Obama still wants public option for health

CINCINNATI — After months of angry protests and Republican pushback on his plans to reform the health care system, President Obama found a safe port on the banks of the Ohio River Monday to make his case.

Nearly 5,000 supporters most of the Cincinnati-area union members and their families roared their approval Monday afternoon when the president, speaking at Riverbend’s PNC Pavilion, said it was time to end the bickering and pass a health care plan that would give “security and stability” to those with health insurance and a chance to buy affordable insurance for those who don’t.

“It is time to put aside partisanship; time to stop saying things that are not true; time to pass health care reform this year,” the president said in his 36-minute speech, bringing the labor crowd to its feet in a deafening cheer.

Obama’s speech came two days before he is scheduled to address a joint session of Congress on the progress of health care reform, where he is expected to state his bottom-line position on the issue that has led to multimillion ad campaigns for and against and a summer full of public forums. Members of Congress have gotten an earful from those who oppose Obama’s call for a government-run alternative to private health insurance.

The president, though, didn’t entirely tip his hand on what he will say.

“I want you all to tune in,” Obama said, drawing a laugh from the crowd.

But Obama reiterated some core principles of reform in which people wouldn’t lose health insurance if they lost their jobs, where there is a cap on out-of-pocket expenses and where people would not be denied coverage because of a pre-existing medical condition.

And he made it clear that he still believes in the “government option.”

“And I continue to believe that a public option within the basket of insurance choices would help improve quality and bring down costs,” he said.

If the White House was looking for a friendly venue at a time when the president’s poll numbers are plummeting and job losses continue to mount, it could not have picked a better place on this Labor Day than Riverbend and Coney Island, where the Cincinnati AFL-CIO Labor Council was holding its 23rd annual Labor Day picnic.

Obama spent a good deal of his time extolling the virtues of the union movement.

“It was labor that helped build the largest middle class in history. So, even if you’re not a union member, every American owes something to America’s labor movement,” said Obama, whose run for the presidency was energized in no small part by unions.

The event was moved at the last minute to the covered PNC Pavilion next door to Coney Island, where it had been scheduled for an open air mall, when it appeared there would be more rain Monday afternoon a threat that never materialized.

Local labor leaders said they distributed 10,000 tickets to the outdoor rally, but the PNC Pavilion only holds about 5,000; a handful of seats in the upper reaches were still empty when the president arrived on the Marine One helicopter shortly after 1 p.m.

Many in the crowd were wearing the same Obama/Biden T-shirts they wore last fall when organized labor here hit the streets and the phone banks by the thousands to help elect the Democratic ticket.

And many of them did the same last fall for the Cincinnati area’s only Democratic congressman, Steve Driehaus of West Price Hill, who is one of the Democrats in the House who have so far withheld their support from health care bills proposed by the Obama administration and the Democratic House leadership.

Driehaus arrived at the pavilion about an hour before the president’s appearance with his wife and family. He said that he would be returning to Washington on Air Force One with President Obama and said the conversation would doubtless turn to health care reform.

“I think we have spent the last month here in the district listening to all points of view and I think I’m better for it. What I want to do now is get the president’s perspective on this,” Driehaus said.

Obama had sharp words for those who have loudly opposed his proposals in public forums and for the insurance industry, which has spent millions on advertising against his proposals for a government-run health care option. He said he will listen to critics, but wants to hear them offer alternatives. “What’s your answer?” Obama said. “What’s your solution? The fact is, they don’t have one. It’s do nothing.”

Inside the PNC Pavilion, the response to Obama was positive and enthusiastic. Outside was a different matter.

About 80 people, organized by the Community Tea Party organization, protested Obama’s health care policies and federal spending, lining Kellogg Road near the gate to Coney Island.

Hamilton County Republican Chairman Alex Triantafilou issued a statement saying that the president’s visit comes at an “interesting” time.

“His approval rating is plummeting almost as quickly as his plans to nationalize our health care system,” Triantafilou said.

After the speech, Obama worked the rope line in front of the stage for about 20 minutes, shaking hands and signing autographs before heading back to the airport and the return trip to Washington, D.C.

