Study: Heart Failure Drug Guidelines Often Ignored
Only one-third of 12,565 patients eligible for the drugs got them – even though they were treated at 201 hospitals that had voluntarily enrolled in the American Heart Associations Get with the Guidelines program.
Reasons why so few doctors “got with the program” are unclear. But the study authors offered some theories, from lack of marketing for the decades-old drugs to concerns about their safety.
The main drug studied, spironolactone, is a water pill that helps prevent kidneys from absorbing too much sodium, which can lead to excess fluid. In heart failure, water often builds up in lungs, blood and tissue because the heart cant pump properly.
The pills studied have been shown to reduce hospitalizations and deaths. But they also can be hard on the kidneys and when used in the wrong patients, side effects can be deadly – another reason some doctors may avoid them.
The study found that inappropriate use – in patients with signs of kidney trouble or other specific conditions – was uncommon.
The study appears in Wednesdays Journal of the American Medical Association.
Spironolactone is an old generic drug that is not heavily marketed, so doctors may lack promotional material on how to use it, said Cleveland Clinic researcher Nancy Albert, the studys lead author.
Another reason for infrequent use is that the original 2005 American College of Cardiology/American Heart Association guidelines said these drugs “should be considered.” The wording was changed this year to “recommended,” after the 2005-2007 study ended, the study authors said.
Dr. Ileana Pina, a spokeswoman for the heart group and professor at Clevelands Case Western Reserve University, said the results arent surprising since other reports have shown doctors dont always follow guidelines.
But because these drugs can improve survival, she said the study results should serve as “a call to action” for doctors who treat heart failure patients.
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On the Net:
American Heart Association: http://www.heart.org
Sugar Cereals Are Smart Choices? Fda Not So Sure
Well, federal health officials are having similar thoughts, and theyre warning food manufacturers.
The Food and Drug Administration said Tuesday that nutritional logos from food manufacturers may be misleading consumers about the actual health benefits of cereal, crackers and other processed foods. The agency sent a letter to companies saying it will begin cracking down on inaccurate food labeling. The FDA did not name specific products or give a timeline for enforcement.
U.S. manufacturers, including Kellogg, Kraft Foods and General Mills, rolled out their so-called Smart Choices program last year, amid growing concern about obesity rates. The green labels appear on the front of foods that meet certain standards for calories per serving and fat content.
But consumer advocates complain about lax standards for the program, with logos appearing on everything from frozen sweets to sugary cereals.
“There are products that have gotten the Smart Choices check mark that are almost 50 percent sugar,” FDA Commissioner Margaret Hamburg said during a call with reporters.
The agency is developing proposed nutritional standards that would have to be met before manufacturers place such claims on their packages, Hamburg said. She added that she hoped industry would cooperate with the FDA to develop standardized “labeling that all Americans can trust and use to build better diets.”
Mike Hughes, chair of the Smart Choices Program, said in a statement that Smart Choices is based on the U.S. Dietary Guidelines for Americans.
“We believe in the science behind the Smart Choices Program,” he said. “We also look forward to the opportunity to participate in FDAs initiatives on front-of-package labeling.”
There are more than a half-dozen labels crowding grocery packages, including the American Heart Associations heart-shaped logo, Giant Food Stores Healthy Ideas box and Supervalus Nutritional IQ logo.
“Theres a growing proliferation of forms and symbols, check marks, numerical ratings, stars, heart icons and the like,” said Hamburg. “Theres truly a cacophony of approaches, not unlike the tower of Babel.”
The FDA plans to research whether one particular approach would make it easier for consumers to select healthy foods. Hamburg pointed to the success of the U.K.s traffic light system, which uses red, yellow and green lights to highlight nutritional quality.
The Grocery Manufacturers Association said its members will work with the FDA to provide useful nutritional information to consumers. The Washington-based group – which includes Kraft, Nestle USA and most other large food processors – said companies already have reformulated 10,000 products to make them healthier.
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AP Business Writer Sarah Skidmore contributed to this report from Portland, Ore.
