Health Forum - Health Care in America

Author

Health Care in America

Abel Malcolm

2004-10-12, 7:06 am

It's a long article (attached below), but the jist of it is this...in
America, we spend more than twice as much on health care than people
spend on health care in other industrialized democracies, such as
Canada and Japan. In Canada, for example, their total monetary
expenditure on health care is 60% less per person than we spend here
in America, and they are still healthier and live longer than we do
here. The statistic is even more stark in Japan, where they have one
of the healthiest populations in the world, and where health care
costs are among the lowest in the world.

The difference is in governmental regulations, there are very few
here, and therefore the system has run amok, to the detriment of the
American people. In our country, the number of people with no health
insurance has risen to 45 million already; the numbers and percent of
un-insured just keeps rising every year.

Drugs represent the fastest growing part of the health care bill, with
Americans paying the world's highest prices for medication.
Pharmaceutical companies, which are among the most profitable of
industries, are also heavily subsidized by the American tax payer, the
Pharmaceuticals say that they need these subsidies in order to conduct
vital research & development, yet they spend more than twice as much
on administration & advertising than they spend on research &
development.

Experts say that health care costs have spiraled upwards because the
American health care system is fragmented, with thousands of insurers,
hospital groups, physician groups, benefit administrators, medical
equipment providers, drugmakers and health care systems, all of them
combined along the way in trying to get the biggest cut of dollars for
themselves. A Harvard Medical School report recently found out that
of the hundreds of billions spent on health care each year, about
one-third of that money does not go into health care at all but into
feeding the bureaucracy, essentially the administrative costs of the
insurers, hospitals, doctors, nursing homes, other institutions,
e.t.c.

Experts and advocates make a compelling argument that the only way to
achieve universal coverage is to have a national health insurance
program modeled after the "single payer system" that the rest of the
world has, this would cut the one-third of the cost that is associated
with the overwhelmingly costly bureaucracy.

Further compounding the problem is that a significant contributor to
the rise to the cost health care is the providing of care to the
rising number of Americans who are not insured, this is resulting in
health care costs going up even more, as the rest of us foot the bill
for those who are uninsured and who are therefore unable to pay health
care.

In the rest of the world, medical costs are kept down by government
regulations, but that doesn't exist in America, because the very
powerful health care groups have been extremely effective at lobbying
our government to limit regulations that would benefit the consumers.

The United States has a health care system that is unique in the
industrialized world. Costs are high, employers pay most of the
bills, and tens of millions have no coverage. Polls show that most
Americans believe that the system does not work and want universal
coverage.

Abel Malcolm

From: http://www.sfgate.com/cgi-bin/artic...MNGII96CVP1.DTL
_______________

IN CRITICAL CONDITION: HEALTH CARE IN AMERICA

How the health care system is failing -- and why it's hard to fix
- Victoria Colliver, Chronicle Staff Writer
Monday, October 11, 2004

Some 40 years after the enactment of Medicare and Medicaid and more
than a decade after the Clinton administration failed in its bid to
extend coverage to all Americans, the nation's system of funding
health care is on the verge of breaking down.

Employers, consumers and governments at every level are straining
under the burden of a health care bill that is growing at a pace five
or six times the rate of inflation.

Businesses, squeezed by soaring health insurance costs, are passing an
increasing share of the price tag to their workers. That's forcing
employees to dig ever deeper into their pockets, prompting millions to
forgo coverage altogether and gamble that their families will stay
healthy.

The public health care system is overwhelmed by the country's 45
million uninsured who turn to hospital emergency rooms for even
routine care. And Medicare -- the crown jewel of government health
programs -- is projected to run out of funds by 2019 at the current
rate of expenditure growth.

The soaring cost of health care has emerged as one of the top issues
in the race for the White House. Both President Bush and Sen. John
Kerry, D-Mass., are offering programs to make health coverage more
affordable and reach more of the uninsured. (See accompanying
article.) But experts say the fixes proposed by the two candidates
would not fundamentally alter the dynamics that are putting health
care costs out of reach.

"When we have faced these so-called crises in health care before --
health care cost spikes, an increase in the uninsured -- there was
always a sense that there was some big solution coming," said Drew
Altman, president of the Henry J. Kaiser Family Foundation. "What's
different now is there is no sense there is a big reform idea out
there that might save us."

Consider these symptoms of a system on the critical list:

-- Employer health care insurance premiums jumped an average of 11.2
percent in 2004, lower than the 13.9 percent reported last year but
still more than five times the rate of inflation, according to a
survey by the Kaiser Foundation and the Health Research and
Educational Trust.

-- The United States spends nearly $5,000 per person on health care --
more than twice the amount of some other industrialized countries. But
it's not making us live any longer. Canada, for example, spends about
60 percent less per person than the United States but has longer life
expectancies.

-- The number of people without health coverage rose to more than 45
million nationwide in 2003, 15.6 percent of the population compared to
15.2 percent in 2002. California is home to the greatest number, with
6.4 million uninsured, or 18.2 percent of the population.

-- Battles over health care costs have moved to the top of labor-
management agenda. A 139-day strike by Southern California grocery
workers was resolved this year when union negotiators reluctantly
agreed to a contract that requires new workers to wait 12 months
before getting individual coverage and 30 months before family
coverage kicks in.

-- The California Public Employees' Retirement System, one of the
country's largest buyers of health care, accepted health maintenance
organization rate increases of 25 percent in 2003 and 18 percent in
2004 before pushing back by dropping costlier hospitals from its 2005
network.

As insurance costs climb, employers find themselves forced to make
harsh choices about the kinds of coverage to offer.

At Cosco Marking, a Seattle firm that owns the San Francisco Rubber
Stamp Co., premiums on a health plan covering 60 employees have gone
up between 11 percent and 15 percent during each of the last five
years. To save money last year, the company added a $750 deductible
and raised co-payments, making insurance so expensive that six workers
who were their families' sole breadwinners opted not to take it.

"When I look at the plan I have now versus the plan I offered five
years ago, it's much worse," said Rick Roddis, Cosco's general
manager.

Those who deliver care say the system is held together with gauze that
is getting more frayed every day.

At Marin General Hospital in Greenbrae, Dr. Myles Riner, an emergency
room physician, is seeing an increasing number of uninsured and
underinsured patients, or people with such high deductibles that they
put off seeking care until they have a serious health condition.