Tags: Health, Healthcare, Medicare, Obama, public, xray

By Lauran Neergaard, The Associated Press

PITTSBURGH — Baby Riley Matthews wheezed noisily on the exam table. “He’s belly-breathing,” the emergency-room doctor said worriedly — Riley’s little abdomen was markedly rising and falling with each breath, a sign of respiratory distress.

In most emergency rooms, the doctor would grill Mom: Has he ever been X-rayed? Do you remember what it showed? But in the new all-digital Children’s Hospital of Pittsburgh, doctors just clicked on a COW — a “computer on wheels” that rolls to each patient’s side. Up popped every test and X-ray the 6-month-old has ever had.

This is the eerily paperless hospital of the future, what the “electronic medical record” that President Obama insists will transform what health care looks like.

No chart full of doctors’ scribbles hanging on the bed. No hauling around envelopes full of X-rays. No discharge with a prescription slip. Even the classic ER patient list has changed from the white-board of TV-drama fame to a giant computer screen.

By the best count, only 1.5% of the nation’s roughly 6,000 hospitals use a comprehensive electronic record.

Even that statistic belies how hard it will be for health care to jettison its 19th-century filing system by 2014, the federal government’s goal — despite the $19 billion that the economic stimulus package is providing to help doctors start. It took Children’s seven hard years and more than $10 million to evolve a system that lets its doctors check on patients with a few mouse clicks from anywhere and use speedily up-to-date records in directing their care.

“Sometimes before I even see the ER patient, the X-ray is in here and finished and read,” said Dr. Jonathan Bickel, the ER attending physician who whipped out his laptop to check on Riley’s overnight stay. Not too long ago, “I had to take mom’s word for it.”

Look, he pointed: An outpatient lung specialist tested Riley for cystic fibrosis just before his mother brought the 6-month-old to the emergency room. The specialist’s detailed exam notes hit the ER computer in hours, not the days it takes to transcribe into a paper chart. Cystic fibrosis didn’t cause his wheezing; quick, test for something else.

Still, Children’s evolution isn’t finished.

Money, and doctors’ resistance: A study in the New England Journal of Medicine this spring named hospitals’ top two reasons for not going digital.

“When you walk into a hospital, you’re like, ‘Whoa, I’m back in the 1970s,’” said lead researcher Dr. Ashish Jha of the Harvard School of Public Health. Younger patients growing up with the speed of e-mail and now Twitter “are shocked.”

It’s not just the equipment’s price tag. Administrators find the cash to buy new MRI machines or build new hospital wings, said Dr. David Blumenthal, the Obama administration’s new health IT director.

Studies show electronic medical records, or EMRs, can greatly improve the quality of patient care and reduce errors. Children’s has seen medication errors drop 45% since it started automating in 2002. But hospitals won’t necessarily recoup their investment, because a patient who goes home sooner means lost revenue.

“Our health care system has not valued quality and efficiency,” said Blumenthal.

So Congress added a stick to the carrot of the stimulus money: Health providers that aren’t digital enough by 2015 will start losing Medicare dollars. Blumenthal told The Associated Press he’s seeing a sudden surge in interest.

Children’s moved from a decades-old building to a new hospital in May, a final step in its digital journey. One wing is inpatient, the other houses offices for specialists’ outpatient care, all linked by the “eRecord.”

Some 4,000 computers line the halls. Nurses swipe patients’ wristbands with bar-code scanners to see when it’s time for medication, and then match the bar-coded dose to the prescription.

in the intensive care unit, computer “dashboards” automatically graph patients’ vital signs and other readings from monitors and lab tests — letting nurses spot at a glance a drop or spike that signals a patient about to get in trouble, instead of rifling pages of a paper chart to tell.

And the giant patient database lets health IT chief Dr. James Levin spot practices that need improving. He found too many doctors ordering specially filtered blood transfusions, at $30 extra a bag, when medical guidelines say few patients truly need them.

Building an EMR doesn’t just mean buying software and flipping a switch. It physically changes how doctors and nurses work, a disruption that Harvard’s Jha sees as key to even tech-savvy doctors’ resistance.

Children’s first step: Install electronic prescribing. In October 2002, verbal or paper orders for medications, lab tests, X-rays, IVs ended hospital-wide. Medication errors immediately started dropping.

