A Reminder to Americans:In God We Trust

Many Americans don’t believe in hell, but what about pastors?

Just when it seemed to have cooled off, the topic of hell is back on the front burner — at least for pastors learning to preach about a topic most Americans would rather not talk about.

Only 59% of Americans believe in hell, compared with 74% who believe in heaven, according to the recent surveys from the Pew Forum on Religion and Public Life.

“I think it’s such a difficult and important biblical topic,” said Kurt Selles, director of the Global Center at Samford University’s Beeson Divinity School. “There’s a big change that’s taken place as far as evangelicals not wanting to be as exclusive.”

At the recent annual Beeson Pastors School, Selles led two workshops to discuss “Whatever happened to hell?” He asked how many of the pastors had ever preached a sermon on hell. Nobody had, he said.

I think it’s something people want to avoid,” he said. “I understand why. It’s a difficult topic.”

The Rev. Fred Johns, pastor of Brookview Wesleyan Church in Irondale, Ala., said after a workshop discussion of hell that pastors do shy away from the topic of everlasting damnation.

“It’s out of fear we’ll not appear relevant,” he said. “It’s pressure from the culture to not speak anything negative. I think we’ve begun to deny hell. There’s an assumption that everybody’s going to make it to heaven somehow.”

The soft sell on hell reflects an increasingly market-conscious approach, Selles said.

“When you’re trying to market Jesus, sometimes there’s a tendency to mute traditional Christian symbols,” he said. “Difficult doctrines are left by the wayside. Hell is a morally repugnant doctrine. People wonder why God would send people to eternal punishment.”

Speakers said the seriousness of Jesus dying for man’s sins relates to the gravity of salvation vs. damnation, according to Johns. “If you don’t mention God’s judgment, you are missing a big part of the Christian gospel,” Selles said. “Without wrath, there’s no grace.”

Pope John Paul II stirred up a debate in 1999 by describing hell as “the state of those who freely and definitely separate themselves from God, the source of all life and joy.”

Although the pope was reflecting official Roman Catholic teaching, some U.S. evangelicals expressed misgivings about the implication that hell is an abstract separation from God rather than a literal lake of fire as described in the Book of Revelation.

The pope’s comments on hell stirred up the ancient debate about whether hell is a real place of burning fire or a state of mind reflecting a dark, cold emptiness and distance from God.

Evangelical Christians have traditionally offered a sterner view of salvation and damnation. A Southern Baptist Home Mission Board study in 1993 estimated that 70% of all Americans are going to hell, based on projected numbers of those who have not had a born-again experience.

Human ideas about hell were still in ferment as the Bible was being written. The theological concept of hell has a rich cultural heritage, according to historian Alan Bernstein, author of The Formation of Hell.

The ancient Hebrews focused on the afterlife following their Babylonian captivity, when they experienced the torment of ungodly enemies who seemed to have an unjustifiably good life on Earth. During the Babylonian exile, Jews were exposed to Zoroastrianism, which asserts there is an eternal struggle between good and evil, with good triumphing in the end.

The Hebrew concept of “Sheol” — the realm of the dead — may also have been influenced by the Greek mythology of Tartarus, a place of everlasting punishment for the Titans, a race of gods defeated by Zeus, Bernstein writes.

From about 300 B.C. to 300 A.D., those influences combined with Hebrew speculation about an eventual comeuppance to the worldly wicked.

In translating the Bible from Hebrew to Greek, the Greeks used the terms Tartarus, Hades and Gehenna. In Greek thought, Hades is not a place of punishment; it’s where the dead are separated from the living.

The term Gehenna referred to a ravine outside Jerusalem that was used as a garbage dump. It had once been a place of child sacrifice and became a symbol of pain and suffering, Selles said. As a garbage dump, it was probably often a place of fire as trash was burned, emphasizing the symbolism of the flames of eternal damnation, he said.

Jesus never soft-pedaled the concept of hell, Selles said. “It’s not metaphorical in Jesus’ mind; it’s a real place,” he said.

