Dog Health

WASHINGTON (AP) -- Medicare recipients could see higher premiums for prescription drug coverage as a result of changes to complex provisions in a Senate health care bill, a senior Republican said Friday.

At issue are marching orders for a powerful new commission that would recommend annual Medicare savings to Congress. Those recommendations would go into effect unless overruled by lawmakers.

Sen. Chuck Grassley, R-Iowa, said an amendment approved by the Finance Committee in the pre-dawn hours Friday would allow the commission to recommend changes leading to higher Medicare prescription drug premiums. The Democratic amendment was approved on a 13-10 party line vote.

"Americans considering what this health care proposal means for them deserve to know that Medicare prescription drug premiums would probably go up," Grassley said in a statement.

As the prescription benefit is designed now, taxpayers cover three-fourths of the cost of the benefit, while Medicare recipients pay the remaining 25 percent.

The amendment would allow the new Medicare commission to recommend "reductions in federal premium subsidies" to the private insurance plans that deliver the prescription drug benefit. Grassley's office said the "premium subsidies" are taxpayers' share of the cost of the prescription plan. If those are reduced, the plans will make up the difference by raising premiums for seniors.

As originally envisioned by Finance Committee Chairman Max Baucus, D-Mont., the Medicare commission would have been barred from recommending any changes to Medicare benefits or cost-sharing.

A Baucus spokesman said the bill would protect seniors and strengthen Medicare. "The Medicare commission will look broadly at Medicare to find savings and efficiencies in the Medicare program, which will only help seniors," said the spokesman, Scott Mulhauser.

Grassley said the Democratic amendment was geared to compensate for a deal that would exempt hospitals from the commission's cost cutting scalpel.

The hospitals have already agreed to forego $155 billion in Medicare and Medicaid payments over the next ten years to help pay for the health care overhaul.

© 2009 The Associated Press.

AUSTIN, Texas (AP) -- Texas gave birth to the modern oil industry, invented the handheld calculator and sent man to the moon. But can the Lone Star State cure cancer?

Texas is ready to try by investing $3 billion over the next decade in cancer research and prevention, which would make the state the gatekeeper of the second largest pot of cancer research dollars in the country, behind only the National Cancer Institute.

"I don't know anyone that would stand shoulder-to-shoulder with what they're trying to do," said Robert Urban, executive director of the Koch Institute for Innovative Cancer Research at MIT.

That gee-whiz impression is what Texas leaders sought in 2007, when the state created the Cancer Prevention and Research Institute of Texas through an ambitious bond measure approved by voters. Lance Armstrong, champion cyclist and cancer survivor, sold the plan to voters, and Gov. Rick Perry said he dreamed of a day "we talk about cancer the same way we talk about polio."

Texas is now putting out the call to scientists: Come and get the money.

Institute leaders say the money will fund drug developments, gamble on high-risk research turned away elsewhere and attract big-name scientists to Texas. Creating the first statewide clinical trial network, which could give cancer patients more access to experimental drugs, also is being discussed.

But so much money on the table - particularly in the hands of a state that's new to funding cancer research - has some researchers worried that politics and backroom deals will play a role in deciding who gets what. The agency will invest upward of $260 million a year on cancer research and $30 million in preventive services such as early detection screenings.

A sagging economy also makes some skittish about whether the state will follow through with funding for an entire decade.

"That $3 billion isn't in the bank," said Dr. Tyler Curiel, executive director of the Cancer Therapy & Research Center at the University of Texas Health Science Center at San Antonio. "What if the money isn't going to be there in the future?"

Curiel is among the hundreds of researchers who began writing applications last month for a slice of the $450 million Texas will hand out over the first two years. The first grants are expected to be awarded by spring.

The state also is hoping to lure more top scientists to Texas with $2 million offers for salary and research and is prepared to offer even more for "superstars."

But once the money is doled out, the agency cautions, don't expect any overnight miracles.

"(We're) not going to bring new drugs to market during the first two years. Nor during the first four years," said Dr. Alfred Gilman, the institute's chief scientific officer. "It will take a good deal of time."

No other state comes close to the amount of cancer research dollars Texas has pledged. California voters in 2004 approved a $3 billion plan for a stem cell research agency, which opponents tied up in court for two years over the ethics of creating and destroying embryos from which the cells could be harvested.

Massachusetts in 2008 passed a $1 billion, 10-year initiative to fund life sciences research, but some have wondered about the viability of that big-ticket endeavor given the state's economic woes.

Texas, meanwhile, is doling out cancer research dollars at a time when funds nationwide have been flat or drying up. The National Cancer Institute handed out $3.14 billion in so-called extramural grants in fiscal year 2008, a slight drop from 2007 and down from $3.25 billion in 2005. The federal stimulus bill gave the NCI an additional $1.26 billion in grant money, but researchers say it's still not enough.