Glaxo, Human Genome Say Lupus Drug Worked 16 Weeks Into Study
The 865-patient study, known as Bliss-52, found Benlysta was more effective at easing pain, hair loss and skin rash than a placebo, London-based Glaxo and Rockville, Maryland-based Human Genome said in July, when they announced the initial results of the trial.
A full presentation of the data today showed that the improvement was statistically significant and sustained for both the higher dose and lower dose of the drug from week 24 and week 28, respectively, for the duration of the 52-week test. The rate of improvement was “generally consistent” across different groups of patients, according to the data presented today at the Scientific Meeting of the American College of Rheumatology in Philadelphia.
“The main thing were looking for is if the improvement versus placebo was sustained during the year,” Matrix Corporate Capital analyst Navid Malik said in an interview before the announcement. “How fast does this drug kick in?”
The initial findings triggered Human Genome Sciences shares to more than triple on July 20 to their greatest increase since the stock began trading in 1993. The positive overview of the data surprised analysts, who cited disappointing earlier clinical trials and a history of failures for treatments of lupus, which causes the immune system to attack healthy cells.
Peak Sales
Benlysta, known chemically as belimumab, may become the first new drug in 50 years for the autoimmune disease and bring in annual peak sales of $3.5 billion by 2015, according to Panmure Gordon analyst Savvas Neophytou.
Patients in the study received one of two doses of the drug or a placebo. At the lower dose, 51.4 percent of patients showed improved symptoms compared with 43.6 percent who took the placebo, Human Genome said in July. At a higher dose, 57.6 percent had improved symptoms, according to the company.
If Benlysta succeeds in its next trial, Bliss-76, the companies plan to apply for approval to sell it in the U.S., Europe and other countries in the first half of 2010.
The drug may fetch $15,000 to $20,000 a year per patient, based on the history of rheumatoid arthritis and multiple sclerosis treatments, Barry Labinger, Human Genomes chief commercial officer, said on July 20.
Human Genome is conducting Bliss-76, a 76-week trial of Benlysta. Both studies are being conducted under a “special protocol assessment” from the U.S. Food and Drug Administration, which allows a drugmaker to work with the agency to design a late-stage clinical trial with scientific goals that, if met, would be sufficient for marketing approval.
Results of the 76-week trial are expected on Nov. 2.
Full Results Show Aids Vaccine Is Of Modest Help
Yet the findings are exciting to scientists, who think that blood samples from the trial may show how to make a vaccine that does a better job.
The results also hint that the vaccine may work better in the general population than in those at higher risk of infection, such as gay men and intravenous drug users. It was the first time an AIDS vaccine was tested mostly in heterosexuals at average risk, and doctors have long known that how a person is exposed to HIV affects the odds of becoming infected.
“This study becomes a landmark. You can put it on a map and begin to figure out where you go from here,” said Col. Jerome Kim, the U.S. Army doctor who co-led the trial.
Last month, researchers announced that a two-vaccine combination cut the risk of becoming infected with HIV by more than 31 percent in a trial of more than 16,000 volunteers in Thailand.
Full results, published online Tuesday by the New England Journal of Medicine and presented at a scientific conference in Paris, include two additional analyses that merely suggest the vaccine is beneficial, rather than providing definitive proof.
Thats mostly because so few participants became infected – only 125 people, 10 times less than in previous HIV vaccine trials, said Dr. Anthony Fauci, director the National Institute of Allergy and Infectious Diseases, the studys main sponsor.
Critics had leaked one of the analyses last week, saying it showed the original results may have been a fluke. A California-based AIDS advocacy group criticized study leaders for not giving a fuller picture when they held their news conference last month.
“The bottom line is that those results are real,” even though they are not good enough to justify using this vaccine now, said Dr. Alan Bernstein, executive director of the Global HIV Vaccine Enterprise, an alliance of governments, AIDS scientists, the World Health Organization and funders such as the Bill & Melinda Gates Foundation.
“We, for the first time, have evidence of protection, and the nitty gritty (arguments) to me dont matter a damn,” Bernstein said.
