Clinton's Exit Deals Setback to the Push for Health-Care Mandates

Sen. Hillary Clinton's exit from the presidential race will deal a blow to supporters of a key element in the tussle over universal health coverage: the idea that all Americans be required to buy or have health insurance.

That mandate has been an important tenet of Sen. Clinton's health-care plan and the only substantive difference from Sen. Barack Obama's health policy. As a major sparring point in debates between the two Democratic Party candidates, it has become a dominant issue in the national discussion over how to expand coverage to the country's nearly 50 million uninsured.

But with Sen. Clinton failing to secure enough delegates for the nomination, the concept of a broad insurance mandate lost its most prominent platform. For the remainder of the election season, at least, it is likely to fade from the national stage.

Sen. John McCain, the Arizona Republican awaiting his party's formal nomination, opposes the idea of government requiring people to buy insurance. And, while Sen. Obama hasn't ruled out mandates as an option down the road, the Illinois Democrat argues they are ineffective without first making insurance plans affordable.

"Neither of the two presidential candidates still standing believes it's necessary," said Robert Laszewski, a health-care consultant and analyst in Washington. "So we're not going to have anyone talking about it."

After gaining considerable political ground, especially at the state level, the concept has suffered other setbacks lately, too. Despite years of entrenched political opposition to the idea of a mandate, it was a key part of the 2006 universal health care legislation enacted in Massachusetts and of California Gov. Arnold Schwarzenegger's plan to overhaul health care in that state.

The Schwarzenegger plan, though, failed this year, in part because unions and business groups objected to its individual and employer mandates. In Massachusetts, results have been mixed. While the overall plan has cut the number of uninsured adults in that state by roughly half, the state authority responsible for overseeing the program has exempted nearly 20% of uninsured residents because it has deemed they can't afford the policy premiums on offer.

As budgets become more strapped, other states are shifting to less-costly approaches to revamping health care. Last month, for instance, Florida's legislature approved a plan to let insurers sell bare-bones policies with the aim of lowering the cost of individual health insurance.

Mandates aren't likely to vanish from the public conversation altogether. Sen. Obama does support a mandate that all children be provided with health insurance. His proposal also requires that insurance companies be required to take all applicants, regardless of how sick they may be -- a position, many insurers argue, that can work only if everyone is required to have some sort of coverage.

Nor has Sen. Obama entirely ruled out an insurance mandate. His camp argues that reducing costs and making health-plan premiums affordable would be more effective in expanding coverage than would mandating health insurance with the threat of sanctions.

But once that is achieved and there is still a small percentage of people who elect not to buy insurance, "maybe [a mandate] is something you look at," said David Cutler, professor of applied economics at Harvard University and senior health-care adviser to Sen. Obama. But "it's very clear that if it's not affordable, then people won't buy it."

Obama's health care lite

A remarkable thing just happened in the people's party. Democrats have chosen a candidate, in the year 2008, who does not have a plan for universal health coverage. Barack Obama caresses the words "universal coverage" almost hourly, but his proposal offers nothing of the kind — unlike the plans of Hillary Rodham Clinton, John Edwards and other Democratic hopefuls.

Most striking, the man who showed such timidity on health care became the hero of ardent progressives. So forgiving was their love of Mr. Big that they virtually abandoned what should have been the Democrats' most potent promise: medical coverage for all.

This is political opportunity lost. In a new CNN/Opinion Research Corp. poll, 49 percent of registered voters list the economy as their No. 1 issue, with the Iraq war second at 19 percent. Health care comes in a close third at 14 percent.

Make no mistake: A universal health-care system is an economic as well as social imperative — the idea that in a rich country, no one should go without medical care. The lack of one hurts Americans' ability to compete with foreigners whose governments have controlled national health-care costs and achieved better average medical outcomes through their national systems of universal coverage.

So how are voters to compare the health-care proposals of Obama and presumptive Republican candidate John McCain?

McCain proposes tax credits for families to buy their own coverage. This is not the freshest of ideas, though he does call for federal aid to help states cover sick people rejected by private insurers. McCain opposes a mandate requiring everyone to get health insurance.

And so does Obama. He would insist that all children have health coverage, but not adults. As he said during the recent campaign, "Sen. Clinton believes the only way to achieve universal health care is to force everybody to purchase it."

