Monthly Archives: December 2008

Why a vegetarian diet may leave a man less fertile

Too much tofu could affect a man’s fertility, scientists warn.

Researchers have found that eating even a modest amount of soya products – which are popular with vegetarians – could significantly lower your sperm count.

Men who ate an average of half a serving of soya food a day had lower concentrations of sperm than those who did not, the study found. And for those who were overweight or obese, the effects were more pronounced.

Low sperm count is known to make it harder for a man to conceive.

It is thought that soya compounds called isoflavones, which mimic the female sex hormone oestrogen, are behind the effect. Animal studies have linked a high consumption of isoflavones with infertility.

World’s heaviest man helps another obese man diet

World’s heaviest man helps another obese man diet

MONTERREY, Mexico (AP) — When critically obese, bedridden Jose Luis Garza pleaded for help in shedding a few hundred pounds, he landed the world’s biggest weight watcher. Garza is getting diet advice from Manuel Uribe, a fellow Mexican who has been fighting to lose his title as the world’s heaviest man. Both men live around the Monterrey area in Mexico. Neither can get out of bed.

Although Garza has not been on a scale in years, doctors estimate he could weigh about 450 kilograms (990 pounds). He got a call from Uribe after going on national television to plead for help. “Manuel inspires me with courage and the will to live,” Garza told The Associated Press. “I understand that this is matter of life and death and that I have to follow the instructions that are given to me.”

This year, the Guinness Book of World Records declared Uribe, who tipped the scales at 1,230 pounds (560 kilograms) in 2006, the world’s heaviest man. “I have no interest in reaching that record,” Garza said. Uribe, 43, has since shed about 550 pounds (250 kilograms) with the help of his girlfriend Claudia Solis. The two are getting married on Oct. 26.

Uribe sent Solis to Garza’s home on Friday night with kiwis, grapefruit and pears, along with protein supplements recommended by his diet doctors. He said he would also help Garza get a wheel-equipped iron bed similar to his own. “I spoke with him and I really want to give him a hand and give him the benefit of my own experiences,” Uribe told AP. Garza, who used to work as a chef at a bowling alley, said he has always been overweight and blamed a diet of junk food and greasy tacos.

But he said his condition drastically worsened nine months ago when both his parents died within 13 days of each other, leaving him alone in his home and plunging him into a cycle of depression and binge-eating. He said he had been unable to get out of his bed for four months. One of his sisters has had to move in to take care of him.

Breast cancer survival is associated with telomere length in peripheral blood cells

Breast cancer survival is associated with telomere length in peripheral blood cells.Svenson U, Nordfjäll K, Stegmayr B, Manjer J, Nilsson P, Tavelin B, Henriksson R, Lenner P, Roos G. Department of Medical Biosciences/Pathology, Umeå University, Umeå, Sweden.

Telomeres are essential for maintaining chromosomal stability. Previous studies have indicated that individuals with shorter blood telomeres may be at higher risk of developing various types of cancer, such as in lung, bladder, and kidney. We have analyzed relative telomere length (RTL) of peripheral blood cells in relation to breast cancer incidence and prognosis.

The study included 265 newly diagnosed breast cancer patients and 446 female controls. RTL was measured by real-time PCR, and our results show that the patient group displayed significantly longer telomeres compared with controls (P < 0.001). Age- adjusted odds ratios (OR) for breast cancer risk increased with increasing telomere length, with a maximal OR of 5.17 [95% confidence interval (95% CI), 3.09-8.64] for the quartile with the longest telomeres.

Furthermore, RTL carried prognostic information for patients with advanced disease. Node positive (N+) patients with short telomeres (</=median) showed an increased survival compared with N+ patients with long telomeres (P = 0.001).

For patients with ages <50 years with tumors >16 mm (median tumor diameter), short telomeres were associated with a significantly better outcome than longer telomeres (P = 0.006). Cox regression analysis showed that long RTL was a significant independent negative prognostic factor (hazards ratio, 2.92; 95% CI, 1.33-6.39; P = 0.007). Our results indicate that blood RTL may serve as a prognostic indicator in breast cancer patients with advanced disease.

What Causes Breast Cancer?

We do not yet know exactly what causes breast cancer, but we do know that certain risk factors are linked to the disease. A risk factor is anything that increases a person’s chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, such as smoking, can be controlled. Others, like a person’s age or family history, can’t be changed. But having a risk factor, or even several, doesn’t mean that a person will get the disease.