Other scientists who, like Bernstein, had no role in the trial, agreed.
“Its a consistent story. There seems to be some effect. And I think it is an important study. It redirects the field to look at a different kind of vaccine and different kinds of immune responses” than what have been the focus in the past, said Dr. Lawrence Corey of the University of Washington. He heads the HIV Vaccine Trials Network, an international group of scientists who test vaccines.
The Thailand Ministry of Public Health conducted this trial, which used vaccines made from strains of HIV common in Thailand. They are ALVAC, made by Sanofi Pasteur, and AIDSVAX, originally developed by VaxGen Inc. and now held by the nonprofit Global Solutions for Infectious Diseases. The vaccines are not made from whole virus and cannot cause HIV infection.
New infections occurred in 51 of the 8,197 given vaccine and in 74 of the 8,198 who received dummy shots. That worked out to a 31 percent lower risk of infection for the vaccine group.
In a smaller analysis of just the 12,452 participants who received all six shots exactly on schedule, there were 86 infections – 36 in the vaccine group and 50 in those given dummy shots.
Though not a statistically significant trend, the vaccine appeared nearly twice as effective among those at low or moderate risk of becoming infected, versus people who share needles, have contact with prostitutes or engage in other risky behaviors.
“Perhaps the requirements for protection against transmission in low-risk heterosexual persons are considerably different or less stringent,” Dr. Raphael Dolin of Beth Israel Deaconess Medical Center in Boston wrote in an editorial published by the medical journal.
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Somers New Target: Conventional Cancer Treatment
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NEW YORK (AP) – Suzanne Somers is at it again.
Less than a year after the former sitcom actress frustrated mainstream doctors (and cheered some fans) by touting bioidentical hormones on “The Oprah Winfrey Show,” shes back with a new book. This ones on an even more emotional topic: Cancer treatment. Specifically, she argues against what she sees as the vast and often pointless use of chemotherapy.
Somers, who has rejected chemo herself, seems to relish the fight.
“Cancers an epidemic,” said the 63-year-old actress in an interview in a Manhattan hotel a day before Tuesdays release of “Knockout,” her 19th book. “And yet we keep going back to the same old pot, because its all weve got. Well, this is a book about options.
“Im us,” Somers adds. “Im not them. Ive been on the other side of the bed. And its powerful to have information.”
The American Cancer Society is concerned.
“I am very afraid that people are going to listen to her message and follow what she says and be harmed by it,” says Dr. Otis Brawley, the organizations chief medical officer. “We use current treatments because theyve been proven to prolong life. Theyve gone through a logical, scientific method of evaluation. I dont know if Suzanne Somers even knows there IS a logical, scientific method.”
More broadly, Brawley is concerned that in the United States, celebrities or sports stars feel they can use their fame to dispense medical advice. “Theres a tendency to oversimplify medical messages,” he says. “Well, oversimplification can kill.”
Though she may be one of the most visible, Somers is hardly the only celebrity whos advocated alternative treatments recently.
Radio host Don Imus says hes eating habanero peppers and taking Japanese soy supplements to help treat his prostate cancer. The late Farrah Fawcett underwent a mix of traditional and alternative treatments, and made a poignant plea for supporting alternative methods in her film, “Farrahs Story.” Actress Jenny McCarthy advocates a special dietary regime, supplements, metal detox and delayed vaccines to treat autism.
The issue goes beyond alternative medicine. Tennis great John McEnroe has been advocating widespread screening for prostate cancer, which Brawley and others say is not necessarily wise.
While its hard to imagine a comedian like Maher influencing public health decisions, there have been cases where celebrities have been seen to influence the public, says Barron Lerner, a doctor whos looked at celebrity illnesses through history.
He recalls how some desperately ill cancer patients took their cues from Steve McQueen, the rugged actor who turned to unorthodox cancer treatment in 1980. When conventional medicine failed to halt his mesothelioma, a cancer of the lung lining, McQueen traveled to Mexico, where he was treated with everything from coffee enemas to laetrile, the now debunked remedy involving apricot pits.