"The system is not going to fail like a volcano blowing its top off or
the Golden Gate Bridge crashing into the ocean," he said. "What's
going to happen here (in America) is not a 9/11. It's going to be a
war of attrition where patient care falls apart one patient at a
time."

Consumers, like Robert Bushansky, 60, who ran his own cleaning
services for 26 years, never expected that he or his loved ones would
be without health care. After his business failed in part because of
his ulcerative colitis, Bushansky got Medicare disability coverage.
But his wife, who continues to work, is uninsured because her employer
doesn't offer health coverage.

"We tout ourselves as being the richest, the biggest economy and being
the best country in the world and here we have 45 million without
health insurance. It's a contradiction in terms," said Bushansky, who
lives in the North Coast town of Elk.

In 2004, premium increases haven't been as big as they were last year
because insurers are already enjoying hefty profits from price
increases they imposed in previous years. In addition, employers are
buying cheaper and less comprehensive plans and passing more costs on
to their workers. Consumers, now feeling more of the pain in their
pocketbooks, appear to be using fewer discretionary health services.

But such trends do not significantly stem the underlying pressures
that are pushing health care costs up at double-digit rates.

Why are medical costs rising so fast when overall inflation is
relatively tame?

"It is hard to boil it down to one bogeyman," said Dr. Mark Smith,
president of the California HealthCare Foundation, a nonprofit health
research group based in Oakland.

New medical technologies -- everything from faster CT scans and drug-
coated stents to targeted chemotherapies -- may be responsible for as
much as 50 percent of U.S. medical cost growth, according to some
health economists.

Drugs represent the fastest growing part of the health care bill, with
Americans paying the world's highest prices for medication. While the
industry says it needs to charge high prices to finance research and
development, the largest pharmaceutical companies in 2002 spent 14
percent of their revenues on research and development while devoting
31 percent to marketing and administration.

Laurence Baker, an associate professor of health policy and research
at Stanford University, doesn't see this changing any time soon.
"Really reducing health care costs will mean reducing what we do for
patients," he said.

Experts say costs are also rising fast because the American health
care system is fragmented, with thousands of insurers, hospital
groups, physicians groups, benefit administrators, medical equipment
providers, drugmakers and health care unions all trying to get the
biggest cut of the health care dollar they can.

The combination of that quest for more revenue and the lack of any
outside restraint -- in a market in which consumers frequently have
little choice about buying services -- is a recipe for fast-rising
costs.

Many health care corporations, including insurers, hospital networks
and large medical groups, have posted significant earnings gains in
recent years. WellPoint Health Networks Inc. of Thousand Oaks, which
Indiana's Anthem Inc. is trying to buy to create the country's largest
health plan, reported a 34 percent increase in earnings for the second
quarter compared with the same period in 2003. Nonprofit Sutter
Health, which has 26 hospitals in Northern California, saw its income
increase nearly 64 percent from 2002 to 2003.

In many countries, medical costs are kept down by government
regulation. But the United States lacks meaningful health care price
controls and powerful health care groups lobby to limit government
regulation.

Meanwhile, lawsuits against health care institutions and
practitioners, many initiated by class-action attorneys looking for
big payouts, drain cash from the system. In many states, high
malpractice insurance costs have caused shortages in certain
specialties. Some argue the practice of "defensive" medicine -- the
ordering of additional tests or procedures to avoid litigation -- has
added to the health care dollar.

There are other factors pushing up costs:

-- A big part of U.S. health care expenditures have little to do with
patient care. Harvard Medical School researchers reported earlier this
year that the United States spends $399 billion per year on health
care bureaucracy, essentially the administrative costs of insurers,
hospitals, doctors, nursing homes and other institutions. In
California, $45 billion of the $163 billion spent on health care, or
28 percent, went to administration.

-- Doctors are becoming more aggressive in administering treatment. A
study published in the August journal of Health Affairs found the top
15 medical conditions accounted for about half the overall growth in
spending, with most of the costs associated with a rise in treatment
rates rather than just the cost per treatment going up.

-- Providing care to the uninsured takes up a significant share of the
health care dollar.

California has some cost drivers that are particular to the state.
Hospitals are required to seismically retrofit their facilities and
maintain certain nursing staff levels. In addition, hospital and
medical group consolidations -- especially in Northern California --
have created powerful provider groups that can command higher
reimbursements and all-or- nothing contracts from payers.

When health experts look at what's coming down the pike -- aging Baby
Boomers, growing obesity and other conditions that boost demand for
health care -- things go from bad to worse.

The last time the nation went through a period of soaring health care
costs, the response was the adoption of a new way of administering
treatment - - a system that went under the name of managed care and
was delivered through a new type of institution, the health
maintenance organization.

The HMO kept a tight reign on expenses by changing the way doctors and
hospitals were reimbursed for their services and requiring
authorizations before covering certain treatments and services.

One of the principal missions of HMOs was cost control and this they
did with a vengeance. Horror stories were legion, including people
denied essential treatments by administrators looking to save money.
Consumers, frustrated by restrictions on which doctors they could see
and which treatments they could get, fueled a well-publicized
backlash. That groundswell led employers to choose less restrictive
plans. But that loosened the grip on costs.

Meanwhile, hospitals and doctor groups, drained by low reimbursements
from HMOs and government payers such as Medi-Cal, started going
bankrupt. To protect themselves, they banded together to form larger
networks with greater bargaining power.

As the cost of care started rising rapidly again in the late 1990s,
insurers rushed to catch up by raising premiums. The economy was
booming. Employers, scrambling to keep workers, swallowed those
increases.

Then the economy tanked. Costs companies could live with in good times
turned into heavy loads in bad times.

In the wake of these shifts, coverage offered to working Americans
eroded. Premiums and out-of-pocket costs increased. In California,
workers paid 30 percent of their premium costs in 2003, up from 26
percent just a year earlier, according to the Kaiser Foundation.

Now, some health plans are returning to the unpopular policies they
adopted in the heyday of managed care. Techniques such as reviewing
inpatient hospital services to shorten stays, steering members toward
low-cost providers and scrutinizing whether specialists are necessary
are becoming more common, according to a study published in August in
the journal Health Affairs.

The United States has a health care system unique in the developed
world. Costs are high, employers pay most of the bills and tens of
millions have no coverage. Polls show that most Americans believe the
system doesn't work and want universal coverage.

Some advocates argue that the only way to achieve universal coverage
would be to replace the American health care system with a system in
which the government pays the bills, a so-called single-payer system.
Other experts argue that universal coverage could be achieved without
a government takeover.

