Today I studied about cancer the whole day… I wonder if someone is expecting wild student stories, but unfortunately for a medical students holidays are the perfect time to catch up on one’s reading… Research (ie I asked a couple of people on my class) indicates that everyone is doing the same…

I have also read a few books on interviewing patients. Of course we have to be nice to them, after all they are paying for services, but I think that people exagerate in the opposite direction. For instance, we read about patient education, ie to get smokers to quit smoking, to involve the family, etc. But isn’t that being paternalistic? I mean, if a patient comes to be because he coughs the whole day and I find out he has been smoking three packs a day since forever, of course I will tell him he shouldn’t smoke and I can also give suggestions on how to stop smoking.

However, he might just not take my advice. According to most people in my class and all the books I read, I should try to convince him that he is harming himself, etc. I agree up to a point. Once he is informed of the dangers of smoking, if he keeps smoking and getting worse, I shouldn’t make it *my* problem. He knows what to do. He is an adult. Why should I go on a crusade to change him? Perhaps he *wants* to keep smoking even if he becomes sicker.

It is also strange that, for example, we have to make sure someone takes a medicine. I understand some people might forget, etc. But let’s say someone has too much cholesterol and has to follow a diet and take some pills. He comes back six months later, and hasn’t taken the pills and hasn’t started his diet. I don’t think I should go to great lengths to *convince* him to do so. He came to me for advice, right? He is buying a service from me. If he doesn’t do what he should, then it shouldn’t be *my* problem.

Of course, if it’s a public service, it’s a bit different, because after all also the doctors pay taxes and sick people are a burden on everyone. But stil…

12/25/09

We are on a much awaited for vacation in Aruba. I traveled with about 25 different medications in my wash kit. Some of whom I don’t remember why they were prescribed to me but I keep them as if they were a talisman.  I am taking the same medications here for my Hashimoto’s Thyroiditis, an auto immune disease, and a variety of other symptoms, fibromyalgia, a torn ligament, excruciating back spasms from having to wear the dreaded but classic “black boot”of the podiatric and orthopedic world for many months.

Back home, lying in my bed, day after day, I was always tired, achey and filled with pain.  I admit that the plane ride itself was exceedingly painful but I am off that plane now; and I feel ever so fine.

My Dr. a guru in NYC was considering prescribing me (self ) injectable medication, at a much higher dosage than the pill form I still take.   I had been considering it. I had been pondering how much is too much? Wondering if  I was at the half way point for feeling good, by HIS standards, if that wasn’t good enough.  But, what about MY standards? What about my level of pain and misery and feeling , always, like a patient and feeling good enough.

What about the mind/body experience? What happened after I dragged my worn out body, aching foot and excruciating back pain and came here?  I was minus the snow and ice, minus the bedroom I had been living in for almost two years and feeling very sorry for myself. I was determined that this vacation, “if we should be so blessed” would be the start of a new beginning for me. Despite the cane that came crashing on my head during the flight and injuring my eye, this was starting anew.

It was. It is.  So, who really defines what an illness is, a Dr. or the patient?  On the journal I keep for my Dr. at home, 1 being in really bad shape and 10 being something “I can never achieve” at home I am a solid 5, maybe 4.  The same symptoms and diagnosis in a beautiful new environment for a few sun-filled days and I am an 8 if not 9.  Do we look at things differently if we are in a different environment, or do we look at ourselves differently? If there is something beautiful to see does that help beautify the mind and body?  I feel good here, I feel warm here, I feel  something that I haven’t felt in over 2 years; I feel alive. And hopeful.

dedicated to Phylor who makes me think, and wonder.

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Versi benar

Jaga Dak Luqman dari dalam perut lagi.

Dah besar

Dah 2 tahun..

“Mata Luqman macam mata Doktor lah..besar…”

“Memang sama..”

“Sebab tu dia panggil Doktor.. “Mama..”  ”

Ummi dia kata..

.

Versi Perasan..

Jaga Dak Umairah dari dalam perut lagi..

Dah besar dah.. dah nak dekat setahun dah

Cakap kat Miza dan Zaizal..Ummi dan Papa dia..

Besarnya mata Umairah!!

Macam mata saya kan!!!

I was chatting with a veteran of the medical insurance business the other day and mentioned “cognitive load“, which is a common enough concept in psychology, systems usability, and human factors engineering, but otherwise sounds like arcane jargon. The demands on attention are labeled cognitive load, and job performance can suffer with too high a load. My companion gave me a look as if I had once again strayed far off into academic theory-land, but I made the point that high cognitive load is directly related to medical error and risk management. Indeed, liability management may be the next growth area for the new field of medical cognition.

Not so long ago I did research on limiting physician liability for Texas Medical Liability Trust because of the overhead associated with patients suing due to the adverse effects of “off label” medications. Doctors have a lot to worry about, their workflow involves high cognitive load, the proliferation of forms and paperwork subverts their job satisfaction, and of course my recommendation was to add yet another standard operating procedure!

This article in the New Yorker about “the checklist” for reducing the high cognitive load of medical professionals via a standard operating procedure opened up my eyes to the benefits of implementing best practices:

“On any given day in the United States, some ninety thousand people are in intensive care. Over a year, an estimated five million Americans will be, and over a normal lifetime nearly all of us will come to know the glassed bay of an I.C.U. from the inside. Wide swaths of medicine now depend on the lifesupport systems that I.C.U.s provide: care for premature infants; victims of trauma, strokes, and heart attacks; patients who have had surgery on their brain, heart, lungs, or major blood vessels. Critical care has become an increasingly large portion of what hospitals do. Fifty years ago, I.C.U.s barely existed. Today, in my hospital, a hundred and fifty-five of our almost seven hundred patients are, as I write this, in intensive care. The average stay of an I.C.U. patient is four days, and the survival rate is eighty-six per cent. Going into an I.C.U., being put on a mechanical ventilator, having tubes and wires run into and out of you, is not a sentence of death. But the days will be the most precarious of your life.

(snip)

Expertise is the mantra of modern medicine. In the early twentieth century, you needed only a high-school diploma and a one-year medical degree to practice medicine. By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. Already, though, this level of preparation has seemed inadequate to the new complexity of medicine. After their residencies, most young doctors today are going on to do fellowships, adding one to three further years of training in, say, laparoscopic surgery, or pediatric metabolic disorders, or breast radiology—or critical care. A young doctor is not so young nowadays; you typically don’t start in independent practice until your mid-thirties.

We now live in the era of the super-specialist—of clinicians who have taken the time to practice at one narrow thing until they can do it better than anyone who hasn’t. Super-specialists have two advantages over ordinary specialists: greater knowledge of the details that matter and an ability to handle the complexities of the job. There are degrees of complexity, though, and intensive-care medicine has grown so far beyond ordinary complexity that avoiding daily mistakes is proving impossible even for our super-specialists. The I.C.U., with its spectacular successes and frequent failures, therefore poses a distinctive challenge: what do you do when expertise is not enough?

(snip)

Yet it’s far from obvious that something as simple as a checklist could be of much help in medical care. Sick people are phenomenally more various than airplanes. A study of forty-one thousand trauma patients—just trauma patients—found that they had 1,224 different injury-related diagnoses in 32,261 unique combinations for teams to attend to. That’s like having 32,261 kinds of airplane to land. Mapping out the proper steps for each is not possible, and physicians have been skeptical that a piece of paper with a bunch of little boxes would improve matters much.

In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. He didn’t attempt to make the checklist cover everything; he designed it to tackle just one problem, the one that nearly killed Anthony DeFilippo: line infections. On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check. These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.

The next month, he and his team persuaded the hospital administration to authorize nurses to stop doctors if they saw them skipping a step on the checklist; nurses were also to ask them each day whether any lines ought to be removed, so as not to leave them in longer than necessary. This was revolutionary. Nurses have always had their ways of nudging a doctor into doing the right thing, ranging from the gentle reminder (“Um, did you forget to put on your mask, doctor?”) to more forceful methods (I’ve had a nurse bodycheck me when she thought I hadn’t put enough drapes on a patient). But many nurses aren’t sure whether this is their place, or whether a given step is worth a confrontation. (Does it really matter whether a patient’s legs are draped for a line going into the chest?) The new rule made it clear: if doctors didn’t follow every step on the checklist, the nurses would have backup from the administration to intervene.

Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.”

NEWS

House Democrats making plans for final health care bill
By Deirdre Walsh,
December 23, 2009 9:44 p.m. EST

Nancy Pelosi said staff will provide comparison of bills soon to help members prioritize the changes they want to see.

Washington (CNN) — House Democrats are already home for the holidays, but they huddled on a conference call Wednesday afternoon to discuss the next steps in negotiating a final health care bill with the Senate.

Speaker Nancy Pelosi restated that the goal is to get a final bill to the president’s desk before his State of the Union address in late January or early February, but she admitted the timeline could slip, according to two senior Democratic aides who were on the call.

Members made it clear to House leaders that they don’t want to simply accept the bill that is expected to pass the Senate on Thursday morning, the aides said.

“Their point is that while both bills are a major step toward making affordable, quality health care available to all Americans, the House bill has quicker reform, is more affordable and covers more people,” according to one of the aides.

Why one House Democrat isn’t impressed with Senate’s bill

The Wednesday call followed a Tuesday meeting that Pelosi convened via phone with other top House Democratic leaders and committee chairs to map out the House’s game plan for a conference with the Senate early next year.

Although the House won’t be in session until January 12, House staff next week will begin working through the differences in the two chambers’ health care bills, according to several Democratic aides. Leaders and committee chairmen will return in early January for health care meetings.

The aides were hesitant to get into specific details because the Senate hasn’t yet passed a bill, but they emphasize that the House Democratic leaders will push hard for some key elements of their reform measure.

Pelosi told rank-and-file Democrats on Wednesday that staff would put together a comparison of the House and Senate bills soon to help members prioritize the changes they want to see in a final bill. Leaders will schedule another conference call with all House Democrats before the House returns in January.

The House and Senate will be in session very few days in January and will need to get final cost estimates from the Congressional Budget Office before voting on a bill.

Given the reality of the 60-vote threshold in the Senate, there wasn’t much discussion among House leaders about pushing hard for the public option the House passed in its final bill.

“They [the Senate] tried to see if they had support for it. There isn’t. That’s the reality,” a top Democratic leadership aide told CNN. “I think a lot of people are coming to terms with that, and I don’t know how productive it would be to bring it out again.”

House Democratic leaders will push their Senate counterparts to include more affordability credits in the final bill. They also want the new health care exchange — where consumers can shop for insurance plans — to start in 2013 instead of the Senate’s start date of 2014.

