Psychedelic Trips Aid Anxiety Treatments In Study
She swallowed it, lay on the couch with her eyes covered, and waited. And then it came.
“The world was made up of jewels and I was in a dome,” she recalled. Surrounded by brilliant, kaleidoscopic colors, she saw the dome open up to admit “this most incredible luminescence that made everything even more beautiful.”
Tears trickled down her face as she saw “how beautiful the world could actually be.”
Thats how Nicky Edlich, 67, began her first-ever trip on a psychedelic drug last year.
She says it has greatly helped her psychotherapeutic treatment for anxiety from her advanced ovarian cancer.
And for researchers, it was another small step toward showing that hallucinogenic drugs, famous but condemned in the 1960s, can one day help doctors treat conditions like cancer anxiety and post-traumatic stress disorder.
The New York University study Edlich participated in is among a handful now going on in the United States and elsewhere with drugs like LSD, MDMA (Ecstasy) and psilocybin, the main ingredient of “magic mushrooms.” The work follows lines of research choked off four decades ago by the war on drugs. The research is still preliminary. But at least its there.
“There is now more psychedelic research taking place in the world than at any time in the last 40 years,” said Rick Doblin, executive director of the Multidisciplinary Association for Psychedelic Studies, which funds some of the work. “Were at the end of the beginning of the renaissance.”
He said that more than 1,200 people attended a conference in California last weekend on psychedelic science.
But doing the research is not easy, Doblin and others say, with government funders still leery and drug companies not interested in the compounds they cant patent. That pretty much leaves private donors.
“Theres still a lot of resistance to it,” said David Nichols, a Purdue University professor of medicinal chemistry and president of the Heffter Institute, which is supporting the NYU study. “The whole hippie thing in the 60s” and media coverage at the time “has kind of left a bad taste in the mouth of the public at large.
“When you tell people youre treating people with psychedelics, the first thing that comes to mind is Day-Glo art and tie-dyed shirts.”
“The whole idea was to create a living room-like setting” that would be relaxing, said study leader Dr. Stephen Ross.
Edlich, whose cancer forced her to retire from teaching French at a private school, had plenty of reason to seek help through the NYU project. Several recurrences of her ovarian cancer had provoked fears about suffering and dying and how her death would affect her family. She felt “profound sadness that my life was going to be cut short.” And she faced existential questions: Why live? What does it all mean? How can I go on?
“These things were in my head and I wanted them to take a back seat to living in the moment,” she said. So when she heard NYU researchers speak about the project at her cancer support group, she was interested.
Psilocybin has been shown to invoke powerful spiritual experiences during the four to six hours it affects the brain. A study published in 2008, in fact, found that even 14 months after healthy volunteers had taken a single dose, most said they were still feeling and behaving better because of the experience. They also said the drug had produced one of the five most spiritually significant experiences theyd ever had.
Experts emphasize people shouldnt try psilocybin on their own because it can be harmful, sometimes causing bouts of anxiety and paranoia.
Fda Stepping Up Supervision Of Drug Pumps
“Its clear from the history of problems were seeing that there is a need for more careful infusion pump design and testing,” said Dr. Jeffrey Shuren of the U.S. Food and Drug Administration. He announced the initiative Friday at a health journalists conference in Chicago.
Infusion pumps are used to deliver fluids – liquid nutrients and medicines like insulin, morphine, chemotherapy or anesthesia – into a patients body. They are used in hospitals as well as by patients at home.
Over the past five years, the FDA has received reports linking 710 deaths to infusion pump problems, and that likely is an underestimate, said Shuren, the FDAs director of the Center for Devices and Radiological Health,
In the past, many problems were attributed to human error, a doctor or nurse thinking they mistyped infusion directions. But FDA officials believe that software and design issues are actually at the root of many of them.
The FDA is working on new guidelines that call on manufacturers to provide more detailed design and engineering information to FDA for new pumps. The FDA also wants manufacturers to try out the devices in settings where they are commonly used, and when necessary, it wants to be able to inspect the manufacturing plant before approving the device.