Some women who have one or more risk factors never get breast cancer. And most women who do get breast cancer don’t have any risk factors. While all women are at risk for breast cancer, the factors listed below
can increase a woman’s chances of having the disease.

Risk Factors That You Cannot Change

Gender Simply being a woman is the main risk factor for breast cancer.
Age The chance of getting breast cancer goes up as a woman gets older.
About 8 out of 10 breast cancers are found in women over age 50.
Genetic risk factors  About 1 case of breast cancer in 10 is linked to
changes (mutations) in certain genes. The most common gene changes are
those of the BRCA1 and BRCA2 genes. But other gene changes may raise
breast cancer risk as well.

Family history Breast cancer risk is higher among women whose close
blood relatives have this disease. The relatives can be from either the
mother’s or father’s side of the family. Having a mother, sister, or
daughter with breast cancer about doubles a woman’s risk.
Personal history of breast cancer A woman with cancer in one breast has
a greater chance of getting a new cancer in the other breast or in
another part of the same breast. This is different from the first cancer
coming back (recurrence).

Race White women are slightly more likely to get breast cancer than are
African-American women. But African-Americans are more likely to die of
this cancer. Asian, Hispanic, and American Indian women have a lower
risk of getting breast cancer.
Earlier breast biopsy Certain types of abnormal biopsy results can be
linked to a slightly higher risk of breast cancer.
Earlier radiation treatment Women who have had chest area radiation
treatment earlier in life have a greatly increased risk of breast cancer.

Menstrual periods
Women who began having periods early (before 12 years of age) or who
went through the change of life (menopause) after the age of 50 have a
small increased risk of breast cancer. The same is true for women who
have not had children, or who had their first child after they were 30
years old.
Treatment with DES In the 1940s through the 1960s some pregnant women
were given DES (diethylstilbestrol) because it was thought to lower
their chances of losing the baby. Recent studies have shown that these
women have a slightly increased risk of developing breast cancer.

Breast Cancer Risk and Lifestyles

Not having children Women who have had no children, or who had their
first child after age 30, have a slightly higher risk of breast cancer.
Birth control pills It is still not clear what part birth control pills
might play in breast cancer risk. Studies have found that women now
using birth control pills have a slightly greater risk of breast cancer.
Women who stopped using the pill more than 10 years ago do not seem to
have any increased risk. It’s a good idea to discuss the risks and
benefits of birth control pills with your doctor. Hormone replacement
therapy (HRT) It has become clear that long-term use (several years or
more) of combined HRT (estrogens together with progesterone) for relief
of menopause symptoms may slightly increase the risk of breast cancer as
well as the risk of heart disease, blood clots, and strokes. The breast
cancers are also found at a more advanced stage. As well, HRT seems to
reduce the effectiveness of mammograms. Five years after stopping HRT,
the breast cancer risk appears to drop back to normal. Estrogen alone
(ERT) does not seem to increase the risk of breast cancer as much, if at

At this time, there appear to be few strong reasons to use HRT, other
than for temporary relief of menopausal symptoms. Because there are
other factors to think about, you should talk with your doctor about the
pros and cons of using HRT.

Breast feeding Some studies have shown that breastfeeding slightly
lowers breast cancer risk, especially if the breast feeding lasts 1½ to
2 years. This could be because breast feeding lowers a woman’s total
number of menstrual periods. Alcohol Use of alcohol is clearly linked to
a slightly increased risk of getting breast cancer. Women who have one
drink a day have a very small increased risk. Those who have 2 to 5
drinks daily have about 1½ times the risk of women who drink no alcohol.
The ACS suggests limiting the amount you drink, if you drink at all.
Diet Being overweight is linked to a higher risk of breast cancer,
especially for women after change of life and if the weight gain took
place during adulthood. Also, the risk seems to be higher if the extra
fat is in the waist area. But the link between weight and breast cancer
risk is complex and studies of fat in the diet as it relates to breast
cancer risk have often given conflicting results. Since diet and weight
have been shown to affect the risk of getting several other types of
cancer and heart disease, the ACS says it’s best to stay at a healthy
weight and limit your use of red meats, especially those high in fat or

Exercise Exercise and cancer is a fairly new area of research. Some
studies suggest that exercise in youth might give life-long protection
against breast cancer. A small amount of physical activity as an adult
may also lower breast cancer risk. More research is being done to
confirm these findings.

