Change. Gov

"Today we begin in earnest the work of making sure that the world we leave our children is just a little bit better that the one we inhabit today!" . Site do presidente eleito. Barack Obama link

Obama, reforma da Saúde

1. Finalmente!
   Obama é o 44.º presidente dos EUA.
   Durante a longa campanha, abordámos aqui o essencial do programa de saúde do partido democrático.
   Uma vez eleito, o que podemos esperar do novo presidente dos EUA sobre esta matéria ?
   Num depoimento “Modern Health Care for All Americans” link dado à NJEM em 09 10 08 (já aqui referido), o então candidato Barack Obama expôs os três objectivos essenciais da sua reforma de Saúde:
   1.º Garantir a todos os cidadãos americanos cuidados de saúde de elevada qualidade a preços acessíveis.
   2.º- Eliminação do desperdício através do combate à burocracia e redução de cuidados inapropriados.
   3.º - Cuidados primários capazes de promover medidas eficazes de prevenção da doença.

Vamos esperar para ver.

Election 08, resultados

Obama: 53% (64.518.479 votos); McCain: 46% (56.783.877 votos)
Senado: Dem: 57; Rep: 40. Câmara Representantes: Dem: 254; Rep: 173.

BO, win

A more perfect union

The Choice link The New Yorker
(...) Nowadays, almost every politician who thinks about running for President arranges to become an author. Obama’s books are different: he wrote them. “The Audacity of Hope” (2006) is a set of policy disquisitions loosely structured around an account of his freshman year in the United States Senate. Though a campaign manifesto of sorts, it is superior to that genre’s usual blowsy pastiche of ghostwritten speeches. But it is Obama’s first book, “Dreams from My Father: A Story of Race and Inheritance” (1995), that offers an unprecedented glimpse into the mind and heart of a potential President. Obama began writing it in his early thirties, before he was a candidate for anything. Not since Theodore Roosevelt has an American politician this close to the pinnacle of power produced such a sustained, highly personal work of literary merit before being definitively swept up by the tides of political ambition.
A Presidential election is not the awarding of a Pulitzer Prize: we elect a politician and, we hope, a statesman, not an author. But Obama’s first book is valuable in the way that it reveals his fundamental attitudes of mind and spirit. “Dreams from My Father” is an illuminating memoir not only in the substance of Obama’s own peculiarly American story but also in the qualities he brings to the telling: a formidable intelligence, emotional empathy, self-reflection, balance, and a remarkable ability to see life and the world through the eyes of people very different from himself. In common with nearly all other senators and governors of his generation, Obama does not count military service as part of his biography. But his life has been full of tests—personal, spiritual, racial, political—that bear on his preparation for great responsibility.
Editorial, The Choice, The New Yorker

Obama girl

Obama girl, aliás a modelo Amber Lee Ettinger não votou nas primárias por não estar registada em NYC (Amber é de New Jersey).
Não sabemos se Amber votou hoje em NYC ou NJ.
Pouco importa.
Como alguém comentou a propósito: ninguém poderá dizer que a boazona de NJ não contribuiu.

Change

Sumário das Sondagens

Estou confiante na vitória de Obama. Logo veremos. Mas há quem se entretenha a imaginar : "the morning after the night before". Vale a pena ler. link

Obama Win

victor
In 2000, the entire election came down to a small number of votes in one county in Florida. Four years later, we came up short by an average of nine voters per precinct in Ohio. A small change in voter turnout would have made all the difference. Take it from me, elections matter. And this time, supporters like you can make it happen.
I know this might not be possible for everyone, but I'm asking you to consider volunteering anytime between now and Election Day -- Tuesday, November 4th. With so much at stake this year, we can't miss any opportunity to get more voters to the polls -and make sure their votes are counted. We all watched in the last two presidential elections as the course of our nation was determined by a few thousand votes in key battleground states.
After eight years of failed policies and divisive politics, we can take back the White House and set our nation on the right path. It's up to each of us to make sure we turn this movement for change into millions of more votes on Election Day.
Find out how you can make a difference in these last two days, and help support Barack Obama and Joe Biden:
With your help, we can make history -and bring the change we need to our country.
Thank you,
Al Gore

Infelizmente não posso votar.