Scientists Seek Origins Of Obesity In The Womb
She went on to have two daughters, and she may have boosted their chances of avoiding becoming obese, like her two older children are.
Thats the implication of research suggesting that something in an obese womans womb can program her fetus toward becoming a fat child and adult. Its not about simply passing along genes that promote obesity; its some sort of still-mysterious signal.
The idea has only recently entered conversations between doctors and female patients, and scientists are scrambling to track down a biological explanation. That knowledge, in turn, may provide new ways to block obesity from crossing generations.
While theres some disagreement on how important the womb signal is, “the evidence is building and building that it is a substantial issue,” said Dr. Matthew Gillman of Harvard Medical School, who studies prevention of obesity.
Others agree. “I think it could be a hugely significant factor,” said Robert Waterland of the Baylor College of Medicine in Houston, who studies the effect in mice.
Dr. Rudy Leibel, an obesity expert at Columbia University, says he doubts it plays a huge role, but still believes its worth studying. If scientists can uncover its biological underpinnings, he said, they may be able to use that knowledge to prevent or treat obesity from other causes.
Perusse, 39, of Three Rivers, Quebec, knows the effects of being very fat. Before her weight-loss surgery in 1995, she packed 284 pounds on her 5-foot-2 frame. She could not ride a bike or climb stairs to her second-floor home without stopping to rest.
Now, although shes still overweight, those limitations are history, she said through an interpreter.
But her older children struggle with their weight. At 5-foot-3 and 300 pounds, her 22-year-old daughter cant bathe her own two children, Perusse said. Her 16-year-old son weighs 230 pounds and stands 5-foot-6.
They were born before she had the weight-loss surgery. Her two younger daughters, ages 4 and 7, came along afterward. Their weights are normal so far, though Perusse said her older children werent overweight at those ages either.
So shes using diet and exercise to try to protect them against what she called rotten genes, including those from their 400-pound father. She said she isnt optimistic.
But Dr. John Kral of the SUNY Downstate Medical Center in New York says his research suggests that obese women who lose weight before pregnancy may be helping the next generation keep off excess pounds – even if fat-promoting genes run in the family.
In addition, those born afterward showed lower levels of blood fats and indicators of future diabetes.
Kral says families typically dont change lifestyle or diet after surgery, so that doesnt explain the outcome.
Instead, he says, the surgical bypass operation made the womens bodies less efficient at digesting and absorbing food, and lowered levels of sugar and fat in the blood. That, in turn, would reduce the number of calories delivered to the fetus to levels like those provided by a normal-weight mother, he said.
And the womens shedding of pounds before the pregnancy would also help, he said.
While scientists are still trying to explain just how obesity could be transmitted from the womb, it makes sense that a mothers obesity could affect her childrens long-term weight, Waterland said. Cues in early life, including some in the womb, guide the development of a persons brain circuitry for controlling the balance between calories consumed and those burned away, he said. So a signal there could have a long-lasting impact.
House Targets Insurers With Antitrust Challenge, Public Option
The House Judiciary Committee yesterday voted 20-9 to approve legislation that would ban insurers from engaging in price fixing, bid-rigging and market allocation. The measure may be added to broader health-care overhaul legislation.
At the same time, Democratic leaders said they can win passage for a government program to compete with private insurers and drive down prices, one of the most contentious issues dividing Democrats and Republicans.
“We have the votes to pass a robust public option,” said Connecticut Representative John Larson, chairman of the House Democratic Caucus. A Congressional Budget Office estimate that the House measure would cut the deficit over 20 years “has placed us in a good spot with the caucus,” he said.
Democratic leaders in the Senate had a tougher time yesterday, when they lost a bid to stave off Medicare-payment cuts to doctors because Republicans and even some Democrats objected to the $247 billion cost. Democrats have been courting the doctors to support the revamp of the medical system.
Lawmakers are considering the biggest changes to U.S. health care since the creation of Medicare in 1965. The legislation, President Barack Obamas top domestic priority, attempts to curb health-care costs while covering tens of millions of uninsured Americans.