While a direct link between smoking and breast cancer has not been
found, smoking affects your overall health and increases the risk for
many other cancers, as well as heart disease. If you smoke, you should
make every attempt to quit.

Recent internet e-mail rumors have suggested that underarm
antiperspirants or underwire bras can cause breast cancer. There is no
evidence to support this idea.

Several studies show that induced abortions do not increase the risk of
breast cancer. Also, there is no evidence to show a direct link between
miscarriages and breast cancer.

Silicone breast implants can cause scar tissue to form in the breast.
But several studies have found that this does not increase breast cancer
risk. If you have breast implants, you might need a special x-ray
picture during mammography.

Right now, research does not clearly show a link between breast cancer
risk and pollutants such as pesticides. A great deal of research has
been reported and more is going on in this area.

Liberals won’t tell:Abortions= 30% increased risk of Breast Cancer

The Freaking Liberals don’t want the Dr’s to tell women who are about to get Abortions about the 30% increased risk of Breast Cancer for this sick reason ” an abortion/breast cancer link makes a hard decision harder. ”

Can you believe that?

They would rather leave the woman in the dark and not only encourage her to kill her baby, but increase her future risk of Breast Cancer by 30%

Liberals are very, very sick people.

Should Docs Warn About an Abortion/Breast Cancer Link?

By Daniel DeNoon WebMD Medical News Archive  Reviewed By Gary Vogin, MD

Dec. 5, 2001 — Should doctors add to the distress of abortion by warning that
it might — or might not —  increase the risk of future breast cancer? No,
says a new review of the scientific evidence.

The review takes the form of an editorial in the journal The Lancet Oncology.
Author Tim Davidson, MD, argues that telling a woman about the evidence for and
against an abortion/breast cancer link makes a hard decision harder.

Why is this an issue? Anti-abortion groups have seized on studies suggesting
that women have a slight but significant increase in breast-cancer risk if they
have an abortion. Many of these groups overstate the risk in their efforts to
persuade women to continue their pregnancies. Pro-choice groups point to
studies suggesting that there is no such risk. Both sides in the highly-charged
debate point to flaws in the studies they don’t agree with.

“In the absence of robust evidence that an increased risk of breast cancer in
later life is relevant to her deliberations, a woman deciding whether to opt
for termination or to continue with an unwanted pregnancy has a hard enough
task without being made to confront the breast-cancer issue,” writes Davidson,
a breast surgeon and lecturer in medicine at Royal Free Hospital, London.

Davidson’s article lays out the theory behind the abortion/breast-cancer link.
It considers arguments on both sides. It concludes that the jury is still out.
That’s also the conclusion of the U.S. National Cancer Institute and the
American Cancer Society, says Joann Schellenbach, national director of medical
and scientific information for the ACS.

“The article itself will be very useful, because our role is to collect
information from scientific research to give women guidance,” Schellenbach
tells WebMD. “This supports the idea that it is not possible to give guidance
one way or the other because the evidence from scientific studies doesn’t
justify it.”

This is hardly the last word on the subject.

“There is no other issue than abortion that would be so immune from the concept
of informed consent,” Joel Brind, PHD, tells WebMD. “What could possibly be
more paternalistic to a young woman making such an important decision? Davidson
wants ‘robust evidence’ of relevance beyond any proof of a link between breast
cancer and abortion. If you don’t have proof a woman is going to be concerned,
you shouldn’t tell her. That just blew me away.”

Brind, a professor of biology and endocrinology at Baruch College of the City
University of New York, is lead author of the most important scientific study
to link abortion to breast cancer. This 1996 study analyzed data from 23
independent studies that asked women with and without breast-cancer whether
they had ever had an abortion.

The study suggested that having had an abortion increased a woman’s risk of
breast cancer by about 30%. That’s a relatively small risk — having a sister
or mother with breast cancer increases a woman’s risk by 200-300%. Having two
alcoholic drinks a day increases breast cancer risk by 40-70%.

Women who never give birth — or who have their first child after age 30 —
have a 200-300%greater risk of breast cancer than a woman who gives birth
before age 20. Nobody is sure why. Since there is a link between reproductive
history and breast cancer, abortion could theoretically affect risk.