Thing is, a system based on private coverage that doesn't force everyone to participate is, by definition, not universal. What happens is that the young and healthy don't bother buying in. (They figure that they can always glom onto a taxpayer-supported program, should they face a medical crisis.)

The inevitable result is that the government programs fill with expensive patients, while the hearty souls — who in any coherent system subsidize their sick neighbors — get to sit on the sidelines. This is a disaster in the making.

The logic of Obama's argument isn't great, either. His line about Hillary forcing people to buy insurance was followed by this: "And my belief is, the reason that people don't have it is not because they don't want it but because they can't afford it." Well, if his plan makes health insurance affordable, why can't everyone afford it?

For the record, McCain also vows to make coverage affordable for all. And although his more free-market approach to health care can't possibly deliver on this (without spending a lot more than he says he will), the McCain vision stands on a sturdier reality.

The best idea is to enroll all Americans in Medicare. This would be much simpler and administratively cheaper than either the McCain or Obama (or Clinton) plan. As it now does for the elderly, Medicare would pick up most of the hospital and physician bills for everybody. An expanded Medicare would free businesses from the burden of providing medical care to employees and their kin.

Obama's health-care plan looks like a back-of-the-napkin scribbling by someone who didn't care all that much but needed something. How curious that out of the smoke and drama of the Democratic race, there emerged a "candidate of change" whose health-care proposal is not universal, much less bold.

Want Universal Health Care? The Operative Word Is 'Care.'

On a recent YouTube music video, to a hypnotic bongo beat, rapper MIKE-E knocks out rhymes about . . . universal health care:




You are among the masses/One of 47 million people without health care access . . . Focus on the laws that must be enacted/Because we know there are flaws in our health care practices.

These may sound like lyrics only a lobbyist could love, but the video -- sponsored by the American Cancer Society -- expresses the frustration felt by those trying to end the United States's status as the only industrialized nation whose citizens don't have universal access to health care.

Here's a cold truth: Despite much media hand-wringing on the subject, most of us give about as much thought to those who lack health coverage as we do to soybean subsidies.The major obstacle to change? Those of us with insurance simply don't care very much about those without it. It's only when health care costs spike sharply, the economy totters or private employers begin to cut back on benefits that the lack of universal health care comes into focus. Noticing the steadily growing ranks of the uninsured, the broad American public -- "us" -- begins to worry that we'll soon be joining the ranks of "them."

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News stories about the uninsured typically offer poignant profiles of people with whom the public can easily identify. As an award-winning article in Redbook last year informed its readers, "Increasingly, this is a problem for the middle class." Similarly, the Cover the Uninsured Web site, sponsored by the Robert Wood Johnson Foundation, highlights personal stories of seven appealing individuals. Several are current or former small-business owners. Six are white, and one is an African-American woman. There are no identifiable Hispanics.

The reality, however, is that only a minority of the uninsured are either the typical Redbook reader or that nice shopkeeper down the street. Two-thirds of those without health insurance are poor or near poor, according to the Kaiser Family Foundation. And there are clear disparities in how different racial and ethnic groups are affected. Only 13 percent of non-Hispanic white Americans is uninsured, compared with 36 percent of Hispanics, 33 percent of Native Americans, 22 percent of blacks and 17 percent of Asians/Pacific Islanders.

Politicians understand what this means in practical terms. If a lack of health insurance were truly a white middle-class crisis, then conservatives and liberals would long ago have joined together, carved out a compromise and done something. Instead, we're served a constantly recycled set of excuses for legislative stalemate.

The unofficial Republican attitude toward universal health care can be boiled down to the three "nots": not our voters, not our kind of solution and not our priority. None of the Republican presidential candidates even pretended to present a serious plan for universal coverage, nor did Republican primary voters demand one. The only candidate who had actually worked successfully toward universal health care -- former Massachusetts governor Mitt Romney -- apologetically disowned his own groundbreaking achievement. Presumptive nominee John McCain's recent health care proposal doesn't make anything more than a start toward actually covering all the uninsured.

Meanwhile, Democrats play their own "us vs. them" games. Although high-profile party leaders are loudly calling for universal coverage -- recall the Barack Obama-Hillary Clinton slugfest over their respective plans -- they reassure the middle class that the cost of compassion will be covered by repealing tax cuts for the wealthy. This "free lunch" approach may tax credulity, but it does avoid the need for discussing other taxes.