Showdown With Senate
The proposal to create a public option is dividing House and Senate Democrats. While the idea has met resistance in the Senate, House Speaker Nancy Pelosi has insisted on keeping it in her version, setting up a clash between the two chambers later when they must reconcile their legislation.
Under one House plan, the public option would peg rates to 5 percent above those paid by Medicare, the government program for the elderly.
An alternative plan would negotiate rates, as private insurers do. A group of fiscally conservative Democrats known as Blue Dogs supports that idea, saying it would provide fairer competition for insurers such as Indianapolis-based WellPoint Inc.
Preliminary Congressional Budget Office estimates show that the legislation with a public option pegged to Medicare rates would cost $871 billion over 10 years, while a bill requiring negotiated reimbursements would be $895 billion, a House leadership aide said on condition of anonymity.
To raise money, House Democratic leaders are considering an annual fee for medical-device manufacturers that would bring in $20 billion over 10 years, the aide said.
“We have a couple of good options,” Pelosi said in a Bloomberg Television interview yesterday. “I dont think we have a bad option in the mix.”
Pelosi and Senate Majority Leader Harry Reid are blending versions passed by three House committees and two Senate panels. In all the measures, Americans would be required to buy insurance, helped by purchasing exchanges and government aid. Insurers would face new rules and have to accept all clients.
While House Democrats are nearing agreement, lawmakers in the Senate are debating other issues. Chief among them are whether to require that employers cover workers, and how to pay for legislation that will cost more than $800 billion over 10 years, as well as the public option.
Senator Ben Nelson, a Nebraska Democrat, said he met with Reid on Oct. 20 and pushed him to drop a “robust public option.” He and Maine Senator Olympia Snowe, the only Republican to support any measure so far, talked with Reid again yesterday about the employer requirement.
“There are a number of our colleagues who have concerns about the employer mandate,” Nelson said.
Biggest Hits
Insurers have taken some of the biggest hits in the debate. The industry opposes the public option, and Americas Health Insurance Plans, a Washington trade group, said action on the antitrust exemption isnt needed and might create “increased regulatory and legal uncertainty.”
Production Of Swine Flu Vaccine Is Way Behind
As nervous Americans clamor for the vaccine, production is running several weeks behind schedule, and health officials blame the pressure on pharmaceutical companies to crank it out along with the ordinary flu vaccine, and a slow and antiquated process that relies on millions of chicken eggs.
There have been other bottlenecks, too: Factories that put the precious liquid into syringes have become backed up. And the government itself ran into a delay in developing the tests required to assess each batch before it is cleared for use.
What effect the delays will have on the course of the outbreak is unclear, in part because scientists cannot say with any certainty just how dangerous the virus is, how easily it spreads, or whether it will mutate into a more lethal form.
Since April, swine flu has killed more than 800 people in the U.S., including 86 children, 39 of them in the past month and a half, according to the Centers for Disease Control and Prevention. More than half of all hospitalizations since the beginning of September were people 24 and under.
“Were in this race against the virus, and only Mother Nature knows how many cases are going to occur over the next six to 10 weeks,” said Michael Osterholm, a vaccine expert at the University of Minnesota.
In the meantime, many states have had to postpone mass vaccinations. Clinics around the country that managed to obtain doses of the vaccine have been swamped. And doctors are getting bombarded with calls from worried and angry parents.
“Nobody has it,” said AnnMarie OConnor, who waited more than four hours for the vaccine in Rockville, Md., standing in line with her two young children and about 1,000 other people. Health officials “said the shots would be here in early October. But where are they?”
Federal officials counsel patience, saying that eventually there should be enough of both vaccines for everyone who wants them.
“We wish we had better ways to produce vaccines perfectly predictably, but this is how influenza vaccine production often goes,” Dr. Anne Schuchat, who heads the CDCs immunization and respiratory disease section, said last week.
The delays have led to renewed demands for a quicker, more reliable way of producing vaccines than the chicken-egg method, which is 50-year-old technology and involves injecting the virus into eggs and allowing it to feed on the nutrients in the egg white.