Critics of Brind’s study point to the fact that it relies on women to report
having had an abortion. Women looking for an explanation of their breast cancer
may be less reluctant than healthy women to report abortions. Studies probing
this issue contradict each other.

The strongest study to show no link between breast cancer and abortion is a
1999 study led by Mads Melbye, MD, head of the epidemiology department at
Denmark’s Statens Serum Institut. In Denmark, women’s detailed medical records
are a matter of record. Analysis of these records for 1.5 million women —
including 280,965 who had abortions and 10,246 who had breast cancer — showed
absolutely no effect of abortion on breast cancer.

“We had information on women before they developed breast cancer — and we
followed the women forward,” Melbye tells WebMD. “We actually found no effect,
absolutely zero. For many years we had registered all women who had induced
abortions. We have a file of who they are. You can then link those up against
the entire population of women in Denmark. You have all women’s full
reproductive history. That kind of information is important because these
reproductive risk factors also have an independent effect on breast cancer by
themselves, so if you have many cases, your risk of making an error is

Brind is a vocal critic of Melbye’s work. “There is so much wrong with that
paper, it is just like how not to do a study,” he says. He insists that
researchers routinely cover up evidence linking breast cancer to abortion, and
that the U.S. NCI and CDC promote a political, pro-abortion agenda. Brind’s
critics point to his presentations to anti-abortion groups as proof of his own
political agenda.

Brind raises a number of valid objections. None seems to justify overturning
the advice of the U.S. National Cancer Institute, the American Cancer Society,
and the United Kingdom’s Royal College of Obstetricians and Gynecologists. That
advice: women considering abortion need not worry about the risk of breast

Health & Life Insurance?

I’m costing out a 1 year hiatus from work, one of the concerns is
benefits cost as I currently receive from a cushy corporate job:
– Health (Doctors & Medicine prescriptions)
– Life, Accidental, Short & Long Term insurance
– Also interested in COBRA coverage & costing (if you’ve had to
recently depart the lazy M)

I’m looking at paying this out of my own pocket (as I’ll be on my own,
with a single income family).

Any suggestions on providers? agents? structuring it to reduce tax
(can I pay for it out of a Flexible Spending Account for example)?

I was in your exact same position about a year ago, wanting to leave
Microsoft, and trying to calculate the cost of my benefits.

The exact cost of the COBRA option is published on either hrweb or the
benefits website on the Microsoft intranet.  If I recall correctly, it was
coming to about $1250/month for my family of four (me, wife, two kids)
including medical and dental.  But that was for the specific health plan I
was on, and yours may be different.  Plus that was a year ago, and costs
have risen since then.  I decided COBRA was too expensive for our needs.

Since leaving Microsoft, I am paying for our own health insurance with
Regence Blue Shield.  Because we are a relatively healthy family, I opted
for the lowest premiums and highest deductibles.  As such, we are paying
$192/month for the whole family with a $15,000 deductible per person.  This
basically means that we pay all of our own medical bills unless there’s a
major catastrophe.  We no longer have dental insurance, and so are paying
our own dental bills which is basically just the regular cleanings and

The main point of life insurance is to compensate for a lost income in case
of death.  Not to be morbid, but if you have no income after leaving MSFT,
then your death wouldn’t cause any financial hardship for your family.  So
you may just decide not to get life insurance at all.

I use Lifewise myself, but you should check out the Microsoft Alumni
Association’s health care plan.  I’ve heard its good from random
people on the street (or, at least random people at various tech
gatherings).  I can’t really speak to how good Lifewise is, since it’s
one of the high-deductible plans and I’ve never needed it for
something serious.  Insurance is annoying that way – there’s no real
way to stress test it before you actually need the thing.

Single-Payer Health Care: If Not Now, When?

All Things Considered, December 24, 2008 ·  For supporters of a
national health insurance plan funded solely by the government, you
would think things are looking up.

There’s a new Democratic president about to take office, with
substantial Democratic majorities in the U.S. House and Senate. So,
many people think a “single-payer” health care bill could be on the
verge of passage.

“The country needs it and the American people support it, so that
makes the prospects pretty good,” says David Himmelstein, an associate
professor at the Harvard Medical School and co-founder of Physicians
for a National Health Program, which has been advocating for a single-
payer health plan since the late 1980s.