“Its difficult to quantify his influence, but there was a lot of traffic to Mexico of end-stage cancer patients after his death,” says Lerner, author of “When Illness Goes Public.”
Though his alternative treatments didnt work, the actor, who embodied a sense of rebellion and individualism, gave voice to an emerging feeling that mainstream medicine might not be enough, Lerner says.
Fast forward to the 21st century, where Somers, who played the ditzy blonde in TVs “Threes Company,” has written a series of books making that point. In “Ageless,” she argued that doctors dont understand womens bodies, especially those going through menopause.
Merck, Glaxo Prepare For Hpv Vaccine Battle With U.s. Approvals
The Food and Drug Administration authorized sales of Gardasil to prevent genital warts in males ages 9 to 26 and Glaxos Cervarix to prevent cervical cancer in females ages 10 to 25, the companies said today in separate statements. Gardasil has been approved in the U.S. since 2006 and is part of routine vaccinations for school-age girls.
The shots target strains of human papillomavirus, or HPV, a common sexually transmitted virus that can cause cancer and serious infections. Concerns about Cervarixs safety contributed to a regulatory delay in 2007, helping give Merck a head start on the U.S. market. Outside advisers to the FDA on Sept. 9 backed Cervarix as well as Mercks proposal to expand Gardasils market.
“Nearly 17,000 new cases of genital HPV infection, of any type, occur each day in the United States, in both males and females,” said Anna Giuliano, a program leader in risk assessment, detection and intervention at the Moffitt Cancer Center in Tampa, Florida, in Mercks statement.
Broader use could revive Gardasils sales, which declined 5 percent last year to $1.4 billion amid questions about side effects and cost.
Approval in boys may add as much as $200 million to $300 million in annual sales for Merck, of Whitehouse Station, New Jersey, Leerink Swann & Co. analyst Seamus Fernandez said in a research report last month.
Challenge for Glaxo
London-based Glaxo faces a challenge in winning doctors and parents support for Cervarix because Gardasil also protects against genital warts. Cervarix is cleared in 100 countries, including approval today in Japan, and had sales of 125 million pounds ($232 million) last year, about one-sixth as much as Gardasil. The average estimate of three analysts surveyed by Bloomberg calls for sales worth 603 million pounds in 2013.
Demand for both vaccines will likely be affected by recommendations of the Centers for Disease Control and Preventions Advisory Committee on Immunization Practices next week. The 15-member panel that sets national guidelines plans to review Cervarix for girls and Gardasil for boys at an Oct. 21 meeting in Atlanta.
Twenty million Americans are infected with HPV, and most will be able to fight off the infection naturally. This year, an estimated 11,270 new cases of cervical cancer will be diagnosed in the U.S. and 4,070 women will die of the disease, according to the National Cancer Institute, a U.S. agency. About 1 percent of sexually active men in the U.S. will develop genital warts from HPV, according to the CDC.
Three Doses
Gardasil and Cervarix are given in three doses during a six-month period to trigger immune responses that help protect against the two HPV strains responsible for most U.S. cervical cancer cases. Gardasil also protects against two additional strains of HPV that cause 90 percent of genital warts.
It would cost more than $100,000 to vaccinate enough boys with Gardasil to get one year of additional life compared with less than $50,000 for girls, according to a study by Harvard University researchers presented in June. Mercks studies show it would cost $50,000 for boys and girls at a price of $400 per vaccine.
Paying for Shots
Merck will expand a patient rebate and dose replacement program to help cover the cost of the vaccine for 19- to 26- year-old men without health insurance and those with private insurance with partial or no coverage for the shots, according to the companys statement.
Glaxos studies showed a slight increase in miscarriages among young women who took Cervarix. Outside advisers to the FDA who backed the safety and effectiveness of Cervarix said Glaxos plan to register patients and monitor for pregnancies would mitigate any potential risks.