Federal officials initially projected that as many as 120 million doses of the vaccine would be ready to dispense by mid-October. They later reduced their estimate to 45 million. As of Tuesday, only 12.8 million were available. (Health officials say a single dose will protect adults, while children under 10 will need two doses.)
In a sign of how rapidly the virus is spreading, education officials said 198 schools in 15 states were closed Wednesday because of swine flu, with more than 65,000 students affected. That was up from 88 school closings the day before.
The government now hopes to have about 50 million doses out by mid-November and 150 million in December, Dr. Nicole Lurie, assistant health and human services secretary for preparedness, told The Associated Press on Wednesday.
“By the end of November, I think were going to be pretty well back on track,” she said.
However, a study by Purdue University researchers said the vaccinations will probably come too late to significantly reduce the number of infections. The study, published last week, predicted that infections would peak in late October and that by the end of the year, 63 percent of the U.S. population will have caught the virus.
The blame for the delays has been placed in part on the chicken-egg technology. It is a slow process, and the pressure on manufacturers to produce two vaccines at the same time – for both swine flu and ordinary flu – has made it even slower.
Also, the virus on which the swine flu vaccine is based was found to reproduce very slowly in eggs – much more slowly than the ordinary flu virus. Health and Human Services Secretary Kathleen Sebelius, who on Wednesday was grilled about the delays by the Senate Homeland Security Committee, said the problem has been fixed.
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.
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.
Senate Has Miles to Go On Health Care After Committee Vote
Senate Majority Leader Harry Reid now has to meld the $829 billion legislation with a measure passed by the Senate health committee in July. While both proposals aim to curb medical costs and cover tens of millions of uninsured Americans, their different paths to the goal have divided Democrats and unsettled some of the partys main supporters.
Lawmakers are grappling with a host of issues — whether to create a government-run insurance program, whether to require that employers cover workers and how to pay for all the changes. Even as Democrats stuck together in yesterdays 14-9 panel vote and won the support of Republican Senator Olympia Snowe of Maine, they hardened their stances.
“The bill before us still falls short of what people need and what people expect,” said Senator Jay Rockefeller, a West Virginia Democrat who supports a government insurance entity, or public option, to compete with private insurers such as Indianapolis-based WellPoint Inc.
The public option is a fault line, with a majority of House Democrats and senators including Rockefeller and New Yorks Chuck Schumer lined up on one side and Democrats from Republican-leaning states, such as Senators Blanche Lincoln of Arkansas and Kent Conrad of North Dakota, on the other.
Schumer yesterday said the option must be in final legislation, after the finance committee voted against it. Conrad said at least one version of the plan is a “nonstarter” because his states hospitals would go bankrupt.
Unions Weigh In
The United Auto Workers and 26 other unions will publish a newspaper advertisement today saying labor will oppose the legislation unless lawmakers include a public option, among other changes, before a vote by the full Senate.
House Democrats and Senate Democrats led by John Kerry of Massachusetts, are lining up to support another proposal that Senate Finance Committee Chairman Max Baucus knocked down: a requirement that employers cover workers.
While Reid tries to navigate the conflicting demands from his party, he may not have much room to change the finance panel proposal. Lincoln warned that her support wouldnt extend to a final bill that “strays too far.” And Snowe was measured in backing the legislation, President Barack Obamas top domestic priority.
“There are many miles to go in this legislative journey,” Snowe said. “My vote today is my vote today. It doesnt forecast what my vote will be tomorrow.”
60 Votes
Reid, a Nevada Democrat, will face a similar challenge if his chamber passes the legislation: working with House Speaker Nancy Pelosi to craft a compromise.
“Every step in this process you see the degree of difficulty notched up,” said Jennifer Duffy, senior editor at the Cook Political Report in Washington.
Like measures passed by other committees, the Senate finance proposal requires that Americans get insurance, creating purchasing exchanges and tax credits to help. Instead of a public option, it offers $6 billion in seed money for nonprofit insurance cooperatives.
Tug-of-War
The Senate health committee left the work of paying for the legislation to the finance panel, which opted for $13 billion in annual fees on health-care industries as well as a tax on insurers that offer the most generous benefit plans, which the Congressional Budget Office says would raise $201 billion over 10 years.