In 410 A.D., St. Augustine defined four states of afterlife: those so good they go to heaven; those so bad they go to hell; those who deserve some relief in their eternal torment; and those who deserve to be lifted out of torment after repenting for their sins. That set the stage for the doctrine of purgatory in 1237 A.D.

The Bible contains a litany of colorful images of hell as both fire and darkness, as in the Gospel of Matthew, which refers to “the eternal fire prepared for the devil and his angels” and “the outer darkness” where “men will weep and gnash their teeth.”

Either way, Selles said, pretending that hell doesn’t exist, or trying to preach around it, short-circuits the Bible.

“This is a doctrine, a teaching, that’s being neglected in churches,” Selles said. “It needs to be preached. It’s part of the Gospel.”

Americans spend $34B for alternative medicine

– Americans spend more than a 10th of their out-of-pocket health care dollars on alternative medicine, according to the first national estimate of such spending in more than a decade.

Chiropractors, massage therapists, acupuncturists and herbal remedies are commanding significant consumer dollars as people seek high-touch care in a high-tech society, the report released Thursday by the government shows.

Altogether, consumers spent an estimated $34 billion on those and other alternative remedies in 2007, the report found.

“We are talking about a very wide range of health practices that range from promising and sensible to potentially harmful,” said Dr. Josephine Briggs, director of the National Center for Complementary and Alternative Medicine, the federal agency that leads research in this field.

More research into which therapies work is critically needed, because the spending on them is “substantial,” she said.

The data, gathered in 2007 mostly before the recession was evident, don’t clearly reflect whether the economy played a role in spending on these therapies. But Briggs noted there has been “speculation that as the number of uninsured grows, there may be increased utilization of some of these approaches, which tend to be relatively inexpensive.”

Nearly half of those who use alternative medicine say they cannot afford conventional care, according to government data published in a separate report.

Some consumer advocates say people are wasting money on some products that rigorous studies have shown don’t work. Dr. Sidney Wolfe, who leads Public Citizen’s health research, has long criticized the government for what he considers lax regulation of prescription drugs and mainstream medicine. Yet, he also sees problems with the widespread use of dietary supplements.

“People think they are cleared” by the Food and Drug Administration, he said, when in fact they do not need proof of safety or effectiveness to go on the market.

“Mainly, they’re ineffective,” he said.

The report is based on a 2007 survey by the U.S. Centers for Disease Control and Prevention of more than 23,000 adults nationwide. An earlier report from this survey, released in December, found that more than one-third of adults use alternative medicine.

That includes a wide range of services from meditation and yoga to herbal supplements, such as echinacea and ginseng. Vitamins and minerals are not included in this report but will be addressed in a future one.

Pain was the main reason people tried massage, chiropractic care and other alternative therapies. Among supplement users, most popular were glucosamine for joint pain and fish oil to cut the risk of heart disease.

The new survey results focus on how often Americans use these things, and how much they pay for them. The numbers show that alternative medicine accounts for more than 11 percent of out-of-pocket spending on health care in the United States.

The study found that about 44 cents out of every dollar spent on alternative medicine was for products like fish oil, glucosamine and echinacea. Spending on these products was nearly $15 billion, or about a third of what Americans spend out-of-pocket for prescription drugs.

“I personally am pretty conservative about supplement use,” Briggs said. She believes that research her center has sponsored has affected consumer use. After widely publicized studies showed the ineffectiveness of echinacea for colds and St. John’s wort for major depression, their use fell; fish oil use has risen following some research suggesting it might help lower risk of heart problems.

The survey shows about 35 cents of each alternative therapy dollar was for visits to acupuncturists, chiropractors, massage therapists and other practitioners. That totals nearly $12 billion, or about one-quarter of what Americans spend on visits to mainstream physicians.

“Some of the useful things chiropractors are doing amounts to physical therapy,” Wolfe said. “Medicine is beginning to realize how important physical therapy is.”

The last government estimate for out-of-pocket spending on alternative medicine came from a 1997 survey. That research suggested $27 billion was being spent.

The new report concludes that 38 million adults visited alternative medicine practitioners in 2007. They paid less than $50 per visit on average, but many paid $75 or more for services such as acupuncture, homeopathy and hypnosis therapy.

