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Healthcare system wastes up to $800 billion a year

Luis — Tue, 27 Oct 2009 00:21:23 +0000

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - The U.S. healthcare system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report released on Monday.

The U.S. healthcare system wastes between $505 billion and $850 billion every year, the report from Robert Kelley, vice president of healthcare analytics at Thomson Reuters, found.

"America's healthcare system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," the report reads.

"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," Kelley said in a statement.

"The good news is that by attacking waste we can reduce healthcare costs without adversely affecting the quality of care or access to care."

One example -- a paper-based system that discourages sharing of medical records accounts for 6 percent of annual overspending.

"It is waste when caregivers duplicate tests because results recorded in a patient's record with one provider are not available to another or when medical staff provides inappropriate treatment because relevant history of previous treatment cannot be accessed," the report reads.

Some other findings in the report from Thomson Reuters, the parent company of Reuters:

* Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year.

* Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.

* Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.

* Medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11 percent of the total.

* Preventable conditions such as uncontrolled diabetes cost $30 billion to $50 billion a year.

"The average U.S. hospital spends one-quarter of its budget on billing and administration, nearly twice the average in Canada," reads the report, citing dozens of other research papers.

"American physicians spend nearly eight hours per week on paperwork and employ 1.66 clerical workers per doctor, far more than in Canada," it says, quoting a 2003 New England Journal of Medicine paper by Harvard University researcher Dr. Steffie Woolhandler.

Yet primary care doctors are lacking, forcing wasteful use of emergency rooms, for instance, the report reads.

All this could help explain why Americans spend more per capita and the highest percentage of GDP on healthcare than any other OECD country, yet has an unhealthier population with more diabetes, obesity and heart disease and higher rates of neonatal deaths than other developed nations.

Democratic Senator Charles Schumer said on Sunday that Senate Democratic leaders are close to securing enough votes to pass legislation to start reform of the country's $2.5 trillion healthcare system.

Obama tells troops he will not rush Afghan decision

Luis — Mon, 26 Oct 2009 23:25:56 +0000

By Steve Holland

JACKSONVILLE, Florida (Reuters) - President Barack Obama, accused by some of dithering over a new strategy for Afghanistan, vowed on Monday not to be rushed into a decision over whether to send more U.S. troops to the war zone.

Obama spoke to U.S. Navy personnel in Jacksonville on the same day 14 Americans were killed in helicopter crashes in Afghanistan and shortly after he met top advisers for a sixth time about a new Afghan strategy that the White House said was still weeks away.

Obama is debating whether to follow the advice of his military commander in Afghanistan, General Stanley McChrystal, who wants to send at least 40,000 more U.S. forces there.

Just last week, the White House rejected former Vice President Dick Cheney's charge that Obama was "dithering" over the strategy review and needed to send more troops.

"I will never rush the solemn decision of sending you into harm's way," Obama said to applause from the sailors at the event and their families. "I won't risk your lives unless it is absolutely necessary. And if it is necessary, we will back you up to the hilt."

"Because you deserve the strategy, the clear mission, the defined goals as well as the equipment and support you need to get the job done," Obama said, vowing not to have a situation where troops in the field are not supported by people at home.

Opinion polls show flagging public support for the war effort and members of Obama's own Democratic Party are divided over whether to send more troops.

The United States now has 65,000 troops in Afghanistan, which is expected to reach 68,000 later this year. Other countries, mainly NATO allies, have some 39,000 troops there.

Obama expressed condolences to the families of the latest 14 Americans killed in Afghanistan.

Three special agents from the Drug Enforcement Administration were among those who died in the helicopter crash in western Afghanistan, said U.S. Attorney General Eric Holder, who hailed their work in fighting the drugs trade there.

On the Air Force One flight from Washington, White House spokesman Robert Gibbs said Obama met with Vice President Joe Biden and other senior advisers at the White House for the latest session on Afghanistan.

DECISION IN "COMING WEEKS"

Gibbs said Obama's decision on a new strategy will take place "in the coming weeks."

ABC News cited unnamed sources as saying Obama's decision likely will come between Afghanistan's run-off election on November 7 and his departure for Japan on November 11.

The Pentagon carried out internal assessments of the two main proposals for troop levels -- sending roughly 40,000 more troops or a far smaller number, an option McChrystal and other defense officials see as having a higher risk of failure.

The reviews were overseen by Admiral Mike Mullen, chairman of the Joint Chiefs of Staff, one military official said.

Senator John Kerry, who heads the Senate Foreign Relations Committee, gave conditional support for additional troops.

He told the Council on Foreign Relations he would support more troops only if there were enough "reliable" Afghan forces to partner with as well as local leaders who could deliver basic services to the people.

"What we need, above all, what our troops deserve -- and what we haven't had -- is a comprehensive strategy, military and civilian combined," Kerry said.

Obama is also looking at a "civilian surge" of boosting staff in areas stabilized by the military and seeking to improve the capacity of the Afghan government.

