WASHINGTON – Much of the money and strategy behind groups organizing opposition to the Democrats’ health care plans comes from conservative political consultants, professional organizers and millionaires, some of whom hold financial stakes in the outcome.
If President Barack Obama and Congress extend health coverage to millions of uninsured Americans, raise taxes on the wealthy to pay for it and limit insurers’ discretion on whom they cover and what they charge, that could pinch these opponents.
Most of them say they oppose big government in principle. Despite Obama’s assurances to the contrary, many of them insist the Democrats’ legislation is but the first step toward creation of a single-payer system, where the federal government hires the doctors, approves treatments, sets the rules and imperils profit.
These opposition groups appear to have spent at least $10 million so far on ads attacking the Democrats’ plans.
Still, supporters of a health care overhaul have outspent opponents by more than a 2-1 ratio, according to Evan Tracey of the Campaign Media Analysis Group, which tracks ad spending. Supporters include drug makers angling for their own protections, unions, the American Medical Association and AARP, the seniors’ lobby. Supporters said this week they intend to spend $150 million promoting an overhaul.
The opposition groups’ names sound catchy and populist: Patients First. Patients United. Americans for Prosperity. Conservatives for Patients’ Rights. FreedomWorks. 60 Plus. Club for Growth.
Here’s who’s behind them:
• Conservatives for Patients’ Rights is led by health care entrepreneur Rick Scott, the co-founder of Solantic urgent care walk-in centers, which he’s spread across Florida and is looking to expand.
While 80 percent of its patients have at least some insurance, Solantic also bills itself as an alternative to emergency-room care and a resource for patients with no insurance.
Scott said he wasn’t concerned that the Democrats’ proposed revisions would undercut his business: “It’s irrelevant to us.”
Instead, he said he opposes the Democrats’ plans because he doesn’t believe government involvement will contain health care costs. He sees it killing off the best private insurance plans and leading to a single-payer system, which he predicts would lead to waiting lists and denial of treatments.
• FreedomWorks, which has been advocating against the overhaul but has not launched TV ads, is chaired by Dick Armey, the former Republican majority leader of the House of Representatives from Texas.
But also noteworthy are the group’s other backers and board members. They include billionaire flat-tax proponent and former GOP presidential candidate Steve Forbes; Richard Stephenson, who founded Cancer Treatment Centers of America, which offers alternative as well as standard therapies, sometimes not covered by insurance; and Frank Sands Sr., CEO of an investment management firm whose offerings include a Healthcare Leaders portfolio.
“They’re on our board because they support lower taxes, less government and more freedom,” said FreedomWorks spokesman Adam Brandon.
Matt Kibbe, chief executive officer of FreedomWorks, said its members believe that “the government is already way too involved in the nation’s health care system” and that government is to blame for health-cost inflation.
Kibbe acknowledged that private insurance is out of reach for many small businesses and individuals, but he contended that can be dealt with without creating a government-managed exchange.
• Patients First and Patients United are creations of a larger group called Americans for Prosperity. AFP’s Web site describes a grass-roots organization with more than 700,000 members that advocates “for public policies that champion the principles of entrepreneurship and fiscal and regulatory restraint.”
It was started by billionaire David Koch of the Koch Industries oil family, one of the country’s top donors to conservative, free-market causes. The foundation’s board includes Art Pope, a former North Carolina legislator also involved in conservative causes, whose family owns hundreds of discount stores.
Tim Phillips, AFP’s president, is a former GOP congressional staffer who helped former Christian Coalition Executive Director Ralph Reed start the consulting firm Century Strategies in the 1990s. Clients paid the firm to build Christian grass-roots support for various business causes. That included work for since-convicted lobbyist Jack Abramoff.
The group, along with FreedomWorks, was involved in promoting the anti-tax “tea parties” earlier this year. AFP also is organizing a campaign “exposing the ballooning costs of global warming hysteria.”
AFP’s Phillips said he couldn’t think of anyone on his board with a direct financial stake in the health care industry. “It’s more freedom-based,” Philips said. “They have a deep interest in protecting economic freedoms.”
He also said that no one in his organization believes that more government involvement in health care will lead to reduced costs for taxpayers.
• Two other grass-roots groups have financed ads targeting peoples’ fears that more government involvement would hurt seniors and hasten end-of-life decisions.
