I was in the Northeast last week for my annual trek to see friends and family. In NJ, where Rob grew up, I stayed with friends who are as close as family. They're more conservative than I am, although they're far from what I would call right-wing.

Bruce and I enjoy talking politics, and he wants to know more about my views on health care, whether he agrees or not. It's always a spirited discussion, but it never devolves into anger. We usually wind up toasting each other and saying, "I love you even though you're wrong."

The other night, though, I had to put my foot down when he said, "waste, fraud and abuse." It's always those three words, in that order, and never any specifics. Just, "waste, fraud and abuse." I think Rep. Heath Shuler said it hundreds of times during his campain -- a half dozen times in the half hour I met with him a few days before he voted against the health care law.

I told Bruce not to use those words again unless he could recount some of what he meant. Medicare spends 97 percent of the money it takes in on care; insurance companies had to be told they must spend at least 80 percent.

Yes, people abuse it. They should be prosecuted. But there's more trouble in the private, for-profit insurance industry than in government-funded Medicare. Medicare didn't spend billions on lobbyists and advertising and public relations campaigns while looking for ways to boot sick people out of the program and refuse to cover anyone who's ever been sick before.

The phrase, "waste, fraud and abuse," should be copyrighted as the property of the insurance industry, or perhaps Fox News, which uses it all the time; it should not be used in honest debate about health care.

A new report from the American Lung Association gives failing grades to 45 states for their failure to protect Americans from the harmful effects of tobacco, which kills 443,000 people a year.

The federal government got passing grades in all four categories: program spending, smoke-free air, cigarette tax and cessation. It did not get any A's, but the report said the Obama administration passed more and stronger anti-tobacco legislation than any other administration so far -- quite a feat for an administration led by a closet smoker.

Among the 5o states, only five --Arkansas, Maine, Montana, Oklahoma and Vermont got all passing grades, although Oklahoma squeaked by with all D's.

Several states are relying on increased taxes on tobacco products to help close budget gaps, but few are investing in programs to prevent or reduce tobacco use, and tobacco companies are still finding clever ways to get their message across to young people.

In addition to the 443,000 deaths each year, tobacco-related illnesses cost us $193 billion in health care and lost productivity.

The tobacco industry created and refined the tactics now used by big insurance and big pharma to deceive the public and sway legislatures, and the tobacco companies are still at it.

Those of us who want to see improvements in public health need to speak up when state and local legislatures start talking about regulating tobacco products more. When you walk into a room where someone is smoking, you're at risk too from second-hand smoke, which we know causes harm.

It's not so much about the freedom of one person to smoke, but the freedom of the rest of us to not be harmed by someone else's addiction.

You can check on how your state did here: http://www.stateoftobaccocontrol.org/ (my state, North Carolina got four F's), or download the entire report here: http://www.stateoftobaccocontrol.org/ala-sotc2010.pdf.

The Republicans have managed to get health reform repeal through the House, but it never will see the light of day in the Senate.

So, they have appeased their conservative base, which believes that health care for everyone is a bad idea. Now they will set out to sabotage the bill by refusing to fund portions of it, and even shut down the government with their stubborn refusal to back off.

While they're fighting health care, millions still are unemployed and foreclosures are at an all-time high. Our nation's infrastructure is crumbling

But all they want to do is bring the government to a screeching halt and blame the Democrats for allowing it to happen.

House Speaker John Boehner said he wants to push for much stricter limits on abortion and allow individuals more "choice."

From the New York Times:

"By a vote of 253 to 175, the House on Thursday directed four committees to draft legislation that would replace the health care law. The directive sets forth 13 objectives.

"It says, for example, that the legislation should 'lower health care premiums through increased competition and choice,' provide access to affordable coverage for people with pre-existing conditions, increase the number of Americans with insurance and provide states with 'greater flexibility' to run their Medicaid programs.

Republicans did not say how they would achieve those goals, but made clear that they did not want to impose detailed federal requirements on individuals, families, employers or states.

What they really want to do is to gut the health care law of any regulations the big insurance companies don't like. I will lay odds the individual mandate does not go away.

We need to stay on top of this and raise our voices whenever opponents try to take away what we have achieved.



