation plan as an important part of his running campaign. The core of the plan is intended to provide insurance for a big chunk of the 46 million Americans who don’t have it.

So congratulations, Mr. President – and just how soon are we likely to see any changes in health care?

Obama’s Health Insurance Plan

Obama’s universal health care plan is certainly ambitious, aiming to provide insurance for millions of uninsured Americans, and to cut health care spending at the same time.

What are the finer points of this plan?

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