“I think people on both sides of the Capitol would like to see the effective date moved up. Whether we can do that and pay for it is a question,” another senior Democratic aide noted.

Because most of the major health care reforms won’t go into effect until well after the 2010 election, House Democrats also are focused on showing immediate and tangible benefits to consumers. Leaders want a final bill to begin closing what is called the prescription drug “donut hole” for seniors next year.

When an individual’s drug costs reach $2,700 under current Medicare coverage limits, seniors must begin to pay all costs out of pocket until they reach $6,154, at which point Medicare coverage kicks back in. Under the House bill, this hole in coverage would be cut by $500 immediately and seniors would get a 50 percent discount for some drugs. The House version closes the hole completely by 2019, but the Senate bill takes longer.

The aides said keeping cost-control measures in the final bill will be a priority. There will be negotiations over abortion language as well as a fight between the chambers over how to pay for health care reform. The vast majority of House Democrats are on record opposing the Senate’s “Cadillac tax” on high-cost insurance plans. But several aides concede that House Democrats may be able to live with a compromise that ups the threshold at which the tax goes into effect.

House Democrats also recognize their surtax on wealthy Americans faces problems in a conference with the Senate. In lieu of the House proposal, there is discussion about increasing the rate of the Senate’s Medicare payroll tax on higher-income taxpayers.

With the health care debate moving to another stage next year, House Democrats are pressing again for President Obama to get more personally engaged in negotiating final details. One senior aide told CNN that there will be push for the White House to change the largely hands-off approach it used in 2009 toward passing the administration’s key goals in the House.

“House Democrats have been eager to move the president’s agenda; they support the president’s agenda. But we expected there to be more lifting from the White House,” the aide said.

Several House Democrats on the Wednesday call also told leaders they are worried that the longer the process drags out, the harder it would be to make the case to voters in their districts about the benefits of passing health care reform, the aides said.
© 2009 Cable News Network. Turner Broadcasting System, Inc.

NEWS

Senate reform bill passes last hurdle en route to passage
December 23, 2009 5:14 p.m. EST

‘On the doorstep of history’ :
Sen. Harry Reid applauds the work of his Senate colleague in moving the health care bill to a final vote.

Washington (CNN) — The Senate health care bill cleared a third and final procedural hurdle Wednesday as Democrats successfully limited remaining debate time on the $871 billion measure.

The Senate voted 60-39 along party lines to set a timetable for likely passage of the bill early Thursday morning.

Democrats also turned back last-ditch motions from Republicans claiming various provisions in the bill, including a mandate that individuals purchase coverage, are unconstitutional.

“It’s long past time we declare health care a right and not a privilege,” Senate Majority Leader Harry Reid, a Nevada Democrat, said after the vote.

“Today is a victory … for American families,” proclaimed Sen. Max Baucus, D-Montana. “Americans won.”

The expected victory for President Obama’s top domestic priority comes after nearly a year of sharply polarized deliberations on Capitol Hill. Any measure passed by the Senate, however, will still have to be merged with a $1 trillion plan approved by the House of Representatives in November.

Increasingly confident Democrats hope to have a bill ready for Obama’s signature before his State of the Union address early next year.

“Health care reform is not a matter of if,” White House Press Secretary Robert Gibbs said Tuesday. “Health care reform now is a matter of when.”

If a combined House-Senate health care bill clears Congress and is signed by Obama, it would be the biggest expansion of federal health care guarantees since the enactment of Medicare and Medicaid over four decades ago.

Republicans have mounted a no-holds-barred legislative campaign against the bill, using a series of procedural maneuvers to slow debate while arguing that the measure will raise taxes while doing little to slow spiraling health care costs.

They’ve also ripped Senate Majority Leader Harry Reid, D-Nevada, for garnering the 60 votes necessary to pass the bill in part by cobbling together a series of “sweetheart deals” for wavering members of the Democratic caucus.

“This bill is a grab bag of Chicago-style, backroom buyoffs,” Utah GOP Sen. Orrin Hatch said Wednesday.

Recent compromises made to win the backing of moderates such as Sen. Ben Nelson of Nebraska and Sen. Joe Lieberman of Connecticut also angered many liberal Democrats and threatened to undermine support for the bill.

Democrats have now held three key procedural votes on the health care bill this week. The backing of all 60 members of the Democratic caucus was required during each vote in order to overcome a filibuster from a GOP minority united in opposition.

Final passage of the measure, in contrast, will require only a bare majority in the 100-member chamber.

Enthusiastic top Democrats argue the Senate bill would constitute a positive change of historic proportions. The legislation, according to the nonpartisan Congressional Budget Office, would extend health insurance to more than 30 million Americans currently lacking coverage while reducing the federal deficit.

The House and Senate bills agree on a broad range of changes that could impact every American’s coverage.

Among other things, they have agreed to subsidize insurance for a family of four making up to roughly $88,000 annually, or 400 percent of the federal poverty level.

They also have agreed to create health insurance exchanges designed to make it easier for small businesses, the self-employed and the unemployed to pool resources and purchase less-expensive coverage. Both the House plan and the Senate bill would eventually limit total out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.

Insurers also would be barred from charging higher premiums based on a person’s gender or medical history. However, both bills allow insurance companies to charge higher premiums for older customers.

Medicaid would be significantly expanded under both proposals. The House bill would extend coverage to individuals earning up to 150 percent of the poverty line, or roughly $33,000 for a family of four; the Senate plan ensures coverage to those earning up to 133 percent of the poverty level, or just over $29,000 for a family of four.

Major differences between the bills will be the focus of the conference committee that will try to merge them. House and Senate Democrats are still divided over how to pay for their plans. They are also split on, among other things, language relating to abortion coverage and whether to include a government-run public health insurance option.

The House bill includes a public option; the more conservative Senate measure would instead create nonprofit private plans overseen by the federal government.

© 2009 Cable News Network. Turner Broadcasting System, Inc.

NEWS

Health bill clears last hurdle before passage
Dec 23, 4:36 PM EST
By Erica Werner
Associated Press Writer

From left, Senate Minority Whip Jon Kyl of Ariz., Sen. Judd Gregg, R-N.H., and Sen, Jeff Sessions, R-Ala., confer on Capitol Hill in Washington, Wednesday, Dec. 23,2009, prior to a health care news conference. (AP Photo/Harry Hamburg)

WASHINGTON (AP) — Exultant Senate Democrats pushed President Barack Obama’s landmark health care overhaul past a final procedural hurdle Wednesday, setting up a Christmas Eve vote to pass the legislation extending coverage to 30 million Americans.

Democrats voted 60-39 to end a GOP filibuster and move to a final vote Thursday. All 58 Democrats and two independents hung together against unanimous Republican opposition.

It was the 24th day of debate on the 10-year, nearly $1 trillion bill.

“It is now only hours until this Senate will pass meaningful health care reform,” said Finance Committee Chairman Max Baucus, D-Mont.

“It has been a long time coming,” Baucus said. “I thank God that I have lived to see this day.”

It was the third time Democrats have put up 60 votes on procedural measures since Monday. Final passage requires just a simple majority so Democrats should triumph easily. It will be a big victory for Obama and the Democrats, although the Senate bill will still have to be reconciled with a House-passed version before Obama could sign a final package.

There are some thorny differences between the two chambers, including stiffer abortion curbs in the House bill and a new government-run insurance plan in the House bill that’s not in the Senate version.

The sweeping legislation, crafted over months of laborious negotiations, would dramatically remake the country’s health care system with new requirements for nearly everyone to purchase insurance. The government would provide subsidies to help lower-income people pay for coverage. Unpopular insurance company practices such as denying coverage to people with pre-existing conditions would be banned.

Powerless to stop the bill, Republicans stepped up their attacks, contending the sweeping bill threatened to harm Medicare and add billions to the deficit.

“Tomorrow the Senate will vote on a bill that makes a bad situation worse,” Sen. Charles Grassley, R-Iowa, said on the Senate floor. “This bill slid rapidly down the slippery slope to more and more government control of health care.”

The final vote is now set for 7 a.m. Thursday, not 8 a.m. as agreed to earlier in the week. It had originally been scheduled for 7 p.m., but Republicans agreed not to use all their debate time so they could leave town earlier for the holidays and avoid bad weather looming in the midwest. On Wednesday, senators advanced the vote from 8 a.m. to 7 a.m. Thursday. Sen. Patrick Leahy, D-Vt., suggested moving it up some more and holding it Wednesday night, but Republicans didn’t agree to that.

The last time the Senate voted on Christmas Eve was Dec. 24, 1895, on a military affairs bill concerning employment of former Confederate officers, according to the Senate Historical Office.

Democrats also cast several votes Wednesday turning back points of order raised against the bill by Republicans, including one by Sen. John Ensign, R-Nev., questioning the constitutionality of requiring most every American to buy health insurance.

Away from Capitol Hill, special deals on Medicaid obtained by some Democrats – notably Ben Nelson of Nebraska, who provided the crucial 60th vote – continued to provoke grumbling. Under the Senate bill the federal government will pay the entire cost of an expansion of Medicaid in Nebraska, unlike other states, which will have to start picking up a portion of the tab themselves after several years.

In New York, state Senate Republican Leader Dean Skelos sent a letter to the attorney general and the governor urging them to join other states, including South Carolina, that are considering legal challenges over the issues.

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Sleigh bells ring, are ya listenin’? At Kellerman Dental, teeth are glistenin’!

Admit it, we say it every year…’I can’t believe it’s already the holidays!’ It’s funny how Christmas always lands on the same day, yet we’re always so surprised. Baffling, isn’t it??

Well, this year has been yet another adventure for the team at Kellerman Dental. We brought in fantastic new patients every month. We developed a strong and dedicated staff, and we went to Vegas (just can’t stop thinking about it!).

Of course, in the spirit of the holidays, it is unavoidable to want to thank each and every person that continues to make Kellerman Dental everything that we want it to be. We have such a great year coming up and can’t wait to unveil some great new things that will benefit our patients and the ease of visiting the dentist.

If you know our fantastic staff, then you know that we manage to incorporate some fun into our days whenever at all possible. So for your viewing pleasure, we decided to throw on our reindeer ears and gather ‘round the Christmas tree to sing you a song!

So until the next year, stay tuned to our Facebook profile (Kellerman Dental) and fan page (Kellerman Cosmetic & Family Dentistry), and follow us on Twitter (KellermanDental)! We’ll be launching a new website during the first part of 2010, so keep up with all the great news and happenings! Happy Holidays and Happy New Year!

The holiday spirit has spread to Ho Chi Minh City hospitals where rooms are decorated in Christmas colors with flying reindeer, pine trees and colorful lights, especially in children’s rooms.