American depositary receipts of Glaxo, each representing two ordinary shares, fell 8 cents to $41.20 at 4:01 p.m. in New York Stock Exchange composite trading. Merck dropped 9 cents to $33.21.
Merck, Glaxo Prepare For Hpv Vaccine Battle With U.s. Approvals
The Food and Drug Administration authorized sales of Gardasil to prevent genital warts in males ages 9 to 26 and Glaxos Cervarix to prevent cervical cancer in females ages 10 to 25, the companies said today in separate statements. Gardasil has been approved in the U.S. since 2006 and is part of routine vaccinations for school-age girls.
The shots target strains of human papillomavirus, or HPV, a common sexually transmitted virus that can cause cancer and serious infections. Concerns about Cervarixs safety contributed to a regulatory delay in 2007, helping give Merck a head start on the U.S. market. Outside advisers to the FDA on Sept. 9 backed Cervarix as well as Mercks proposal to expand Gardasils market.
“Nearly 17,000 new cases of genital HPV infection, of any type, occur each day in the United States, in both males and females,” said Anna Giuliano, a program leader in risk assessment, detection and intervention at the Moffitt Cancer Center in Tampa, Florida, in Mercks statement.
Broader use could revive Gardasils sales, which declined 5 percent last year to $1.4 billion amid questions about side effects and cost.
Approval in boys may add as much as $200 million to $300 million in annual sales for Merck, of Whitehouse Station, New Jersey, Leerink Swann & Co. analyst Seamus Fernandez said in a research report last month.
Challenge for Glaxo
London-based Glaxo faces a challenge in winning doctors and parents support for Cervarix because Gardasil also protects against genital warts. Cervarix is cleared in 100 countries, including approval today in Japan, and had sales of 125 million pounds ($232 million) last year, about one-sixth as much as Gardasil. The average estimate of three analysts surveyed by Bloomberg calls for sales worth 603 million pounds in 2013.
Demand for both vaccines will likely be affected by recommendations of the Centers for Disease Control and Preventions Advisory Committee on Immunization Practices next week. The 15-member panel that sets national guidelines plans to review Cervarix for girls and Gardasil for boys at an Oct. 21 meeting in Atlanta.
Twenty million Americans are infected with HPV, and most will be able to fight off the infection naturally. This year, an estimated 11,270 new cases of cervical cancer will be diagnosed in the U.S. and 4,070 women will die of the disease, according to the National Cancer Institute, a U.S. agency. About 1 percent of sexually active men in the U.S. will develop genital warts from HPV, according to the CDC.
Three Doses
Gardasil and Cervarix are given in three doses during a six-month period to trigger immune responses that help protect against the two HPV strains responsible for most U.S. cervical cancer cases. Gardasil also protects against two additional strains of HPV that cause 90 percent of genital warts.
It would cost more than $100,000 to vaccinate enough boys with Gardasil to get one year of additional life compared with less than $50,000 for girls, according to a study by Harvard University researchers presented in June. Mercks studies show it would cost $50,000 for boys and girls at a price of $400 per vaccine.
Paying for Shots
Merck will expand a patient rebate and dose replacement program to help cover the cost of the vaccine for 19- to 26- year-old men without health insurance and those with private insurance with partial or no coverage for the shots, according to the companys statement.
Glaxos studies showed a slight increase in miscarriages among young women who took Cervarix. Outside advisers to the FDA who backed the safety and effectiveness of Cervarix said Glaxos plan to register patients and monitor for pregnancies would mitigate any potential risks.
American depositary receipts of Glaxo, each representing two ordinary shares, fell 8 cents to $41.20 at 4:01 p.m. in New York Stock Exchange composite trading. Merck dropped 9 cents to $33.21.
Minn. Pigs May Have Tested Positive For Swine Flu
The samples were taken from pigs shown at the Minnesota State Fair between Aug. 26 and Sept. 1 as part of a university research project. Officials expect results next week to confirm whether the pigs were infected with swine flu virus, also known as H1N1.
The pigs did not show signs of sickness and officials said they likely contracted the virus from some of the nearly 1.8 million people who visited the fair.
