Oregon voters this week gave us an unusual opportunity to learn in real time what voters think about a legislative proposal being considered in Congress.
When asked about raising state cigarette taxes to add more children to publicly-funded health coverage, Oregon voters rejected the plan by a 59% to 41% margin.
Congress, of course, has passed legislation that would do just that — increase federal cigarette taxes by 61 cents a pack to pay for an expansion of the State Children's Health Insurance Program to cover more children, including many in middle-income families. Members have been meeting into the midnight hours in Washington to try to write another bill that can gain enough support to override President Bush's veto.
Oregon's ballot results aren't going to help.
Measure 50 would have increased Oregon's cigarette tax by 85 cents a pack. The measure went to the voters for a referendum after Democratic state legislative leaders failed to get enough support to pass the measure outright. They didn't have the three-fifths vote needed to pass revenue-raising bills in the legislature, but they did have the simple majority needed to ask voters to amend the constitution and add the cigarette tax. All they needed was a simple majority of the voters to say yes.
The measure failed in every county but one.
President Bush has said that he wants Congress to focus on devising an SCHIP bill that would focus on enrolling the lower-income children who already are eligible for Medicaid and SCHIP before expanding coverage to kids in higher-income families.
And that is what Oregon's fallback plan will be. Oregon State Rep. Gene Whisnant said that after the defeat of Measure 50, lawmakers now should focus on finding ways to enroll the children who already qualify for aid but aren't signed up.
The ballot initiative was the most expensive campaign in Oregon history, with strong support for the measure from the governor, the majority in the legislature, from labor unions, hospitals, and citizens' groups who said that the tax increase would go to insure nearly 100,000 children and would discourage more Oregonians from smoking.
Supporters of Measure 50 blamed a huge advertising campaign financed by tobacco companies for its defeat. But their message must have resonated. Opponents zeroed in on four basic arguments against the tax, according to The Oregonian: They argued that there was no way to account for how the money would be spent; it was inappropriate to stick a product tax in the constitution; it was unfair to smokers; and the program was fiscally unsustainable as costs eventually would outstrip revenue.
The editorial in The New York Times yesterday was predictably scathing: "Big tobacco defeats sick kids." An editorial in The Oregonian offered a similar indictment.
But it is always a mistake to tell voters that they are stupid, which is what these editorials basically do.
Nina Owcharenko at Heritage has a good paper, explaining that the direction Congress is taking with its SCHIP legislation is fundamentally flawed. Voters need to have real options presented, and Oregon voters, like California and Missouri voters faced with similar referenda before, said this wasn't it.
It seems we learn best from the French who we are as Americans. French President Nicolas Sarkozy gave an incredibly inspiring speech before a joint session of Congress on Wednesday that was full of admiration and affection for the United States, referring often to our shared love for freedom and justice. And members of Congress responded with loud cheers and standing ovations. All is now forgiven.
You need to read or watch the full speech to hear how truly extraordinary it was.
Sarkozy praises America, which, he said, "opened a new era for all of humanity.
"From the very beginning, the American dream meant proving to all mankind that freedom, justice, human rights and democracy were no utopia but were rather the most realistic policy there is and the most likely to improve the fate of each and every person.
"America did not tell the millions of men and women who came from every country in the world and who — with their hands, their intelligence and their heart — built the greatest nation in the world: 'Come, and everything will be given to you.' She said: 'Come, and the only limits to what you'll be able to achieve will be your own courage and your own talent.'
"Here, both the humblest and most illustrious citizens alike know that nothing is owed to them and that everything has to be earned. That's what constitutes the moral value of America. America did not teach men the idea of freedom; she taught them how to practice it. And she fought for this freedom whenever she felt it to be threatened somewhere in the world. It was by watching America grow that men and women understood that freedom was possible.
"What made America great was her ability to transform her own dream into hope for all mankind." And to always emerge from every adversity "even greater and stronger."
The speech is worthy of an inaugural, describing France's eternal gratitude for the sacrifices of American lives to win Europe's freedom, and describing the challenges that lie ahead in foreign and economic policy.
Can France now become a leader in Europe in strengthening ties with the U.S.? With this courageous new leader at the helm, c'est possible.
I've known, since our trip to Normandy on the 60th anniversary of D-Day, that the French people love America; we watched them reenact the liberation while dressed as World War II American soldiers racing around the countryside in antique Jeeps. Finally, France has a president who speaks for them.
On Wednesday after the speech, President Bush took President Sarkozy to George Washington's Mt. Vernon estate south of Alexandria, VA. I was heading from our offices to National Airport as police lined the George Washington Parkway in preparation for the motorcade. It was a beautiful fall day and so inspiring to watch this bit of history unfold.