Texas already is no slouch when it comes to fighting cancer. The University of Texas M.D. Anderson Cancer Center in Houston is one of the top cancer research sites in the country, and the state is home to headquarters of Susan G. Komen for the Cure and the Lance Armstrong Foundation.

Dr. Patrick Reynolds, director of the cancer center at the Texas Tech University Health Sciences Center, returned to Texas last year after working at the University of Southern California. He said there was frustration among researchers in California with the state spending billions on stem cell research but nothing to help cancer patients in the short term.

He expects other researchers to flock to Texas.

"I think what people are saying is that (Texas) really cares," Reynolds said. "And by golly, now we got some more resources to do something."

But the new institute has been pinched by the economic slowdown. State lawmakers did not fully fund it for the first two years, leaving $150 million on the table. Institute officials believe the agency may be able to recoup that money down the road, Executive Director Bill Gimson said.

State Rep. Garnet Coleman voted for the initiative, but the Houston Democrat was disappointed that no more than 10 percent of the money is earmarked for preventive services that have a more immediate impact.

Gimson said he could not imagine a scenario in which drug companies would be awarded the money, but Coleman is worried that Big Pharma could still find a way to take advantage of state dollars. He also worried about the institute's transparency when it comes to where the money will be spent.

Institute leaders say the agency's ethics standards will avoid any conflicts of interest and ensure that the awards will be merit-based. The agency will use out-of-state peer review groups composed of doctors and scientists to review the grant applications.

"The people have given us a lot of money," said James Mansour, chairman of the institute's oversight committee. "It's incumbent on us to spend the money and spend it properly."

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On the Net:

Cancer Prevention and Research Institute of Texas: http://www.cprit.state.tx.us

© 2009 The Associated Press.

WASHINGTON (AP) -- Eight months in office, Barack Obama has now pushed closer than any other president in generations to creating a basic health care safety net for working Americans. Yet the fate of legislation delivering on his goal is far from certain: Republicans are nearly unified in opposition, Democrats hardly united in support.

Indeed, few if any of the major arguments about the scope and costs of the historic undertaking are settled as congressional leaders prepare to take legislation to the floor in the next two weeks.

Democrats on the Senate Finance Committee came together early Friday - after 2 a.m. - to finish the heavy lifting on a bill designed to appeal to moderates. Obama hailed it as a milestone and noted, for history, that overhauling health care has eluded presidents from Harry S. Truman to Richard Nixon to Bill Clinton.

"We are now closer than ever before to finally passing reform that will offer security to those who have coverage and affordable insurance to those who don't," Obama said.

But not yet. And not for sure.

The 10-year, $900 billion bill would remake one-sixth of the U.S. economy, clearing a path to health insurance for millions who don't have it now. It would be financed by reducing Medicare and Medicaid payments to health care providers, and by ordering new taxes and fees that are already meeting resistance. Insurers would no longer be able to turn away those in poor health.

Final passage in the Finance Committee, a political bellwether, is all but assured next week. After that, things really start to get interesting.

Senate Democratic leaders will begin tugging on Finance Chairman Max Baucus' hard-won compromise to try to meld it with a liberal-leaning version passed by the Senate Health, Education, Labor and Pensions Committee. That second version would allow the government to sell insurance in competition with private industry, a highly controversial issue, while the plan from Baucus, D-Mont., would not.

The government-run plan doesn't appear to have the votes to clear the Senate. In the House, it's the other way around. A bill that doesn't include a government plan to compete with private insurers won't get off the floor, Democratic leaders say.

That's not the only fault line.

The House plan taxes the wealthy to pay for subsidies needed to make health coverage affordable for millions who are now uninsured. The Senate instead taxes the health care haves - those with expensive insurance plans.

The House plan - and the Senate health committee bill - would require employers to offer coverage to their workers or pay a tax penalty. The Senate Finance bill has no requirement that employers offer coverage, although it would levy a charge on businesses whose workers end up getting government subsidies.

If lawmakers manage to work their way through those issues, they still won't be safely through the political minefield. They'll face contentious issues including how to deal with coverage for abortions and how to keep benefits from going to illegal immigrants.

"A lot of people have a lot of non-starters, and they are different non-starters," said House Majority Leader Steny Hoyer, D-Md. "If you add up all the non-starters, it makes it very difficult to pass a bill. When we get an agreement in the House, it will contain things some people will prefer weren't in there. It will also contain things they want. As in every major piece of legislation, you have to find a balance."

Increasingly, Obama will have to step in to settle disputes and keep the bill moving forward. That will please some lawmakers and alienate others. He can't afford to lose many of his fractious Democrats.