Californians in November will vote on a referendum that would require
employers over a certain size to provide coverage. But there is
nothing on the horizon that would move the country toward universal,
affordable care.

In that stark context, employers are scrambling to cope. Increasingly,
they are opting for health care plans that make the patient more
accountable for health decisions and give them incentives to choose
the most cost- efficient options.

Christopher Renz, a principal in Mercer's San Francisco offices, said
the stakes are high: "If the employers don't solve it, the government
is going to have to provide a solution, and most people in the private
sectors don't want that."

What's driving medical costs?

-- Medical technology: New medical devices and the latest
pharmaceuticals are pushing prices up fast.

-- Litigation: The rising cost of malpractice insurance is also
increasing the practice of defensive medicine.

-- Uninsured: The growing number of uninsured is an increasing burden
on the medical establishment.

-- Administrative costs: Health bureaucracy consumes money that does
not go directly to patient care.

--------------------------------------------------------------------------------
Percentage of all workers receiving health coverage through their
employers
2001: 65%

2004: 61%.

Average annual amount workers contributed for individual coverage

2001: $360

2004: $558.

Percentage of large firms offering retiree health coverage

1988: 66%

2004: 36%.

Number of uninsured Americans working full time

2001: 19 million

2003: 20.6 million.

Amount workers contributed for family coverage

2001: $1,788

2004: $2,661.

Amount premiums for family coverage have increased

Since 2000: 59%.

Percentage of insured Americans covered under an HMO

2003: 24.6%.

Percentage of Californians covered under an HMO

2003: 48.5%.

Percentage drug spending increased

2002: 15.3%.

Sales of drugs sold in U.S. retail pharmacies

Year ending December 2001: $132 billion

Year ending July 2004: $170 billion.

Sources: The Henry J. Kaiser Family Foundation, U.S. Census, IMS
Health.

FIVE-PART SERIES

This week The Chronicle is examining in depth the causes, effects and
responses to rising health care costs in America.

The series continues Tuesday through Friday in the Business section.

E-mail Victoria Colliver at vcolliver@sfchronicle.com.

Page A - 1
URL: http://sfgate.com/cgi-bin/article.c...MNGII96CVP1.DTL

--------------------------------------------------------------------------------
©2004 San Francisco Chronicle | Feedback | FAQ

Christian Williamson

2004-10-12, 7:06 am

Abel Malcolm wrote:
> It's a long article (attached below), but the jist of it is this...in
> America, we spend more than twice as much on health care than people
> spend on health care in other industrialized democracies, such as
> Canada and Japan.

We also spend billions on defending nations with large socialist welfare
programs. Or is Canada ready to lead the War on Terror?

How about the Middle East conflict? Is Canada ready to step in as an
interlocutor?

We have a stronger economy than Canada. Look at the currency devaluation
that has occurred over the years because of Canada's reliance on natural
resources for all their social welfare. When the price of resources
drops, so does Canada's wealth.

