Although the national debate over health-care reform has only just begun, the first battle lines are being drawn over whether there should be a Medicare-like “public” insurance plan to compete with private insurers in a restructured market.

The public plan has already become a political litmus test for the Democratic left, which sees it as the only antidote to a private market that can’t be trusted to deliver quality, affordable health care, and for the Republican right, which sees it as the Trojan horse for a government-run health-care system that will raise taxes and ration care.

The first thing to note is that this is hardly the most important issue in health-care reform. It is possible to design a system that could control costs, improve quality and increase access to care without giving everyone the chance to sign up for a government-run health-insurance plan modeled after Medicare. It’s also possible to design a system that includes a public option.

The other thing to note is that if by “public option” you mean the current Medicare fee-for-service plan — a plan that makes no attempt to manage and coordinate care and pay for that care on the basis of the quality of the outcome — then a public option would be an awful idea and move the system in exactly the wrong direction.

This is not to say that a well-designed public insurance option couldn’t become the model that private competitors would be forced to emulate. It could.

One thing we know about private health plans is that they spend anywhere from 12 to 30 percent of what they take in on non-medical costs: marketing, taxes, reserves, underwriting and profit. In Medicare, these “administrative expenses” run about 5 percent.

That doesn’t mean that a public plan for the non-elderly would have the same cost advantage. Unlike Medicare, a new public plan hoping to attract paying customers would have to spend some amount on marketing. And like any insurer, it would probably want to invest in systems and medical staff to discourage doctors and hospitals from ordering up unnecessary tests and procedures. At the same time, under most reform scenarios, private insurers would be able to reduce administrative costs by eliminating their considerable underwriting expenses.

Bottom line: The administrative-cost advantage of a public insurance plan wouldn’t be as big as Medicare’s, but it could still be large enough to help drive down premiums in a competitive insurance market.

The better argument for a public option is that it could provide some serious pricing discipline for a market that suffers from runaway medical costs.

Rapid consolidation has given big hospital chains so much market power that they can effectively dictate prices even to the largest insurers, which know that they cannot compete for subscribers if they don’t have the major hospitals in their networks. And in a similar fashion, pharmaceutical companies can virtually dictate prices to insurers for patented drugs if they are the most effective means of treating a particular ailment.

But while hospitals and drug companies often have more negotiating leverage than insurers, it is also true that insurers don’t go out of their way to compete on the basis of price. The market in most regions is dominated by two or three big players that have learned they are better off raising prices in tandem than getting into price wars from which only the customers emerge as winners. Rather than compete on price, insurers compete to attract the healthiest patients.

That’s why advocates of a public option believe a government insurance plan is needed to bring more robust price competition to the market, using its size to extract lower prices from providers and passing those savings on to consumers. Medicare already effectively dictates the prices it is willing to pay to doctors and hospitals, and there are very few providers who choose to opt out of the system. A public insurance plan for the non-elderly could simply piggyback on those lower Medicare prices.

The problem with this arrangement is that Medicare is so powerful that it can get away with paying only 80 to 85 percent of actual costs, forcing doctors and hospitals to overcharge private insurers to make up the difference. Private insurers fear that if they were forced to compete against a public plan with that kind of cost disadvantage, they would be driven out of the market. And doctors and hospitals warn that, without private insurers to overcharge, they’ll wind up out of business, as well.

Uwe Reinhardt, a Princeton University economist, has a simple fix for this screwy pricing system. Reinhardt suggests that, once a year, each hospital or physicians group come up with a list of prices for individual procedures, or bundles of services, that it is willing to offer to any and all insurers, regardless of size. After reviewing the offers, Medicare and private insurers can then announce what price they are willing to pay and give providers one last chance to adjust their offers accordingly. After that, everyone would be free to do business with whomever they choose on the basis of the posted bids.

There is, of course, a name for such an arrangement. It’s called a free market — in this case a market open to multiple buyers and sellers with regular bidding and transparent pricing. More to the point, it is a market that would work whether there was a public insurance option or not.