To be fair to the politicians, the interest groups representing the public have exhibited little appetite for genuinely grappling with the uninsured problem. AARP, one of the most powerful consumer groups, is running a high-profile ad campaign advocating a vague health care "reform." But imagine the revolt if the organization's leaders had asked its elderly membership to insist that those with no health insurance, including 9 million children, should be guaranteed basic care before Congress spent hundreds of billions of dollars adding a Medicare pharmaceutical benefit.

Though the American Medical Association has been a consistent voice for covering the uninsured, it reserves its political muscle for issues that excite its members. And the blunt truth is that the percentage of physicians who actually provide care to the uninsured or to Medicaid patients has been steadily declining for a decade.

When the American Cancer Society decided to focus its marketing budget on coverage for the uninsured, some supporters grumbled that it wasn't "our fight." The society responded that cancer patients without health insurance are diagnosed later and have a far greater chance of dying.

Kidney Cancer

• what is Kidney Cancer?

Renal cell carcinoma (RCC) is the most common form of kidney cancer arising from the renal tubule. It is the most common type of kidney cancer in adults. Initial treatment is surgery. It is notoriously resistant to radiation therapy and chemotherapy, although some cases respond to immunotherapy. The advent of targeted cancer therapies such as sunitinib has vastly improved the outlook for treatment of RCC.

• Signs and symptoms

The classic triad is hematuria (blood in the urine), flank pain and an abdominal mass. This is now known as the 'too late triad' because by the time patients present with symptoms, their disease is often advanced beyond a curative stage. Today, the majority of renal tumors are asymptomatic and are detected incidentally on imaging, usually for an unrelated cause.

Other signs may include:

• Abnormal urine color (dark, rusty, or brown) due to blood in the urine
• Weight loss, malnourished appearance
• The presenting symptom may be due to metastatic disease, such as a pathologic fracture of the hip due to a metastasis to the bone
• Enlargement of one testicle known as varicocele (usually the left, due to blockage of the left gonadal vein by tumor invasion of the left renal vein -- the right gonadal vein drains directly into the inferior vena cava)
• Vision abnormalities
• Pallor or plethora
• Hirsutism - Excessive hair growth (females)
• Constipation
• High blood pressure
• Elevated calcium levels (Hypercalcemia)

• Treatment

Watchful waiting

Small renal tumors represent the majority of tumors that are treated today by way of partial nephrectomy. The average growth of these masses is about 4-5 mm per year, and a significant proportion (up to 40%) of tumors less than 4cm in diameter are benign. More centers of excellence are incorporating needle biopsy to confirm the presence of malignant histology prior to recommending definitive surgical extirpation. In the elderly, patients with co-morbidities and in poor surgical candidates, small renal tumors may be monitored carefully with serial imaging. Most clinicians conservatively follow tumors up to a size threshold between 3-5 cm, beyond which the risk of distant spread (metastases) is about 5%.

Surgery

Surgery is the initial treatment for the majority of kidney cancers. Surgical procedures used to treat kidney cancer include:

• Removing the affected kidney (nephrectomy). Radical nephrectomy involves the removal of the kidney as well as the adrenal gland that sits atop the kidney, a border of healthy tissue and adjacent lymph nodes. Nephrectomy can be done through an incision, meaning the surgeon makes a large cut in your skin to access your kidney. Or nephrectomy can be done laparoscopically, using small incisions to insert a video camera and tiny surgical tools. The surgeon watches a video monitor in order to perform the nephrectomy.
• Removing the tumor from the kidney (nephron-sparing surgery). During this procedure, the surgeon removes the tumor, rather than the entire kidney. Nephron-sparing surgery may be an option if you have only one kidney or if you have an early-stage kidney cancer.

What type of surgery your doctor recommends will be based on your cancer and its stage, as well as your health and personal preferences. Surgery carries a risk of bleeding and infection.