Young patients of the Tumor Hospital’s Internal Medicine Department No.3 receive gifts from Santa Claus.

Volunteers and benefactors dressed up as Santa Claus recently and delivered presents to delighted young patients around the city.

In the Cardiovascular Department of the Children Hospital No.2, a sparkling fairy garden has been set up in the corridor. The garden comes alive at night in an array of dazzling colors, providing a welcome oasis for children and their families.

The Children Hospital No.2 is also working with sponsors to organize a music performance and offer 1,000 gifts to children on December 23, said Dr. Nguyen Thi Hanh Le, deputy director of the hospital.

The Children Hospital No.1 and Department of Internal Medicine No.3 of the Tumor Hospital have been visited by several charity delegations in recent days. Young patients seem to forget their illnesses, distracted by hundreds of gifts, confectionary and playtime with Santa Claus.

Local doctors say strength of spirit plays a very important role in the treatment of cancer patients especially. Joy helps them forget pain, combat disease and enjoy life.

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Patients will receive text messages and phone calls to remind them about appointments at Lincolnshire hospitals in a scheme to reduce waiting times…. From BBC News. Full story

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Main Entrance at Manav Parivar

Good morning friends,

This is the Main Entrance in the Free Medical Camp at Manav Parivar in Matar.  It’s a wide entrance.  As you can see, the space before the main entrance  is a big space where patients are waiting.  The patients stayed there as when the Medical Camp is going on, all patients were not assisted all at the same time as there were a lot of patients waiting inside.  After some patients were checked and give proper medication, some patients outside the Camp will come inside and have their turn to be check.  Different kind of patients were coming there.  It was the word of mouth that there’s a one organization (Manav Parivar), who help many people who have a problem with their health.  That’s why every time I visited the Manav Parivar there are always a huge crowd who came there.  Not less than 8,000 patients are going to Free Medical Camp every time they have their medical service there. Good feeling to be there at Manav Parivar.

NEWS

Senate health bill creates new insurance program
Reporting by Donna Smith; Editing by Bill Trott

WASHINGTON (Reuters) – A new government insurance program that would help the elderly and disabled stay in their homes is headed for passage in the U.S. Senate’s sweeping healthcare revamp despite doubts about its viability and cost.

Barack Obama |  Healthcare Reform

The measure has not received the intense scrutiny focused on a proposed government-run medical coverage plan, which has been jettisoned from the Senate’s healthcare bill and is unlikely to be restored in final legislation.

But the Community Living Assistance Services and Supports (CLASS) Act, which was championed by the late Senator Edward Kennedy, is a significant program that supporters say is long overdue and critics say could add to the federal treasury’s long-term debt problems.

“If the CLASS Act becomes law, the federal taxpayer is at very serious risk of paying the price to clean up the fiscal disaster when the CLASS Act fails,” Republican Senator Charles Grassley said in a Senate speech on Tuesday.

Backers said the bill would allow disabled people to stay in their homes and out of institutional care.

It also could save states billions of dollars in the Medicaid health insurance program for the poor, which provides long-term institutional care for the disabled poor typically at much higher cost than supporting them to stay in their homes.

“We think CLASS is one of the real transformational items in the (healthcare reform) bill,” said Larry Minnix, chief executive at the American Association of Homes and Services for the Aging. He said the cost to states to provide long-term care for their elderly and disabled through Medicaid will skyrocket during the next 10 to 15 years without the new program.

The insurance is voluntary and would provide a cash benefit to participants if they become unable to perform at least two activities of daily life, such as dressing and bathing.

Under the Senate proposal, workers pay a monthly premium to buy coverage, probably through their employer. They would have to pay into the program for at least five years before qualifying for benefits.

PART-TIME HELP

The benefit would be at least $50 a day and the nonpartisan Congressional Budget Office, which estimates the cost of pending legislation, assumed it would provide about $75 a day.

Senator Tom Harkin, a Democrat who chairs the Senate Health, Education, Labor and Pensions Committee, says that would be enough to hire a nurse for a few hours to help a disabled person get ready for work or to give a break to someone who is caring for an elderly parent or disabled family member.

Harkin said it was Kennedy’s wish that the measure be included in the sweeping healthcare overhaul that the Senate is expected to pass on Christmas Eve.

The measure is supported by dozens of healthcare groups and stands a good chance of being part of a final healthcare bill that goes to President Barack Obama for his signature. But a number of analysts have voiced concern about whether the program would be financially sound over the long run.

“I think there is a significant risk it won’t work,” said Allen Schmitz, an actuary with Milliman Inc, a global consulting firm. With an initial monthly premium that one estimate said could be as high as $240, few healthy people would choose to purchase the insurance and that could undermine the financial stability of the program, he said.

“They are creating a new government program that everyone concedes is clearly unsustainable,” said Dennis Smith, a healthcare reform analyst at the conservative Heritage Foundation think tank.

The insurance program would not screen people the way private insurers do. For that reason the program is likely to attract mostly those who will need some sort of long-term care, eventually undermining its financial health, he said.

The CBO said in its analyses that the program initially would raise enough money to reduce the federal deficit by $72 billion in the first 10 years, with about $2 billion of that attributed to savings in Medicaid, which provides long-term institutional care for the disabled poor.

Premium income would continue to help reduce federal deficits in the second decade. But after that it would begin to add to deficits as benefit payments exceeded premium income and any savings to the Medicaid program, CBO said without providing specific numbers.

A similar provision was included in the healthcare overhaul passed by the U.S. House of Representatives in November. The House calls for a more expansive program than the Senate. The Senate would make the program available to active workers while the House would allow non-working spouses to join as well.

The two chambers would have to work out their differences before a final bill can be delivered to Obama.

East York hospital launches electronic health records
Patient records go digital, phasing out handwritten charts
By Kris Scheuer
(Written for Town Crier Dec. 10)

Dr. Pieter Jugovic uses the new electronic patient record software on a mobile hospital computer. Photo courtesy of Toronto East General Hospital.

Deciphering illegible handwriting will be all but eliminated at Toronto East General Hospital thanks to a new electronic health record system.
This is the main benefit of having over 80 percent of all health records and medicine orders available electronically rather than handwritten, say TEGH staff.
“No more bad doctor handwriting,” Dr. Pieter Jugovic tells the Town Crier during a demonstration of two new programs, Computerized Provider Order Entry and Electronic Medication Administration Record.
In the past when a doctor wrote a prescription it was possible for pharmacists to misread the dosage and fill the order incorrectly. Now, info is inputed into the computer and in-house pharmacists can access prescriptions electronically.
But that’s just the start.As of Nov. 24, hospital staff started to eliminate the need for a clipboard and paper patient records that travel between departments. Almost all patient orders for tests and procedures are retrieved by hospital staff in real time via computers.
“TEGH is the first community hospital in the city that has achieved this high degree of automation,” says Karin Archer Myles, a hospital spokesperson.
When a doctor is looking to treat a cancer patient or someone admitted with a drug overdose, they can check the new computer system for an electronic menu of what meds can be used for treatment or blood tests are needed and check off boxes accordingly.
“Physicians can choose what’s most appropriate for a patient,” says Jugovic.
And nurses can access information indicating when it is time to administer another dose of medication or check back with a patient to see if pain medicine is working.
Hospital staff don’t have to be inside the building to see patients’ records.
“It’s universally accessible technology,” says Jugovic. “You could be on a beach and do this.”
The system took two years to develop and another six months of training before it was launched at the hospital in late November.
Funding came from both the hospital budget and a federal government grant.
Jugovic says some day electronic patient info will be standard practice in all hospitals.
“It’s the way of the future,” he says. “We will have (medical) residents in the future who have only ever entered orders in computers and never written an order.”

How the system works
Toronto East General Hospital now uses Computerized Provider Order Entry software that allows clinicians to enter their orders directly into the electronic patient record on a computer instead of a paper chart.
As well, hospital staff use Electronic Medication Administration Record, which incorporates a person’s medication orders with an automatic schedule for nurses prompting them when to give meds.
On top of the software, hospital staff to access patient information from their desktop computer or a mobile workstation that can be wheeled into a patient’s room.
A separate scanner can be used to scan barcodes on patient’s hospital ID bracelet and barcodes on medication, to instantly update computer records, as well as a portable handheld tablet computer that has a scanner built in.
Authorized staff can also access patients’ records by logging onto a secure website, typing in their hospital authorization and viewing information from cell phones, Blackberries or computers outside the hospital.

Well, the Senate has not seen this much rancor since the 1850’s – and we know where that all ended up.  The reality is not that 100 members of the senate do not agree on the need for health insurance reform or health reform in general, but that that there are polar opposite views of how this should be accomplished.  This difference is reflective of the breakdown of the populace into two opposing camps over the role of centralized federal government, with it’s entrenched bureaucracy, special interests and unlimited power to enact confiscatory taxes on the populace.  One camp seeks expansion of the federal role in everyday life as well as expansion of the welfare state while the other camp seeks greater autonomy for the states and limits on federal power and federal taxation.  Sound familiar.  Check your history books.  This debate is as old as the Republic itself.  The main concern is that now that we have the majority of citizens (and illegals) paying no income tax, the desire to raise taxes on the minority is becoming insatiable in an effort to fund ever more ambition and far reaching programs to “take care of” those with less.  This then is the fundamental impasse.  This along with the unwillingness of both sides to tackle head on regulation of the health insurance industry as opposed to working toward federal control or no control.

The other sad note in all of this is the transparent and obvious vote buying that is going on.  We have commented on this before.  If any private citizen paid members of the Senate in cash or kind, it would be called bribery.  It seems however when the Majority Leader, Mr. Reid, with approval of the President does the same thing, but with taxpayer dollars, it is called compromise and savvy legislating.  Semantics cannot hide the seedy reality of this type of back room wheeling and dealing with other peoples money – the taxpayers  money.  Since Mr. Reid and his Senate cronies are already feeding at the public trough, it is doubly sad that they are using taxpayer money to “persuade” their erstwhile Democratic colleagues to vote in a manner they wish.

Overlooked in all of this is the fact neither conservatives or liberals are happy with the outcome so far.  Some would argue that this means the legislation is good, making all sides unhappy.  We however would argue that this represents the fundamental flaws in the bills in the House and Senate.  Most worrisome is that neither bill definitively bans private insurers from denying coverage for pre-existing conditions without any caveats.  It also does not definitively ban, in plain language, the dropping of subscribers who become ill. Oh, it says that more or less on both counts, until you get into the detail and legalese and find what appears to be ample wiggle room for health insurers to weasel out on these two most fundamental reforms.  There is also no real attempt to control health insurance premiums or to modify the underwriting formulas used by health insurers.  All glaring flaws.