The Centers for Disease Control and Prevention released its first report on health disparities in the US. As expected, the lower the levels of income and education, the more likely people will be ill or at much higher risk.

The report says the country has made substantial gains in reducing disparities, but they still persist.

Among the findings:

• Lower income residents report fewer average healthy days.

• Air pollution-related disparities associated with fine particulates and ozone are often determined by geographical location. Local sources of air pollution can impact the health of people who live or work nearby. Both poor and wealthy can experience these unhealthy effectys, but poor and minority people are more likely to live in these areas.

• Large disparities in infant mortality rates persist. Infants born to black women are 1.5 to 3 times more likely to die than infants born to women of other races or ethnicities.

• Men of all race/ethnicities are two to three times more likely to die in motor vehicle crashes than are women, and death rates are twice as high among Native Americans.

• Men of all ages and race/ethnicities are approximately four times more likely to die by suicide than females. Though native Americans and non-Hispanic whtes have more than twice the suicide rates than blacks, Asian Pacific Islanders and Hispanics.

• Men are much more likely to die from coronary heart disease, and black men and women are much more likely to die of heart disease

• Rates of preventable hospitalizations increase as incomes decrease. Data from the Agency for Healthcare Research and Quality indicate that eliminating these disparities would save about $6.7 billion in health care costs each year. There also are large racial and ethnic disparities in preventable hospitalizations with blacks experiencing a rate at more than double that of whites.

• Hypertension is by far most prevalent among non-Hispanic blacks (42% vs 28.8% among whites), while levels of control are lowest for Mexican Americans. People without health insurance are only about half as likely to have hypertension under control than those with insurance.

• Rates of adolescent pregnancy and childbirth have been falling or holding steady for all racial/ethnic minorities in all age groups. However, disparities persist as birth rates for Hispanics and non-Hispanic blacks are 3 and 2.5 times those of whites, respectively.

Again and again, people on the lower end of the income scale -- those who have less access to regular health care -- experience the most preventable illnesses and deaths.

Public health laws have lowered the rates of many serious diseases for people of all income levels and races, but we need to do more.

Some disparities can be leveled with education, but we also need to get people the access to care that they need. If you don't know you have diabetes, high cholesterol or hypertension, you won't be able to control it.

Equal access to health care means fewer disparities. It's as simple as that.

To read the report, visit http://www.cdc.gov/mmwr/pdf/other/su6001.pdf


It appears that law enforcement agencies knew about Jared Loughner before he bought a super clip and emptied it into a crowd.

The folks at WalMart, where he bought the ammo clip, knew something was wrong when he first tried to buy the clip; they refused to sell it to him initially because something seemed wrong. He went back later and was able to buy the clip.

Former teachers, friends, a former boss -- all knew he was having difficulties.

Arizona is one of a handful of states where people can recommend someone have a psychiatric evaluation, but even though his problems seemed to be on everyone's radar, no one called.

And what would have happened if someone had called?

No one knows for sure, but we do know that Arizona recently slashed its mental health budget, and in Pima County in Gabrielle Giffords' district, 45 percent of the people being served by the state system were booted off the rolls as the state tried to cut its way to a balanced budget.

Some were kicked off because they didn't seem to be all that ill. That's because they were being treated successfully; their chronic illness was being managed.

The cracks in the system have become huge, yawning crevasses.

As we talk about toning down the partisan nastiness and shoring up our gun laws, let's also look at funding mental health care. It will save lives.

There's good news and bad about health care costs, according to an article in the Wall Street Journal today.

The figures are in, and health care costs were down in 2009. In fact, it was the slowest rate of growth in 50 years, said the Centers for Medicare & Medicaid Services Office of the Actuary.

The reason why is the bad news: It's the economy, stupid.

People lost their jobs, and with the jobs went their health insurance, so fewer dollars were spent on insurance premiums. Then, since fewer people had access to care, they spent less money.

The other bad news: Our spending on health care as a percentage of the gross national product rose a full percentage point, to 17.6 percent. In other words, the number of dollars spent might have decreased, but actual cost is up.

People are sicker before they seek care and that means costs will rise again, both in dollar amounts and in percentage of GNP. Either that or the funeral business is in for a big boost. I wonder if anybody tracks that.