The Department of Agricultures veterinary lab in Ames, Iowa, is conducting tests to confirm the results, Agriculture Secretary Tom Vilsack said in a statement.
In a conference call with reporters Friday, Minnesota Agriculture Commissioner Gene Hugoson said officials dont know what happened to the three pigs, but that they probably were sent to slaughter soon after they were shown at the fair, which ended on Labor Day.
“This is not an issue of food safety,” Hugoson said. “Pork products are and continue to be safe to eat.”
Authorities arent planning special measures if the tests confirm the Minnesota pigs had the virus. Hugoson said farmers will continue watching herds for flu symptoms, and slaughterhouse inspectors will continue rejecting pigs showing disease symptoms.
Agriculture officials had long expected the virus to reach domestic pigs this year and have guidelines to slow its spread, said Jeff Bender, director of the University of Minnesotas Center for Animal Health and Food Safety. Herd infections previously were reported in Canada, Australia, Argentina, Ireland, the United Kingdom and Norway. A hog vaccine for the virus is being developed but isnt yet available.
Jose Diez, a USDA veterinary official on Fridays call, said killing pigs to stop the spread of the virus has not been considered. He and other officials said swine usually recover quickly from influenza, and generally are sent to slaughter after theyre healthy and ready for market.
While the chance of a pig infecting a person is considered remote, the animals can act as mixing vessels if they happen to catch two different strains at the same time, allowing mutation of a new one. Officials said theres no evidence thats happened.
Still, the news was clearly unwelcome for the pork industry, which has worked to distance itself from the swine flu virus.
“At the end of the day this is not a big deal,” said Mike Wegner, a spokesman for the National Pork Board. “There is no reason for anyone to be concerned about the safety of pork, either eating or handling.”
Hugoson said its too early to gauge the impact of Fridays news on the industry, which already was struggling with decreasing exports fueled by virus fears.
“Im more concerned with the public fear,” he said. “How many thousands of people die a year from the flu? Most years nobody thinks about it, but now everyone is up in arms because of this H1N1 thing.”
Minnesota is the countrys No. 3 pork-producing state behind Iowa and North Carolina. Minnesota pork producers had 7.3 million hogs and pigs as of Sept. 1, according to USDA figures, while the national inventory was 66.6 million head. The pork industry contributes nearly $1.5 billion and more than 21,000 jobs to the states economy, according to the National Pork Producers Council.
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Associated Press writers Henry C. Jackson and Lauran Neergaard in Washington, and Michael J. Crumb in Des Moines, Iowa, contributed to this report.
Some Poor Nations Succeeding In Fighting Hunger
Thanks to fertilizer he couldnt afford without government help, Jesitala harvested enough corn to feed his family this year. A report released Friday praised Malawis program, saying governments simply making agriculture a top priority and offering financial and other incentives to small farmers have seen some poor countries quickly move from importing food to producing surpluses.
In its report, ActionAid International ranked Malawi among the top five successful developing nations, with Brazil taking the lead, for cutting child malnutrition by 73 percent in six years.
“Whos Really Fighting Hunger” said Brazil succeeded at cutting child malnutrition by investing extensively in small-holder farmers and implementing strong social welfare policies.
In Malawi, the past two growing seasons have ended with impressive surpluses of the staple crop, corn. President Bingu wa Mutharika persisted with his program to help farmers buy fertilizer despite opposition from Western donor nations and agencies that see subsidies as contrary to free market principles.
During the 2008-09 growing season, the government spent $183 million on the farm subsidy program, which resulted in Malawi realizing a surplus of 1.3 million metric tons of maize. Under the program, a farming family gets two 50-kilogram bags of fertilizer and packets of seed.
Before he started using fertilizer, Jesitala harvested fewer than 15 bags of corn from his one-acre plot. This year, he harvested 40 bags, enough to feed his family for the year.
“We will also even sell some of the maize,” he said.