I was headed to give a speech in Salt Lake City yesterday to the Utah Health Insurance Association. Here is my PowerPoint, which focuses on state-level efforts at health reform, including an overview of the Massachusetts experience. I travel again on Monday to Colorado Springs to speak to a Chamber of Commerce forum there on the same issue.
It is all about freedom, liberty, and justice.
RECENT NEWS ARTICLES AND STUDIES:
FDA Says Consumers Continue to Buy Risky Drugs Online
U.S. Food and Drug Administration, 11/01/07
A yearlong U.S. Food and Drug Administration (FDA) investigation into drugs mailed to the United States from foreign countries suggests that consumers may be buying drugs online to avoid the need for a prescription from their physician, "an intrinsically risky practice," said Randall Lutter, FDA's deputy commissioner for policy. The FDA survey was conducted from September 2006 to August 2007 in international mail facilities and courier facilities across the country. The FDA warns that Web sites can appear legitimate, but in fact may be a front for an illegal operation. The FDA urges consumers to beware of unregulated Internet drug sellers because many of their products might not contain the correct ingredients and could contain toxic substances. Several drugs found in this survey require special monitoring by physicians or other health care professionals for potential adverse events.
Brian Ferguson of the Canadian-based Atlantic Institute for Market Studies provides a comprehensive overview of drug re-importation in North America and Europe.
Congress' Patent Mistakes
John E. Calfee and Claude Barfield, American Enterprise Institute
The Wall Street Journal, 10/29/07
Congress is preparing to enact far-reaching reforms of the patent system, and the stakes are high: Intellectual property in the U.S., the security of which relies upon the patent system, is worth more than $5 trillion today — roughly 40% of our annual GDP. Sweeping legislative changes would, however, be a dangerous mistake. Before rushing to enact major changes, Congress should remember that its past reforms have often spawned new problems. This is no time to slice and dice a truckload of compromises among bitterly opposed special interests. The economic cost of forcing the patent system to lean decisively one way or another — crippling the ability of the U.S. Patent and Trade Office and the courts to adjust to changing conditions — would be immense. Congress should be mindful of the physician's oath as it contemplates patent reform: First, do no harm.
Attack of the Superbugs
Scott Gottlieb, M.D., American Enterprise Institute
The Wall Street Journal, 10/30/07
Recent news coverage has focused on the virulent and drug-resistant bacterium called methicillin-resistant staphylococcus aureus, or MRSA. Gottlieb writes that the real news isn't that these bugs exist, but how woefully unprepared we are to deal with them. Only 13 new antibiotics are in development inside big drug companies, compared to an average of 60 more than a decade ago. Gottlieb writes that we also need better tools for rapidly detecting resistant infections in blood. If there were better diagnostics, bacterial infections could be distinguished early and doctors could treat patients with confidence. Drug companies could also more easily develop drugs targeted to specific bugs and make sure the right patients got the right drug in the course of their illness.
A new report released this week by the Pharmaceutical Research and Manufacturers of America finds that America's pharmaceutical research companies are now testing 338 new medicines to help treat infectious diseases, including 11 medicines and four vaccines to treat staphococcal infections like MRSA.
If R&D Ain't Broke, Why Break It?
Philip Stevens, International Policy Network
Investor's Business Daily, 11/07/07
Ideological NGOs are pushing the World Health Organization toward a global treaty that would have a central United Nations bureaucracy deciding what diseases to research while allocating funds, contracts and prizes accordingly. Giving discretionary power to bureaucrats would politicize research and development, with resources likely going to the loudest pressure groups. It is also unclear how an unelected body in Geneva would be better at setting priorities than the thousands of scientists and businessmen whose livelihoods depend on getting these decisions right. The treaty would also turn drug manufacturers into utilities, living off government contracts. Removing the freedom to decide what to sell and at what price will discourage companies from risking capital to reap rewards, which is how innovation happens.
Health Systems Abroad
Medical Tourism: Global Competition in Health Care
Devon M. Herrick
National Center for Policy Analysis, 11/07
An estimated 500,000 Americans traveled abroad for health care treatment in 2005. A majority traveled to Mexico and other Latin American countries, but they were also among the estimated 250,000 foreign patients who sought care in Singapore, the 500,000 traveling to India and as many as 1 million going to Thailand. Other findings:
- Apollo Hospital in New Delhi, India, charges $4,000 for cardiac surgery, compared to about $30,000 in the United States.
- Hospitals in Argentina, Singapore or Thailand charge $8,000 to $12,000 for a partial hip replacement — one-half the price charged in Europe or the United States.
- Foreign health care providers often have physicians with internationally respected credentials, many of them with training in the U.S., Australia, Canada or Europe.