Kerry, who was in Afghanistan last week to put pressure on President Hamid Karzai to accept a run-off election, was scathing of the U.S. civilian effort so far.

"Our civilian presence there is disgraceful compared to what it ought to be relative to the challenge," Kerry said.

But Deputy Secretary of State Jacob Lew sought to squash criticism, telling reporters earlier that the State Department was on track to get nearly 1,000 people in place by year-end.

There are now just over 600 U.S. civilians in Afghanistan, including specialists from the treasury and agriculture departments and the U.S. Agency for International Development, said Lew.

The Bush administration struggled to find enough civilians for its mission in Iraq during the height of the conflict there but Lew said this was not a problem in Afghanistan.

"We have many more people applying than there are positions," said Lew.

(Writing by Steve Holland and Sue Pleming; additional reporting by Adam Entous; Editing by Philip Barbara and John O'Callaghan)

Castro sister recounts role as CIA spy in Cuba

Luis — Mon, 26 Oct 2009 23:19:42 +0000

By Pascal Fletcher

MIAMI (Reuters) - Using the code name Donna, the younger sister of Fidel and Raul Castro worked undercover for the CIA in Cuba in the early 1960s, helping opponents of their communist rule escape execution and imprisonment, she said in memoirs published in exile on Monday.

Revealing what the publishers called a closely guarded secret kept hidden for four decades, Juanita Castro described in the book how she was recruited by the U.S. Central Intelligence Agency in Havana two years after the 1959 Revolution led by her brothers, which she initially supported.

There was no immediate reaction to her revelation from the U.S. authorities or the Cuban government, which routinely dismisses critics as mercenaries in the pay of Washington.

Juanita Castro, 76, broke publicly with the Cuban government led by her brother Fidel Castro in 1964 after leaving Cuba for Mexico. She went into exile in Miami and has remained a firm critic of communist rule in Cuba.

In the memoirs entitled "Fidel and Raul, My Brothers, the Secret History," told to Mexican journalist Maria Antonieta Collins, she says she quickly became disenchanted with Fidel Castro's rule over the Caribbean's largest island because he increasingly persecuted opponents and turned to communism.

She says Fidel Castro "betrayed" her and other Cubans by abandoning the nationalist democratic revolution he had promised and imposing a one-party Marxist state on Cuba.

Juanita Castro wrote she was recruited to be a clandestine CIA operative by her friend Virginia Leitao da Cunha, the wife of the Brazilian ambassador to Cuba, who in 1958 sheltered her and other revolutionary followers of Castro during the armed struggle to topple dictator Fulgencio Batista.

She said that at a meeting with an American CIA officer "Enrique" in a Mexico City hotel in 1961, she was given the code name Donna and codebooks to use in Cuba with a short-wave radio to receive instructions from her CIA handlers.

Former leader Fidel Castro, 83, who last year handed over the presidency of Cuba to his younger brother Raul, 78, for health reasons, has long considered the CIA his arch-enemy. He says the U.S. spy agency was behind most of the 600 or so assassination plots he claims were made against his life.

In her memoirs, Juanita Castro wrote she agreed to work for the CIA under the noses of her brothers on the condition that she was not asked to participate in any violent acts against them or any other member of their government.

"Did I feel remorse about betraying Fidel by agreeing to meet with his enemies? No, for one simple reason: I didn't betray him. He betrayed me," she writes in the 432-page book published in Spanish by Grupo Santillana.

UNPAID COLLABORATION

"He betrayed the thousands of us who suffered and fought for the revolution that he had offered, one that was generous and just and would bring peace and democracy to Cuba, and which, as he himself had promised, would be as 'Cuban as palm trees,'" she said.

Juanita Castro said in her memoirs and in a TV interview that she never accepted any money from the CIA for her collaboration. "I never put any price on my desertion ... on my activities against the communist dictatorship," she told the Spanish language TV channel Univision-Noticias 23 on Monday.

She described in her book how, following CIA instructions often secretly picked up at isolated roadside drop points in Cuba, she helped people persecuted by Fidel Castro's secret police to escape capture, imprisonment and possible execution.

Some were sheltered at the house where she lived with her mother, Lina Ruz Gonzalez, who was also the mother of Fidel and Raul Castro. Lina Ruz, who also helped some friends escape persecution, died in 1963, Juanita Castro said.

She recalled her own shock when Fidel Castro, who had denied publicly that he was a communist, declared on December 2, 1961, that he was a Marxist-Leninist and that he would remain one for the rest of his life.

"Fidel's radical change to communism was not out of political conviction, but simply out of the need to hold power, which is what has always been important to him," she wrote.

"I have no other explanation: He turned to the Soviet Union to perpetuate himself in power."

The collapse in 1991 of the Soviet Union, Cuba's main ally and economic benefactor for years, plunged the island into economic crisis. But despite the economic problems, both Fidel and Raul Castro have ruled out any shift to capitalism.