Malawi, which has had acute food shortages in the past, has been a donor in recent times, giving 500 metric tons of corn each to Swaziland and Lesotho and selling some to Zimbabwe in the 2007-08 growing season. Talks are under way to sell to Kenya and Zimbabwe this year.
The World Food Program is warning that, because of drought, Malawians in some southern regions will need food aid this year despite the national surplus. But the Ministry of Agriculture and Food Security says theres enough stock to respond to any food emergency.
The U.N. Food and Agriculture Organization said in a report released Wednesday that the worlds hungry reached 1.02 billion this year, attributing the steady rise in the number of undernourished people to governments reducing their spending on agriculture for more than a decade.
“Its the role of the state and not the level of wealth, that determines progress on hunger,” said Anne Jellema, ActionAids policy director.
“Every six seconds a child dies from hunger, but this scandal could easily be ended if all governments took determined action,” said Jellema.
The report grades rich nations on the measures they have taken to end hunger such as how much agriculture aid they give or what they are doing to reverse the effects of climate change.
Luxembourg tops the list of 22 rich nations, followed by Finland and Ireland.
“Whos Really Fighting Hunger,” ranks 51 countries where either ActionAid has a presence or have reliable data that makes comparisons possible. So, for example, Zimbabwe is not included because of doubts about data generated in that country.
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Maliti contributed from Nairobi, Kenya.
Rockefeller Says Democrats Cant Tailor Health Care to Snowe
“We cant sort of hedge and say whats Olympia going to do,” Rockefeller, a West Virginia Democrat, said in an interview on Bloomberg Televisions “Political Capital with Al Hunt,” airing this weekend. “Weve got to decide what we want.”
Snowe, who this week voted for an $829 billion finance committee bill, is the only Republican to back an overhaul plan. Keeping the Maine lawmaker on board as the legislation moves through the Senate may help attract Democrats facing re- election battles and possibly other Republicans.
Senate Majority Leader Harry Reid is trying to craft a final measure that satisfies conflicting demands of his party, such as whether to include a government-run plan.
“If we calculate so finely and so exquisitely, were going to lose our leadership and our momentum,” said Rockefeller, 72. “And right now yes, we did get her vote. As she said yes for this one, it doesnt mean for the next round of votes.”
Rockefeller said Reids legislation would have to include a government plan, or public option, to compete with private companies, such as Indianapolis-based WellPoint Inc.
Counterweight to Malevolence
“There has to be a counterweight to the malevolence of the insurance industry,” Rockefeller said.
Snowe, who is being courted for her support on the health overhaul by the White House, has urged President Barack Obama to drop the public option and instead suggested a so-called trigger that would activate a public option only if private insurers fail to make coverage affordable.
While Rockefeller, a member of the finance committee, voted for the panels plan, he was critical of it because it failed to include the public option.
He and other Democrats say the public option is the best way to lower costs so more uninsured Americans can afford coverage. The finance committee measure instead offers $6 billion in seed money for nonprofit insurance cooperatives.
“There were 30 Democrats that signed a petition asking Harry for a public option,” he said.
Reid is “more likely” to include a version of the public option that requires the government to negotiate rates with providers, as private insurers do, than peg them to the less- expensive Medicare rates, Rockefeller said.
That proposal would be similar to an amendment offered by Senator Chuck Schumer, a New York Democrat, that was rejected by the finance panel.
Rockefeller also said he favors greater checks on insurance companies. He said he would introduce an amendment requiring insurers to spend 85 percent of their revenue on health care for consumers.
“This is in a couple of the House bills,” he said. “I think its a discipline which works very, very well.”
Rockefeller has expressed concern over a plan to impose a tax on insurance companies most-expensive policies because it would affect coal-miners and other working-class Americans. The finance committee bill is the only one of five overhaul versions passed by House and Senate panels to include the levy.
The 40 percent excise tax, which would begin in 2013, would be placed on insurers of employer-sponsored health plans with benefits exceeding $8,000 for individual coverage and $21,000 for families. Thresholds are increased by $1,850 and $5,000 for retirees 55 and older and for employees in union- heavy industries.
Antitrust Exemption