Like it or not, fixing our overpriced, under-performing health system will require substantial new government involvement in the markets for health insurance and medical care. Beyond that, however, there remains plenty of room for healthy debate on what form that government involvement should take.
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By Dan Balz
President Obama’s weekend of summitry in Latin America will be remembered most for his cordial encounter with Venezuelan President Hugo Chavez. The images of that smiling handshake spoke vividly to the changes Obama is bringing to U.S. relations abroad.

The underlying question in all this is whether Obama’s approach means the United States will be dealing out of a position of strength or weakness as the new administration confronts problems ranging from Iran’s nuclear ambitions to Middle East peace to better relations in this hemisphere. Does Obama’s desire to deal more cordially with leaders who are hostile to the United States make him more or less likely to achieve the country’s strategic goals in tough negotiations?

The president was asked at the end of his trip to define an Obama doctrine in foreign policy. After his trips to Europe and Latin America and his meetings with many world leaders, how should Americans and the rest of the world interpret what sets his approach apart from other presidents?

Obama was understandably reluctant at this early stage in his president to offer a lengthy or overly precise answer. But what he said underscored that his early steps are very much in reaction to former president George W. Bush’s style of interacting with the world.

He said he believes the United States remains the most powerful nation in the world, but cannot solve problems by itself. That means listening as well as talking when working with other nations. He said the United States should stand for a universal set of values, live those values whenever possible — and acknowledge mistakes when they occur.

Obama defended his approach as an improvement on the past. He said he is prepared to jettison doctrines and practices that now seem outdated, or that failed to produce real results. But he said there were limits to what he can achieve.

“In Europe, people believe in our plan for Afghanistan, but their politics are still such that it’s hard for leaders to want to send more troops into Afghanistan,” he told reporters on Sunday. “That’s not going to change because I’m popular in Europe or leaders think that I’ve been respectful towards them. On the other hand, by having established those better relations, it means that among the population there’s more confidence that working with the United States is beneficial, and they are going to try to do more than they might otherwise have done.”

No one should be surprised that Obama has adopted this attitude in his first meetings with world leaders. To the extent that there is an Obama doctrine that describes his approach to the world, it was defined on July 23, 2007, during a Democratic debate in South Carolina.

Obama was asked an explicit question. Would he, in his first year as president, be willing to meet without preconditions with the leaders of Iran, Syria, North Korea, Venezuela and Cuba. “I would,” he replied. “And the reason is this, that the notion that somehow not talking to countries is punishment to them — which has been the guiding diplomatic principle of this administration — is ridiculous.”

Obama was roundly criticized for that answer by his rivals for the Democratic nomination — and especially by now-Secretary of State Hillary Rodham Clinton. He was also criticized by many foreign policy experts, who took his answer as a sign of political naiveté on the part of an inexperienced politician. Obama stood his ground, convinced that his critics were defending an old paradigm.

Over time, Obama equivocated on that answer but not apparently on his belief that a new approach could yield results that eluded the Bush administration. Having won the presidency, he has begun to act on that conviction.

He has signaled new openness toward diplomatic discussions with Iran. He said in Europe that the United States has not always lived up to its ideals. He has softened U.S. policy toward Cuba and, in return, Cuban President Raul Castro said last week everything was now on the table for talks. The weekend meetings brought him face to face not only with Venezuela’s Chavez but also Bolivia’s Evo Morales.

Obama was asked Sunday whether he was worried about being perceived back home as soft. “We had this debate throughout the campaign, and the whole notion was — is — that somehow if we showed courtesy or opened up dialogue with governments that had previously been hostile to us, that that somehow would be a sign of weakness. The American people didn’t buy it. And there’s a good reason the American people didn’t buy it — because it doesn’t make sense,” he said.

Shaking hands with Chavez does nothing to endanger U.S. strategic interests, he argued. Nor does having a more constructive relationship with Venezuela.

Obama sees irrefutable logic in all this. “On this one, I think I’m right,” he said Sunday — the same posture he took when he was criticized during the campaign. But the opening rounds of his diplomatic outreach to the world provide no real answers to the bigger questions.