> In Canada, for example, their total monetary
> expenditure on health care is 60% less per person than we spend here
> in America, and they are still healthier and live longer than we do
> here. The statistic is even more stark in Japan, where they have one
> of the healthiest populations in the world, and where health care
> costs are among the lowest in the world.
>
> The difference is in governmental regulations, there are very few
> here, and therefore the system has run amok, to the detriment of the
> American people. In our country, the number of people with no health
> insurance has risen to 45 million already; the numbers and percent of
> un-insured just keeps rising every year.
>
> Drugs represent the fastest growing part of the health care bill, with
> Americans paying the world's highest prices for medication.
> Pharmaceutical companies, which are among the most profitable of
> industries, are also heavily subsidized by the American tax payer, the
> Pharmaceuticals say that they need these subsidies in order to conduct
> vital research & development, yet they spend more than twice as much
> on administration & advertising than they spend on research &
> development.
>
> Experts say that health care costs have spiraled upwards because the
> American health care system is fragmented, with thousands of insurers,
> hospital groups, physician groups, benefit administrators, medical
> equipment providers, drugmakers and health care systems, all of them
> combined along the way in trying to get the biggest cut of dollars for
> themselves. A Harvard Medical School report recently found out that
> of the hundreds of billions spent on health care each year, about
> one-third of that money does not go into health care at all but into
> feeding the bureaucracy, essentially the administrative costs of the
> insurers, hospitals, doctors, nursing homes, other institutions,
> e.t.c.
>
> Experts and advocates make a compelling argument that the only way to
> achieve universal coverage is to have a national health insurance
> program modeled after the "single payer system" that the rest of the
> world has, this would cut the one-third of the cost that is associated
> with the overwhelmingly costly bureaucracy.
>
> Further compounding the problem is that a significant contributor to
> the rise to the cost health care is the providing of care to the
> rising number of Americans who are not insured, this is resulting in
> health care costs going up even more, as the rest of us foot the bill
> for those who are uninsured and who are therefore unable to pay health
> care.
>
> In the rest of the world, medical costs are kept down by government
> regulations, but that doesn't exist in America, because the very
> powerful health care groups have been extremely effective at lobbying
> our government to limit regulations that would benefit the consumers.
>
> The United States has a health care system that is unique in the
> industrialized world. Costs are high, employers pay most of the
> bills, and tens of millions have no coverage. Polls show that most
> Americans believe that the system does not work and want universal
> coverage.
>
> Abel Malcolm
>
> From: http://www.sfgate.com/cgi-bin/artic...MNGII96CVP1.DTL
> _______________
>
> IN CRITICAL CONDITION: HEALTH CARE IN AMERICA
>
> How the health care system is failing -- and why it's hard to fix
> - Victoria Colliver, Chronicle Staff Writer
> Monday, October 11, 2004
>
>
>
> Some 40 years after the enactment of Medicare and Medicaid and more
> than a decade after the Clinton administration failed in its bid to
> extend coverage to all Americans, the nation's system of funding
> health care is on the verge of breaking down.
>
> Employers, consumers and governments at every level are straining
> under the burden of a health care bill that is growing at a pace five
> or six times the rate of inflation.
>
> Businesses, squeezed by soaring health insurance costs, are passing an
> increasing share of the price tag to their workers. That's forcing
> employees to dig ever deeper into their pockets, prompting millions to
> forgo coverage altogether and gamble that their families will stay
> healthy.
>
> The public health care system is overwhelmed by the country's 45
> million uninsured who turn to hospital emergency rooms for even
> routine care. And Medicare -- the crown jewel of government health
> programs -- is projected to run out of funds by 2019 at the current
> rate of expenditure growth.
>
> The soaring cost of health care has emerged as one of the top issues
> in the race for the White House. Both President Bush and Sen. John
> Kerry, D-Mass., are offering programs to make health coverage more
> affordable and reach more of the uninsured. (See accompanying
> article.) But experts say the fixes proposed by the two candidates
> would not fundamentally alter the dynamics that are putting health
> care costs out of reach.
>
> "When we have faced these so-called crises in health care before --
> health care cost spikes, an increase in the uninsured -- there was
> always a sense that there was some big solution coming," said Drew
> Altman, president of the Henry J. Kaiser Family Foundation. "What's
> different now is there is no sense there is a big reform idea out
> there that might save us."
>
> Consider these symptoms of a system on the critical list:
>
> -- Employer health care insurance premiums jumped an average of 11.2
> percent in 2004, lower than the 13.9 percent reported last year but
> still more than five times the rate of inflation, according to a
> survey by the Kaiser Foundation and the Health Research and
> Educational Trust.
>
> -- The United States spends nearly $5,000 per person on health care --
> more than twice the amount of some other industrialized countries. But
> it's not making us live any longer. Canada, for example, spends about
> 60 percent less per person than the United States but has longer life
> expectancies.
>
> -- The number of people without health coverage rose to more than 45
> million nationwide in 2003, 15.6 percent of the population compared to
> 15.2 percent in 2002. California is home to the greatest number, with
> 6.4 million uninsured, or 18.2 percent of the population.
>
> -- Battles over health care costs have moved to the top of labor-
> management agenda. A 139-day strike by Southern California grocery
> workers was resolved this year when union negotiators reluctantly
> agreed to a contract that requires new workers to wait 12 months
> before getting individual coverage and 30 months before family
> coverage kicks in.
>
> -- The California Public Employees' Retirement System, one of the
> country's largest buyers of health care, accepted health maintenance
> organization rate increases of 25 percent in 2003 and 18 percent in
> 2004 before pushing back by dropping costlier hospitals from its 2005
> network.
>
> As insurance costs climb, employers find themselves forced to make
> harsh choices about the kinds of coverage to offer.
>
> At Cosco Marking, a Seattle firm that owns the San Francisco Rubber
> Stamp Co., premiums on a health plan covering 60 employees have gone
> up between 11 percent and 15 percent during each of the last five
> years. To save money last year, the company added a $750 deductible
> and raised co-payments, making insurance so expensive that six workers
> who were their families' sole breadwinners opted not to take it.
>
> "When I look at the plan I have now versus the plan I offered five
> years ago, it's much worse," said Rick Roddis, Cosco's general
> manager.
>
> Those who deliver care say the system is held together with gauze that
> is getting more frayed every day.
>
> At Marin General Hospital in Greenbrae, Dr. Myles Riner, an emergency
> room physician, is seeing an increasing number of uninsured and
> underinsured patients, or people with such high deductibles that they
> put off seeking care until they have a serious health condition.
>
> "The system is not going to fail like a volcano blowing its top off or
> the Golden Gate Bridge crashing into the ocean," he said. "What's
> going to happen here (in America) is not a 9/11. It's going to be a
> war of attrition where patient care falls apart one patient at a
> time."
>
> Consumers, like Robert Bushansky, 60, who ran his own cleaning
> services for 26 years, never expected that he or his loved ones would
> be without health care. After his business failed in part because of
> his ulcerative colitis, Bushansky got Medicare disability coverage.
> But his wife, who continues to work, is uninsured because her employer
> doesn't offer health coverage.
>
> "We tout ourselves as being the richest, the biggest economy and being
> the best country in the world and here we have 45 million without
> health insurance. It's a contradiction in terms," said Bushansky, who
> lives in the North Coast town of Elk.
>
> In 2004, premium increases haven't been as big as they were last year
> because insurers are already enjoying hefty profits from price
> increases they imposed in previous years. In addition, employers are
> buying cheaper and less comprehensive plans and passing more costs on
> to their workers. Consumers, now feeling more of the pain in their
> pocketbooks, appear to be using fewer discretionary health services.
>
> But such trends do not significantly stem the underlying pressures
> that are pushing health care costs up at double-digit rates.
>
> Why are medical costs rising so fast when overall inflation is
> relatively tame?
>
> "It is hard to boil it down to one bogeyman," said Dr. Mark Smith,
> president of the California HealthCare Foundation, a nonprofit health