One, Club for Growth, which advocates lower taxes, is led by Chris Chocola, a former GOP congressman from Indiana who lost his re-election bid in 2006. Club for Growth this week announced a $1.2 million ad campaign against a health care overhaul, to run in North Dakota, Colorado, Arkansas and Nevada.
The other, 60 Plus Association, is a conservative senior advocacy group that wants to abolish the estate tax. Singer Pat Boone is the group’s national spokesman. Chairman Jim Martin started the group in 1992 with fundraising help from conservative direct mail guru Richard Viguerie. It spent $1.5 million on TV ads opposing a health care overhaul in the last week.

WASHINGTON – The number of U.S. students who receive free and reduced-cost meals at school could soar to a 41-year high this school year, as record job losses and high unemployment push thousands more children into poverty, many for the first time.
According to projections by the U.S. Department of Agriculture, at least 18.5 million low-income students are expected to eat in the school lunch program each day during the 2009-10 school year. More than 8.5 million are expected to eat breakfast.
Both projections are about the same as the record participation levels the programs set last year. If rising family homelessness and steady growth in the food stamp program are any indication, however, enrollment in both student-meal programs could swell well beyond expectations this fall.
“I think it’s certainly possible, and I hope it’s true,” said Jim Weill, president of the Food Research and Action Center, an anti-hunger nonprofit group. “I hope students are going to be making it into the program in much larger numbers, because we already know there are more families struggling, and the school meals program is a great way for them to get support.”
Students from families that receive food stamps are automatically eligible for both meal programs. Enrollment in the food stamp program, which was renamed the Supplemental Nutrition Assistance Program last year, has set a record in each of the past six months. In May, 34.4 million people used food stamps to buy groceries, up 2 percent from April. Children in homeless families, including those who share housing with other families, also are eligible for free school meals.
While the total number of homeless Americans held steady last year at about 675,000 on any given night, the number of homeless families increased by about 9 percent, said Nan Roman, president of the nonprofit National Alliance to End Homelessness.
“We expect it will continue to go up this year, and there are indications that that’s already happening,” she said.
Some areas of the country are seeing huge increases in free school lunches. In Florida’s economically hard-hit Polk County, public school officials said there’s been a nearly 50 percent jump in the number of students qualifying for free lunches. Before school began there last year, 13,179 students were eligible for free lunches because their families received food stamps or welfare. This year it’s 19,559 students, said Marcia Smith, the district’s food service director.
Chicago public schools have seen a 30 percent increase, going from 107,144 children eligible for free and reduced-cost meals at the start of the last school year to 139,417 this year.
President Barack Obama’s 2010 budget request calls for a $1 billion increase to federal child nutrition programs.

Manuel Zelaya, who was ousted as Honduras’ president on June 28, speaks to supporters Thursday in Santiago, Chile, before meeting with the country’s president to seek support for a return to power. Honduras’ leaders, with a presidential election scheduled in November, don’t want Zelaya back.
ARIEL MARINKOVIC AFPTEGUCIGALPA, Honduras – The month-old mediation effort by Costa Rican President Oscar Arias to resolve Honduras’ political crisis is foundering under the near-universal opposition of Honduras’ top leaders to permitting deposed President Manuel Zelaya to return to power.
Political, business, church and media leaders say they can’t trust Zelaya to keep the commitments that would limit his authority under the Arias plan because, they say, Zelaya repeatedly violated the constitution in the days that led up to his June 28 ouster over a proposed public vote that they think was aimed at extending his stay in office.
They also say that Zelaya proved himself untrustworthy by failing to submit a budget to Congress last year and by shifting left in the middle of his term and allying himself with Venezuelan President Hugo Chávez, a fierce critic of the United States, traditionally Honduras’ most important political and economic ally.
These officials say they prefer that de facto President Roberto Micheletti – or perhaps another senior government official who would replace him – lead the country through the regularly scheduled Nov. 29 presidential elections and let the newly elected president take over as scheduled Jan. 27.
Opposition to the Arias plan runs so deep that Honduras’ decision-makers favor holding tight even in the face of international sanctions and threats that other countries won’t recognize the presidential election result.
“The president put himself above the law,” said Oswaldo Canales, who heads the 9,000-strong Evangelical Fraternity of Honduras, the country’s biggest Protestant organization. “No one is above the law. He cannot return.”