The average annual spending per person to see practitioners was about $122, and the average spending on products was $177.

A whopping $3 billion was spent on homeopathy, a form of treatment that uses highly diluted drugs made from natural ingredients and based on a theory unverified by mainstream science.

Private insurance paid for about 43 percent of all alternative medicine in 2007, public insurance paid for 31 percent and patients paid for the rest, according to a separate government report.

Dianne Shaw, a media relations worker at the University of North Carolina at Chapel Hill, sees value in at least one form of alternative medicine — acupuncture. She says acupuncture helped her recover from a stroke-like facial nerve paralysis that standard drugs didn’t remedy. During an exam, one of her doctors commented on her progress, and she revealed that she was getting acupuncture.

“They said, ‘Well I’m glad it worked,’” Shaw said.

POLL: Obama Faces Trouble with Stimulus and Deficit ABC News-Washington Post Poll: Confidence in Obama’s Economic Plan Down

Rising doubts about the economic stimulus program, broad concern about the federal deficit and tepid support for President Obama’s health care efforts are softening his popularity – and giving the still-struggling Republicans a glimmer of hope ahead.

Doubts about the stimulus and the deficit are softening Obama’s popularity.

(Getty Images)

While 56 percent of Americans still think Obama’s approach will improve the economy, that’s down sharply from a peak of 72 percent when he took office. With the deficit in mind, six in 10 oppose the additional stimulus spending the administration has mooted. And views of Obama as a “tax-and-spend Democrat” – the perception that dogged Bill Clinton in his early days – have gained 11 points since March.More than Clinton, though, Obama is following the early course charted by Ronald Reagan, the last president to take office in the teeth of a recession. Reagan’s job approval rating fell to 57 percent near his six-month mark; Obama’s is nearly the same, 59 percent in this ABC News/Washington Post poll, down 10 points from his springtime peak. The bigger concern for Obama is what came next: Reagan weakened further as the economy struggled, bottoming out at 48 percent approval after his first year in office and 42 percent at the end of his second year, shortly after unemployment hit 10.8 percent, its highest since the 1940s. It’s 9.5 percent now.

That history explains the urgency with which Obama’s pushing a range of issues, notably health care; until the economy heads up, his popularity is likely to continue down.

One measure of what may lie ahead is a shift toward political neutrality: In this survey the number of Americans identifying themselves as independents, as opposed to either Democrats or Republicans, has tied its record high in ABC/Post polling since 1981.

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ISSUES – Obama remains popular personally and far ahead of the Republicans in trust to handle specific issues, but it’s his own ratings for handling those issues where his challenges show best. Barely over half, 52 percent, now approve of his work on the economy, down 8 points from its peak. Just under half, 49 percent, approve of his handling of health care, also down 8. And fewer, 43 percent, approve of his handling of the deficit, with 49 percent disapproving – only the second issue on which more have disapproved than approved of Obama’s work. (The first was the automaker bailout.)

Intensity is running against the president on these issues as well. For the first time more people “strongly” disapprove of his work on the economy than strongly approve, 35 percent vs. 29 percent. Ditto on health care, 33 percent vs. 25 percent. And on the deficit, strong disapprovers now outnumber strong approvers by 2-1, 38 percent vs. 19 percent.

Another issue illustrates the president’s better possibilities: Despite rising casualties, 62 percent approve of his handling of the situation in Afghanistan, a far less partisan rating than his others, and with intensity running for him rather than against.

Specific to health care, this poll finds majority support for the chief elements of the proposal put forward by House Democrats last week, with 54 percent in favor, 43 percent opposed. But strong support and strong opposition are equal, at about a third each. And that’s without the pushback – concern about the impact on choice and quality of care – that long has been a counterweight to support for reform.

Obama has scheduled a prime-time news conference for Wednesday night, chiefly to address his health care efforts. A risk is that he may come to be seen as focused on other issues to the detriment of the economy.