But ICU doctors reported a surprise, a temporary jump in deaths among just those patients transferred in from other hospitals. Those handoffs are a perilous time, and the doctors examined 75 deaths over 18 months to conclude in the journal Pediatrics that the death rate doubled in the five months after the computer switch. They blamed changes to their well-organized routine: Patients weren’t registered en route, delaying medication orders; clicking through unfamiliar software took longer; wireless computers weren’t always at the bedside.

Changes were made, but Levin said the real lesson: Get doctors to help customize their piece of the EMR upfront. That’s who was tapped when it was time to cut paper charts.

“The way physicians think is different” from off-the-shelf EMR software, said ICU specialist Dr. Shekhar Venkataraman, who found himself a convert to the resulting custom digital dashboard. “It is elegant.”

It’s also a work in progress. On the next floor, 7-year-old Nicholas Swinehart had multiple organ transplants and now is recovering from an infection. It takes repeated swipes before the bar-code reader OKs his medication.

“This takes longer, we never used to scan,” said nurse Lindsay O’Toole.

Officials are working on better scanners. “We have to make it work-friendly or they just don’t want to do it,” said hospital president Christopher Gessner.

People always ask, what if the power goes out? There are back-ups for the back-up generators, and for the servers. That’s the easier side of going digital.

The big hurdle: Most of today’s EMRs can’t be read by the computers at another doctor’s office or hospital across town.

Children’s aimed for a community approach, with the eRecord available at all 20 University of Pittsburgh-affiliated hospitals. More than 100 primary-care doctors in western Pennsylvania are adopting it.

But just three miles down the road, Dr. Kristin Hannibal illustrates the hitch. Her 60-pediatrician practice is affiliated with Children’s but only partly digital. She logs in to check on hospitalized patients, but must scan her own patient checkup information into the eRecord. And her practice next year is buying a competing company’s software, one it deemed better suited for outpatient use. The systems don’t read each other.

“We are far better off than we were even five years ago when there was no … access,” Hannibal said. “It’s just we have another big step to make.”

But Riley Matthews’ mother, Kenya, sees the change with every visit. She hauled chest X-rays from doctor to doctor when her oldest child, now 9, was diagnosed with asthma.

“We had to wait on records” just to make appointments, she said. Riley’s ailment isn’t solved yet, but the electronic system is “making our specialist appointments easier.”

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House Panel to Resume Meetings

By JONATHAN WEISMAN

RALEIGH, N.C. — President Barack Obama, acknowledging the rising protests against his health-care efforts, took some of the sharpest jabs yet at his opponents, accusing them of rallying opposition with scare tactics and hypocrisy.

Meanwhile, House Energy and Commerce Chairman Henry Waxman conceded the House wouldn’t vote on a health-care plan before its August recess. But Mr. Waxman said that his committee will resume meetings on health-care legislation Wednesday after reaching an agreement with conservative Democrats on the committee that included a delayed vote.

Mr. Obama spent much of a town-hall meeting here trying to gain back his footing on the health-care debate. He mocked some Americans who say, “I don’t want socialized medicine, and by the way, don’t take away my Medicare,” saying that Medicare and the Veterans Administration have been operating “government run” health care with relatively high rates of approval from their clientele.

“Nobody is talking about some government takeover of health care. I have been as clear as I can be,” he protested. “These folks need to stop scaring everybody.”

And he blasted Republicans for passing a prescription drug benefit for Medicare without offsetting spending cuts or tax increases, then complaining to him about his fiscal discipline.

“I’m now president, so I’m responsible for solving [the deficit], but we shouldn’t have selective memory here,” he said. “You handed me a $1.3 trillion bill, and now, six months later you’re complaining because we haven’t paid it all back.”

The president acknowledged opposition is growing. A large and boisterous clutch of protesters greeted him at Raleigh’s Needham B. Broughton High School with signs reading, “Obamacare is Socialism,” “Stop Lying,” and “Politicians + Health Care = Disaster.”

“As I was driving in, there were some folks cheering, and there were some folks with signs,” he chuckled to knowing laughter in a largely friendly audience.