Zelaya’s supporters scoff at the notion that he’s untrustworthy and say those blocking his return are protecting powerful political and business interests. They say there’s no evidence that Zelaya intended to benefit personally from the referendum.
Arias hasn’t given up on his efforts, although swine flu has sidelined him for the past several days.
The team representing Honduras in the Arias negotiations remains active. It met Thursday in Washington with José Miguel Insulza, the secretary-general of the Organization of American States, to discuss rescheduling a trip to Honduras by foreign ministers and the OAS that the Micheletti government has delayed.
Still, the opposition to a deal is intense, with news reporting slanted against Zelaya and virtually no public opinion leader voicing support.
“He’d breach the agreement, and nobody would stop him,” said Adolfo Facussé, the president of the Honduran National Industrial Association.
That sentiment is based on the events leading to Zelaya’s ouster, which began in March when Zelaya announced he wanted to consult the public on whether to rewrite the constitution to permit a president to succeed himself.
The move alarmed the country’s elite because it resembled acts by Chávez, Bolivia’s Evo Morales and Ecuador’s Rafael Correa to extend their stays in office.
In time, Honduras’ attorney general, Congress and Supreme Court ruled that the vote was illegal because the constitution contains an unusual clause mandating that any president who tries to extend his term must step down.
Zelaya ignored the opposition and fired the armed forces commander June 24 after the commander questioned the legality of Zelaya’s order to distribute the ballots despite the ruling that the referendum was illegal.
The next day, Zelaya led several thousand supporters to an air force base to seize the ballots, as troops stood by.
“If we didn’t have any doubts about what was happening, that ended there,” said Maria Eugenia Landa Molina, a Liberal Party member of Congress who once backed Zelaya but who now says he must never be allowed back into office.
Since his ouster, Zelaya has traveled to the United States, El Salvador, Costa Rica, Mexico, Ecuador, Brazil and Chile to rally support to get the Micheletti government to bend. Each of those countries has voiced support for his return but stopped short of real action.
Zelaya said this week that the U.S. has such influence over Honduras’ economy that Obama administration officials could put him back in power if they enacted tough economic measures. The administration has refused, however, to take anything but symbolic measures and accused Zelaya of “provocative actions” that prompted his ouster.

BAGHDAD – Tempers are cool in Iraq despite a string of bombings that’s killed more than 125 people in the past two weeks, fueling hopes that the attacks won’t trigger retaliatory killings, at least for now.
The Sunni Muslim group al-Qaida in Iraq is the likely culprit in the bombings, which mostly have targeted followers of radical Shiite cleric Muqtada al-Sadr. U.S. and Iraqi officials say the attacks appear to be intended to trigger sectarian violence, as the February 2006 bombing of a Shiite mosque in Samarra did.
But Iraqis so far haven’t sought revenge for the attacks, which have been aimed at mosques and religious celebrations.
“People understand this game now, and they will not be party to it,” said Ali Jawad, 18, who witnessed a series of explosions Tuesday night near a Shiite mosque in Baghdad’s Amil neighborhood.
Many Iraqis, including Jawad, suspect that their political parties have a hand in the bombings. They think that the explosions are intended to discredit Prime Minister Nouri al-Maliki before January’s national elections.
“This is a struggle between the political parties,” said Thikrayat Abdulrazaq, 35, a pharmacist who also saw the explosions near the Amil mosque. “They are using means of intimidation to show that the government is not capable of keeping the peace.”
Al-Maliki is running as the man who stabilized Iraq while laying the groundwork for the drawdown of American forces. Continued violence would puncture his credibility, some lawmakers said.
“There are some political factions who would stoop low enough to encourage these acts of violence in order to crumble the confidence of people on the street in the ability of Prime Minister al-Maliki to run the country,” said Izzat al-Shabendar, an independent Shiite lawmaker in parliament.
His charges carry some weight because some of Iraq’s political parties gained power with their own militias. Al-Sadr’s party was linked to the Mahdi Army, founded to protect Shiites but later connected to deadly attacks of its own. The Islamic Supreme Council of Iraq, another Shiite party, had its own armed wing, the Badr Brigade, and Iraqi Kurds have the peshmerga militia.
“They are showing their muscle to each other, and it is the poor, simple man on the street who is paying the price,” Jawad said.