President-elect Barack Obama said at a town-hall meeting in August
that he would “probably go ahead with a single-payer system” if he
were designing a system from scratch.

But that’s not anywhere close to what he’s been advocating.

Instead, the new administration’s plan is focused on building onto the
existing system, in which most people get insurance through their job.

And on Capitol Hill, the lawmakers who will be charged with overseeing
health care overhaul legislation are singing a similar song.

“I don’t think a single-payer system makes sense in this country,”
said Senate Finance Committee Chairman Max Baucus (D-MT). “We are
America. We will come up with a uniquely American solution, which will
be a combination of public and private coverage.”

Even House Ways and Means Health Subcommittee Chairman Pete Stark (D-
CA), who has in previous sessions of Congress introduced his own
single-payer proposal, says the public is not ready for the huge
change that eliminating the health insurance industry would mean.

“I don’t think with something as personal and important as medical
care, people are ready to give up what they have,” Stark said.

That frustrates people like Himmelstein, who says he’s seen poll after
poll that shows significant public support for a single-payer system.
“A majority of American people say they favor a plan like Medicare
paid for out of taxes covering all Americans,” he says. Medicare is
one type of single-payer system.

Robert Blendon, who studies public opinion and health care at the
Harvard School of Public Health, says it’s true that single-payer
enjoys significant public support. But most of the time, the support
is highest when it’s compared to the status quo.

For example, backers of a single-payer plan frequently cite a December
2007 poll by the Associated Press and Yahoo.

In that poll, 65 percent of respondents said the U.S. “should adopt a
universal health insurance program in which everyone is covered under
a program like Medicare that is run by the government and financed by

But their only other choice in that poll, chosen by 34 percent, was to
“continue the current health insurance system in which most people get
their health insurance from private employers, but some people have no

When given more options about ways to expand coverage, single-payer
“is the least popular,” Blendon says.

For example, a poll conducted by the Kaiser Family Foundation in
September offered respondents seven separate proposals.

Of those, the most popular was offering incentives to employers to
provide coverage to their workers, supported by 79 percent.

Expanding existing public programs was favored by 72 percent.

The only option that failed to garner a majority was providing
universal coverage through a single-payer — 44 percent.

On the other hand, when those same respondents were asked to choose
their top most preferred option, single-payer tied for first,
demonstrating the depth of feeling of its supporters.

But Blendon says opponents of a government-sponsored health system are
equally vehement, which is another reason why no president since Harry
Truman has put such a policy on the table.

“It shows the sense of controversy they felt they would face if they
did that,” Blendon says.

Even Obama demurred when he was asked point-blank about single-payer
back in August.

“A lot of people work for insurance companies, a lot of people work
for HMOs,” Obama said. “You’ve got a whole system of institutions that
have been set up.”

What he left unsaid was that that’s a fight too big even for him to

More on US medical care (or carelessness)

WASHINGTON ­ That day in July was one that Tammy Morse won’t soon forget.
Five months earlier, her husband lost his job as a recruiter for the
financial services industry. Now it was the summer and the family savings
were gone. She saw no way to get health insurance coverage for her family
other than to apply for Medicaid.

And that was why she made the drive from her Stratford, Conn., home to the
nearest office of the state’s Department of Social Services.

“It was humbling,” said the mother of two. “It’s funny how your attitude
changes, because honestly, I was probably a little judgmental previously.

… For lack of a better way to put it, that was for other people. It
wasn’t for me.”

Around the country, similar stories are playing out for thousands of

Since the recession began a year ago, many states have seen increases in the
Medicaid rolls just as tax revenues are falling below projections. Governors
have lobbied President-elect Barack Obama and Congress to help them weather
the downturn by increasing the federal government’s share of Medicaid
spending for at least two years.

The governors said the extra $40 billion would ease the service cuts or tax
increases that legislatures need to balance state budgets.
The unemployment rate has jumped from about 4.7 percent last December, when
the recession began, to 6.7 percent today. Economists estimated in a Kaiser
Family Foundation report that each 1 percent gain in the unemployment rate
adds 1 million people to the Medicaid and State Children’s Health Insurance

In Connecticut, a state faring better than many, enrollment in the Medicaid
program, called HUSKY (Healthcare for Uninsured Kids and Youth), has climbed
from about 312,000 last December to about 329,500 in November ‹ a 6 percent
increase. Many who lost their jobs were eligible to continue group health
insurance. But that is not an option in most cases because they no longer
have an employer picking up a large share of their premiums.