GOP – The Republicans remain slow to capitalize on Obama’s challenges, but there are glimmers – or at least, a few measures that are less bad for them than they’ve been. For one, approval of the way the Republicans in Congress are handling their job is up 6 points since spring and up 11 points from a year ago, albeit just to 36 percent, with 58 percent disapproving. (The Democrats remain better rated; 47 percent approve. And even today just 46 percent of Republicans approve of their own party’s work in Congress; 79 percent of Democrats, by contrast, approve of their home team.)

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Obama leads the GOP by 23 points in trust to handle the economy, 56-33 percent, essentially unchanged from last month; nonetheless that’s the Republicans’ best number on this question this year, and up 9 points from their low in April. Moreover, while Obama leads by 54-34 percent on health care, the Republican score is up 7 points from last month; and Obama’s 54-35 percent lead on the deficit was 56-30 percent in June.

Basic partisanship fills out the picture. Thirty-three percent of Americans in this survey identify themselves as Democrats, slightly below the recent average and numerically the fewest in ABC/Post polls since September 2007. Just 22 percent identify themselves as Republicans, in line with their recent, extreme lows. Instead 41 percent now say they’re political independents – tying the mark set in January 1996 as the most on record since ABC/Post polling began 28 years ago.

Most of the president’s slippage is among Republicans; their approval of his work overall has dropped by 16 points since April, from 36 percent then to 20 percent now. (That honeymoon, such as it was, is over.) But he’s also lost 9 points among independents since April (to 58 percent approval), while holding about steady among Democrats (93 percent then, 90 percent now).

Obama is well off the top-tier of popularity at six months. In polls since Harry Truman, five presidents have been better-rated at about this point (Truman in the 80s; Eisenhower, Kennedy, Johnson and the first president Bush in the 70s.) Four have been similarly rated as Obama is now – Nixon, Carter, Reagan and George W. Bush; two lower, Ford and Clinton. Six-month marks clearly don’t predict long-term outcomes.

ECONOMY – The economy remains the 800-pound gorilla of national politics. Seventy-seven percent of Americans are worried about the economy’s direction in the next few years and 63 percent are worried about their own family’s finances – each below its peak, but still broadly negative. Moreover very few, 8 percent, say they’ve become better off financially (Reagan’s famous benchmark) under Obama’s presidency; 27 percent say they’re doing worse.

But on what to do about the economy, public, and the president, look to be in a bind. On one hand, as noted, confidence that Obama’s efforts in fact will improve the economy has lost 16 points since he took office. On the other, Americans by 55-40 percent now say it’s more important to avoid bigger deficits than to increase stimulus spending – with deficit priority up 11 points, stimulus priority down 11, since January.

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Indeed the public by 61-35 percent opposes increased stimulus spending beyond the nearly $790 billion already committed – a dramatic turnaround from 70 percent support for the initial stimulus in January. And “strong” supporters then outnumbered strong opponents by more than 2-1; now it’s strong opponents who predominate, 43 percent vs. 18 percent.

In another example of deficit fallout, barely over half, 52 percent, now see Obama as a “new-style Democrat who will be careful with the public’s money,” down from 62 percent in March. Forty-three percent instead see him as “an old-style, tax-and-spend Democrat,” up from 32 percent; his 30-point advantage has shrunk to 9. (Clinton, similarly, went from a 26-point to a 5-point advantage on this question in roughly his first six months.)

It all matters: Among people who say they’re worse off financially, 66 percent disapprove of Obama’s job performance overall, while just 29 percent approve. And among those still confident his efforts will improve the economy, 92 percent approve of his work in office; among those who lack such confidence, 78 percent disapprove.

That’s why, where confidence in his economic efforts goes, the president’s overall approval is very likely to follow. (Reagan’s not the only example – nor the most dire, since he had time to recover. The first President Bush saw his approval rating plummet by 36 points as result of the 1990-91 recession, costing him re-election.)

It’s telling, too, that Obama’s approval rating for handling the economy has declined not only by 12 points from its peak among Republicans and 11 points among independents, but also by 9 points from its peak among Democrats. And on the deficit, he’s lost 12 points from his peak approval among Democrats, as well as 9 points among Republicans and independents.