Brig. Gen. Stephen Lanza, the U.S. military’s top spokesman in Iraq and a former brigade commander in Baghdad, said levels of violence in Iraq were at their lowest point since the 2003 invasion despite the high-profile attacks.
“The attacks have the hallmarks of violent extremists who are threatened by a strong, unified population. They prefer to see gains in security and national sovereignty disintegrate. We are not seeing that happen; the people recognize these as attacks against them, not the armed forces or the government,” he said.
Two of the biggest recent attacks occurred in the northern city of Mosul, where al-Qaida in Iraq remains a force and residents sometimes are caught in turf wars between Kurds and Arabs.
Two truck bombs leveled a Shiite village north of Mosul on Monday, killing at least 30 people, and more than 40 died in Mosul last Friday when a bomb exploded near a mosque.

ZHARI DISTRICT, Afghanistan – Two miles from the gates of this isolated Canadian forward military base in southern Afghanistan is Sangsar, where the Taliban’s harsh interpretation of Islam was born.
A few miles farther east is a school in Siah Choy where students learn to build roadside bombs for passing U.S. and Afghan troops or the farmers who welcome them. In Nakhonay, about six miles farther east, the Taliban store thousands of weapons to distribute in the region.
This fertile part of southern Afghanistan is the front line of the war between the American-led coalition and the Taliban, but neither the United States nor its coalition partners have any troops stationed in these villages. The Taliban’s grip here is so strong that Afghan government leaders can’t live in their own villages, so the farmers turn to the militants to settle local disputes. When Afghans go to the polls Thursday to pick a president, no one here will vote because the Taliban has ordered them to stay home.
The coalition’s precarious position in Kandahar province after nearly eight years of a war that’s killed about 700 American lives is a warning that the new U.S. campaign to subdue the Taliban in the Islamists’ heartland will be, at best, an uphill struggle.
Later this month, soldiers from the 5th Brigade of the Army’s 2nd Infantry Division out of Fort Lewis, Wash., will take control of this base, part of an American troop increase that Army Gen. Stanley McChrystal, the top U.S. commander in Afghanistan, has said is key to wresting control from the Taliban.
“Kandahar is very important to Afghanistan,” McChrystal said last month. “As we get additional forces in the country, one of the areas that will be of highest priority is the security of Kandahar city and Kandahar province, because both together have great importance.”
The tactics the United States honed in Iraq will be of little or no use here, where roadways are either dusty unpaved tracks, creek beds or lush Vietnam-like terrain. Indeed, this part of Kandahar province is one of the few places in Afghanistan where farmers can grow grapes, opium poppies and marijuana. Temperatures easily reach 130 degrees in the summer. Soldiers walk a few hundred yards and collapse before a shot is fired.
For three years, a Canadian force of a few hundred has faced as many as 15,000 Taliban here. In those three years, however, the Canadians acknowledge that they’ve had little more than a “finger in the dike strategy” aimed at preventing Taliban forces from capturing Kandahar, Afghanistan’s second-largest city, 20 miles to the east. With few resources, stalemate was the Canadians’ strategy.
America’s allies have no territorial gains to show for the effort. The schools they built were destroyed after the Taliban took them over and used them to stage ambushes. The small outposts they established, including the one in Sangsar, were abandoned in 2007 under constant Taliban attack.
“All we were really able to do, and have been able to do, is keep the insurgency sufficiently at bay that it doesn’t become a real challenge to the state,” said Canadian Brig. Gen. Jonathan Vance, who commands 2,800 troops in Kandahar province, about 300 of them based in Sangsar. “And it’s not a real challenge to the state.”
The Canadians are bitter about their role. They’ve lost 125 soldiers – the highest proportionally of any coalition partner – and have killed thousands of Taliban fighters and hundreds more civilians in short bursts of operations, usually lasting a few days.
Now they feel the clock ticking: They have two years to make a lasting difference before political pressure probably will force them to go home. Canada’s politicians have said that their combat forces will leave Afghanistan by the end of 2011.
“We are proud to have been here. This is the heart of the insurgency,” said Capt. Christian Maranda, 30, of Quebec and of Bravo Company. “But of course it’s frustrating, because we lose ground every time we lose an area.”

KABUL, Afghanistan – The U.S. military commander in Afghanistan is considering pulling American troops out of some remote outposts on the country’s mountainous eastern border with Pakistan, where local guerrillas are allied with the Taliban and al-Qaida, U.S. officials told McClatchy.