No doubt, something is coming out of the Senate.  That means we will refocus on the two bill and what might be accomplished in conference committee to salvage real health reform . . . obi jo and jomaxx

Nasty charges of bribery. Senators cut off midspeech. Accusations of politics put over patriotism. Talk of double-crosses. A nonagenarian forced to the floor after midnight for multiple procedural votes. In the heart of the holiday season, Senate Republicans and Democrats are at one another’s throats as the health care overhaul reaches its climactic votes. A year that began with hopes of new post-partisanship has indeed produced change: Things have gotten worse.

Senate Debate on Health Care Exacerbates Partisanship – http://www.nytimes.com/2009/12/21/health/policy/21senatecnd.html?_r=1&emc=tnt&tntemail0=y

In the great health care debate of 2009, President Obama has cast himself as a cold-eyed pragmatist, willing to compromise in exchange for votes. Now ideology — an uprising on the Democratic left — is smacking the pragmatic president in the face. Stung by the intense White House effort to court the votes of moderate holdouts like Senator Joseph I. Lieberman, independent of Connecticut, and Senator Ben Nelson, Democrat of Nebraska, liberals are signaling that they have compromised enough. Grass-roots groups are balking, liberal commentators are becoming more critical of the president, some unions are threatening to withhold support and Howard Dean, the former Democratic Party chief, is urging the Senate to kill its health bill.

Liberal Revolt on Health Care Stings White House – http://www.nytimes.com/2009/12/18/health/policy/18liberals.html?emc=tnt&tntemail0=y

Senate Democrats said Saturday that they had clinched an agreement on a far-reaching overhaul of the nation’s health care system and forged ahead with efforts to approve the legislation by Christmas over Republican opposition. As the Senate convened in a blizzard, Democratic leaders hailed a breakthrough that came when Senator Ben Nelson, Democrat of Nebraska, agreed to back the bill after 13 hours of negotiations on Friday, making him the pivotal 60th vote for a measure that President Obama has called his top domestic priority. Mr. Nelson committed his vote after winning tighter restrictions on insurance coverage for abortions, as well as increased federal health care aid for his state.

Democrats Clinch Deal for Deciding Vote on Health Bill – http://www.nytimes.com/2009/12/20/health/policy/20health.html?emc=tnt&tntemail0=y

Thirty million people without health insurance stand to gain coverage under a deal announced on Saturday by Senate Democrats. To get the 60 votes needed to pass their bill, Democrats scrapped the idea of a government-run public insurance plan, cherished by liberals, and replaced it with a proposal for nationwide health plans, which would be offered by private insurers under contract with the government. The legislation also includes a proposal that would limit insurance coverage of abortion. The provision, which was the last piece of the puzzle to fall into place, was negotiated by the Senate majority leader, Harry Reid, Democrat of Nevada, to win the support of Senator Ben Nelson, Democrat of Nebraska, who is an opponent of abortion.

Negotiating to 60 Votes, Compromise by Compromise – http://www.nytimes.com/2009/12/20/health/policy/20care.html

Louisiana Senator Mary Landrieu, one of three lawmakers being wooed by Democratic leaders to back health-care legislation, won the inclusion of an extra $100 million in federal aid for low-income people in her state. Landrieu, a Democrat, has championed federal aid for rebuilding Louisiana since Hurricane Katrina devastated the New Orleans area in 2005.  “It is something she has been working on for a long time,” spokesman Robert Sawicki said of the aid, which the Congressional Budget Office estimated at $100 million. Still, he said, Landrieu hasn’t decided whether to back Senate Democratic leader Harry Reid’s bid to start debate on the bill. Jim Manley, a spokesman for Reid, declined to comment.

Mary Landrieu Wooed To Back Health Care With $100 Million For Her State – http://www.huffingtonpost.com/2009/11/20/mary-landrieu-wooed-to-ba_n_365954.html

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NEWS

Senate moves health bill forward
December 22, 2009 12:34 p.m. EST
’s Ted Barrett, Dana Bash and Alan Silverleib contributed to this report.

Health care bill on track: Senate leaders on health care reform hold a news conference to discuss the Patient Protection and Affordable Care Act.

Washington (CNN) — The Senate moved closer to passing health care reform Tuesday as Democrats cleared the second of three key procedural hurdles on the sweeping $871 billion measure.

The Senate voted 60-39 along party lines to adopt changes negotiated by Majority Leader Harry Reid, D-Nevada. The Senate also set a timetable for ending debate on the bill.

A third and final procedural vote is scheduled for Wednesday afternoon.

If Democrats clear that hurdle, the Senate will be on track to take a final vote on Christmas Eve on whether to approve the Senate’s version of the bill to overhaul health care, President Obama’s top domestic priority.

“Health care reform is not a matter of if,” White House press secretary Robert Gibbs said, “health care reform now is a matter of when.”

Sen. Max Baucus, D-Montana, chairman of the Senate Finance Committee, declared that “the finish line is in sight.”

“We’re not the first to attempt such reforms, but we will be the first to succeed,” Baucus said.

Any measure the Senate passes still would have to be merged with the $1 trillion House version in what could be tough negotiations

In remarks Tuesday on the Senate floor, Reid acknowledged the toxic political environment surrounding the nearly yearlong debate.

Senators should set aside “personal animosity,” he said. “There’s a lot of tension in the Senate, but I would hope everyone would go back to their gentlemanly ways. … Let’s just all try to get along.”

Republicans have mounted a fierce campaign against the bill, using procedural tactics to slow debate and casting the measure as an unnecessary government intrusion in health care that will raise costs.

“Mark my words: This legislation will reshape our nation,” Senate Minority Leader Mitch McConnell, R-Kentucky, said Monday. “Americans have already issued their verdict. They don’t want it. They don’t like this bill, and they don’t like lawmakers playing games with their health care to secure the votes they need to pass it.”

If a combined House-Senate health care bill wins final approval from Congress and Obama signs it, the measure would be the biggest expansion of federal health care guarantees since the enactment of Medicare and Medicaid more than four decades ago.

Obama on Monday praised the Senate for “standing up to the special interests who prevented reform for decades and who are furiously lobbying against it now.”

The influential American Medical Association, a traditional opponent of overhauling health care, endorsed the Senate measure hours after a rare 1 a.m. Monday vote to start winding down debate.

Read CNN’s Dr. Sanjay Gupta’s take on the health care bill

All three procedural votes require Democrats to win the backing of 60 members to break a GOP filibuster. Final passage of the measure, by contrast, will require a simple majority of 51 votes.

Back-room deals on health bill: CNN’s Dana Bash reports on Democratic leaders’ back-room deals to clinch health care reform.

To Democrats, Monday’s vote signaled eventual victory on the Senate bill.

“The die is cast. It’s done,” Sen. Charles Schumer, D-New York, said.

Compromises made to win the backing of lawmakers such as Sens. Ben Nelson, D-Nebraska, and Joe Lieberman, a Connecticut independent, enraged many liberal Democrats and threatened to undermine support for the bill.

Liberal Democrats are upset with Reid’s decision to abandon a government-run public health insurance option and an expansion of Medicare to Americans as young as 55.

But top Democrats argue the Senate bill still would constitute a positive change of historic proportions. The legislation would extend health insurance coverage to more than 30 million uninsured Americans while reducing the federal deficit, according to the Congressional Budget Office.

The House and Senate bills agree on a broad range of changes that could affect every American’s coverage.

Among other things, they have agreed to subsidize insurance for a family of four making up to roughly $88,000 annually, or 400 percent of the federal poverty level.

They also have agreed to create health insurance exchanges designed to make it easier for small businesses, the self-employed and the unemployed to pool resources and purchase less expensive coverage. Both the House plan and the Senate bill eventually would limit total out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.

Insurers also would be barred from charging higher premiums based on a person’s gender or medical history. However, both bills allow insurance companies to charge higher premiums for older customers.

Medicaid would be significantly expanded under both proposals. The House bill would extend coverage to individuals earning up to 150 percent of the poverty level, or roughly $33,000 for a family of four; the Senate plan ensures coverage to those earning up to 133 percent of the poverty level, or just more than $29,000 for a family of four.

Major differences between the bills would be the focus of a conference committee that would try to merge them.

One of the biggest divides is over how to pay for the plans. The House package is financed through a combination of a tax surcharge on wealthy Americans and Medicare spending reductions.

Specifically, individuals with annual incomes more than $500,000 — as well as families earning more than $1 million — would face a 5.4 percent income tax surcharge.

The Senate bill also cuts Medicare by roughly $500 billion. But instead of an income tax surcharge on the wealthy, it would impose a 40 percent tax on insurance companies providing what are called “Cadillac” health plans valued at more than $8,500 for individuals and $23,000 for families.

Proponents of the tax on high-end plans argue it’s one of the most effective ways to curb medical inflation. However, House Democrats oppose taxing such policies because it would hurt union members who traded higher salaries for more generous health benefits.

The Senate bill also would hike Medicare payroll taxes on families making more than $250,000; the House bill does not.

Another key sticking point is the dispute over a public option. The House plan includes a public option; the Senate plan would instead create new nonprofit private plans overseen by the federal government.

Individuals under both plans would be required to purchase coverage, but the House bill includes more stringent penalties for most of those who fail to comply. The House bill would impose a fine of up to 2.5 percent of an individual’s income. The Senate plan would require individuals to purchase health insurance coverage or face a fine of up to $750 or 2 percent of his or her income — whichever is greater. Both versions include a hardship exemption for poorer Americans.

iReport.com: Give your thoughts on the Senate health care bill

Employers face a much stricter mandate under the House legislation, which would require companies with a payroll of more than $500,000 to provide insurance or pay a penalty of up to 8 percent of their payroll.

The Senate bill would require companies with more than 50 employees to pay a fee of up to $750 per worker if any of their employees rely on government subsidies to purchase coverage.

Abortion also has been a sticking point for both chambers. A late compromise with Catholic and other conservatives in the House led to the adoption of an amendment banning most abortion coverage from the public option. It would also prohibit abortion coverage in private policies available in the exchange to people receiving federal subsidies.

Senate provisions, made more conservative than initially drafted to satisfy Nelson, would allow states to choose whether to ban abortion coverage in plans offered in the exchanges. Individuals purchasing plans through the exchanges would have to pay for abortion coverage out of their own funds.

Nelson said on CNN’s “State of the Union” on Sunday that he would withdraw his support if the final bill gets changed too much from the Senate version under consideration.

Among other things, Nelson had a provision added to the bill requiring the federal government to cover Nebraska’s costs for expanded Medicaid coverage after 2016. No other state is slated to receive such a benefit.

© 2009 Cable News Network. Turner Broadcasting System, Inc.