> research group based in Oakland.
>
> New medical technologies -- everything from faster CT scans and drug-
> coated stents to targeted chemotherapies -- may be responsible for as
> much as 50 percent of U.S. medical cost growth, according to some
> health economists.
>
> Drugs represent the fastest growing part of the health care bill, with
> Americans paying the world's highest prices for medication. While the
> industry says it needs to charge high prices to finance research and
> development, the largest pharmaceutical companies in 2002 spent 14
> percent of their revenues on research and development while devoting
> 31 percent to marketing and administration.
>
> Laurence Baker, an associate professor of health policy and research
> at Stanford University, doesn't see this changing any time soon.
> "Really reducing health care costs will mean reducing what we do for
> patients," he said.
>
> Experts say costs are also rising fast because the American health
> care system is fragmented, with thousands of insurers, hospital
> groups, physicians groups, benefit administrators, medical equipment
> providers, drugmakers and health care unions all trying to get the
> biggest cut of the health care dollar they can.
>
> The combination of that quest for more revenue and the lack of any
> outside restraint -- in a market in which consumers frequently have
> little choice about buying services -- is a recipe for fast-rising
> costs.
>
> Many health care corporations, including insurers, hospital networks
> and large medical groups, have posted significant earnings gains in
> recent years. WellPoint Health Networks Inc. of Thousand Oaks, which
> Indiana's Anthem Inc. is trying to buy to create the country's largest
> health plan, reported a 34 percent increase in earnings for the second
> quarter compared with the same period in 2003. Nonprofit Sutter
> Health, which has 26 hospitals in Northern California, saw its income
> increase nearly 64 percent from 2002 to 2003.
>
> In many countries, medical costs are kept down by government
> regulation. But the United States lacks meaningful health care price
> controls and powerful health care groups lobby to limit government
> regulation.
>
> Meanwhile, lawsuits against health care institutions and
> practitioners, many initiated by class-action attorneys looking for
> big payouts, drain cash from the system. In many states, high
> malpractice insurance costs have caused shortages in certain
> specialties. Some argue the practice of "defensive" medicine -- the
> ordering of additional tests or procedures to avoid litigation -- has
> added to the health care dollar.
>
> There are other factors pushing up costs:
>
> -- A big part of U.S. health care expenditures have little to do with
> patient care. Harvard Medical School researchers reported earlier this
> year that the United States spends $399 billion per year on health
> care bureaucracy, essentially the administrative costs of insurers,
> hospitals, doctors, nursing homes and other institutions. In
> California, $45 billion of the $163 billion spent on health care, or
> 28 percent, went to administration.
>
> -- Doctors are becoming more aggressive in administering treatment. A
> study published in the August journal of Health Affairs found the top
> 15 medical conditions accounted for about half the overall growth in
> spending, with most of the costs associated with a rise in treatment
> rates rather than just the cost per treatment going up.
>
> -- Providing care to the uninsured takes up a significant share of the
> health care dollar.
>
> California has some cost drivers that are particular to the state.
> Hospitals are required to seismically retrofit their facilities and
> maintain certain nursing staff levels. In addition, hospital and
> medical group consolidations -- especially in Northern California --
> have created powerful provider groups that can command higher
> reimbursements and all-or- nothing contracts from payers.
>
> When health experts look at what's coming down the pike -- aging Baby
> Boomers, growing obesity and other conditions that boost demand for
> health care -- things go from bad to worse.
>
> The last time the nation went through a period of soaring health care
> costs, the response was the adoption of a new way of administering
> treatment - - a system that went under the name of managed care and
> was delivered through a new type of institution, the health
> maintenance organization.
>
> The HMO kept a tight reign on expenses by changing the way doctors and
> hospitals were reimbursed for their services and requiring
> authorizations before covering certain treatments and services.
>
> One of the principal missions of HMOs was cost control and this they
> did with a vengeance. Horror stories were legion, including people
> denied essential treatments by administrators looking to save money.
> Consumers, frustrated by restrictions on which doctors they could see
> and which treatments they could get, fueled a well-publicized
> backlash. That groundswell led employers to choose less restrictive
> plans. But that loosened the grip on costs.
>
> Meanwhile, hospitals and doctor groups, drained by low reimbursements
> from HMOs and government payers such as Medi-Cal, started going
> bankrupt. To protect themselves, they banded together to form larger
> networks with greater bargaining power.
>
> As the cost of care started rising rapidly again in the late 1990s,
> insurers rushed to catch up by raising premiums. The economy was
> booming. Employers, scrambling to keep workers, swallowed those
> increases.
>
> Then the economy tanked. Costs companies could live with in good times
> turned into heavy loads in bad times.
>
> In the wake of these shifts, coverage offered to working Americans
> eroded. Premiums and out-of-pocket costs increased. In California,
> workers paid 30 percent of their premium costs in 2003, up from 26
> percent just a year earlier, according to the Kaiser Foundation.
>
> Now, some health plans are returning to the unpopular policies they
> adopted in the heyday of managed care. Techniques such as reviewing
> inpatient hospital services to shorten stays, steering members toward
> low-cost providers and scrutinizing whether specialists are necessary
> are becoming more common, according to a study published in August in
> the journal Health Affairs.
>
> The United States has a health care system unique in the developed
> world. Costs are high, employers pay most of the bills and tens of
> millions have no coverage. Polls show that most Americans believe the
> system doesn't work and want universal coverage.
>
> Some advocates argue that the only way to achieve universal coverage
> would be to replace the American health care system with a system in
> which the government pays the bills, a so-called single-payer system.
> Other experts argue that universal coverage could be achieved without
> a government takeover.
>
> Californians in November will vote on a referendum that would require
> employers over a certain size to provide coverage. But there is
> nothing on the horizon that would move the country toward universal,
> affordable care.
>
> In that stark context, employers are scrambling to cope. Increasingly,
> they are opting for health care plans that make the patient more
> accountable for health decisions and give them incentives to choose
> the most cost- efficient options.
>
> Christopher Renz, a principal in Mercer's San Francisco offices, said
> the stakes are high: "If the employers don't solve it, the government
> is going to have to provide a solution, and most people in the private
> sectors don't want that."
>
>
> What's driving medical costs?
>
> -- Medical technology: New medical devices and the latest
> pharmaceuticals are pushing prices up fast.
>
> -- Litigation: The rising cost of malpractice insurance is also
> increasing the practice of defensive medicine.
>
> -- Uninsured: The growing number of uninsured is an increasing burden
> on the medical establishment.
>
> -- Administrative costs: Health bureaucracy consumes money that does
> not go directly to patient care.
>
>
>
> --------------------------------------------------------------------------------
> Percentage of all workers receiving health coverage through their
> employers
> 2001: 65%
>
> 2004: 61%.
>
> Average annual amount workers contributed for individual coverage
>
> 2001: $360
>
> 2004: $558.
>
> Percentage of large firms offering retiree health coverage
>
> 1988: 66%
>
> 2004: 36%.
>
> Number of uninsured Americans working full time
>
> 2001: 19 million
>
> 2003: 20.6 million.
>
> Amount workers contributed for family coverage
>
> 2001: $1,788
>
> 2004: $2,661.
>
> Amount premiums for family coverage have increased
>
> Since 2000: 59%.
>
> Percentage of insured Americans covered under an HMO
>
> 2003: 24.6%.
>
> Percentage of Californians covered under an HMO
>
> 2003: 48.5%.
>
> Percentage drug spending increased
>
> 2002: 15.3%.
>
> Sales of drugs sold in U.S. retail pharmacies
>
> Year ending December 2001: $132 billion
>
> Year ending July 2004: $170 billion.
>
> Sources: The Henry J. Kaiser Family Foundation, U.S. Census, IMS
> Health.
>
> FIVE-PART SERIES
>
> This week The Chronicle is examining in depth the causes, effects and
> responses to rising health care costs in America.
>
> The series continues Tuesday through Friday in the Business section.
>
> E-mail Victoria Colliver at vcolliver@sfchronicle.com.
>
> Page A - 1
> URL: http://sfgate.com/cgi-bin/article.c...MNGII96CVP1.DTL
>
>
> --------------------------------------------------------------------------------
> ©2004 San Francisco Chronicle | Feedback | FAQ