In Washington, the news for him was mixed. According to Mr. Waxman (D., Calif.), the Energy and Commerce Committee will hold a legislative session late Wednesday afternoon with the hope of approving the legislation by Friday. Rep. Mike Ross (D., Ark.), who has led health-care negotiations on behalf of the fiscally conservative Blue Dog Coalition, confirmed that Mr. Waxman and Blue Dogs on the committee had arrived at a compromise.

“We have reached an agreement that will allow health-care reform to move forward,” Mr. Ross said.

Mr. Ross said that the overall cost of the bill had been reduced by $100 billion, and that a requirement in the bill that employers offer insurance coverage would exempt small businesses with payrolls of $500,000 or less.

At the town hall here, Mr. Obama defended steps the administration has taken to combat the economic downturn, including the economic stimulus package and lifelines to struggling auto makers. But he said he found this week’s cover of Newsweek magazine declaring the recession to be over “a little startling.”

“Now, it’s true that we’ve stopped the freefall,” he said in remarks prepared for delivery. “The market is up and the financial system is no longer on the verge of collapse. We’re losing jobs at nearly half the rate we were when I took office six months ago.”

“So, we may be seeing the beginning of the end of the recession. But that’s little comfort if you’re one of the folks who have lost their job, and haven’t found another,” Mr. Obama added.

The message isn’t just for the uninsured but also for the vast majority of Americans who have insurance. “My point is,” Mr. Obama said during the town hall meeting, “whether or not you have health insurance right now, the reforms we seek will bring stability and security that you don’t have today; reforms that will become more and more urgent with each passing year.”

The president focused on consumer protections he wants in a health-care bill: no discrimination for pre-existing conditions, no “exorbitant” out-of-pocket expenses, no out-of-pocket expenses at all for preventive health care, no dropping coverage in the event of a serious illness, no gender discrimination, no annual or lifetime coverage caps, more coverage for chronically uninsured or underinsured young adults, likely through their parents’ plans, and guaranteed insurance renewal.

“Back in Washington, there’s been a lot of talk recently about the politics of health care; about who’s up and who’s down; and what it will mean for my party or this presidency if health insurance reform is passed or defeated,” Mr. Obama said. “But here in North Carolina, you know this isn’t about politics. This is about people’s lives. This is about people’s businesses. This is about our future.

As the congressional recess approaches, the president has been mounting more pressure on the House to move to a vote and a bipartisan group of six Senate Finance Committee negotiators to strike a deal. Sen. Charles Grassley of Iowa, the committee’s ranking Republican, said in an interview the committee is moving closer to a deal but he isn’t sure whether now is the best time to come out with it publicly.

If a bipartisan deal can be struck, it could relieve pressure on conservative Democrats in the House, who don’t want to vote on a health care overhaul without assurances that legislation can pass the Senate.

Mr. Obama has said he has been more involved than advertised. In an interview with Time magazine, he said he’s now devoting a third of his days to securing one of the centerpieces of his domestic agenda.

“The truth is we’ve actually, I think, provided more guidance than has been advertised. I mean, if you think about how we’ve moved this forward, we didn’t simply put out some broad principles; we were fairly specific,” he told Time.

The emphasis on insurance regulation shifts the debate from the politically unpopular focuses on cost controls — opponents call it “rationing” — and how to pay for legislation that could cost at least $1 trillion over the first 10 years. Insurance horror stories are a staple of American life and have been a currency of conversation since the rise of health maintenance organizations in the 1990s. Insurers have pledged to make many of those changes on their own, but they are counting on 46 million new customers, many of them subsidized by the U.S. taxpayer, to buy their products in exchange.

Later in the day, the president will deliver his sales pitch at a Kroger grocery store in Bristol, Va.

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UnitedHealth Group Inc. and Cisco Systems Inc. said they plan to build a network linking patients and physicians across the country via video and medical-information technology, establishing a foothold in a telehealth market that is expected to grow to more than $6 billion by 2012.

UnitedHealth, the country’s second-largest health insurer, said it is investing tens of millions of dollars in building the open network with Cisco’s video-conferencing, broadband and other medical-networking capabilities. The network will incorporate an array of technologies from other companies as well, such as fiber-optic cameras for looking into ears and digital medical records, creating a virtual doctor visit.