I just read an article regarding medical marijuana patients getting cited in Arizona for having marijuana on them. In the years between 1999 and 2002, marijuana seizures in the state jumped by nearly 69 percent. That is a huge amount. Some people don’t realize that Arizona is a zero-tolerance state. Any marijuana and I mean any marijuana at all can be a felony. It does not matter if you are a valid patient from another state or not. Most patients should already know it isn’t a good idea to travel across borders with marijuana anyways. Some people will never learn. But good news….thanks to the efforts of some dedicated Arizonans, it looks as if marijuana will be making it onto the 2010 state ballot. It has been on the ballot in the past but for some reason the marijuana guidelines were just too confusing. If it passes patients will have the ability to grow up to 12 marijuana plants. Guide luck Arizona, hopefully we can get medical marijuana passed for your state and you can join the rest of us. If you are interested in getting your medical marijuana verification card in Southern California visit www.8664207215.com

NEWS

Obama: Health care progress a victory for American people
December 21, 2009 12:13 p.m. EST
’s Ted Barrett, Dana Bash and Alan Silverleib contributed to this report.

President Obama rejects GOP arguments that health care reform will increase the deficit.

Washington (CNN) — President Obama on Monday called the Senate vote to end debate and move toward passing a health care bill “a big victory for the American people.”

In remarks at the White House, Obama rejected arguments by Republican opponents of the bill that it will increase the federal deficit.

“That argument that opponents are making against this bill does not hold water,” Obama said.

The nonpartisan Congressional Budget Office says the Senate bill will reduce the deficit by $132 billion in the first 10 years, Obama said.

The Senate will hold more procedural votes on the health care bill this week, with a final vote scheduled for Christmas Eve. If the bill passes, as expected, the Senate version would then be merged in a conference committee with a House health care bill passed last month.

Both chambers would then have to approve the final measure before sending it to Obama to be signed into law.

The Senate vote to end debate was on strictly partisan lines, with all 60 members of the Democratic caucus uniting to overcome a filibuster attempt by the 40 Senate Republicans.

It occurred in a rare overnight session, with voting taking place at 1 a.m. Monday, in order to make it possible for the chamber’s final vote to occur before the upcoming Christmas recess.

Obama said the step brought the nation closer to health care reform that would make “a tremendous difference” to Americans by lowering health care costs and eliminating controversial practices by insurance companies to deny coverage for pre-existing conditions or exceeding benefit caps.

The bill also would keep the government-run Medicare program solvent for nearly a decade longer than current projections, and help reduce the “inexorable and unsustainable rise” in health care costs.

The vote left Obama on the cusp of claiming victory on his top domestic priority and enacting the biggest expansion of federal health care guarantees since the enactment of Medicare and Medicaid over four decades ago.

“Today, the Senate took another historic step toward our goal of delivering access to quality, affordable health care to all Americans,” Senate Majority Leader Harry Reid, D-Nevada, said in a statement.

The bill will help “promote choice and competition to drive down skyrocketing health care costs for families … all across America.”

Republicans ripped the majority for passing the measure in the middle of the night and accused Democrats of ramming the bill through despite growing public opposition.

“Make no mistake: If the people who wrote this bill were proud of it, they wouldn’t be forcing this vote in the dead of night,” argued Senate Minority Leader Mitch McConnell, R-Kentucky.

“Mark my words: this legislation will reshape our nation. And Americans have already issued their verdict. They don’t want it. They don’t like this bill, and they don’t like lawmakers playing games with their health care to secure the votes they need to pass it.”

The unusual timing of the vote was a consequence of Senate rules, Democrats’ determination to pass the bill before adjourning for the holidays, and the GOP’s willingness to use every possible legislative tactic to slow the bill’s progress.

Unanimous Republican opposition has forced Reid to win the support of all 60 members of his traditionally fractious Democratic caucus. Compromises made to win the backing of more conservative members, such as Nebraska Sen. Ben Nelson and Connecticut Sen. Joe Lieberman, have enraged many liberal Democrats and threatened to undermine support for the bill.

Liberal Democrats are particularly upset with Reid’s decision to abandon a government-run public health insurance option and an expansion of Medicare to Americans as young as age 55 — ideas strongly opposed by Lieberman and other centrists.

Top Democrats, however, argue that the Senate bill as written would still constitute a positive change of historic proportions. The legislation, according to the nonpartisan Congressional Budget Office, would extend health insurance coverage to over 30 million Americans while reducing the federal deficit by $132 billion over the next decade.

The deficit would drop by another $1.3 trillion between the years 2019 and 2029, the CBO said.

Democratic leaders in the House and Senate have now reached agreement on a broad range of changes that could affect every American’s coverage.

Among other things, they have agreed to subsidize insurance for a family of four making up to about $88,000 annually, or 400 percent of the federal poverty level.

They have also agreed to create health insurance exchanges designed to make it easier for small businesses, the self-employed and the unemployed to pool resources and purchase less expensive coverage. Both the House plan and the Senate bill would eventually limit total out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.

Insurers would also be barred from charging higher premiums based on a person’s gender or medical history. Medicaid would be significantly expanded under both proposals.

There are, however, major differences between the Senate measure and the more expansive — hence expensive — House bill.

One of the biggest divides is over how to pay for the plans. The House package is financed through a combination of a tax surcharge on wealthy Americans and new Medicare spending reductions. Individuals with annual incomes over $500,000 and families earning more than $1 million would face a 5.4 percent income tax surcharge.

The Senate bill also cuts Medicare by roughly $500 billion. It does not include a tax surcharge on the wealthy, however. It would instead impose a 40 percent tax on so-called “Cadillac” health plans.

Proponents of the tax on high-end plans argue it’s one of the most effective ways to curb medical inflation. House Democrats are adamantly opposed to taxing such policies, arguing that such a move would hurt union members who traded higher salaries for more generous benefits.

Another key sticking point is the dispute over a public option. The House plan includes a public option; the more conservative Senate plan would instead create new nonprofit private plans overseen by the federal government.

iReport.com: Give your thoughts on the Senate health care bill

Under both plans, individuals would be required to purchase coverage. But the House bill includes more stringent penalties for most of those who fail to comply. Both versions include a hardship exemption for poorer Americans.

Employers face a much stricter mandate under the House legislation, which would require companies with a payroll of more than $500,000 to provide insurance or pay a penalty of up to 8 percent of their payroll.

The Senate bill would require any company with more than 50 employees to pay a fee of up to $750 per worker if any of its employees relies on government subsidies to purchase coverage.

Abortion has also been a sticking point for both chambers. A late compromise with conservatives in the House led to the adoption of an amendment banning most abortion coverage from the public option.

It would also prohibit abortion coverage in private policies available in the exchange to people receiving federal subsidies.

Senate provisions, made more conservative than initially drafted in order to satisfy Nelson, would allow states to choose whether to ban abortion coverage in plans offered in the exchanges. Individuals purchasing plans through the exchanges would have to pay for abortion coverage out of their own funds.

Many observers expect the final bill will conform largely to the measure now moving through the Senate.

“Reid had to make a lot of concessions to get his entire caucus behind the Senate bill,” said CNN deputy political director Paul Steinhauser.

“He can’t afford to a lose a single vote. Every Democratic senator has the power to kill this bill, and that fact gives Senate negotiators tremendous leverage in their negotiations with the House.”

Nelson told CNN’s “State of the Union” on Sunday that he would withdraw his support if the final bill gets changed too much from the Senate version under consideration.

Among other things, Nelson had a provision added to the bill requiring the federal government to cover Nebraska’s costs for expanded Medicaid coverage after 2016. No other state is currently slated to receive such a benefit.

© 2009 Cable News Network. Turner Broadcasting System, Inc.

Good morning friends,

This is the Vitiligo OPD of the Free Medical Camp at Manav Parivar in Matar.  This is the place where patients are being examined.   Vitiligo department is 100% computerize.  Patients were being registered in the computer, get examined on the computer, and get medicine on computer.  After given some proper medicine, the patients will proceed to the drug store where they will get the exact medicine they have given to them.

I saw different kinds of people who have that kind of ailment.  Adult people and young people were seen there.  They really needed the help of the Manav Parivar.

NEWS

Senate health care bill clears key hurdle
December 21, 2009 8:15 a.m. EST
’s Ted Barrett, Dana Bash, Alan Silverleib and Jim Acosta contributed to this report.

The Senate vote on health care reform came shortly after 1 a.m. Monday.

Health care hurdle cleared: Health care reform cleared a major hurdle in an early morning vote in the senate. CNN’s Brianna Keilar reports.

What can health bill change?: CNN’s Dr. Sanjay Gupta and Karen Tumulty of Time magazine talk about what the health care bill would do.

Partisan rancor fills D.C.: A blizzard of partisanship blankets Washington in the debate over health care reform. CNN’s Jim Acosta reports.

Washington (CNN) — Democrats won a major victory in their push for health care reform early Monday morning as the Senate voted to end debate on a package of controversial revisions to a sweeping $871 billion bill.

The 60-40 party-line vote, cast shortly after 1 a.m., kept Senate Democrats on track to pass the bill on Christmas Eve. If it passes, the measure will then have to be merged with a roughly $1 trillion plan passed by the House of Representatives in November. Shortly after the vote, the Senate went into recess until noon Monday.

The vote left President Obama on the cusp of claiming victory on his top domestic priority and enacting the biggest expansion of federal health care guarantees since the enactment of Medicare and Medicaid over four decades ago.

“Today, the Senate took another historic step toward our goal of delivering access to quality, affordable health care to all Americans,” Senate Majority Leader Harry Reid, D-Nevada, said in a statement.

The bill will help “promote choice and competition to drive down skyrocketing health care costs for families … all across America.”

The vote was the first of three this week requiring Democrats to win the backing of 60 members — enough to break a GOP filibuster. Final passage of the measure, in contrast, will require a simple majority in the 100-member chamber.

Many political observers believe Monday’s outcome indicates a likely Democratic win on the remaining procedural hurdles and the final vote.

Inside the Senate debate: A major health care victory for Democrats as a 60-40 party line vote was reached to end a package of controversial proposals.

Conservative Dem defends deal: In a CNN Exclusive, Nebraska Democrat Sen. Ben Nelson explains his health care negotiations on ‘State of the Union.’

Obama adviser on drop in polls: Watch as a senior adviser to President Obama discusses the president’s approval rating with CNN’s John King.

“The die is cast. It’s done,” New York Democratic Sen. Chuck Schumer proclaimed after the vote.

Republicans ripped the majority for passing the measure in the middle of the night and accused Democrats of ramming the bill through despite growing public opposition.