LastDance

2004-10-12, 7:06 am

We don't have Health Care = We have Managed Care = BIG DIFFERENCE

We have the most expensive Managed Care System and it is worse then the
Health Care in Canada or Japan.

"Abel Malcolm" <AbelMalcolm@hotmail.com> wrote in message
news:f1fd22d4.0410120203.34a7a8a1@posting.google.com...
> It's a long article (attached below), but the jist of it is this...in
> America, we spend more than twice as much on health care than people
> spend on health care in other industrialized democracies, such as
> Canada and Japan. In Canada, for example, their total monetary
> expenditure on health care is 60% less per person than we spend here
> in America, and they are still healthier and live longer than we do
> here. The statistic is even more stark in Japan, where they have one
> of the healthiest populations in the world, and where health care
> costs are among the lowest in the world.
>
> The difference is in governmental regulations, there are very few
> here, and therefore the system has run amok, to the detriment of the
> American people. In our country, the number of people with no health
> insurance has risen to 45 million already; the numbers and percent of
> un-insured just keeps rising every year.
>
> Drugs represent the fastest growing part of the health care bill, with
> Americans paying the world's highest prices for medication.
> Pharmaceutical companies, which are among the most profitable of
> industries, are also heavily subsidized by the American tax payer, the
> Pharmaceuticals say that they need these subsidies in order to conduct
> vital research & development, yet they spend more than twice as much
> on administration & advertising than they spend on research &
> development.
>
> Experts say that health care costs have spiraled upwards because the
> American health care system is fragmented, with thousands of insurers,
> hospital groups, physician groups, benefit administrators, medical
> equipment providers, drugmakers and health care systems, all of them
> combined along the way in trying to get the biggest cut of dollars for
> themselves. A Harvard Medical School report recently found out that
> of the hundreds of billions spent on health care each year, about
> one-third of that money does not go into health care at all but into
> feeding the bureaucracy, essentially the administrative costs of the
> insurers, hospitals, doctors, nursing homes, other institutions,
> e.t.c.
>
> Experts and advocates make a compelling argument that the only way to
> achieve universal coverage is to have a national health insurance
> program modeled after the "single payer system" that the rest of the
> world has, this would cut the one-third of the cost that is associated
> with the overwhelmingly costly bureaucracy.
>
> Further compounding the problem is that a significant contributor to
> the rise to the cost health care is the providing of care to the
> rising number of Americans who are not insured, this is resulting in
> health care costs going up even more, as the rest of us foot the bill
> for those who are uninsured and who are therefore unable to pay health
> care.
>
> In the rest of the world, medical costs are kept down by government
> regulations, but that doesn't exist in America, because the very
> powerful health care groups have been extremely effective at lobbying
> our government to limit regulations that would benefit the consumers.
>
> The United States has a health care system that is unique in the
> industrialized world. Costs are high, employers pay most of the
> bills, and tens of millions have no coverage. Polls show that most
> Americans believe that the system does not work and want universal
> coverage.
>
> Abel Malcolm
>
> From:
> http://www.sfgate.com/cgi-bin/artic...MNGII96CVP1.DTL
> _______________
>
> IN CRITICAL CONDITION: HEALTH CARE IN AMERICA
>
> How the health care system is failing -- and why it's hard to fix
> - Victoria Colliver, Chronicle Staff Writer
> Monday, October 11, 2004
>
>
>
> Some 40 years after the enactment of Medicare and Medicaid and more
> than a decade after the Clinton administration failed in its bid to
> extend coverage to all Americans, the nation's system of funding
> health care is on the verge of breaking down.
>
> Employers, consumers and governments at every level are straining
> under the burden of a health care bill that is growing at a pace five
> or six times the rate of inflation.
>
> Businesses, squeezed by soaring health insurance costs, are passing an
> increasing share of the price tag to their workers. That's forcing
> employees to dig ever deeper into their pockets, prompting millions to
> forgo coverage altogether and gamble that their families will stay
> healthy.
>
> The public health care system is overwhelmed by the country's 45
> million uninsured who turn to hospital emergency rooms for even
> routine care. And Medicare -- the crown jewel of government health
> programs -- is projected to run out of funds by 2019 at the current
> rate of expenditure growth.
>
> The soaring cost of health care has emerged as one of the top issues
> in the race for the White House. Both President Bush and Sen. John
> Kerry, D-Mass., are offering programs to make health coverage more
> affordable and reach more of the uninsured. (See accompanying
> article.) But experts say the fixes proposed by the two candidates
> would not fundamentally alter the dynamics that are putting health
> care costs out of reach.
>
> "When we have faced these so-called crises in health care before --
> health care cost spikes, an increase in the uninsured -- there was
> always a sense that there was some big solution coming," said Drew
> Altman, president of the Henry J. Kaiser Family Foundation. "What's
> different now is there is no sense there is a big reform idea out
> there that might save us."
>
> Consider these symptoms of a system on the critical list:
>
> -- Employer health care insurance premiums jumped an average of 11.2
> percent in 2004, lower than the 13.9 percent reported last year but
> still more than five times the rate of inflation, according to a
> survey by the Kaiser Foundation and the Health Research and
> Educational Trust.
>
> -- The United States spends nearly $5,000 per person on health care --
> more than twice the amount of some other industrialized countries. But
> it's not making us live any longer. Canada, for example, spends about
> 60 percent less per person than the United States but has longer life
> expectancies.
>
> -- The number of people without health coverage rose to more than 45
> million nationwide in 2003, 15.6 percent of the population compared to
> 15.2 percent in 2002. California is home to the greatest number, with
> 6.4 million uninsured, or 18.2 percent of the population.
>
> -- Battles over health care costs have moved to the top of labor-
> management agenda. A 139-day strike by Southern California grocery
> workers was resolved this year when union negotiators reluctantly
> agreed to a contract that requires new workers to wait 12 months
> before getting individual coverage and 30 months before family
> coverage kicks in.
>
> -- The California Public Employees' Retirement System, one of the
> country's largest buyers of health care, accepted health maintenance
> organization rate increases of 25 percent in 2003 and 18 percent in
> 2004 before pushing back by dropping costlier hospitals from its 2005
> network.
>
> As insurance costs climb, employers find themselves forced to make
> harsh choices about the kinds of coverage to offer.
>
> At Cosco Marking, a Seattle firm that owns the San Francisco Rubber
> Stamp Co., premiums on a health plan covering 60 employees have gone
> up between 11 percent and 15 percent during each of the last five
> years. To save money last year, the company added a $750 deductible
> and raised co-payments, making insurance so expensive that six workers
> who were their families' sole breadwinners opted not to take it.
>
> "When I look at the plan I have now versus the plan I offered five
> years ago, it's much worse," said Rick Roddis, Cosco's general
> manager.
>
> Those who deliver care say the system is held together with gauze that
> is getting more frayed every day.
>
> At Marin General Hospital in Greenbrae, Dr. Myles Riner, an emergency
> room physician, is seeing an increasing number of uninsured and
> underinsured patients, or people with such high deductibles that they
> put off seeking care until they have a serious health condition.
>
> "The system is not going to fail like a volcano blowing its top off or
> the Golden Gate Bridge crashing into the ocean," he said. "What's
> going to happen here (in America) is not a 9/11. It's going to be a
> war of attrition where patient care falls apart one patient at a
> time."
>
> Consumers, like Robert Bushansky, 60, who ran his own cleaning
> services for 26 years, never expected that he or his loved ones would
> be without health care. After his business failed in part because of
> his ulcerative colitis, Bushansky got Medicare disability coverage.
> But his wife, who continues to work, is uninsured because her employer
> doesn't offer health coverage.
>
> "We tout ourselves as being the richest, the biggest economy and being
> the best country in the world and here we have 45 million without
> health insurance. It's a contradiction in terms," said Bushansky, who
> lives in the North Coast town of Elk.
>
> In 2004, premium increases haven't been as big as they were last year
> because insurers are already enjoying hefty profits from price
> increases they imposed in previous years. In addition, employers are
> buying cheaper and less comprehensive plans and passing more costs on
> to their workers. Consumers, now feeling more of the pain in their
> pocketbooks, appear to be using fewer discretionary health services.
>
> But such trends do not significantly stem the underlying pressures