Confidence that Obama’s efforts will improve the economy, further, has not only lost 26 points among Republicans since January, but also 20 points among independents. Among Democrats that’s down by a milder 7 points.

One better bit for Obama is that he still escapes main blame for the economy’s condition in the first place – albeit a bit less so. Sixty-two percent assign the Bush administration a great deal or good amount of blame “for inadequate regulation of the financial industry,” down 8 points from March. Separately, 32 percent assign blame to the Obama administration “for not doing enough to turn the economy around” – up by 6 points.

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While the president doesn’t currently come in for heavy criticism for his focus on top issues, 29 percent do say he’s placing “too little” priority on the economy and more, 39 percent, say he’s underfocused on the deficit. A quarter say he’s spending too much time on health care, but nearly as many say too little.

ATTRIBUTES – For all the challenges on issues, personal appeal can provide the political cartilage that keeps a president popular – as both Reagan and Clinton demonstrated in their presidencies. That Obama retains in good measure – although, again, to a lessened degree.

Sixty-three percent say he “understands the problems of people like you,” more than ever said so about George W. Bush, albeit down significantly from 73 percent in April. Sixty-two percent say Obama’s brought needed change to Washington – steady from April, but down from the 76 percent who expected him to do so at the start of his term. And 71 percent see him as a strong leader, slightly off its peak, 77 percent, three months ago.

Some of these changes represent the inevitable return to Earth of a president who took office with such high expectations, particularly in comparison to his deeply unpopular predecessor. But others – chiefly, declining confidence in his approach to the economy – hold the portent of difficulties ahead.

METHODOLOGY — This ABC News/Washington Post poll was conducted by telephone July 15-18, 2009, among a random national sample of 1,001adults, including landline and cell-phone-only respondents. Results for the full sample have a 3.5-point error margin; click here for a detailed description of sampling error. Sampling, data collection and tabulation by TNS of Horsham, Pa.

http://abcnews.go.com/images/PollingUnit/1092a1ObamaatSixMonths.pdf

Survey: Americans expect widespread swine flu ahead

About three out of five Americans believe there will be widespread swine flu cases this fall or winter, but most are not worried it will strike them or their family, according to a survey released Thursday.

About half of those people surveyed by the Harvard School of Public Health said if someone in their family did get swine flu, it likely would be a life-threatening condition. And roughly 90% said they would be willing to avoid shopping malls, movie theaters, public transportation and worship services for more than two weeks if health officials told them to.

Many parents were worried about outbreak-caused closures of schools or day care centers, with 43% saying they would lose pay or have money problems if they had to stay home a week or more because they were sick or had to care for someone.

About 25% said they probably would lose their job or business, which was especially concerning to black and Hispanic parents. More than 40% in those racial groups feared losing a job or business, compared with 14% of whites.

The telephone survey of more than 1,800 U.S. adults was done in late June. It had a margin of error of plus or minus 2.8 percentage points for the major findings.

The 60% of people who said they were not worried they will get sick from the new flu echoed what was found in a similar survey in May.

Harvard receives funding from the Centers for Disease Control and Prevention to do surveys on public health concerns, but CDC does not dictate how the surveys are designed.

The number of confirmed and probable U.S. swine flu cases has surpassed 37,000 and deaths have risen to 211, according to the most recent numbers from the CDC. But only a fraction of cases are reported, and health officials think more than 1 million Americans have been infected.

The pandemic was first identified in California in April. Since then more than 94,000 cases have been reported in more than 100 countries, according to the World Health Organization.

Scientists are investigating this flu strain and how it is different from seasonal flu, but government officials are concerned it may mutate into a more dangerous form and have been preparing for the possibility of a new wave of illnesses in the fall or winter.

In the survey, most people said they had not seen swine flu cases in their communities, but were taking seriously the predictions of experts. “They’re convinced by what they’ve heard that cases are going to be very serious,” said Robert Blendon, the Harvard researcher who led the polling.

Despite critics, Obama stays course on health care

President Barack Obama is using a touch-all-bases approach to try push through his health care overhaul, a struggle that might demand deep concessions.