Cassandra Edmonds, a single parent who joined HUSKY in October, is a
newcomer to the program like Morse. Her job as a parent-activities
coordinator with the Bridgeport school district was eliminated to save
money. She has found a job selling life insurance, but her earnings are low
enough that she is eligible for HUSKY coverage.

The insurance is particularly important for her 4-year-old son, who has
glaucoma and tubes in his ears to prevent repeated infections. He has to
check in with a specialist about every three months for each condition.
Edmonds said she never imagined she would be relying on government safety
nets to make that happen.

“I never really thought I would be without a job,” Edmonds said. “I have an
MBA. I’m not trying to sound cocky or anything.”

Donny Djurkovic doesn’t have a master’s in business administration, but he
did have decades of work experience when he lost his job with a small food
company. Djurkovic, like Morse and Edmonds, is from the Bridgeport area.
He said he was able to continue health insurance for himself, but insuring
his son would have increased his premium to more than $1,200 a month. So his
son, 6, went without insurance for a few months, leading to much worry.
“I put his bicycle in the shed. I didn’t want anything to happen, to be
honest with you,” Djurkovic said.

He learned about HUSKY from a pharmacy clerk and took her advice to apply.
Despite the relief, he admits to some feelings of guilt about accepting the
government’s assistance.

“In all these years, I never had put my hand out and I was so proud of
myself and everything. But there is unfortunately times when you do need
it,” he said. “And I still feel bad. Would you believe this? When I see my
unemployment insurance, I say this is not me. I’m not used to it.”

Medicaid insures nearly one in six low-income people in the U.S. The program
typically covers the very poor and about half of enrollees are children.
Spending came to $333 billion in the budget year ending Sept. 30, 2007.
Washington picks up about 57 percent of that; the states cover the

Michael Cannon, director of health policy studies at the Cato Institute, a
liberterian think tank, sympathizes with new families now relying on
Medicaid. Still, he disagrees that the federal government should reward
states that did not plan adequately for the bad times. Better planning would
mean setting aside more money for rainy day funds and not expanding the
scope of Medicaid during the good economic times, he said.

“The states make these promises they know they can’t keep and then they run
to Congress to bail them out,” Cannon said. “And Congress typically ends up
bailing them out.”

Cannon said the net result is the government gradually is becoming more
responsible for paying for health insurance coverage.

The bill will fall to future generations. “And who better to push those
costs onto than to people who can’t even vote yet?” Cannon said.

Advocacy groups report that 43 states face budget shortfalls this year or
next. The Center on Budget and Policy Priorities estimates states face a $79
billion gap they must bridge this year.

Nineteen states have enacted or proposed cuts in their Medicaid or State
Children’s Health Insurance Program budgets for the current budget year or
for 2010, according to Familes USA, which conducted a state-by-state survey:
_Arizona now requires adults to reapply for Medicaid every six months rather
than annually, which is expected to reduce the rolls by 4,500.

_California does the same for children, and Republican Gov. Arnold
Schwarzenegger proposed reduce eligibility limits for parents from 100
percent of the poverty level to 72 percent. That would drop it from $17,600
to $12,600 for a family of three. The state also is considering putting new
applicants for children’s insurance on a waiting list.

_Nevada eliminated vision care for adults and limited coverage for personal
care services that reimburse providers for helping people meet basic needs
such as feeding and bathing.

_South Carolina enacted a limit on prescriptions and refills to a maximum
31-day supply.

_Rhode Island limited coverage for prescription drugs to generics.
The most common Medicaid cut that states made was to lower payments to
doctors and other providers; some 14 states have done so this year. Medicaid
patients already often have trouble finding a doctor who will take them, so
the payment cuts could make that problem worse.

Diane Rowland, executive vice president at the Kaiser Family Foundation,
said that boosting the Medicaid matching rate will prevent higher rates of
uninsured and maintain patient access to hospitals, nursing homes and home
health care.

“In the absence of this kind of stimulus, you might see more layoffs in the
health care sector,” she said. “These dollars can start to flow to states
the day after Congress enacts it because it’s just changing the formula for
how Medicaid bills are shared.”