He benefits now from the backlash against Bush’s presidency. In time, his foreign policy will have to stand on its own record.
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“391 Percent Payday Loan” (editorial, April 13) argues that payday loans “are so burdensome and so pernicious” that even a bill to restrict them in more than 20 states does not go far enough in protecting consumers.

Indeed, these loans can be crippling to consumers. What the editorial doesn’t mention, however, is that in one fell swoop, the Payday Loan Reform Act (H.R. 1214) would lower the annual percentage rate on payday loans for nearly 113 million Americans, ban “rollovers,” create a mandatory repayment plan and establish a federal floor on which stronger state and federal laws can then be built.

Payday lenders will lose significant profits if H.R. 1214 passes, whereas consumers in states with weak or no payday lending rules will receive increased protections from unregulated, unscrupulous and predatory lending practices.

My bill is not a cure-all for payday lending, but it is a good start to ensuring consumer protections at a time when consumers need them most. The payday loan industry has grown in size from roughly 300 offices in 1992 to more than 24,000 last year, and they are too poorly regulated in too many states.

The status quo is unacceptable. It would mean that some states have adequate protections from payday lenders, while others continue to be at the mercy of the most unprincipled actors in the industry. Our working families simply cannot afford that outcome.

Luis V. Gutierrez
Washington, April 16, 2009

The writer is chairman of the House Subcommittee on Financial Institutions and Consumer Credit.
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by Nancy Jaffer/For The Star-Ledger
Monday April 20, 2009, 12:39 AM

Rolex FEI World Cup Finals

LAS VEGAS — The dream of an American sweep at the last Rolex FEI World Cup Finals to be held in the U.S. for years fell short of reality Sunday, as even two perfect rounds over the fences couldn’t enable McLain Ward to take the international indoor show jumping title.

Ward, the Olympic double gold medalist from New York, was not quite as fast as Germany’s Meredith Michaels Beerbaum in the first leg of the competition at the Thomas & Mack Center on Thursday night, and that proved to be the difference that gave her a third World Cup title.

Like Ward, who rode Sapphire, Beerbaum and her 16-year-old equine partner, Shutterfly, were penalty-free in the two-round power jumping finale before a vocal crowd of 7,497. Beerbaum retained the two-penalty lead over Ward that she carried into the class, but the world’s number-one ranked rider called her triumph “the hardest win I’ve ever had.”

Ward had worked on a plan since last year to be the first American show jumper since 1987 to earn the title. It could have been quite a coup if he emulated the achievement of his countryman, Steffen Peters, who took the Dressage World Cup honors Saturday night.

“I certainly would have liked to have won, but I’m proud of what my team, my horse and myself did,” said Ward. “We did the best we could, and 99 percent of the time, we would have won.”

The only other American to finish in the ribbons was Ward’s 2004 and 2008 Olympic teammate, Beezie Madden, 12th on an up-and-coming mount, Danny Boy. Third place went to the Netherlands’ Albert Zoer on Oki Doki, who stalked the leaders throughout the competition.

Since 2003, the Cup finals had been held every other year in Las Vegas, but because of the economy, the organizer withdrew bids for 2011 and 2013. It was announced after the show, however, that a bid will be put in for 2014.
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NEW YORK -(Dow Jones)- Three deals eligible for funding under the Federal Reserve’s Term Asset-Backed Securities Loan Facility, or TALF, have sold just ahead of the loan application deadline for the program.

The top-rated portions of these deals total $2.57 billion, significantly less than the $8.2 billion of TALF-eligible deals that were on offer before the first loan application deadline last month.

TALF is geared toward lowering consumer-lending costs, cleaning bank balance sheets and reviving the asset-backed securities market.

The central bank is accepting loan requests between 1 p.m. and 3 p.m. and will release data on how much was requested later Tuesday.

Last month saw just $4.7 billion of funding requests on around $8 billion of securitizations.

World Omni Financial Corp.’s $750 million deal sold, according to a person familiar with the issue. Its largest tranche worth $248 million sold at 185 basis points over a short-term futures benchmark. Joint leads were Barclays and Banc of America Securities.