CC, analisa as propostas

de McCain e Obama
Os programas para a saúde distinguem de forma visível os dois candidatos.

Nenhum deles propõe um SNS, mantendo o mercado de seguros como o modelo de saúde, mas enquanto McCain concentra no indivíduo toda a responsabilidade, Obama alarga a cobertura através de uma combinação público-privada.

McCain propõe substituir a actual isenção fiscal de despesas das empresas com a saúde dos seus trabalhadores, por incentivos ao seguro individual de saúde com deduções fiscais de 2.500 dólares para indivíduos e 5.000 dólares para famílias. As situações de risco catastrófico (doença grave, dispendiosa e irreversível) seriam apoiadas com fundos federais, ajudando a pagar os prémios de seguro aos cidadãos de baixo rendimento. O Estado seria afastado da saúde, a qual se concentra sob responsabilidade dos indivíduos. Para os pobres, excepções caritativas. Uma estimativa dos efeitos a dez anos do programa McCain aponta para uma redução de apenas 2 milhões na população sem seguro.

Obama confirma, e suplementa o sistema actual, com um sistema misto, tipo Massachusetts: mais incentivos ao seguro de empresa, e reforço de dois importantes programas públicos, o Medicaid (para pessoas abaixo do nível estadual de pobreza) e o Programa Estadual de Seguro de Saúde para Crianças (SCHIP). As PME, os trabalhadores independentes e as pessoas sem seguro de empresa, nem Medicaid, nem SCHIP poderiam ter acesso a um novo seguro chamado National Health Insurance Exchange, o qual permitiria a opção entre um plano privado ou um novo plano público, alegadamente semelhante ao que é hoje oferecido aos membros do Congresso e aos funcionários públicos federais. Obama propõe protecção ao consumidor (proibindo a discriminação negativa em função do risco), apoio ao seguro de empresa para PME (através de deduções fiscais), seguros individuais privados e subsídios ao rendimento das famílias pobres (no seguro individual). Uma estimativa dos efeitos a dez anos do programa Obama aponta para uma redução de 34 milhões na população sem seguro.
António Correia de Campos, DE 31.10.08

Election 08 na recta final

Afinal, Sarah Palin a boazona governadora do Alaska, só veio atrapalhar. John McCain já tem uma boa desculpa para o desaire do próximo dia 04.11.08. link link
Critica ao plano de saúde do candidato Barack Obama:“More Regulation, Unsustainable Spending”link

Election 08, debate da saúde

As propostas dos candidatos e o intenso debate que as mesmas têm suscitado, a comprovar a importância impar do tema da saúde nestas eleições e a necessidade de levar a cabo uma reforma profunda do sistema de saúde dos EUA.
A NJEM publica no seu último número de Outubro mais um importante texto sobre as percepções do público votante relativamente ao estado da saúde e das propostas de reforma dos dois candidatos. link

Election 08

Luta estado a estado da união (27.10.08)

BO for president

EDITORIAL NYT

Mr. Obama has met challenge after challenge, growing as a leader and putting real flesh on his early promises of hope and change. He has shown a cool head and sound judgment. We believe he has the will and the ability to forge the broad political consensus that is essential to finding solutions to this nation’s problems. link

NYTimes 23.10.08

Chegou a hora da mudança.

If EU could vote

fonte: the economist (24.10.08) link

Three "inconvenient truths"

about Health Care link
(...) Much discussion of reform concentrates on covering the uninsured. This is a worthy goal, but without sustained attention to the cost of care, gains in coverage will not be sustainable.

(...) Advances in medicine are the main reason why health care spending has grown 2.8% per annum faster than the rest of the economy.
But advances in diagnostic and therapeutic interventions have been largely responsible for increases in the length and quality of life. How can we retain most of the health benefits of future medical advances while slowing the rate of growth of health care expenditures?
Part of the answer lies in the creation of a large, semi-independent organization — something like Britain’s National Institute for Health and Clinical Excellence — to evaluate the benefits and costs of new medical interventions. Such an organization must have a substantial budget, because new interventions flood the market every year and new applications of older technologies add to this problem.
It is not feasible for individual physicians or even large groups of physicians to carry out the necessary analyses, especially when estimates of costs and benefits are indispensable. Furthermore, the funding for such an organization must be relatively steady over time; funding based on the vagaries of annual Congressional appropriations have doomed previous governmental initiatives for technology assessment.
The other part of the answer is for health care organizations to be willing and able to incorporate the assessments into their daily practice. They must have the information, infrastructure, and incentives to deliver high-quality, cost-effective care. This does not mean that they must be fully integrated group practices. It does mean that they must create mechanisms, relationships, and processes to achieve the coordination of care that today’s patients and today’s health care technologies require.(...)
Victor R. Fuchs, nejm 23.10.08