Polls show the public has many concerns and questions about the legislation. But for now, most Americans seem to want Congress to keep working.

Republicans are certain that the more people learn, the less they'll like about the Democrats' approach.

"What we know for sure about this proposal, the core of it will include half a trillion dollars in Medicare cuts over 10 years and hundreds of billions of dollars in tax increases on both individuals and businesses," Senate Republican leader Mitch McConnell of Kentucky told reporters Friday.

Senate Majority Leader Harry Reid of Nevada has said he wants meld the Finance and health committee bills in fairly short order. He could have a bill on the floor the week after next, with debate expected to last for weeks. The Democrats have 60 votes in the Senate - 58 from their party and two independents - and that's the magic number needed to overcome roadblocks. But as yet there's no bill that 60 Democrats would agree to.

In the House, the third week of October is the earliest a bill could come to the floor, Hoyer said. Leaders are still meeting with rank-and-file Democrats to work through disagreements.

On Friday, more than 100 Democrats sent House Speaker Nancy Pelosi, D-Calif., a letter opposing the tax on high cost insurance in the Senate Finance plan. They argued the tax would ultimately be paid by middle-class union members who bargained hard for comprehensive health plans.

"The purpose of this letter is to put a big red flag in front of the White House and the congressional leadership," said Rep. Joe Courtney, D-Conn., who circulated the letter. "This will be a problem."

Finance Democrats have felt the pushback already. Baucus accepted an amendment by Sen. Jay Rockefeller, D-W.Va., that would ease the bite of the insurance tax on retirees over the age of 55 and for plans that cover workers in high-risk jobs like coal mining.

Still, the wrangling obscures considerable agreement on what the health care system would look like after it's reengineered. Some of the outlines have emerged:

- Although government will play a bigger role than it does now, most people will still be covered by private insurance plans sponsored by their employers.

- Medicaid will be expanded to cover more low-income people, including childless adults for the first time.

- Self-employed people and those working for a company that doesn't provide health insurance will be able to buy coverage through new insurance purchasing pools called exchanges. Government would provide tax credits for many middle class people. Insurers participating in the exchanges will have to take all applicants and will be limited in what they can charge those who are older and sicker.

- Medicare would adopt a new philosophy geared to better coordinating care for seniors with chronic illnesses and trying to keep them out of the hospital.

Even Democrats who are upset with the Senate Finance bill say they're optimistic that Congress can get legislation to Obama.

"There is enough momentum now that I would disagree with the characterization that it's going to be impossible to meld the two sides," said Courtney, the Connecticut Democrat trying to derail the insurance tax. "My hope is it will be by Thanksgiving, and my honest opinion is closer to Christmas."

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Associated Press Writers Erica Werner and David Espo contributed to this report.

© 2009 The Associated Press.

CHICAGO (AP) -- Businessman Stewart Grill, 75, believes there's waste in Medicare. He's just skeptical Congress can find and eliminate it without touching what he likes about his government health care plan.

"The talk of potential savings is a little beyond comprehension," Grill said. "Why hasn't it been saved before? It's virtually impossible to save $500 billion and not do any cutting of benefits."

The congressional plans for health care overhaul could mean a major restructuring of Medicare. Dozens of changes are being proposed in hopes of transforming the program from one that rewards doctors for each procedure they do into one that improves people's health and keeps them out of the hospital.

The changes should save money. What many seniors, including Grill, want to know is this: Can lawmakers pull this off without cutting benefits?

Like most seniors, Grill has his Medicare premium deducted from his Social Security check. He sees it as a good deal, but he's worried about Medicare's future.

His knee doctor no longer takes Medicare patients. And he has to pay two other doctors directly and wait for Medicare to reimburse him. He sees those doctors' policies as warnings that Medicare's reliability may be growing shakier.

A lifelong independent politically, Grill said he knows that slowing the rate of growth in Medicare can keep it solvent longer. He thinks that's good for him, and good for his children and grandchildren.

"The figures are so large and so hard to comprehend," Grill said. "The biggest overall problem I see is nobody wants their own ox gored."

Here's a look at the proposals and how they might affect him and other seniors:

-Medicare Advantage

More than 10 million seniors - nearly 1 in 4 - are covered by Medicare Advantage, an alternative that pays for-profit insurance companies to run their own versions of the government program. But the government is spending 14 percent more per patient in Medicare Advantage, so Congress wants to cut some of that - up to $160 billion over 10 years.

That means seniors covered by the plans may lose extra benefits like hearing aids and health club memberships. Some commercial insurers may pull out of Medicare Advantage, forcing some seniors to switch plans.

"There's no way to sugarcoat it and say there's no harm here," said Dr. Robert Berenson, a Medicare official during the Clinton administration and a senior fellow at the Urban Institute.