> that are pushing health care costs up at double-digit rates.
>
> Why are medical costs rising so fast when overall inflation is
> relatively tame?
>
> "It is hard to boil it down to one bogeyman," said Dr. Mark Smith,
> president of the California HealthCare Foundation, a nonprofit health
> research group based in Oakland.
>
> New medical technologies -- everything from faster CT scans and drug-
> coated stents to targeted chemotherapies -- may be responsible for as
> much as 50 percent of U.S. medical cost growth, according to some
> health economists.
>
> Drugs represent the fastest growing part of the health care bill, with
> Americans paying the world's highest prices for medication. While the
> industry says it needs to charge high prices to finance research and
> development, the largest pharmaceutical companies in 2002 spent 14
> percent of their revenues on research and development while devoting
> 31 percent to marketing and administration.
>
> Laurence Baker, an associate professor of health policy and research
> at Stanford University, doesn't see this changing any time soon.
> "Really reducing health care costs will mean reducing what we do for
> patients," he said.
>
> Experts say costs are also rising fast because the American health
> care system is fragmented, with thousands of insurers, hospital
> groups, physicians groups, benefit administrators, medical equipment
> providers, drugmakers and health care unions all trying to get the
> biggest cut of the health care dollar they can.
>
> The combination of that quest for more revenue and the lack of any
> outside restraint -- in a market in which consumers frequently have
> little choice about buying services -- is a recipe for fast-rising
> costs.
>
> Many health care corporations, including insurers, hospital networks
> and large medical groups, have posted significant earnings gains in
> recent years. WellPoint Health Networks Inc. of Thousand Oaks, which
> Indiana's Anthem Inc. is trying to buy to create the country's largest
> health plan, reported a 34 percent increase in earnings for the second
> quarter compared with the same period in 2003. Nonprofit Sutter
> Health, which has 26 hospitals in Northern California, saw its income
> increase nearly 64 percent from 2002 to 2003.
>
> In many countries, medical costs are kept down by government
> regulation. But the United States lacks meaningful health care price
> controls and powerful health care groups lobby to limit government
> regulation.
>
> Meanwhile, lawsuits against health care institutions and
> practitioners, many initiated by class-action attorneys looking for
> big payouts, drain cash from the system. In many states, high
> malpractice insurance costs have caused shortages in certain
> specialties. Some argue the practice of "defensive" medicine -- the
> ordering of additional tests or procedures to avoid litigation -- has
> added to the health care dollar.
>
> There are other factors pushing up costs:
>
> -- A big part of U.S. health care expenditures have little to do with
> patient care. Harvard Medical School researchers reported earlier this
> year that the United States spends $399 billion per year on health
> care bureaucracy, essentially the administrative costs of insurers,
> hospitals, doctors, nursing homes and other institutions. In
> California, $45 billion of the $163 billion spent on health care, or
> 28 percent, went to administration.
>
> -- Doctors are becoming more aggressive in administering treatment. A
> study published in the August journal of Health Affairs found the top
> 15 medical conditions accounted for about half the overall growth in
> spending, with most of the costs associated with a rise in treatment
> rates rather than just the cost per treatment going up.
>
> -- Providing care to the uninsured takes up a significant share of the
> health care dollar.
>
> California has some cost drivers that are particular to the state.
> Hospitals are required to seismically retrofit their facilities and
> maintain certain nursing staff levels. In addition, hospital and
> medical group consolidations -- especially in Northern California --
> have created powerful provider groups that can command higher
> reimbursements and all-or- nothing contracts from payers.
>
> When health experts look at what's coming down the pike -- aging Baby
> Boomers, growing obesity and other conditions that boost demand for
> health care -- things go from bad to worse.
>
> The last time the nation went through a period of soaring health care
> costs, the response was the adoption of a new way of administering
> treatment - - a system that went under the name of managed care and
> was delivered through a new type of institution, the health
> maintenance organization.
>
> The HMO kept a tight reign on expenses by changing the way doctors and
> hospitals were reimbursed for their services and requiring
> authorizations before covering certain treatments and services.
>
> One of the principal missions of HMOs was cost control and this they
> did with a vengeance. Horror stories were legion, including people
> denied essential treatments by administrators looking to save money.
> Consumers, frustrated by restrictions on which doctors they could see
> and which treatments they could get, fueled a well-publicized
> backlash. That groundswell led employers to choose less restrictive
> plans. But that loosened the grip on costs.
>
> Meanwhile, hospitals and doctor groups, drained by low reimbursements
> from HMOs and government payers such as Medi-Cal, started going
> bankrupt. To protect themselves, they banded together to form larger
> networks with greater bargaining power.
>
> As the cost of care started rising rapidly again in the late 1990s,
> insurers rushed to catch up by raising premiums. The economy was
> booming. Employers, scrambling to keep workers, swallowed those
> increases.
>
> Then the economy tanked. Costs companies could live with in good times
> turned into heavy loads in bad times.
>
> In the wake of these shifts, coverage offered to working Americans
> eroded. Premiums and out-of-pocket costs increased. In California,
> workers paid 30 percent of their premium costs in 2003, up from 26
> percent just a year earlier, according to the Kaiser Foundation.
>
> Now, some health plans are returning to the unpopular policies they
> adopted in the heyday of managed care. Techniques such as reviewing
> inpatient hospital services to shorten stays, steering members toward
> low-cost providers and scrutinizing whether specialists are necessary
> are becoming more common, according to a study published in August in
> the journal Health Affairs.
>
> The United States has a health care system unique in the developed
> world. Costs are high, employers pay most of the bills and tens of
> millions have no coverage. Polls show that most Americans believe the
> system doesn't work and want universal coverage.
>
> Some advocates argue that the only way to achieve universal coverage
> would be to replace the American health care system with a system in
> which the government pays the bills, a so-called single-payer system.
> Other experts argue that universal coverage could be achieved without
> a government takeover.
>
> Californians in November will vote on a referendum that would require
> employers over a certain size to provide coverage. But there is
> nothing on the horizon that would move the country toward universal,
> affordable care.
>
> In that stark context, employers are scrambling to cope. Increasingly,
> they are opting for health care plans that make the patient more
> accountable for health decisions and give them incentives to choose
> the most cost- efficient options.
>
> Christopher Renz, a principal in Mercer's San Francisco offices, said
> the stakes are high: "If the employers don't solve it, the government
> is going to have to provide a solution, and most people in the private
> sectors don't want that."
>
>
> What's driving medical costs?
>
> -- Medical technology: New medical devices and the latest
> pharmaceuticals are pushing prices up fast.
>
> -- Litigation: The rising cost of malpractice insurance is also
> increasing the practice of defensive medicine.
>
> -- Uninsured: The growing number of uninsured is an increasing burden
> on the medical establishment.
>
> -- Administrative costs: Health bureaucracy consumes money that does
> not go directly to patient care.
>
>
>
> --------------------------------------------------------------------------------
> Percentage of all workers receiving health coverage through their
> employers
> 2001: 65%
>
> 2004: 61%.
>
> Average annual amount workers contributed for individual coverage
>
> 2001: $360
>
> 2004: $558.
>
> Percentage of large firms offering retiree health coverage
>
> 1988: 66%
>
> 2004: 36%.
>
> Number of uninsured Americans working full time
>
> 2001: 19 million
>
> 2003: 20.6 million.
>
> Amount workers contributed for family coverage
>
> 2001: $1,788
>
> 2004: $2,661.
>
> Amount premiums for family coverage have increased
>
> Since 2000: 59%.
>
> Percentage of insured Americans covered under an HMO
>
> 2003: 24.6%.
>
> Percentage of Californians covered under an HMO
>
> 2003: 48.5%.
>
> Percentage drug spending increased
>
> 2002: 15.3%.
>
> Sales of drugs sold in U.S. retail pharmacies
>
> Year ending December 2001: $132 billion
>
> Year ending July 2004: $170 billion.
>
> Sources: The Henry J. Kaiser Family Foundation, U.S. Census, IMS
> Health.
>
> FIVE-PART SERIES
>
> This week The Chronicle is examining in depth the causes, effects and
> responses to rising health care costs in America.
>
> The series continues Tuesday through Friday in the Business section.
>
> E-mail Victoria Colliver at vcolliver@sfchronicle.com.
>
> Page A - 1
> URL:
> http://sfgate.com/cgi-bin/article.c...MNGII96CVP1.DTL
>
>
> --------------------------------------------------------------------------------
> ©2004 San Francisco Chronicle | Feedback | FAQ