BO, sempre a subir

A vantagem de Barack Obama sobre o seu adversário, John McCain, não pára de crescer. Segundo a última sondagem do WSJ/NBC, a preferência dos votantes americanos por BO atingiu já os dez pontos de diferença sobre JM. link

Health care destruction

(...) In short, the McCain plan makes no sense at all, unless you have faith that the magic of the marketplace can solve all problems. And Mr. McCain does: a much-quoted article published under his name declares that “Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.” link
I agree: the McCain plan would do for health care what deregulation has done for banking. And I’m terrified.
Paul Krugman, NYTimes, 05.10.08

Há muitas formas de matar pulgas. Nós, por cá, temos as PPP.

Obama, soma e segue

Tudo se conjuga para Obama ganhar as próximas eleições.

Empate só na divisão do financiamento ($20 milhões) da Indústria Farmacêutica. A contrariar o sucedido em eleições anteriores, onde o grosso da massa foi dirigido ao partido republicano. Maiores contribuidores: Pfizer, Amgen e Johnson & Johnson link

Obama wins. Now what?

Most pollsters have Obama well ahead nationally and in the swing states, with Gallup reporting he has almost reached a double-digit lead.. And after last night's debate, which Obama 'won' handily more independents look to be behind his campaign (although if you watched the alternate-universe-dwelling wingnuts on Fox, you might not get that impression).
It is looking very good for Obama, and very bad for the Mav (the bettorshave it Obama with a 73% chance of winning).

So, the Senator from Illinois wins. What does that mean for health care?
We've established that his big reform plan is not going to happen. And I couldn't really take Obama at his word when he said last night that health reform would be his second priority after energy. Energy's big, but health care is bigger.

Here's what I'd expect we'll see in 2009-2010 from Congress and the new President.

Expect the new political year to begin with incremental fixes to specific programs - The biggie will likely be Medicare physician compensation. With docs scheduled to see their reimbursement drop by around 20% in 2009, the caterwauling will be heard loud and clear inside the Beltway. Don't look for a major policy change, but rather something to satisfy the physician community and build a little equity for the future. Where will the money come from?

Do not be surprised if CMS is expressly ordered to negotiate prices with big pharma in the near future. The Part D program is a budget buster, big pharma has few political allies (despite big contributions) and reducing the cost of drugs will save CMS budget dollars that can be spent on physicians.

SCHIP may be next out of the blocks. The expansion of coverage for kids is a central piece of Obama's platform on health reform, and with a Democratic Congress the chances of meaningful expansion of this program are pretty good. And it won't just be Democrats voting 'aye'. After the back and forth battles, marked by confusion and consternation from Republicans who felt Pres. Bush threw them under the bus by vetoing a bi-partisan bill to extend SCHIP earlier this year, enough Republicans are likely to cross the aisle to support funding of a somewhat-expanded program.

Also on the table will be reduced funding for Medicare Advantage, a program that has long struck Democrats as a giveaway to big healthplans. Foolishly. the insurance industry worked hard, and effectively, to block reductions in MA this year. As Bob Laszewski notes, with Congress and the White House changing hands, the bill they stopped this year will look great compared to what they'll get next. Expect MA subsidies to be slashed, in what could, and should, be seen as a shot across the bow of the insurance industry.

The FDA will also be under the microscope. Despite passage of the Food and Drug Administration Amendments Act of 2007, ostensibly fully funding the FDA and giving it the staff needed to do its job, the FDA continues to stumble. With a Democrat running the Administration, expect increasing oversight, much more post-approval monitoring, and much less tolerance for patent-extending gamesmanship.

What does this mean for you?

Obama is a very smart guy who knows enough to not try to do everything at once. Incremental steps mean progress towards reform - and are easier to accomplish, build consensus. momentum and working partnerships.

Joseph Paduda