Rowland said some states did expand during the good times, causing a portion
of the budget crunch they now face, but for the most part, the problem is
the economy.

“It’s not so much an issue of expansion. It’s an issue of how we deal with a
downturn in the economy,” she said. “On the income side, we have
unemployment insurance. On the health care side, all we have is Medicaid and
the State Children’s Health Insurance Program.”

How the American Health Care System Got That Way

Jeremy Brecher, Tim Costello and Brendan Smith, Truthout: “As Americans respond to President-elect Obama’s call for town hall meetings on reform of the American health care system, an understanding of how that system came to be the way it is can be crucial for figuring out how to fix it.

The American health care system is unique because, for most of us, it is tied to our jobs rather than to our government. For many Americans, the system seems natural, but few know that it originated not as a well-thought-out plan to provide for Americans’ health, but as a way to circumvent a quirk in wartime wage regulations that had nothing to do with health.”

As far back as the 1920’s, a few big employers had offered health insurance plans to some of their workers. But only a few: By 1935, only about two million people were covered by private health insurance, and on the eve of World War II, there were only 48 job-based health plans in the entire country.

The rise of unions in the 1930’s and 1940’s led to the first great
expansion of health care for Americans. But ironically, it did not
produce a national plan providing health care to all, like those in
virtually all other developed countries. Instead, the special
conditions of World War II produced the system of job-based health
benefits we know today.

In 1942, the US set up a National War Labor Board. It had the
power to set a cap on all wage increases. But it let employers
circumvent the cap by offering “fringe benefits” – notably, health
insurance. The fringe benefits created a huge tax subsidy; they were
treated as tax-deductible expenses for corporations, but not as
taxable income for workers.

The result was revolutionary. Companies and unions quickly
negotiated new health insurance plans. Some were run by Blue Cross,
Blue Shield and private insurance companies. Others were “Taft-Hartley
funds,” run jointly by management and unions. By 1950, half of all
companies with fewer than 250 workers and two-thirds of all companies
with more than 250 workers offered health insurance of one kind or
another. By 1965, nearly three-quarters of the population were covered
by some kind of private health insurance.

This private, job-based insurance covered millions of workers, who
had never had health care insurance before. But this victory also set
patterns that are responsible for many of the problems the health care
system faces today.

Because this private system was tied to employment, it did not
provide health insurance for all. Millions of people outside the
workforce were without coverage. Those most likely to be covered were
salaried or unionized white men in northern industrial states. Two-
thirds of those with incomes under $2,000 a year were not covered, nor
were nearly half of nonwhites and those over 65.

Employer-based plans tied workers to their jobs – something that
benefited employers, but not workers or the economy as a whole. The
quality of the coverage was spotty – some plans were excellent, others
completely inadequate. Doctors accepted this revolution because it
didn’t challenge their power; but, as a result, the system provided no
public control over medical costs.

This revolution had a subtle political effect as well. By giving
much of the workforce health benefits, it reduced the incentive for
them to pursue a system of universal care. And it gave unions a stake
in the private, employer-based health care system. As one opponent of
publicly financed health care put it, “the greatest bulwark” against
“the socialization of medicine” was “furthering the progress already
made by voluntary health insurance plans.”

Since then, many layers have been laid on top of employer-based
health care. Medicare and Medicaid provided government-funded health
insurance for the elderly and impoverished. The “managed care
revolution” led to the takeover of 90 percent of employer-based health
care by HMOs, most of them driven by profit rather than health
concerns. But most people continue to get their health care through
their employer.

Many of the problems of American health care grow out of this
history. The system is so complex that even experts – let alone
ordinary people trying to find care for themselves and their loved
ones – are unable to fully understand it. The system spends one-third
of its cost on paperwork, waste and profit over and above the cost of
actually providing health care. Yet, nearly one-third of Americans are
without health insurance over the course of a year. In all other
developed countries, more than 85 percent of citizens have health
coverage under public programs. The American health care system is
full of inequalities: People who work for one company may have high
quality insurance, while those who work for a similar company have

All of these problems are due at least in part to an employer-
based system, the original intent of which was not to provide quality
health care to all, but to circumvent wartime wage regulations. As we
begin to debate how to reform health care, we should keep in mind that
the American health care system was not created to express American
values or to meet Americans’ health care needs. And knowing that, we
should not be afraid to change the system if we can come up with a
better one.