Robert

2004-10-12, 7:06 am

Christian Williamson wrote:
> Abel Malcolm wrote:
>
>
>
> We also spend billions on defending nations with large socialist welfare
> programs. Or is Canada ready to lead the War on Terror?
>

I was just in Canada.

I felt very, very safe.

Canada has never started a stupid war, never invaded another country to
gain land.

They are not a target of terrorism even though they have more freedom
than we do.

Marvin The Paranoid Android

2004-10-12, 11:06 am

"Robert" <wayne_s_noches@yahoo.com> wrote in message
news:vcPad.3696$wV4.1641@trndny03...
>
>
> Christian Williamson wrote:
>
> I was just in Canada.
>
> I felt very, very safe.
>
> Canada has never started a stupid war, never invaded another country to
> gain land.
>
> They are not a target of terrorism even though they have more freedom
> than we do.
>

Thanks.

---
Outgoing mail is certified Virus Free.
Checked by AVG anti-virus system (http://www.grisoft.com).
Version: 6.0.771 / Virus Database: 518 - Release Date: 9/28/04

AbelMalcolm@webtv.net

2004-10-16, 7:06 pm

>wayne_s_noches@yahoo.com wrote:

[vbcol=seagreen]
[vbcol=seagreen]
[vbcol=seagreen]
>We also spend billions on defending
>nations with large socialist welfare
>programs. Or is Canada ready to lead the
>War on Terror?

>I was just in Canada.
>I felt very, very safe.
>Canada has never started a stupid war,
>never invaded another country to gain
>land.
>They are not a target of terrorism even
>though they have more freedom than we
>do.

Can you believe that nutjob? With that crack about Canada he manages to
change the subject away from health care and tries to pretend that the
Shrub is leading a war on terror.

If anything, Shrub is creating terrorism where it never existed before.
And how is he leading the war on terror? By letting bin Laden get away
and then grabbing the oil fields of Iraq. This is not about fighting
terror, this is about sheer greed and deception.

Abel Malcolm

How Many Lies Can You Take? Vote Democrat in 2004

<><><><><><><><><><><><><><><><>

Educate yourself & go to these links:

www.moveon.org & www.ndol.org & www.alternet.org &
www.americanprogress.org & www.buzzflash.com & www.democracynow.org &
http://ww11.e-tractions.com/truemajority/run/oreo &
http://www.nbc13.com/politics/3820534/detail.html

AbelMalcolm@webtv.net

2004-10-19, 11:06 am

AbelMalcolm@webtv.net

2004-10-22, 7:06 pm