“Make no mistake: If the people who wrote this bill were proud of it, they wouldn’t be forcing this vote in the dead of night,” argued Senate Minority Leader Mitch McConnell, R-Kentucky.

“Mark my words: this legislation will reshape our nation. And Americans have already issued their verdict. They don’t want it. They don’t like this bill, and they don’t like lawmakers playing games with their health care to secure the votes they need to pass it.”

The unusual timing of the vote was a consequence of Senate rules, Democrats’ determination to pass the bill before adjourning for the holidays, and the GOP’s willingness to use every possible legislative tactic to slow the bill’s progress.

Unanimous Republican opposition has forced Reid to win the support of all 60 members of his traditionally fractious Democratic caucus. Compromises made to win the backing of more conservative members, such as Nebraska Sen. Ben Nelson and Connecticut Sen. Joe Lieberman, have enraged many liberal Democrats and threatened to undermine support for the bill.

Liberal Democrats are particularly upset with Reid’s decision to abandon a government-run public health insurance option and an expansion of Medicare to Americans as young as age 55 — ideas strongly opposed by Lieberman and other centrists.

Top Democrats, however, argue that the Senate bill as written would still constitute a positive change of historic proportions. The legislation, according to the nonpartisan Congressional Budget Office, would extend health insurance coverage to over 30 million Americans while reducing the federal deficit by $132 billion over the next decade.

The deficit would drop by another $1.3 trillion between the years 2019 and 2029, the CBO said.

Democratic leaders in the House and Senate have now reached agreement on a broad range of changes that could affect every American’s coverage.

Among other things, they have agreed to subsidize insurance for a family of four making up to about $88,000 annually, or 400 percent of the federal poverty level.

They have also agreed to create health insurance exchanges designed to make it easier for small businesses, the self-employed and the unemployed to pool resources and purchase less expensive coverage. Both the House plan and the Senate bill would eventually limit total out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.

Insurers would also be barred from charging higher premiums based on a person’s gender or medical history. Medicaid would be significantly expanded under both proposals.

There are, however, major differences between the Senate measure and the more expansive — hence expensive — House bill.

One of the biggest divides is over how to pay for the plans. The House package is financed through a combination of a tax surcharge on wealthy Americans and new Medicare spending reductions. Individuals with annual incomes over $500,000 and families earning more than $1 million would face a 5.4 percent income tax surcharge.

The Senate bill also cuts Medicare by roughly $500 billion. It does not include a tax surcharge on the wealthy, however. It would instead impose a 40 percent tax on so-called “Cadillac” health plans.

Proponents of the tax on high-end plans argue it’s one of the most effective ways to curb medical inflation. House Democrats are adamantly opposed to taxing such policies, arguing that such a move would hurt union members who traded higher salaries for more generous benefits.

Another key sticking point is the dispute over a public option. The House plan includes a public option; the more conservative Senate plan would instead create new nonprofit private plans overseen by the federal government.

iReport.com: Give your thoughts on the Senate health care bill

Under both plans, individuals would be required to purchase coverage. But the House bill includes more stringent penalties for most of those who fail to comply. Both versions include a hardship exemption for poorer Americans.

Employers face a much stricter mandate under the House legislation, which would require companies with a payroll of more than $500,000 to provide insurance or pay a penalty of up to 8 percent of their payroll.

The Senate bill would require any company with more than 50 employees to pay a fee of up to $750 per worker if any of its employees relies on government subsidies to purchase coverage.

Abortion has also been a sticking point for both chambers. A late compromise with conservatives in the House led to the adoption of an amendment banning most abortion coverage from the public option.

It would also prohibit abortion coverage in private policies available in the exchange to people receiving federal subsidies.

Senate provisions, made more conservative than initially drafted in order to satisfy Nelson, would allow states to choose whether to ban abortion coverage in plans offered in the exchanges. Individuals purchasing plans through the exchanges would have to pay for abortion coverage out of their own funds.

Many observers expect the final bill will conform largely to the measure now moving through the Senate.

“Reid had to make a lot of concessions to get his entire caucus behind the Senate bill,” said CNN deputy political director Paul Steinhauser.

“He can’t afford to a lose a single vote. Every Democratic senator has the power to kill this bill, and that fact gives Senate negotiators tremendous leverage in their negotiations with the House.”

Nelson told CNN’s “State of the Union” on Sunday that he would withdraw his support if the final bill gets changed too much from the Senate version under consideration.

Among other things, Nelson had a provision added to the bill requiring the federal government to cover Nebraska’s costs for expanded Medicaid coverage after 2016. No other state is currently slated to receive such a benefit.

© 2009 Cable News Network. Turner Broadcasting System, Inc.

NEWS

Senate votes to give green light to health care bill
December 21, 2009 1:50 a.m. & 4:18 a.m. EST
’s Ted Barrett, Dana Bash and Alan Silverleib contributed to this report

Washington (CNN) — Democrats won a major victory in their push for health care reform early Monday morning as the Senate voted to end debate on a package of controversial revisions to a sweeping $871 billion bill.

The 60 to 40 party-line vote, cast shortly after 1 a.m., kept Senate Democrats on track to pass the bill on Christmas Eve. If it passes, the measure will then have to be merged with a roughly $1 trillion plan passed by House of Representatives in November. The Senate went into recess until noon Monday shortly after the vote.

The vote left President Obama on the cusp of claiming victory on his top domestic priority and enacting the biggest expansion of federal health care guarantees since the enactment of Medicare and Medicaid over four decades ago.

“Today, the Senate took another historic step toward our goal of delivering access to quality, affordable health care to all Americans,” Senate Majority Leader Harry Reid, D-Nevada, said in a statement.

The bill will help “promote choice and competition to drive down skyrocketing health care costs for families … all across America.”

The vote was the first of three this week requiring Democrats to win the backing of 60 members — enough to break a GOP filibuster. Final passage of the measure, in the contrast, will require a bare majority in the 100-member chamber.

Many political observers believe Monday’s outcome indicates a likely Democratic win on the remaining procedural hurdles and the final vote.

A major health care victory for Democrats as a 60-40 party line vote was reached to end a package of controversial proposals.

In a CNN Exclusive, Nebraska Democrat Sen. Ben Nelson explains his health care negotiations on ‘State of the Union.’

“The die is cast. It’s done,” New York Democratic Sen. Chuck Schumer proclaimed after the vote.

Republicans ripped the majority for passing the measure in the middle of the night and accused Democrats of ramming the bill through despite growing public opposition.

“Make no mistake: If the people who wrote this bill were proud of it, they wouldn’t be forcing this vote in the dead of night,” argued Senate Minority Leader Mitch McConnell, R-Kentucky.

“Mark my words: this legislation will reshape our nation. And Americans have already issued their verdict. They don’t want it. They don’t like this bill, and they don’t like lawmakers playing games with their health care to secure the votes they need to pass it.”

The unusual timing of the vote was a consequence of Senate rules, Democrats’ determination to pass the bill before adjourning for the holidays, and the GOP’s willingness to use every possible legislative tactic to slow the bill’s progress.

Unanimous Republican opposition has forced Reid to win the support of all 60 members of his traditionally fractious Democratic caucus. Compromises made to win the backing of more conservative members, such as Nebraska Sen. Ben Nelson and Connecticut Sen. Joe Lieberman, have enraged many liberal Democrats and threatened to undermine support for the bill.

Liberal Democrats are particularly upset with Reid’s decision to abandon a government-run public health insurance option and an expansion of Medicare to Americans as young as age 55 — ideas strongly opposed by Lieberman and other centrists.

Top Democrats, however, argue that the Senate bill as written would still constitute a positive change of historic proportions. The legislation, according to the nonpartisan Congressional Budget Office, would extent health insurance coverage to over 30 million Americans while reducing the federal deficit by $132 billion over the next decade.

The deficit would drop by another $1.3 trillion between the years 2019 and 2029.

Democratic leaders in the House and Senate have now reached agreement on a broad range of changes that could effect every American’s coverage.

Among other things, they have agreed to subsidize insurance for a family of four making up to roughly $88,000 annually, or 400 percent of the federal poverty level.

They have also agreed to create health insurance exchanges designed to make it easier for small businesses, the self-employed and the unemployed to pool resources and purchase less expensive coverage. Both the House plan the Senate bill would eventually limit total out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.

Insurers would also be barred from charging higher premiums based on a person’s gender or medical history.

Medicaid would be significantly expanded under both proposals. The House bill would extend coverage to individuals earning up to 150 percent of the poverty line, or roughly $33,000 for a family of four; the Senate plan ensures coverage to those earning up to 133 percent of the poverty level, or just over $29,000 for a family of four.

There are, however, major differences between the Senate measure and the more expansive — and hence expensive — House bill.

One of the biggest divides is over how to pay for the plans. The House package is financed through a combination of a tax surcharge on wealthy Americans and new Medicare spending reductions.

Specifically, individuals with annual incomes over $500,000 — as well as families earning more than $1 million — would face a 5.4 percent income tax surcharge.

The Senate bill also cuts Medicare by roughly $500 billion. It does not include a tax surcharge on the wealthy, however. It would instead impose a 40 percent tax on so-called “Cadillac” health plans valued at more than $8,500 for individuals and $23,000 for families.

Proponents of the tax on high-end plans argue it’s one of the most effective ways to curb medical inflation. House Democrats are adamantly opposed to taxing such policies, arguing that such a move would hurt union members who traded higher salaries for more generous benefits.

The Senate bill would also hike Medicare payroll taxes on families making over $250,000; the House bill does not.

Another key sticking point: the dispute over a public option. The House plan includes a public option; the more conservative Senate plan would instead create new nonprofit private plans overseen by the federal government.

iReport.com: Give your thoughts on the Senate health care bill.

Individuals under both plans would be required to purchase coverage, but the House bill includes more stringent penalties for most of those who fail to comply. The House bill would impose a fine of up to 2.5 percent of an individual’s income. The Senate plan would require individuals to purchase health insurance coverage or face a fine of up to $750 or 2 percent of his or her income — whichever is greater.

Both versions include a hardship exemption for poorer Americans.

Employers face a much stricter mandate under the House legislation, which would require companies with a payroll of more than $500,000 to provide insurance or pay a penalty of up to 8 percent of their payroll.

The Senate bill would require companies with more than 50 employees to pay a fee of up to $750 per worker if any of its employees relies on government subsidies to purchase coverage.

Abortion has also been a sticking point for both chambers. A late compromise with Catholic and other conservatives in the House led to the adoption of an amendment banning most abortion coverage from the public option.

It would also prohibit abortion coverage in private policies available in the exchange to people receiving federal subsidies.