Treatments when surgery isn't possible
For some people, surgery may be too risky. These people have other options for treating their kidney cancers, including:

• Blocking blood flow to the tumor (embolization). In this procedure, a special material is injected into the main blood vessel leading to the kidney. By clogging this vessel, the tumor is deprived of oxygen and other nutrients. Arterial embolization also may be used before an operation or to relieve pain and bleeding when an operation isn't possible. Side effects may include temporary nausea, vomiting or pain.
• Treatment to freeze cancer cells (cryoablation). Recent studies show cryoablation may be useful for treating kidney tumors that can't be removed through surgery. During cryoablation, one or more special needles (cryoprobes) are inserted through small incisions in your skin and into the tumor. Gas in the needles creates extreme cold that causes the cells around the point of each needle to freeze. Doctors use CT scans to monitor the procedure and to ensure that all of the visible cancer tissue and some of the surrounding healthy tissue is frozen. Another type of gas in the needles creates warmth to thaw the frozen tissue. Then the process is repeated. The cycles of freezing and thawing cause cancer cells to die. You may experience some pain after the procedure. Rare side effects may include bleeding, infection and damage to tissue surrounding the tumor.

Treatments for advanced and recurrent kidney cancer
Kidney cancer that recurs and kidney cancer that spreads to other parts of the body may be curable. In these situations, treatments may include:

• Surgery to remove as much of the kidney tumor as possible. Even when surgery can't remove all of your cancer, in some cases it may be helpful to remove as much of the cancer as possible.
• Drugs that use your immune system to fight cancer (biological therapy). Biological therapy (immunotherapy) uses your body's immune system to fight cancer. Drugs in this category include interferon and interleukin-2, which are synthetic versions of chemicals made in your body. These biological therapy drugs have serious side effects, including chills, fever, nausea, vomiting and loss of appetite. Biological therapy drugs are sometimes used alone, in combination or after surgery.
• Treatment that targets specific aspects of your cancer (targeted therapy). Targeted treatments block specific abnormal signals present in kidney cancer cells that allow them to proliferate. These drugs have shown promise in treating kidney cancer that has spread to other areas of the body. Two targeted drugs, sorafenib (Nexavar) and sunitinib (Sutent), block signals that play a role in the growth of blood vessels that provide nutrients to cancer cells and allow cancer cells to spread. Temsirolimus (Torisel), another targeted drug, blocks a signal that allows cancer cells to grow and survive. Targeted therapy drugs can cause side effects, such as a rash that can be severe, diarrhea and fatigue. Targeted drugs can also be very expensive, sometimes costing over $1,000 a treatment.
• Treatments for distant tumors. Kidney cancer cells that travel to other parts of the body (metastasize) can sometimes be treated. This depends on the number of distant tumors, their locations and your general health. Treatment options vary based on where your cancer has spread. Options might include surgery for brain metastasis or radiation for kidney cancer that has spread to bones.
• Clinical trials. Clinical trials are studies of new treatments and new techniques for treating kidney cancer and other diseases. Participating in a clinical trial may give you a chance to try the latest treatments, but it can't guarantee a cure. Discuss the available clinical trials with your doctor and carefully weigh the benefits and risks. Many kidney cancer clinical trials are studying new and existing targeted therapies to determine the best ways to use this new class of drugs.

Treatment for transitional cell cancer
Treatment for transitional cell cancer typically involves an extensive operation to remove the tumor, ureter, kidney and a portion of the bladder. Surgery to remove only the tumor may be an option in some cases.

Chemotherapy may be useful in treating transitional cell cancer that has spread or that recurs. Chemotherapy is a drug treatment that uses chemicals to kill quickly growing cells, such as cancer cells. Other rapidly growing cells, such as those in your gastrointestinal tract and your hair follicles, also are killed by chemotherapy drugs, which can cause side effects including nausea, vomiting and hair loss.

Dental Health|Oral health

Dental Health is the practice of keeping the mouth clean in order to prevent cavities (dental caries), gingivitis, periodontitis, bad breath (halitosis), and other dental disorders.

Personal care:-
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Brushing and flossing

Careful and frequent brushing with a toothbrush and the use of dental floss help to prevent build-up of plaque bacteria on the teeth. These bacteria metabolize carbohydrates in our meals or snacks and excrete acid which demineralizes tooth enamel, eventually leading to tooth decay and toothache if acid episodes are frequent or are not prevented. Calculus (dental) or tartar buildup on teeth usually opposite salivary ducts is because of calcium deposits in resident plaque. Frequent brushing and swishing saliva around helps prevent these deposits. Cavities can be costly, in terms of the monetary cost to drill out the cavities and insert dental fillings, and in terms of the tissue already damaged.