In response to a call for a "new beginning" in U.S.-Cuban ties made by U.S. President Barack Obama, the Cuban leadership has started talks with Washington on issues like migration and postal service ties, but it demands that Obama completely end the 47-year-old U.S. trade embargo against Cuba.

Obama says he wants to see Havana free jailed dissidents and improve human rights.

Juanita Castro says she has not spoken to Fidel or Raul Castro since she left Cuba in 1964.

Pilots on wayward jetliner were using laptops: officials

Luis — Mon, 26 Oct 2009 21:59:10 +0000

WASHINGTON (Reuters) - Pilots of a Northwest Airlines jetliner that overshot its destination by 150 miles last week told U.S. investigators they became distracted during an extended discussion of crew scheduling that included their use of personal laptops, officials said on Monday.

"The pilots said there was a concentrated period of discussion where they did not monitor the airplane or calls from (air traffic controllers) even though both stated they heard conversation on the radio," the National Transportation Safety Board (NTSB) said after interviewing the pair on Sunday.

"Both said they lost track of time," the safety board said in a report on its investigation, which included disclosures about the nature of the conversation and the use of laptop computers.

The two veteran commercial pilots said they were not fatigued during the evening flight on October 21 from San Diego to Minneapolis, countering speculation they may have fallen asleep.

Air controllers and airline dispatchers sought to contact Flight 188, an Airbus A320 with 144 passengers, for more than an hour with the plane at 37,000 feet.

Neither pilot was aware of the plane's wayward state until a flight attendant asked them about their scheduled arrival time, the NTSB said.

The captain looked at his flight display data, realized the mistake and then contacted controllers for permission to turn around. The plane landed without incident in Minneapolis.

Delta Air Lines, which owns Northwest, said in a statement the use of laptops or "engaging in activity unrelated to" flying the aircraft violates company policy.

The airline has suspended the pilots pending the outcome of government and internal investigations. They could be fired, Delta said.

The pilots said they were discussing new monthly crew schedules, which were put in place as a result of Northwest's merger with Delta in 2008.

Investigators are also reviewing information from the plane's flight data recorder.

(Reporting by John Crawley; editing by Todd Eastham)

Chinese military backs closer U.S. ties

Luis — Mon, 26 Oct 2009 21:25:24 +0000

By Adam Entous

WASHINGTON (Reuters) - China's military sought to assure the United States on Monday that its arms buildup was not a threat and said Beijing wanted to expand cooperation with the Pentagon to reduce the risk of future conflicts.

At the start of a visit to Washington, Xu Caihou, vice chairman of the People's Liberation Army Central Military Commission, said military ties were generally moving in a "positive direction" and defended China's fast-paced military development as purely "defensive" and "limited" in scope.

"We are now predominantly committed to peaceful development and we will not and could not challenge or threaten any other country" and "certainly not the United States," Xu told a Washington think tank ahead of talks with Defense Secretary Robert Gates.

Xu described China's development of advanced weapons systems, including cruise and ballistic missiles, as "entirely for self-defense" and justified "given the vast area of China, the severity of the challenges facing us."

"As you know, China has yet to realize complete unification," Xu said, in an apparent reference to Taiwan, which China considers a renegade province. "So I believe it is simply necessary for the PLA to have an appropriate level of modernity in terms of our weapons and equipment."

Xu's visit, which will include a tour of major U.S. military bases, including U.S. Strategic Command, was meant to give a boost to military-to-military dialogue, which Beijing resumed this year after halting it in 2008 to protest a $6.5 billion U.S. arms sale to Taiwan.

NAVAL INCIDENTS

U.S. officials have expressed alarm about what they see as China's unprecedented military expansion over the past year. Last week, Gates said better dialogue was needed to avoid "mistakes and miscalculations."

"I want to make clear that the limited weapons and equipment of China is entirely to meet the minimum requirements for meeting national security," Xu said through a translator.

He said military mechanization was still at an early stage. "China's defense policy remains defensive" and was designed to repel attacks, not initiate attacks, he said. "We will never seek hegemony ... military expansion."

Chinese vessels have confronted U.S. surveillance ships in Asian waters repeatedly this year and Beijing has called on the United States to reduce and eventually halt air and sea military surveillance close to its shores.

Xu said those U.S. missions "infringed upon Chinese interests," adding: "It is encouraging to see that both sides have recognized that we should not allow such incidents to damage our ... mil-to-mil relations."

Xu said U.S.-Chinese military relations have improved since President Barack Obama took office in January and can be expanded further.

"The military-to-military relationship constitutes an important part of overall bilateral relations. It is important not only to strategic trust ... but also to regional stability," he said. "The Chinese military is positive toward developing mil-to-mil relations with the U.S. military."

Last month, U.S. intelligence agencies singled out China as a challenge to the United States because of its "increasing natural resource-focused diplomacy and military modernization."

(Reporting by Adam Entous; editing by Stacey Joyce)