- More than 120 hospitals abroad are accredited by the Joint Commission International, an arm of the organization that accredits American hospitals participating in Medicare; another 20 are accredited through the International Standards Organization; and some countries are adopting their own accrediting standards.
- Some foreign hospitals are owned, managed or affiliated with prestigious American universities or health care systems such as the Cleveland Clinic and Johns Hopkins International.
Record Numbers Go Abroad for Health
Laura Donnelly and Patrick Sawer
The first survey of Britons opting for treatment overseas shows that record numbers of Britons are flying abroad for medical treatment to escape NHS waiting lists and the rising threat of hospital superbugs. More than 70,000 Britons will have treatment abroad this year — a figure that is forecast to rise to almost 200,000 by the end of the decade. India is the most popular destination for surgery, followed by Hungary, Turkey, Germany, Malaysia, Poland and Spain. Research by the Treatment Abroad website shows that Britons have traveled to 112 foreign hospitals in 48 countries for treatment. Almost all of those who had received treatment abroad said they would do the same again, with patients pointing out that some hospitals in India had screening policies for the superbug MRSA that have yet to be introduced in Britain.
Some Canadians Willing to Jump Health-Care Queues, Says Study
Ottawa Citizen, 10/27/07
A survey of Toronto residents shows that many people would seriously consider pulling strings to jump a health-care queue. Sixteen percent of those responding to the Toronto telephone survey said they had already contacted a friend in the medical system in an effort to get moved up a waiting list. About 29% said they would consider giving a gift or donation to get ahead in the health-care queue, and 36% agreed that patients should be allowed to pay extra to get quicker access. Almost two-thirds said they were willing to pay more for taxes for an improved health care system.
Health Care Basics
Malignant Rumor: On Cancer Survival Rates, Rudy's Right and His Critics Are Wrong
City Journal, 10/31/07
Rudy Giuliani's presidential campaign recently released a radio ad in which the candidate says: "I had prostate cancer, five, six years ago. My chance of surviving prostate cancer?in the United States, 82 percent. My chances of surviving prostate cancer in England, only 44 percent under socialized medicine." He drew those statistics from an article that Dr. David Gratzer wrote for the Summer 2007 issue of City Journal. The ad has already aroused intense criticism, most of it claiming that survival rates in Britain aren't nearly so low.
Gratzer says that the percentage of people diagnosed with prostate cancer who die from it is much higher in Britain than in the United States. According to a study published in 2000, 49 Britons per 100,000 were diagnosed with prostate cancer, and 28 per 100,000 died of it. This means that 57 percent of Britons diagnosed with prostate cancer died of it; and, consequently, that just 43 percent survived. And newer studies show a similar trend: Americans do better when diagnosed with cancer than their European counterparts do, he says.
Since the publication of Gratzer's City Journal essay, the prestigious journal Lancet Oncology has released a landmark study on cancer survival rates. Its findings:
- The American five-year survival rate for prostate cancer is 99 percent, the European average is 78 percent, and the Scottish and Welsh rate is close to 71 percent. (English data were incomplete.)
- For the 16 different types of cancer examined in the study, American men have a five-year survival rate of 66 percent, compared with only 47 percent for European men. Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.
- American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared with 56 percent for European women. For women, only five European countries have an overall survival rate of more than 60 percent.
Community Conversation on Healthcare in Colorado
The Greater Colorado Springs Chamber of Commerce Event
Tuesday, November 13, 2007, 7:00 a.m. – 2:00 p.m.
Colorado Springs, CO
Rep. Amy Stephens will introduce Grace-Marie Turner as the keynote speaker at this healthcare summit.
Beyond Health Insurance: Public Policy to Improve Health
University of Illinois Event
November 15-16, 2007
For more information, contact firstname.lastname@example.org or 312-996-6188.
Aiming High for Health Care in 2008
Citizens' Council on Health Care Event
Thursday, November 15, 2007, 7:30 a.m. – Noon (Breakfast included)
Overtreated: Why Too Much Medicine is Making Americans Sicker and Poorer
National Institute of Health Policy Lecture
Thursday, November 15, 2007, 4:30 p.m. – 8:00 p.m.
Transforming Health: Fulfilling the Promise of Research
PhRMA and Research!America Event
Friday, November 16, 2007, 8:30 a.m. – 2:00 p.m.
Patient Centric Leadership Forum
Duke University Center for Research on Prospective Health Care Event
Tuesday, November 20, 2007, 9:00 a.m. – 3:00 p.m.
For more information, contact Alexandra Preate at email@example.com.
Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features research and writings by participants in the Health Policy Consensus Group, articles of interest from the health policy world, and announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at www.galen.org.
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