Democrats expressed concern that the tax on so-called Cadillac plans would affect people such as coal miners who need high-end benefits because of dangerous work. The House plan instead imposes surtaxes on the wealthiest Americans, and leaders are considering levies on insurers profits.
“We see a five-party tug-of-war” among labor unions, senior citizens, lawmakers, employers and health industries, said Anne Kim, economic program director for Third Way, a Washington research institution. “The right compromise is going to be one that requires each of these groups to hurt just a little.”
Health-care Tactic Future Rests On Snowe, Battling Democrats, Cbo
The Senate Finance Committee tomorrow is scheduled to vote on a plan to curb rising medical costs and cover tens of millions of uninsured Americans at a cost of $829 billion over 10 years. The next step for Senate leaders is to try to bring together divided Democrats to craft a compromise for the full chamber, a process also taking place in the House.
Senate leaders are also wooing Republican Olympia Snowe of Maine, whose support may help shore up backing from Democrats in Republican-leaning states. In the House, lawmakers are waiting for the Congressional Budget Office to analyze the costs of various proposals to make sure they dont add to the deficit, meeting a requirement of President Barack Obama.
“Snowes a pivotal vote, and the CBOs the pivotal actor,” said Rogan Kersh, a public policy professor and associate dean at New York University. “Everybodys held hostage to what figure they come up with.”
The nonpartisan agency last week blessed the Senate finance panels plan, which requires that all individuals obtain insurance, imposes restrictions on insurers ability to deny people coverage, and establishes nonprofit cooperatives to compete with private insurers.
The plan, built on a framework by Senator Max Baucus, a Montana Democrat who runs the committee, contains enough new taxes and savings that it would cut the budget deficit by $81 billion over 10 years, the CBO estimated.
Last to Act
The finance committee will be the last of five congressional panels to act on Obamas top domestic priority. Baucus delayed a vote for months while trying to win Republican support, an effort he continues with Snowe and others. None of the other four measures has won any Republican backing.
Snowe has been noncommittal. While saying the CBO analysis of her committees bill was “important,” she told reporters on Oct. 7 she still has “a lot to review.” She is one of 10 Republicans on the panel, which has 13 Democrats.
Michigan Senator Debbie Stabenow, a Democrat on the committee, said she spoke with Snowe last week and is eager to see what she decides about the vote.
“The big question is whether it will be bipartisan,” Stabenow told reporters on Oct. 9.
While Democrats say they are unified in their desire to get legislation passed, they are split on the specifics. Among other issues, the party is grappling with whether to create a government-run insurance option, whether to require that employers cover workers and how to pay for the legislation.
Two of the Democrats on the finance panel, Senators Ron Wyden of Oregon and Jay Rockefeller of West Virginia, wont yet say how they will vote. Both are proponents of the government- run program, or public option, and said they are focused on making health care more affordable.
“The primary focus should be on bringing premiums down,” Wyden said. “You dont have, when you go home, people saying, what I really want is an exemption or a hardship waiver.”
Baucus opted against an employer mandate and the public option. He also included $6 billion in federal seed money for the cooperatives to offer an alternative to insurers such as Hartford, Connecticut-based Aetna Inc.
The Senate finance panel plan calls for new taxes on high- end insurance plans and fees on industries such as drugmakers and medical device manufacturers. The House versions would institute surtaxes on the wealthiest Americans, and leaders are now considering new ideas such as a tax on insurer profits.
Common Ground
There is common ground in all the measures. They require that Americans get insurance, with varying penalties for failing to do so. They also encourage greater use of preventive care, electronic records and research on the effectiveness of treatments. Under all the plans, insurers would have to accept new clients, regardless of preexisting conditions.
Lawmakers will face some pushback from health-care industries in the weeks ahead. Insurers are upset that the finance panel scaled back penalties for not buying insurance. The hospitals, which agreed to contribute $155 billion in savings toward the effort, said not enough new people will be covered by the finance committees version.