Retooling our health care

Not many people are buying cars built 60 years ago. No one is
watching TV on a set manufactured in the 1940s. Patients are not
lining up to see a doctor who hasn’t cracked a book since before the
polio vaccine was discovered. Why, then, do millions of Americans get
their health care through an employer-based system from the 1940s?

Employers didn’t start offering health benefits roughly 60 years ago
because they were experts in medical decisions. It was a way of
circumventing the World War II wage-and-price controls. Barred from
offering higher salaries to attract workers, employers offered health
insurance instead. Aided by an Internal Revenue Service ruling that
said workers who received health benefits did not have to pay income
taxes on them, and by the fact that employers could write off the cost
of the health benefits as a business-related expense, this accidental
arrangement became the primary way most Americans access health care.

The system worked at first, but a lot has changed in 60 years.

Back then, the average soldier returning from World War II took a job
with a local company, where he would work for decades until he got a
gold watch at a retirement party. Today, lifetime employment is dead.
By 42, the average American will change jobs 11 times.

Sixty years ago, most American companies competed only against
neighboring companies for lucrative contracts. Today, most businesses
are up against foreign companies that don’t foot the bill for their
employees’ health-care costs.

Today, health-care costs are increasing at twice the rate of
inflation. To stay in the black, companies are forced to raise their
employees’ premiums and deductibles, opt for cheaper insurance plans,
or worse yet, drop health benefits altogether. Since 2000, the
percentage of employers providing health insurance has declined by
nearly 10 percent.

For too many, the employer-based system is inefficient. Each employer
purchases health insurance separately. According to a recent estimate
by the McKinsey Global Institute, this adds more than $75 billion in
underwriting, marketing, sales, billing and other administrative costs
that offer no health benefits. More than half of all American
employers who offer health-care benefits don’t offer their employees a
choice. Consequently, most Americans don’t have the option of giving
their business to insurance companies that treat them well and only
cover what they need. This prevents the usual market forces from
holding down costs.

Workers are the ones paying for this waste. The money that employers
are spending to buy health care for their employees could otherwise go
to workers in the form of higher wages, empowering individuals to make
their own health-care choices.

The available alternative to this employer-based system is even more
horrifying. Individuals buying insurance don’t have the same
purchasing power as large businesses and end up paying much higher
prices to cover administrative costs and risks. They also don’t get
the tax breaks that employers get for buying health insurance. In most
states, insurance companies have the right to discriminate against
individuals by denying coverage or charging astronomical prices to
anyone with a pre-existing condition.

It is no surprise that, when given the choice between the employer-
based system and buying health insurance on their own, the vast
majority of Americans reject the latter. (A Kaiser Health Tracking
Poll this summer, for example, found that only 17 percent of Americans
said they would prefer to buy insurance on their own.)

But this is a false choice. It assumes that the current system is the
only option. Why can’t Americans have the best of both worlds?

Americans need some of the benefits of the employer-based system: the
security of being part of a large group, of not being denied coverage
because of age and pre-existing conditions, and the convenience of
having experts screen qualified plans and manage enrollment. But
Americans also need portable insurance — coverage that follows them
when they change jobs, lose jobs, start a business or whatever else
may come. Americans need more choices and the market power to buy the
health coverage that works best for them and their families and, in
turn, to make insurance companies compete for their business.

Such a system could be implemented today by creating state or regional
insurance exchanges that pool individuals and small groups to pay the
same lower prices charged to larger employers; that certify that all
insurance benefit packages meet minimum consumer protection standards;
that manage the enrollment process; that collect premiums; and that
require insurance companies to issue and renew coverage for anyone who
applies, protecting the insurers by paying them a risk-adjusted
premium that pays them more when they enroll sicker, more costly,

Fundamentally, this means that insurance companies would have to
change their business model to compete on the basis of quality, price
and benefits, rather than by “cherry picking” the healthiest people to
cover. It means spending less money on administrative costs and more
money on keeping patients healthy. And it means letting everyone keep
the health insurance they have if that’s what they want, but giving
all employers and employees more choices for their health care.

In the coming year, there will be no shortage of suggestions for
fixing the nation’s health-care system. But what Americans and the
president-elect need to ask is whether the health-care system that was
founded in the 1940s is the best health-care system for the 21st

We believe that Americans deserve better.