The partners are kicking off the launch with several pilot programs, including one in rural New Mexico and another via a mobile clinic that will tour the country this summer. Ultimately, UnitedHealth and Cisco say they plan to connect thousands of physicians and hospitals with patients in rural and underserved areas, simulating in-person physician visits from terminals in homes, malls, workplace sites and other outlets.

The network’s launch comes as the Obama administration and Congress seek to overhaul the country’s health-care system — in part by wiring hospitals, doctors and patients to reduce medical errors and duplication of services. As part of the effort, the federal government is pouring more than $20 billion in economic-stimulus money into electronic medical records and some $6 billion into various telemedicine efforts.

UnitedHealth Executive Vice President Steve Rodgers said the company hopes to position itself to team up with various states as they invest that stimulus money. Longer term, Mr. Rodgers said, the health-care system will have to rely on new ways to connect patients to doctors, as the number of Americans over age 65 swells and puts more demand on an already short supply of primary-care physicians and some specialists.

“This is going to make it a lot easier for providers and patients to work together,” Mr. Rodgers said.

The insurer said it hopes to add the telehealth network to the vast arsenal of health-care services it already sells, such as medical-claims processing systems and consulting services to hospitals. It also plans to integrate the telehealth services into health plans that it administers for employers, state Medicaid programs and other customers.

The announcement comes on the heels of other big moves in the telemedicine field, including an alliance formed by Intel Corp. and General Electric Co. in April to invest more than $250 million over five years in technology to help care for the elderly and chronically ill in their homes remotely. According to market-research firm Datamonitor, the U.S. telemedicine market is expected to grow to more than $6 billion by 2012 from $900 million in 2007.

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By KENNETH CHANG

In a tour de force of office supply physics, researchers at the University of California, Los Angeles, have shown that it is possible to produce X-rays by simply unrolling Scotch tape.

Next step: nuclear fusion.

“We’re going to do that,” said Seth J. Putterman, a professor of physics at U.C.L.A. “I think it will work.”

But first, X-rays.

In the current issue of the journal Nature, Dr. Putterman and his colleagues report that surprisingly fierce flows of electrons were unleashed as the tape was unpeeled and its gooey adhesive snapped free of the surface. The electrical currents, in turn, generated strong, short bursts of X-rays — each burst, about a billionth of a second long, contained about 300,000 X-ray photons.

“Some kind of microscopic lightning effect,” Dr. Putterman said.

The scientists even demonstrated that the X-rays were bright enough to take an X-ray of a finger.

That does not mean that tape dispensers on office desks are mini X-ray machines. The phenomenon has been observed only when tape is unpeeled in a vacuum. Something about air, moisture perhaps, short-circuits the X-rays.

The work is not unprecedented. In 1939, scientists showed that peeling tape emits light, an experiment anyone can conduct in a closet. But visible light photons have only about one ten-thousandth the energy of an X-ray photon.

Russian scientists reported as far back as 1953 that from tape they had detected electrons energetic enough to emit X-rays. “But as far as I can tell, no one ever believed them,” Dr. Putterman said. “It was a big surprise to discover this deep dark corner of past research.”

All of the experiments were conducted with Scotch tape, manufactured by 3M. The details of what is occurring on the molecular scale are not known, the scientists said, in part because the Scotch adhesive remains a trade secret.

Other brands of clear adhesive tapes also gave off X-rays, but with a different spectrum of energies. Duct tape did not produce any X-rays, Dr. Putterman said. Masking tape has not been tested.

The research opens up the possibility of looking for X-ray emissions from composite materials as they fatigue. Such materials, increasingly used in airplanes and automobiles, do not show the visible weaknesses that metals do before breaking.

The tape phenomenon could also lead to simple medical devices using bursts of electrons to destroy tumors. The scientists are looking to patent their ideas.

Finally, there is the possibility of nuclear fusion. If energy from the breaking adhesive could be directed away from the electrons to heavy hydrogen ions implanted in modified tape, the ions would accelerate so that when they collided, they could fuse and give off energy — the process that lights the sun.

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