World Financial Network National Bank also sold its $709 million credit-card loan-backed deal Tuesday. The largest triple-A rated tranche worth $560 million sold at 280 basis points over swaps.

CarMax Inc.’s (KMX) prime auto loan backed deal also sold with the largest triple-A rated portion worth $260 million sold at 265 basis points over a short- term futures benchmark. The deal is $840 million is size but only four tranches are TALF-eligible.

Retailer Cabela’s Inc. (CAB) is offering a credit-card-backed $486 million deal, due to be sold later Tuesday.

Under the program, investors can apply for financing by handing over eligible collateral such as new bonds backed by auto loans, student loans and credit-card debt. The list of collateral will eventually expand to commercial and risky, older residential mortgage-backed securities.

Investors have been wary of the program because of lengthy documentation requirements, provisions curbing the employment of foreign nationals and possible interference from legislators.

The World Financial deal had Barclays Capital and JP Morgan as joint leads.

The Cabela’s deal has JP Morgan and Wachovia as joint leads. Its triple-A rated tranche worth $425 million has guidance of 200 basis points over one month Libor.

-By Anusha Shrivastava, Dow Jones Newswires; 201-938-2371; anusha.shrivastava@ dowjones.com
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BRIDGEVIEW, Ill. — Defense is the name of the game. And the Houston Dynamo figured things out on Friday night. The Dynamo held an explosive Chicago Fire squad scoreless with a 1-0 win.

“It was one of those games where we were under a lot of pressure,” Houston goalkeeper Pat Onstad said. “We had to defend with our lives today. I thought we did a great job.”

Before Chicago could create a decent play, Houston already jumped up to a 1-0 lead. Receiving a long ball in the left corner, Kei Kamara challenged Fire defender C.J. Brown and won. He rounded Brown and sent a low pass into Stuart Holden, who knocked a first-time shot over goalkeeper Jon Busch in just the third minute.

After that, Houston turned up the defense. And the Fire turned up the offense for a classic battle at Toyota Park. The Fire had seven shots on the night, including three on goal. Onstad or the Dynamo backline handled each one.

Richard Mulrooney had one of the biggest saves of the night, aside from Onstad. In the 35th minute, Marco Pappa sent a corner into the box. Brian McBride headed a pass to Patrick Nyarko on the left side of the box. Nyarko headed a point-blank shot toward goal. The only thing standing between him and the goal was Mulrooney, who knocked it out of harm’s way.

“Our defenders have been really great this season,” Onstad said. “Our guys are all playing well.”

Houston may have found the winning combination. They struggled to create offensive opportunities, with just five shots total on the night. But they shut down the Fire. They had one shot on goal in the entire match and it proved to be lethal for the Fire.

“It was one play again,” Fire goalkeeper Jon Busch said. “That was it. Other than that, we played well. We let Stuart slip through and he scored a goal.”

The Dynamo have posted a 6-0-2 record in their last eight games. They’ve outscored opponents 8-2. And in that stretch, they’ve collected eight shutouts. It takes a goal to win a game, but a strong defense to shut down the opposing squad.

“I’m happy we won,” Dynamo head coach Dominic Kinnear said. “It was a tough win. It was a great start to the game. Chicago really gained some momentum, especially in the second half.”

Holden said Houston was prepared for Chicago, which leads the league in scoring with 20 goals, to come out firing shots in the second half. But instead, they held the home club to one shot over the final 45 minutes — a shot on goal by Nyarko in the 47th minute. Nyarko sent a short ball directly into Onstad’s arms.

“We knew they were going to give it a good go,” Holden said. “We neutralized that. We couldn’t be happier to leave here with a win. It wasn’t pretty. But by any means it’s three points. We’ll take it.”