Senate provisions, made more conservative than initially drafted in order to satisfy Sen. Nelson, would allow states to choose whether to ban abortion coverage in plans offered in the exchanges. Individuals purchasing plans through the exchanges would have to pay for abortion coverage out of their own funds.

Many observers expect the final bill will conform largely to the measure now moving through the Senate.

“Reid had to make a lot of concessions to get his entire caucus behind the Senate bill,” said CNN Deputy Political Director Paul Steinhauser.

“He can’t afford to a lose a single vote. Every Democratic senator has the power to kill this bill, and that fact gives Senate negotiators tremendous leverage in their negotiations with the House.”

Nelson told CNN’s “State of the Union” on Sunday that he would withdraw his support if the final bill gets changed too much from the Senate version under consideration.

Among other things, Nelson had a provision added to the bill requiring the federal government to cover Nebraska’s costs for expanded Medicaid coverage after 2016. No other state is currently slated to receive such a benefit.

© 2009 Cable News Network. Turner Broadcasting System, Inc.

NEWS

Senate pushes to pass bill by holiday

December 20, 2009 6:10 p.m. EST

This weekend's snowstorm in Washington hasn't stalled the Senate debate to overhaul health care.

Washington (CNN) — Senate Democrats braved the aftermath of a blizzard Sunday to continue their push to pass a sweeping health care bill before Christmas.

The Senate began an all-day session, to be followed by a crucial vote scheduled for after midnight, on changes crafted by Majority Leader Harry Reid of Nevada to gain support for the bill from all 60 members of the Democratic caucus.

With Republicans unanimously opposed, Democrats need the support of their entire caucus to overcome a filibuster and move to a final vote on the bill later this week.

“We have had a long, arduous and I think sometimes taxing debate to reach this moment,” said Illinois Sen. Dick Durbin, the chamber’s second-ranking Democrat, to open the session. “I think it’s time for a vote.”

A key hurdle was cleared Saturday when the last Democratic holdout, Sen. Ben Nelson of Nebraska, agreed to support the bill in return for compromise language on federal funding for abortion and more money for his state. It was the latest in a series of deals with Senate Democrats to hold together caucus support for the bill.

iReport.com: Give your thoughts on the Senate health care bill

The House of Representatives already has passed its health care bill, and if the Senate also passes legislation, the two versions would be merged by a conference committee. Both chambers then would have to approve a final version before it goes to President Obama to be signed into law.

Obama had wanted to sign the bill by the end of year, but his senior adviser, David Axelrod, acknowledged Sunday that wouldn’t happen.

“I think we’re going to have some work to do when we come back” from the Christmas-New Year break, Axelrod said Sunday on NBC’s “Meet the Press.”

Both Axelrod and Vice President Joe Biden said Sunday the Senate bill lacks some provisions the Obama administration wanted, but that it would bring much-needed health care reforms.

“There is no major piece of legislation that’s ever been passed without compromise; that’s the legislative process,” Axelrod said on NBC. “It is not perfect. Over time it may be improved, as all legislation is.”

In a New York Times op-ed published Sunday, Biden said the bill was “not perfect,” but called it “very good” because it expands coverage to those currently unable to afford or obtain health insurance while holding down the nation’s spiraling health care costs.

“I’ve been around a long time, and I know that in Washington big changes never emerge in perfect form,” Biden wrote.

Republicans, however, accused the Senate’s Democratic majority of working secretly to force through a poorly conceived bill that required special deals with recalcitrant caucus members.

Sen. Lindsey Graham, R-South Carolina, said on CNN’s “State of the Union” that the wheeling and dealing “personifies the worst” in how Washington operates, while Sen. Tom Coburn, R-Oklahoma, accused the Democrats of buying support.

“This process is not legislation; this is corruption,” Coburn said at a news conference.

The only Republican to have voted for a health care reform plan in the Senate Finance Committee in October, Sen. Olympia Snowe of Maine, said Sunday she would oppose the measure now before the full chamber.

“I deeply regret that I cannot support the pending Senate legislation as it currently stands, given my continued concerns with the measure and an artificial and arbitrary deadline of completing the bill before Christmas that is shortchanging the process on this monumental and trans-generational effort,” Snowe said in a statement.

While Reid apparently believes he has the 60 votes now to pass the Senate bill, it was unclear how senators would react to changes by a conference committee.

Nelson told “State of the Union” on Sunday that he would withdraw his support if the final bill gets changed too much from the Senate version under consideration. In particular, Nelson said he would oppose a bill that includes a government-run public health insurance option in the House version but cut from the Senate bill.

Facing criticism from both Republican opponents of health care and liberal Democrats seeking a stronger bill, Nelson said, “It’s like going home and getting bit by the family dog. Who enjoys that?”

“The high intensity here is as harsh and unforgiving and unrelenting as I have ever seen it in my nine years here,” he said of the health care debate.

Meanwhile, Republican Mike Huckabee, a former presidential hopeful and ex-governor of Arkansas, traveled to Nelson’s home state to rally against the senator’s decision to vote in favor of the bill. Speaking at an Americans for Prosperity event in Omaha, Huckabee invoked the holiday spirit, likening the health care bill to a “lump of coal” that has “fired up” the public.

“If the members of this Congress will not pay attention to the people who elected them, who hired them and who have the right to fire them, then the people in this country will remind them who they work for when they no longer get to work for them,” he said.

The $871 billion Senate bill would be the largest deficit-reduction measure in a decade, Obama said Saturday.

“We are on the cusp of making health care reform a reality,” the president said.

According to the Congressional Budget Office, the legislation could decrease the deficit by $132 billion over the first decade, and more than $1 trillion in the 10 years afterward, Obama said at a brief news conference.

While the House and Senate bills agree on most issues, there are significant differences over how to pay for them and how they will expand health coverage to more than 30 million uninsured Americans.

The House bill calls for an income tax surcharge on the wealthy, while the Senate version would increase the Medicare payroll tax for those earning more than $200,000 and levy a tax on insurance companies that provide expensive health plans.

Axelrod told “State of Union” that the president thinks the Senate idea to tax insurance companies that provide high-cost “Cadillac” health care coverage is worth considering.

Axelrod avoided discussing details but said that taxing the expensive insurance plans would lower their long-term costs because insurers would seek to bring down the price to avoid the tax. Obama “thinks that has some merit,” Axelrod said.

Organized labor opposes taxing expensive health plans, arguing such benefits have been negotiated for workers in lieu of pay raises in a changing economy.

Axelrod noted the plan would tax insurance companies, forcing them to become more efficient. Eventually, he said, reducing the cost of employer-provided health care should mean more money to raise wages.

Some liberal Democrats criticize the Senate bill as being too weak, but Axelrod said a final health care measure passed by Congress will mean historic and far-reaching benefits for the nation.

“It is so wrong to suggest that this is somehow some kind of middling improvement for the American people,” Axelrod said.

In a CNN Exclusive, Nebraska Democrat Sen. Ben Nelson explains his health care negotiations on ‘State of the Union’.

Obama adviser David Axelrod tells John King that his administration is on the cusp of reforming health care.

CNN’s Howard Kurtz talks with three top journalists about the personal tone of the health care debate coverage.

Sen. Lindsey Graham gives scathing criticism of the Obama administration and the proposed Senate health care bill.

CNN’s Dana Bash reports, as Sen. Ben Nelson pledges support for health care reform, bring the vote count to 60.

© 2009 Cable News Network. Turner Broadcasting System, Inc.

NEWS

The White House

Remarks by the President during press availability in Copenhagen

The President speaks and takes questions at the United Nations Climate Change Conference in Copenhage, Denmark.
December 18, 2009.
Bella Center
Copenhagen, Denmark
10:30 P.M. CET (4:30 P.M. EST)

THE PRESIDENT:  Let me start with a statement and then I’ll take a couple of questions.

Today we’ve made meaningful and unprecedented — made a meaningful and unprecedented breakthrough here in Copenhagen.  For the first time in history all major economies have come together to accept their responsibility to take action to confront the threat of climate change.

Let me first recount what our approach was throughout the year and coming into this conference.  To begin with, we’ve reaffirmed America’s commitment to transform our energy economy at home.  We’ve made historic investments in renewable energy that have already put people back to work.  We’ve raised our fuel efficiency standards.  And we have renewed American leadership in international climate negotiations.

Most importantly, we remain committed to comprehensive legislation that will create millions of new American jobs, power new industry, and enhance our national security by reducing our dependence on foreign oil.

That effort at home serves as a foundation for our leadership around the world.  Because of the actions we’re taking we came here to Copenhagen with an ambitious target to reduce our emissions.  We agreed to join an international effort to provide financing to help developing countries, particularly the poorest and most vulnerable, adapt to climate change.  And we reaffirmed the necessity of listing our national actions and commitments in a transparent way.

These three components — transparency, mitigation and finance — form the basis of the common approach that the United States and our partners embraced here in Copenhagen.  Throughout the day we worked with many countries to establish a new consensus around these three points, a consensus that will serve as a foundation for global action to confront the threat of climate change for years to come.

This success would have not been possible without the hard work of many countries and many leaders — and I have to add that because of weather constraints in Washington I am leaving before the final vote, but we feel confident that we are moving in the direction of a significant accord.

In addition to our close allies who did so much to advance this effort, I worked throughout the day with Prime Minister Meles of Ethiopia, who was representing Africa, as well as Premier Wen of China, Prime Minister Singh of India, President Lula of Brazil, and President Zuma of South Africa, to achieve what I believe will be an important milestone.

Earlier this evening I had a meeting with the last four leaders I mentioned — from China, India, Brazil, and South Africa.  And that’s where we agreed to list our national actions and commitments, to provide information on the implementation of these actions through national communications, with international consultations and analysis under clearly defined guidelines.  We agreed to set a mitigation target to limit warming to no more than 2 degrees Celsius, and importantly, to take action to meet this objective consistent with science.

Taken together these actions will help us begin to meet our responsibilities to leave our children and our grandchildren a cleaner and safer planet.

Now, this progress did not come easily, and we know that this progress alone is not enough.  Going forward, we’re going to have to build on the momentum that we’ve established here in Copenhagen to ensure that international action to significantly reduce emissions is sustained and sufficient over time.  We’ve come a long way, but we have much further to go.

To continue moving forward we must draw on the effort that allowed us to succeed here today — engagement among nations that represent a baseline of mutual interest and mutual respect.  Climate change threatens us all; therefore, we must bridge old divides and build new partnerships to meet this great challenge of our time.  That’s what we’ve begun to do here today.

For energy holds out not just the perils of a warming climate, but also the promise of a more peaceful and prosperous tomorrow.  If America leads in developing clean energy, we will lead in growing our economy, in putting our people back to work, and in leaving a stronger and more secure country to our children.