Almost all cavities occur where food is trapped between teeth and inside deep pits and fissures in grooves on chewing surfaces where the brush, toothpaste, mouthwash, saliva and chewing gum, cannot reach.

Special appliances or tools may be recommended to supplement (but not to replace) toothbrushing and flossing. These include special toothpicks, oral irrigators, or other devices. Initially electric toothbrushes were only recommended for persons who have problems with strength or dexterity of their hands, but many dentists are now recommending them to many other patients in order to improve their home dental care. In many parts of the world natural toothbrushes are used. In the Muslim world the miswak or siwak is made from twigs or roots that are alleged to have an antiseptic effect when applied as a toothbrush.

Food and drink in relation to oral Health

Foods that help muscles and bones also help teeth and gums. Dairy contributes vitamin D, strengthening teeth. Breads and cereals are rich in vitamin B while fruits and vegetables contain vitamin C, both of which contribute to healthy gum tissue. Lean meat, fish, and poultry provide magnesium and zinc for teeth. Some people recommend that teeth be brushed after every meal and at bedtime, and flossed at least once per day, preferably at night before sleep. For some people, flossing might be recommended after every meal.
Dentists and dental hygienists can instruct and demonstrate brushing and flossing techniques.

Better

Some foods may protect against cavities. Milk and cheese appear to be able to raise pH values in the mouth, and so reduce tooth exposure to acid. They are also rich in calcium and phosphate, and may also encourage remineralisation. All foods increase saliva production, and since saliva contains buffer chemicals this helps to stabilise the pH at just above 7 in the mouth. Foods high in fiber may also help to increase the flow of saliva. Unsweetened (basically sugar free) chewing gum stimulates saliva production, and helps to clean the surface of the tooth.

Worse

Sugars are commonly associated with dental cavities. Other carbohydrates, especially cooked starches, e.g. crisps/potato chips, may also damage teeth, although to a much lesser degree. This is because starch is not an ideal food for the bacteria. It has to be converted by enzymes in saliva first.

Sucrose (table sugar) is most commonly associated with cavities, although glucose and maltose seem equally gervic (likely to cause cavities). The amount of sugar consumed at any one time is less important than how often food and drinks that contain sugar are consumed.[citation needed] The more frequently sugars are consumed, the greater the time during which the tooth is exposed to low pH levels, at which point demineralisation occurs. It is important therefore to try to encourage infrequent consumption of food and drinks containing sugar so that teeth have a chance to repair themselves. Obviously, limiting sugar-containing foods and drinks to meal times is one way to reduce the incidence of cavities.

Artificially refined sugar is not the only type that can promote dental cavities. There are also sugars found in fresh fruit and fruit juices. These foods (oranges, lemons, limes, apples, etc.) also contain acids which lower the pH level. On the other hand, carbonic acid found in soda water is very weakly acidic (pH 6.1), and not associated with dental cavities(provided the soft drink is sugar free, of course). That said, soft drinks are not as healthy for the teeth as milk, because of their lower pH and lack of calcium. Drinking sugared soft drinks throughout the day raises the risk of dental cavities tremendously.

Another factor which affects the risk of developing cavities is the stickiness of foods. Some foods or sweets may stick to the teeth and so reduce the pH in the mouth for an extended time, particularly if they are sugary. It is important that teeth be cleaned at least twice a day, preferably with a toothbrush and fluoride toothpaste, to remove any food sticking to the teeth. Regular brushing and the use of dental floss also removes the dental plaque coating the tooth surface.

Chewing gum assists oral irrigation between and around the teeth, cleaning and removing particles, but for teeth in poor condition it may damage or remove loose fillings as well.

Smoking and chewing tobacco are both linked with multiple dental hazards. Regular vomiting, as seen in those who practice bulimia, also causes significant damage.

Other

Retainers- can be cleaned in mouthwash or denture cleaning fluid. Fluoride-containing, or anti-plaque (tartar control) toothpastes or mouthwashes may be recommended by the dentist or dental hygienist. Dental braces may be recommended by a dentist for best oral hygiene and health. Dentures, retainers, and other appliances must be kept extremely clean. This includes regular brushing and may include soaking them in a cleansing solution.