Kathryn L. Knapp is a contributor to MLSnet.com.
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Now that Sprint has absorbed Nextel, the carrier’s Ready Link phones seem to be suffering from an identity crisis. Before the merger, the handsets were sort of Nextel-lite. You could get push-to-talk service and a rugged handset, but you didn’t have to lug around a brick, totally devoid of style, and you didn’t have to be chained to Nextel’s businesscentric services. But now that Nextel and Sprint have joined forces, and Nextel is putting out smaller, more attractive phones, Sprint’s Ready Link handsets just look a little ridiculous. Take the new Sanyo RL4930: Although it is on the bulky side, as well as sports rubber edges and PTT capability, we’d rather go with the real thing and just get a Nextel phone, such as the i355. The RL4930 is $189, but it’s cheaper with a service plan.

To be perfectly frank, the Sanyo RL4930 is not a looker. A dull candy bar shape, along with a basic-gray color scheme and a protruding antenna, makes it more like a cordless phone than a mobile device. Also, considering it measures 4.5 by 2 by 1 inches and weighs 4.4 ounces, it’s not compact by any means. On the upside, a rubber coating on either spine adds a touch of durability, but the extendable antenna is rather flimsy.

The Sanyo RL4930’s 65,000-color display measures 1.6 inches (128×112 pixels) and is the best thing about the handset’s design. Although its overall resolution is a bit washed out, it’s nonetheless fine for viewing the user-friendly menus. You can adjust the contrast, the font size, and the backlighting time, but you can’t alter the brightness.

Below the Sanyo RL4930’s display are the main navigation controls with a standard Sanyo design. There’s a five-way toggle that acts as a shortcut to messaging, and the phone book has a menu where you can program more shortcuts, as well as a My Content folder for storing games and other downloaded files. The toggle is large enough, but the other navigation controls may trouble users with larger fingers. Two soft keys, dedicated Web and Back buttons, and the Talk and End/power keys are all much too small. However, we liked the fact that the Back buttons double as a key lock if held down and that there’s a dedicated speakerphone button below the keypad. Speaking of the keypad, the buttons are raised just above the surface of the phone, which made it easy to dial by feel. They’re also decently sized and lit by a green backlighting. The only controls on the outside of the phone are the Ready Link button and a wide volume rocker on the left spine.
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By Peter Wallsten
April 6, 2009
Reporting from Washington — With the White House positioned to reshape the future of the auto industry, Republican Sen. Bob Corker was so concerned about the prospects for his home state of Tennessee that he delivered a personal warning to the administration’s point man on the issue.

Don’t keep plants open in Ohio and Michigan, which voted for President Obama last year, at the expense of a plant in Tennessee, which is solidly Republican, he said.

“I wanted to know: Would they employ a blue-state, red-state strategy?” Corker said in an interview, recalling his phone conversation last week with Steven Rattner, the administration’s top advisor on restructuring the domestic auto industry.

The question illustrates the new dynamic as Obama tries to balance the economic need to salvage a struggling industry that employs hundreds of thousands of people, and affects millions, against the needs of key constituencies and possibly his own reelection hopes.

Like Corker, all sides are attempting to decode messages from the White House.

The administration has sent reassuring signals to the United Auto Workers, a staunch campaign supporter of Obama, amid fears that union members and retirees will be forced to sacrifice more benefits.

By contrast, bondholders who are owed money by General Motors Corp. say they are still waiting to see whether the White House will consider their needs.

Corker would not divulge how Rattner responded to his concerns, saying only that he believed the White House would “try to do the right thing.”

But he added that politics could prove unavoidable, given the president’s ties to the UAW and his election campaign’s reliance on auto-heavy states such as Ohio, Michigan and Indiana.

“The administration owns this now,” Corker said. “They’ve taken over a private company, and in essence you can imagine the kinds of pressures on them as they move ahead.”

Rattner did not respond to requests for an interview.

A White House official, requesting anonymity because of the sensitive nature of the negotiations, said the president and his auto task force were focused on solutions that would save the industry — not on political calculations that pale in comparison with the larger risks awaiting Obama if the auto industry were to collapse.
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Gastritis is not a sickness on its own but a symptom of abnormal digestion. It is characterized by inflammation or irritation of the lining of the stomach. It affects millions of people worldwide. It can be divided into 3 categories: (1) erosive and hemorrhagic gastritis (2) non erosive and nonspecific gastritis (3) limited gastritis indicative of a disorder.