He’s summoned Republicans and Democrats to the White House. He’s used public forums to bypass Congress and make a direct pitch to the people. He’s turned to his political operation to air campaign-like TV ads.

But it hasn’t squelched congressional concerns about the high cost of extending insurance coverage to millions of Americans.

So the president soon must decide how hard to press contentious cost-saving plans such as limiting Medicare reimbursements. Obama also must choose, at some point, whether to make concessions on his top domestic priority that could attract a few Senate Republican votes — and anger liberal supporters. The alternative is a bare-knuckled parliamentary tactic that would inflame partisan tensions and probably kill some of the items he wants in the legislation.

In a week that presented plenty of good and bad news for Obama, the White House took a stay-the-course approach. The president promoted his proposals daily. There was a last-minute White House statement Friday and a health-focused radio and Internet address Saturday.

In public at least, Obama has embraced a general message and left the specifics to Congress. He hasn’t backed away from major parts of the plan or the fast-approaching deadline he has sought for weeks, despite requests from various Democrats to do so.

That was true even when the nonpartisan Congressional Budget Office stunned Obama’s supporters by saying the bills moving through Congress would add to the nation’s long-term health care costs rather than reduce them.

Critics reveled in the news.

Several Democrats said they could not support the bills without significant changes. Their threats could doom the legislation because GOP lawmakers are nearly unanimous in their opposition.

For the most part, Obama exuded optimism and emphasized the week’s positive developments. “Those who are betting against this happening this year are badly mistaken,” he said Friday.

Two House committees and one Senate committee endorsed bills containing many of Obama’s priorities: subsidizing insurance for the poor, limiting insurers’ ability to deny coverage, providing a government-run option for insurance. Major groups representing doctors and nurses became the latest to endorse the efforts.

Still, some of Obama’s tactics left people scratching their heads.

On Wednesday he invited four Republican senators to the White House to discuss health care. Three — Sens. Saxby Chambliss of Georgia, Bob Corker of Tennessee and Lisa Murkowski of Alaska — are seen by colleagues as highly unlikely to vote for an Obama-backed plan.

The fourth, Sen. Susan Collins of Maine, is a moderate Republican viewed as a possible supporter, even though she has demanded changes in the Democratic-drafted bills.

Even those who accepted White House invitations said it’s hard to imagine that Obama thinks such chats with conservatives will win him any votes.

“I think he’s just trying to get a sense as to what the prognosis might be in the Senate,” Murkowski said in an interview.

As for Obama’s push to get the House and Senate to pass separate bills by August, she said, “I just don’t see how it comes together.”

Murkowski said the White House is sending a “mixed message” by coupling its GOP outreach with thinly veiled threats to use strong-arm tactics to ram home a health care bill if Republicans insist on too many changes.

Obama adviser David Axelrod is walking that line.

“We want to work with everyone who will work with us, and we want to do it in the spirit of bipartisanship,” he said in an interview Thursday. But, he added, “We can’t defer reform and we want to move forward. Those who don’t, they need to address those Americans struggling with higher premiums and losing their insurance.”

Senate Democrats could resort to a parliamentary procedure, known as “reconciliation,” that essentially would bar Republicans from using stalling tactics to block a health care bill. But Senate rules would allow opponents to knock some nonbudgetary items from the bill. Those might include the “public option” for insurance, which is dear to many liberals.

“It’s obviously better to have it bipartisan,” said John Podesta, who headed Obama’s transition team and advises on health care. “But there is a considerable amount that could be done, and will be done, with reconciliation” if Republicans don’t come on board, he said.

With high cost projections posing the greatest political threat to Obama’s plans, the White House gently promoted two ideas last week that would give the executive branch greater control over medical costs.

One would allow a panel of medical experts to endorse certain treatments that would be eligible for federal payments under Medicare and Medicaid. The second would empower a different board to set Medicare reimbursement rates, which now vary considerably from state to state. Congress could vote to reject the rates, but the plan would substantially reduce lawmakers’ direct role in the politically tinged process of running Medicare.

Outside Washington, people are seeing dueling TV ads from groups favoring and opposing Obama’s health care proposals.