Abandoning U.S. forward outposts, and possibly turning them over to Afghan forces, would be a tacit admission that the presence of American troops has fueled insecurity by embroiling them in local feuds and driving some local tribes to align with the Taliban.
“These (outposts) are costly and dangerous and not doing much to bring security to the people or connect the people to their government,” said a U.S. official who’s familiar with the region. “The terrain is too rugged, the infrastructure and especially roads do not exist and couldn’t be built on short order, and the population is too low and too dispersed.”
American commanders had hoped that sending more troops to the border area, coupled with a new Pakistani drive against the militants on its side of the border, could deprive al-Qaida and the Taliban of a sanctuary and end infiltration from Pakistan. However, two senior U.S. officials said, there’s no sign that the Pakistani military is prepared to move against the militants, and as one of them put it: “There’s no point swinging a hammer if there’s no anvil there.”
Instead, American forces have found themselves tied down in costly clashes with insurgents, and it now may make more sense to move them to more populated areas to bolster security for a redoubled effort to rebuild the war-torn country, U.S. officials said.
Although no final decision has been made, Army Gen. Stanley McChrystal, the top American commander in Afghanistan, is reviewing the idea as he finalizes a new strategy for containing the expanding Taliban-led insurgency nearly eight years after the United States invaded Afghanistan after the Sept. 11, 2001, terrorist attacks. Secretary of Defense Robert Gates asked McChrystal, who took command in July, to submit the strategy by sometime next month.
Eight U.S. officials in Kabul and Washington who discussed the issue spoke only on the condition of anonymity, because McChrystal and his commanders are still debating it.
Freeing resources that are tied up in outposts in thinly populated areas of eastern Nuristan and Kunar provinces, such as the Korengal and Pech valleys, also would reflect what many American commanders think is a shortage of foreign forces supporting the U.S. effort in Afghanistan.
Despite President Barack Obama’s decision to boost the American contingent to 68,000 troops by this fall, there’s uncertainty about further increases next year given the continued instability in Iraq and public angst over rising casualties in Afghanistan and federal spending at home.
Given these limitations, the officials said, McChrystal wants to focus the troops he has on Afghanistan’s population centers.
“It’s a concession that we don’t have enough troops,” said a U.S. military officer at the Pentagon. “It may seem counterintuitive to move the fight closer to population centers, but being farther away hasn’t worked.”
Abandoning more outposts where U.S. forces have suffered significant casualties would be a boon to the propaganda-savvy Taliban and their patron, al-Qaida, which almost certainly would trumpet any redeployment as an American retreat. It also would shift the war in Afghanistan from fighting al-Qaida and other terrorists, which soldiers are trained to do and which the American public continues to support, to protecting the Afghan population and training local forces, which may be harder for the Obama administration to defend in Congress and during next year’s congressional elections.
Several U.S. officials, however, said the advantage gained by redeploying forces probably would outweigh any short-term Taliban propaganda victory.
“Should we withdraw and the bad guys move into the highlands in large numbers, then the challenge will be to contain them there,” the official continued. “I’d wager that if we could make significant progress in the areas with higher population concentration, which are easier to defend, then the problem in the remote and inaccessible areas will diminish. The bad guys aren’t interested in setting up little Islamic emirates in isolated valleys. They’re interested in seizing the reins of power.”
Troops redeployed from border areas would be used to bolster security in more populated areas where building support for the Afghan government and its international backers is considered more crucial to defeating the Taliban-led insurgency, the officials said.

Freed journalists Euna Lee and Laura Ling are posting expressions of gratitude and snippets of their lives returning to normal on a Web site that was created to keep their cause alive when they were captives in North Korea.
The two women were detained at the North Korean border on March 17 while reporting on the trafficking of women and children along the border between China and North Korea. North Korea convicted both women of entering the country illegally and sentenced them to 12 years at hard labor in prison. Former President Bill Clinton traveled to North Korea to meet with the country’s leader, Kim Jong Il, and last week negotiated the women’s release after they had been held for more than four months.
Ling, a reporter for Current TV who grew up in Carmichael, wrote in a posting Wednesday that she was touched by the support back home.