Gastritis can be due to a number of causes including excessive alcohol consumption, prolonged use of non steroidal anti-rousing drugs, also known as NSAIDs, such as aspirin or ibuprofen, or bacterial infection. Commonly, the bacterium that causes the swelling of gastritis is the same as that which causes most stomach ulcers. Sometimes gastritis can develop after major surgery, burns, traumatic impairment.

Symptoms of gastritis include abdominal discomfort, pain, bloating or gas, irritation, headache, vague malaise, nausea and sometimes vomiting. Aside the use of medications, there are ways to combat gastritis by selective food inclusions or eliminations.

Forceful actions to overcome gastritis include the following:

1. Limit or where possible eliminate your intake of unassuming sugar (sweet, fruit, and milk), flour, caffeine, alcohol, fatty foods, spicy foods and tomato products. These foods exasperate the stomach lining, increase the production of stomach acid and weaken the sphincter at the end of the esophagus causing the spear-carrier acid to move up the esophagus.

2. Coconut water is an excellent remedy for gastritis. It gives the stomach the imperative rest and provides vitamins and minerals.

3. Eating a light or soft diet provides a lot of aid. Cessation of smoking and relaxation therapy can also help. Eating a diet high in fiber may not only cut your risk of developing gastritis and ulcers in half, but fiber-copious in foods may also speed the healing of ulcers. Vegetables are particularly protective sources of fiber and seem to reduce the amount of swelling in the lining of the stomach.

4. Take a long term daily dose of Omega 3 Fish Oil 1000 mg to restrict and subsequently eliminate inflammation.

5. A daily dose of a multi vitamins and minerals tablet to work for in digestive health.

The financial crisis means boom times for spooks-for-hire.

By Barney Gimbel, writer
Last Updated: December 8, 2008: 11:16 AM ET

NEW YORK (Fortune) — If James Bond’s “License to Kill” gets revoked, he’d have no problem finding work as a corporate spy. To the short list of sectors that stand to gain from the financial crisis, add corporate intelligence firms.

They are seeing a dramatic uptick in business from a surge of banks, private equity firms, and hedge funds that need to make sure those pesky multimillion-dollar investments they made when times were good will hold up.

Firms like Control Risks, a London-based risk consultancy staffed by ex-CIA agents, and its rival, New York-based Kroll say they have seen a 20% jump in new business over the past two months. Together the two firms control the majority of the market.

These spook outfits have long carved out a lucrative business investigating corporate fraud, performing due diligence, or simply ferreting out the things not on a balance sheet - be they a company’s shady associates in Brazil or corrupt investors in Texas.

But in the recent heady times, some fast-moving investment outlets cut corners.

Now they are hoping to save face - and money - before precarious deals fall apart altogether. “The tolerance for failure has diminished,” says Jim Brooks, who heads North American operations for Control Risks.

Already, spies-for-hire are finding a couple of embarrassing flubs.

Consider the more than $300 million that one international bank lent to a sketchy Russian magnate (we’d tell you who it was, but then we’d have to kill you). When he stopped paying his bills, the bank brought in Control Risks to find out where the money had gone. (They found the Russian could have funneled money out of the country through various, seemingly unrelated shell companies.)

Another big client, a Washington-based law firm, hired it to investigate a wealthy, if not highly leveraged, Bolivian who had been claiming poverty while secretly moving his assets to places like Poland, Switzerland and Sylvania.

Tactics range from mundane document searches to clandestine interviews with former employees, customers, or government officials. Much of the work is happening overseas, where public records don’t always exist.

For the Bond wannabes, the new business isn’t adding to the bottom line so much as replacing the business they lost when pre-deal due diligence went out the window. Still, they expect the boom times to continue.

“Companies are only beginning to deal with the situation,” says Bob Brenner, who heads Kroll’s business intelligence and investigations practice in the U.S.

It may not match the martini swilling and jet setting the real Bond gets to do, but it pays the bills, which in these times is exotic-sounding enough.
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