Outlook no brighter for Obama's new health plan

...The Justice Department is investigating and has won settlements with two lesser-known device makers. A former device saleswoman who brought those two cases has also sued Boston Scientific, Medtronic and St. Jude Medical. The DOJ hasn't joined in those cases and the companies say none of their top execs were involved in any illegal marketing of the devices. More on the situation is here.

Coronary angiograms, widely used tests to detect artery blockages in the heart, often turn up little or no evidence of disease, a study in the New England Journal of Medicine found. That suggests that the more than a million U.S. patients who undergo the diagnostic test each year at a cost of about $10,000 each, are frequently exposed to unneeded risks of a costly procedure, the WSJ says in another article.

The study of nearly 400,000 angiograms performed between 2004 and 2008 in the U.S. found that 62% of the patients didn't have evidence of significant obstructions, while 38% had important blockages. Of course, a clean angiogram can still provide useful informaton and the findings don't apply in cases when there is established heart disease or the threat of an imminent heart attack. Patients included in the study weren't previously diagnosed with heart disease and represent about 20% of those who get angoigrams.

Still, the data indicate overuse of angiograms. "We've got to get much smarter about how we're ordering and interpreting these tests," a Mayo Clinic cardiologist told the WSJ.

Will It Pass? The Odds on Health Care

Senate Faces Slog Over Health Bill Amendments

Health Care Gains Start Soon - Bigger Ones Later

The real transformation of America's health insurance system won't take place until 2014.

Four breathtaking changes will happen simultaneously:

* Insurers will be required to take all applicants. They won't be able to turn down people in poor health, or charge them more.

* States will set up new insurance supermarkets for small businesses and people buying their own coverage, pooling together to get the kind of purchasing clout government workers have now.

*Most Americans will be required to carry health insurance, either through an employer, a government program or by buying their own. Those who refuse will face fines from the IRS.

* Tax credits to help pay for premiums will start flowing to middle-class working families, and Medicaid will be expanded to cover more low income people. Households making up to four times the poverty level - about $88,000 for a family of four- will be eligible for assistance. But the most generous aid - including help with copayments and deductibles * will be for those on the lower-to-middle rungs of the income scale.

Cost could be the Achilles' heel of the whole effort.

"I hope it is not repealed, because we do need to extend coverage to most of our population," said Gail Wilensky, who ran Medicare for President George H.W. Bush and remains a leading health care adviser to Republicans. "But it could well be substantially modified. It expands coverage, but it does very little to take on two other major issues: improving quality and leveling the rate of growth in spending."