“While in detention in North Korea, isolated and scared, one of the things that gave me strength and sustained my faith was hearing about the groundswell of support for Euna and me,” Ling wrote. “You were a part of this incredible movement, and for that I will be forever thankful.”
Through the letters she received, Ling learned about vigils, the lauraandeuna.com Web site and other grass-roots efforts. “I am deeply humbled,” she wrote.
Lee wrote that she has been reacquainting herself with her 4-year-old daughter, Hana, and husband, Michael Saldate.
“What have I done … hmmm … let’s see. I made scrambled eggs with Hana, I walked around the neighborhood with Michael and Hana after dinner, I combed Hana’s hair and dressed her for school, I danced and jumped with Hana, I went to a cafe and had a very happy time with Michael, listening to his life and shared mine, I went to church and was able to sing unto the Lord.”

The U.S. Department of Energy is backing research and development aimed at getting light-emitting diodes into common use in homes and businesses at a price that saves money.
HURDLES REMAIN
Costs are still high, the quality of what’s on the market varies and not all the technical issues have been worked out. LEDs are directional lights, used in recessed lighting and undercounter lights, for example. They’re not yet available as bulbs that cast light all around and fit in ordinary sockets. Energy experts are confident, however, that this new lighting is the future and that energy savings will be enormous.
WHAT’S AT STAKE
Lighting consumes 22 percent of electricity in the United States. The DOE predicts that solid-state lighting – which uses semiconducting materials to convert electricity into light, and includes LEDs – has the potential to reduce energy use for lighting by one-third by 2030. That’s the equivalent of saving the output of 40 large (1,000-megawatt) power plants, the greenhouse gas emissions of 47 million cars and $30 billion.
– McClatchy Washington Bureau

Ask around for the healthiest country in the world, and the United States won’t come close to topping the list.
People live longer in just about every industrialized nation, from Canada to our north, throughout much of Europe, and around the Pacific in Japan, Australia and New Zealand.
New mothers and their babies also face a rockier start here, with U.S. infant and maternal death rates double some of our industrialized peers.
As debate swirls in Washington and at town halls nationwide over health care reform, there is also a more fundamental question – what about health?
Could policymakers change our medical system in ways that would make America a healthier country?
Insuring everyone should help – but less than people might think, according to doctors and public health experts who’ve studied the issue. Putting more resources into primary care should also make a dent, they say.
Neither one, though, is likely to send America to the top ranks of its global peers.
“If you want to see dramatic changes in health, you’re not going to get there even by doubling the efficiency and effectiveness of the health care system,” said Dr. Richard Kravitz, a University of California, Davis, professor of medicine whose research interests include quality of care.
“When you need it, you really need it … but in general, the benefits of medical care to populations are a little bit overrated,” he said.
When taken all together, the other factors that play a bigger role include education, income, toxins in the environment, crime, violence, family structure, stress, obesity, nutritious food and exercise.
Across large populations, he said, numerous studies suggest that medical care contributes only modestly to overall health, perhaps somewhere between 10 percent and 25 percent.
Health care for all would provide a “very large” improvement for some deprived populations, Kravitz said, but “a surtax on high fructose corn syrup would probably be more effective … than anything we could do for the health care system, just because of obesity.”
Researchers who have delved into the effects of medical care on the health of large groups overall have made some surprising and sometimes conflicting discoveries.
An experiment in the 1980s that extended different levels of insurance to otherwise uninsured people found that more coverage fostered more use of the medical system but not necessarily healthier people, said Dr. Peter Muennig, a professor of health policy and management at Columbia University’s Mailman School of Public Health.
A 2006 study that compared white people in England with whites in the United States, in an effort to keep different ethnicities from complicating the findings, reached conclusions Muennig found startling. Even the richest white Americans, who are pretty much universally insured, had more diabetes, more high blood pressure, more heart disease and more cancer than the richest white Britons. On most measures they were a little less healthy than middle income Britons.
This points to a vast range of things health care cannot do, from providing mass transit that makes it likelier people will walk more, to providing the kind of education that correlates strongly with better health.
“Education is the fundamental ingredient for what you need to survive in any ecological niche,” Muennig said. People with less education are likely to have jobs that are lower paying, higher stress and possibly more dangerous. They’re likelier to live in unsafe housing and eat cheap, calorie-dense food. They’re less likely to be offered job-related health insurance. Except for the insurance, he said, health care reforms cannot fix that.