And around the world, energy is an issue that demands our leadership.  The time has come for us to get off the sidelines and to shape the future that we seek.  That’s why I came to Copenhagen today, and that’s why I’m committed to working in common effort with countries from around the globe.  That’s also why I believe what we have achieved in Copenhagen will not be the end but rather the beginning, the beginning of a new era of international action.

So with that, let me just take a couple of questions, and I’m going to start with Jeff Mason.

Q    Thank you, Mr. President.  Can you give a little bit more detail about how the transparency issue will work, how countries will show or prove that they’re doing what they say they’ll do on emissions curbs?  And can you speak also more specifically about cutting emissions?  There’s no mention of that in your statement or in what we’ve heard so far, specifically about the agreement.

THE PRESIDENT:  Well, on the second question first, the way this agreement is structured, each nation will be putting concrete commitments into an appendix to the document, and so will lay out very specifically what each country’s intentions are.

Those commitments will then be subject to a international consultation and analysis, similar to, for example, what takes place when the WTO is examining progress or lack of progress that countries are making on various commitments.  It will not be legally binding, but what it will do is allow for each country to show to the world what they’re doing, and there will be a sense on the part of each country that we’re in this together, and we’ll know who is meeting and who’s not meeting the mutual obligations that have been set forth.

With respect to the emissions targets that are going to be set, we know that they will not be by themselves sufficient to get to where we need to get by 2050.  So that’s why I say that this is going to be a first step.  And there are going to be those who are going to — who are going to look at the national commitments, tally them up and say, you know, the science dictates that even more needs to be done.  The challenge here was that for a lot of countries, particularly those emerging countries that are still in different stages of development, this is going to be the first time in which even voluntarily they offered up mitigation targets.  And I think that it was important to essentially get that shift in orientation moving, that’s what I think will end up being most significant about this accord.

From the perspective of the United States, I’ve set forth goals that are reflected in legislation that came out of the House that are being discussed on a bipartisan basis in the Senate.  And although we will not be legally bound by anything that took place here today, we will I think have reaffirmed our commitment to meet those targets.  And we’re going to meet those targets, as I said before, not simply because the science demands it, but also because I think it offers us enormous economic opportunity down the road.

Q    And the first part of the question, about the transparency issue?

THE PRESIDENT:  Well, as I said, there is a specific –

Q    (Inaudible.)

THE PRESIDENT:  Exactly.  There is the annexing combined with a process where essentially they are presenting to the world — subject to international consultation and then analysis — exactly what are these steps.  So if I make a claim that I’m reducing greenhouse gases because I’ve changed mileage standards on cars, there will be a process whereby people will be able to take a look and say, is that in fact in effect?

Jennifer Loven.

Q    Thank you, sir.  You’ve talked to, in your remarks earlier today, about other nations needing to accept less than perfect in their view.  Can you talk about what you gave up and where you might have shifted the U.S. position to get to this point?  And also, if this was so hard to get to, just what you have today, how do you feel confident about getting to a legally binding agreement in a year?

THE PRESIDENT:  I think it is going to be very hard and it’s going to take some time.  Let me sort of provide the context for what I saw when I arrived.

And I think it’s important to be able to stand in the shoes of all the different parties involved here.  In some ways the United States was coming with a somewhat clean slate, because we had been on the sidelines in many of these negotiations over several years.

Essentially you have a situation where the Kyoto Protocol and some of the subsequent accords called on the developed countries who were signatories to engage in some significant mitigation actions and also to help developing countries.  And there were very few, if any, obligations on the part of the developing countries.

Now, in some cases, for countries that are extremely poor, still agrarian and so forth, they’re just not significant contributors to greenhouse gases.  But what’s happened obviously since 1992 is that you’ve got emerging countries like China and India and Brazil that have seen enormous economic growth and industrialization.  So we know that moving forward it’s going to be necessary if we’re going to meet those targets for some changes to take place among those countries.  It’s not enough just for the developed countries to make changes.  Those countries are going to have to make some changes, as well — not of the same pace, not in the same way, but they’re going to have to do something to assure that whatever carbon we’re taking out of the environment is not just simply dumped in by other parties.

On the other hand, from the perspective of the developing countries like China and India, they’re saying to themselves, per capita our carbon footprint remains very small, and we have hundreds of millions of people who don’t even have electricity yet, so for us to get bound by a set of legal obligations could potentially curtail our ability to develop, and that’s not fair.

So I think that you have a fundamental deadlock in perspectives that were brought to the discussions during the course of this week.  And both sides have legitimate points.

My view was that if we could begin to acknowledge that the emerging countries are going to have some responsibilities, but that those responsibilities are not exactly the same as the developed countries, and if we could set up a financing mechanism to help those countries that are most vulnerable, like Bangladesh, then we would be at least starting to reorient ourselves in a way that allows us to be effective in the future.

But it is still going to require more work and more confidence-building and greater trust between emerging countries, the least developed countries, and the developed countries before I think you are going to see another legally binding treaty signed.

I actually think that it’s necessary for us ultimately to get to such a treaty, and I am supportive of such efforts.  But this is a classic example of a situation where if we just waited for that, then we would not make any progress.  And in fact I think there might be such frustration and cynicism that rather than taking one step forward, we ended up taking two steps back.

But I want to be very clear that ultimately this issue is going to be dictated by the science, and the science indicates that we’re going to have to take more aggressive steps in the future.  Our hope is that by investing in clean energy, in research, in development, in innovation, that in the same way that the Clean Air Act ended up spurring all kinds of innovations that solved the acid rain problem at a much cheaper and much more rapid pace than we expected, that by beginning to make progress and getting the wheels of innovation moving, that we are in fact going to be in a position to solve this problem.

But we’re going to need technological breakthroughs to get to the goals that we’re looking for.  In the meantime, we’ve got to be able to take the steps that are in our grasp right now, like for example energy efficiency, something I emphasized last week.

All right.  Helene Cooper.  I’m sorry.

Q    What about the compromise shift question?

THE PRESIDENT:  I have to say that, quietly, we did some pretty good ground work during the course of this year, so that our position was relatively clear.  I think that the one principle that I brought to this is that whatever commitments we make, I want to be able to be sure that they’re actually commitments that we can keep.  So we tried to be modest in what we thought we could accomplish.  I think there was interest on the part of some to, for example, increase our mitigation targets.  Although when you look out in the years 2025 or 2030, our goals are actually entirely comparable with Europe’s.  On the front end they appear to be less, because frankly, they’ve had a head start over the last several years in doing things like energy efficiency that we care about.

What I said to the other people in the room is, is that I want to make sure that whatever it is that we promise we can actually deliver on, and that it would be unrealistic for us to think that we can turn on a dime and that suddenly a clean-energy economy is going to emerge overnight, given the fact that it’s going to require significant effort.  And companies and industries are going to be wanting to make changes — we’re already seeing those changes, but they haven’t all borne fruit yet.  And we want to make sure that we’re not getting too far ahead of ourselves in terms of targets, even as I understand that the science compels us to move as rapidly as we can.

All right.  Helene Cooper.

Q    Thank you.  I wanted to ask you about this listing of the — in the appendix.  Going forward do you think that’s going to continue to be sufficient, or do you think verification is going to remain a source of friction between the U.S. and China?  And also on cap and trade, are you able to — were you able to assure the leaders here that you’ll make that a legislative priority next year?

THE PRESIDENT:  With respect to the appendix, these countries have set forth for the first time some very significant mitigation efforts, and I want to give them credit for that.  I mean, if you look at a country like India, as I said, they’ve got hundreds of millions of people who don’t have electricity, hundreds of millions of people who, by any standard, are still living in dire poverty.  For them, even voluntarily to say, we are going to reduce carbon emissions relative to our current ways of doing business by X percent is an important step.  And we applaud them for that.

The problem actually is not going to be verification in the sense that this international consultation and analysis mechanism will actually tell us a lot of what we need to know.  And the truth is that we can actually monitor a lot of what takes place through satellite imagery and so forth.  So I think we’re going to have a pretty good sense of what countries are doing.

What I think that some people are going to legitimately ask is, well, if it’s not legally binding what prevents us from, 10 years from now, looking and saying, you know, everybody fell short of these goals and there’s no consequences to it?  My response is that, A, that’s why I think we should still drive towards something that is more binding than it is.  But that was not achievable at this conference.

And the second point that I’d make is that Kyoto was legally binding and everybody still fell short anyway.  And so I think that it’s important for us, instead of setting up a bunch of goals that end up just being words on a page and are not met, that we get moving — everybody is taking as aggressive a set of actions as they can; that there is a sense of mutual obligation and information sharing so that people can see who’s serious and who’s not; that we strive for more binding agreements over time; and that we just keep moving forward.  That’s been the main goal that I tried to pursue today.

And I think that as people step back, I guarantee you there are going to be a lot of people who immediately say, the science says you got to do X, Y, Z; in the absence of some sort of legal enforcement, it’s not going to happen.  Well, we don’t have international government, and even treaties, as we saw in Kyoto, are only as strong as the countries’ commitments to participate.

Because of the differing views between developing countries and developed countries, in terms of future obligations, the most important thing I think we can do at this point — and that we began to accomplish but are not finished with — is to build some trust between the developing and the developed countries to break down some of the logjams that have to do with people looking backwards and saying, well, Kyoto said this, or Bali said that, or you guys need to do something but we don’t need to do something; getting out of that mindset and moving towards a position where everybody recognizes we all have to move together.  If we start from that position, then I think we’re going to be able to make progress in the future.

But this is going to be hard.  This is hard within countries; it’s going to be even harder between countries.  And one of the things that I’ve felt very strongly about during the course of this year is that hard stuff requires not paralysis, but it requires going ahead and making the best of the situation that you’re in at this point, and then continually trying to improve and make progress from there.

Okay, thank you very much everybody.  We’ll see some of you on the plane.

Q    Mr. President, who will sign the agreement — since you’re leaving, who here has the power to sign it?

THE PRESIDENT:  We’ve got our negotiators who are here.  I’m not going to be the only leader who I think leaves before it’s finally presented, but they are empowered to sign off — given at this point that most of the text has been completely worked out.

Q    Does it require signing, is it that kind of agreement?

THE PRESIDENT:  You know, it raises an interesting question as to whether technically there’s actually a signature — since, as I said, it’s not a legally binding agreement, I don’t know what the protocols are.  But I do think that this is a commitment that we, as the United States, are making and that we think is very important.

All right.  Thanks, guys.

The White House .

NEWS

The White House

Progress on Health Care and Climate Change

President  Obama speaks to the media about the progress being made in the Senate to pass health care reform legislation as well as breakthroughs made in Copenhagen to address climate change. December 19, 2009.

The White House