Everyone in Medicare pays $3 a month extra to subsidize the Medicare Advantage plans, the Leadership Council of Aging Organizations estimates.

Berenson tells seniors in Medicare Advantage it's a matter of fairness: "You've been getting extra benefits for many years beyond what the program really promised you."

-Preventing illness

Free preventive services would be more common in Medicare under the congressional plans. Medicare would pay 100 percent for mammograms, diabetes classes and other preventive services. The Senate bill would include a free annual wellness exam too.

"It starts to change the nature of the relationship from one where you go to the doctor when you're feeling sick to one that's more focused on proactive prevention," said Ken Thorpe, executive director of the Partnership to Fight Chronic Disease.

Paying doctors fairly sharpens the focus on prevention. Democrats in the House and Senate want to delay scheduled decreases in doctors' fees and provide bonus payments that would make it more lucrative to see Medicare patients.

-Staying out of the hospital

Nearly one in five Medicare patients lands back in the hospital within a month of getting out, costing billions annually.

To attack the problem, social workers in Chicago telephone patients after they leave Rush University Medical Center. The social workers find out what patients need to avoid repeat hospital trips. They help arrange rides to doctors and make sure seniors can afford their medicine.

"It can be one call or 30 calls," said Robyn Golden, who directs the hospital's older adult programs. "We call the providers to make sure they're following through when the patient says they're not."

Congress wants more hospitals to think like this. The leading Senate legislation would penalize hospitals with the highest readmission rates by reducing Medicare payments for repeat visits that could have been avoided.

-Coordinating care

A recent study found the typical primary care doctor must coordinate their Medicare patients' care with hundreds of other doctors. But rarely does any one doctor take charge of one patient's care from start to finish of a health problem.

"As it is now, the doctor asks the patient, 'What did the specialist say?'" said Joseph Baker of the nonprofit Medicare Rights Center.

Proposals in the House and Senate would set up pilot programs to better coordinate care with the goals of saving money and improving quality. Buzzwords are "medical homes" and "accountable care organizations," but the goals are the same, Baker said, "a more seamless provision of care without the bumps or gaps people experience now."

-Filling prescription drug gap

When Congress created the Medicare drug program it left a coverage gap called the "doughnut hole." More than 3 million Medicare beneficiaries a year hit this gap and start paying the full cost of their drugs until they qualify for catastrophic coverage.

Drug companies have promised a 50 percent discount on brand-name prescriptions for people in the doughnut hole. House Democrats want to eliminate the gap entirely by 2023.

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On the Net:

Leadership Council of Aging Organizations:

http://www.lcao.org/

Medicare Rights Center:

http://www.medicarerights.org/

Partnership to Fight Chronic Disease:

http://www.fightchronicdisease.org/

© 2009 The Associated Press.

LONDON (AP) -- Most babies born in rich countries this century will eventually make it to their 100th birthday, new research says. Danish experts say that since the 20th century, people in developed countries are living about three decades longer than in the past. Surprisingly, the trend shows little sign of slowing down.

In an article published Friday in the medical journal Lancet, the researchers write that the process of aging may be "modifiable."

James Vaupel of the Max Planck Institute in Germany and colleagues in Denmark examined studies published globally in 2004-2005 on numerous issues related to aging. They found life expectancy is increasing steadily in most countries, even beyond the limits of what scientists first thought possible. In Japan, for instance, which has the world's longest life expectancy, more than half of the country's 80-year-old women are expected to live to 90.

"Improvements in health care are leading to ever slowing rates of aging, challenging the idea that there is a fixed ceiling to human longevity," said David Gems, an aging expert at University College London. Gems was not connected to the research, and is studying drugs that can lengthen the life span of mice, which may one day have applications for people.

"Laboratory studies of mice, including our own, demonstrate that if you slow aging even just a little, it has a strong protective effect," he said. "A pill that slowed aging could provide protection against the whole gamut of aging-related diseases."

While illnesses affecting the elderly like heart disease, cancer and diabetes are rising, advances in medical treatment are also making it possible for them to remain active for longer. The obesity epidemic, however, may complicate matters. Extra weight makes people more susceptible to diseases and may increase their risk of dying.

In the U.S., data from 1982 to 2000 showed a major drop in illness and disability among the elderly, though that has now begun to reverse, probably linked to the rise in obesity.

The graying population will slowly radically transform society, and retirement ages may soon be pushed back, said Richard Suzman, an aging expert at the U.S. National Institute on Aging.

"We are within five to 10 years of a watershed event where there will be more people on earth over 65 than there under five," he said. "Those extra years need to be financed somehow and we need to start thinking about it now."

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On the Net:

http://www.lancet.com

© 2009 The Associated Press.