Those who examine health across many nations puzzle over other oddities.
In international health care measures, America’s ranking improves when life expectancy is measured for people age 65 and older. While still not at the top of the health heap, Americans who make it to age 65 have remaining life expectancies closer to 65-year-olds in other developed countries, and men stack up a little better than women against their peers worldwide.
That might mean that American medicine treats older people more effectively. Or it could mean that Medicare, universal coverage available at age 65, may be keeping older people healthier. Or it could be something called the “survivor effect,” suggesting those who have lived past earlier perils are more robust.
While the factors that optimize health are complex, doctors say there are things federal policymakers could do to make America a little healthier.
Among them are strengthening primary care, finding ways to encourage better diet and exercise, and effectively reforming how health care is financed, said Dr. James G. Kahn, a professor of health policy and epidemiology at the University of California, San Francisco.
People do better in nations that encourage them to have a regular primary care provider, Kahn said, perhaps partly because regular, front-line care helps bolster healthy habits.
“Even in the United States, in locations with a higher concentration of primary care providers, people have somewhat better outcomes and also lower costs,” he said.
Rewarding and encouraging primary care might also offset an American tendency to do too much, driven by a system that pays for each procedure performed by a doctor, hospital or testing lab, Kahn added.
“We do too many surgeries,” he said. “Rates of cardiac surgery are lower in Canada, yet they have better outcomes.”
There is hope, too, for “accountable care” groups that would move away from fee for service payments but be held accountable for keeping all their patients as healthy as possible, said Stephen Shortell, dean of the school of public health at UC Berkeley.
Shortell is also pleased that the health legislation being discussed in Washington includes billions for disease prevention and health promotion.
“You can’t ignore the health care system, but the big payoff is in lifestyle factors and disease prevention,” he said. “A dollar spent on those activities saves $5 in health care costs.”

Karl Rove saw the attorney in New Mexico as a “serious problem,” sworn testimony says.WASHINGTON – Karl Rove and other top officials in the George W. Bush White House were deeply involved in pushing for the ouster of several U.S. attorneys, notably including one in New Mexico, according to testimony and e-mails released Tuesday by the House Judiciary Committee.
Sworn testimony from former White House Counsel Harriet Miers revealed that Rove considered former U.S. Attorney David Iglesias of New Mexico a “serious problem” and “wanted something done about it” because of complaints about politically sensitive investigations that Iglesias had mounted. Miers said that she couldn’t recall whether Rove specifically demanded Iglesias’ firing during a 2006 conversation, but Iglesias was fired later that year.
Miers’ testimony and e-mails between White House officials contradict Rove’s assertion that he was merely a passive conduit to the Justice Department for complaints from Republican operatives and wasn’t himself an advocate for the administration’s eventual ouster of nine U.S. attorneys.
In sworn closed-door testimony to the House Judiciary Committee in July, Rove continued to distance himself from the decision to push out certain prosecutors. He recalled a proposal to fire some or all of them in late 2004, but denied that he’d come up with a plan to have it done and rejected the suggestion that he had a direct role.
“My view was this is a decision that had to be made at the Justice Department,” Rove said, according to a transcript of his sworn testimony.
House Judiciary Chairman John Conyers, D-Mich., issued a statement that said: “After all the delay and despite all the obfuscation, lies and spin, this basic truth can no longer be denied: Karl Rove and his cohorts at the Bush White House were the driving force behind several of these firings, which were done for improper reasons.”
Iglesias, too, said Tuesday that the e-mails confirmed his suspicions that Rove was more directly involved in his December 2006 firing than he’d acknowledged.
“That was just spin,” he said of Rove’s claim that he’d merely passed along complaints from Republican operatives and had no active role. “The e-mails and testimony confirm my worst fears that the true basis for not only my removal but for several of my colleagues’ was improper political reasons.”
In a statement released Tuesday afternoon, Rove again denied that he’d sought to influence any of the prosecutors’ investigations.
Rove, who said the documents showed the allegations against him “have proved utterly groundless,” urged the public to read the documents rather than rely on “partisans selectively quoting testimony or excerpting e-mail messages.”
The committee’s release of more than 700 pages of transcripts and 5,000 pages of White House and Republican National Committee e-mails on these subjects marks the end of the House investigation into the U.S. attorneys’ firings.