Families USA and a major pharmaceutical group are airing ads supporting the president’s agenda on three major national cable networks.

Organizing for America, the Democratic Party organization that is closely tied to Obama, is running a nationwide campaign that includes thousands of house parties and other grass-roots activities. It is airing ads in Arkansas, Indiana, Florida, Louisiana, Maine, North Dakota, Nebraska and Ohio to get senators to back the health care effort.

On the other side, a coalition of health insurance groups is readying TV ads opposing a public option for insurance. Other groups are airing ads suggesting that Obama would push the United States into a Canada-like system that would require long waits for important medical treatments.

Obama to Congress: Don’t lose heart on health care

President Barack Obama, worried about growing resistance to his health care plan, exhorted Congress not to “lose heart” Friday and urged deeper cost cuts to calm concern over the huge expense of covering millions of uninsured Americans.

“What we want to do is force the Congress to make sure that they are acting” on recommendations to hold down Medicare and Medicaid spending, the president said, rather than allowing reports to sit unused on a shelf.

Aiming to rally lawmakers, he spoke from the White House near the end of a week of tumult for the legislation atop his domestic agenda.

“Now, I realize that the last few miles of any race are the hardest to run, but I have to say now is not the time to slow down, and now is certainly not the time to lose heart,” he declared.

A few hours earlier, two House committees approved their portions of the sweeping health care bill over Republican objections.

That left one more panel to act, but conservative Democrats were rebelling, demanding additional measures to hold down skyrocketing costs.

Given the complexities, as well as fresh calls for delay in the Senate, House Speaker Nancy Pelosi, D-Calif., opened the door to pushing off a vote past the early August timeline she and Obama laid out weeks ago.

Whatever the difficulties, she predicted legislation would pass that will transform the nation’s health care system, extending coverage to millions who lack it while slowing the growth in costs generally. “It is really historic. It’s transformation. It’s momentous,” she told reporters at a news conference.

If anything, Obama tried to project even more confidence.

Ticking off a list of accomplishments to date, he said, “We are going to get this done. We will reform health care. it will happen this year. I’m absolutely convinced of that.”

Without the overhaul, he said, “no one’s health insurance is going to be secure, because you’re going to continue to see premiums going up at astronomical rates.”

Obama’s call for additional steps to hold down costs came one day after the head of the Congressional Budget Office told Congress the legislation taking shape so far would fail to accomplish that.

Those remarks by Douglas Elmendorf produced fresh criticism from Republicans, and gave pause to Democrats, as well.

In letters to Pelosi as well as key committee chairman, administration budget director Peter Orszag called for additional steps to ensure the bill “rewards quality, restrains unnecessary costs and provides better care to more Americans.”

Legislation is already pending in the Senate to reduce the control individual lawmakers and Congress as a whole have over setting the rates doctors and other providers are paid under Medicare. In his letter, Orszag forwarded an alternative proposal that he said would accomplish the same goal.

“We’re very proud of the savings (already in the legislation)” Pelosi told reporters, although she added, “Of course, we want more.”

Under current law, a Medicare Payment Advisory Commission makes recommendations to lawmakers annually on the rates Medicare pays doctors and other health care providers. Lawmakers are not obliged to follow them, or even vote on them.

Obama recommended changing that, requiring lawmakers to vote on the recommendations and proposing they take effect unless rejected by the House and Senate.

In a statement released after Obama spoke, Senate Majority Leader Harry Reid said lawmakers “now stand on the doorstep” of enacting legislation.

For her part, Pelosi signaled that she, too, was open to additional cost-cutting provisions and suggested they may be incorporated into the bill next week by the House Energy and Commerce Committee.

Any legislation that emerges from Congress is expected to require insurance companies to issue policies to anyone who seeks coverage, without turning them down or charging higher premiums on the basis of pre-existing medical conditions.

To spread insurance more widely, both the House bill and companion proposals in the Senate would rely on hundreds of billions of dollars in federal subsidies to assist lower income families. The House bill also calls for the government to sell insurance in competition with private industry, a provision that Republicans in particular oppose strongly.

While Pelosi has long said the House will vote on legislation by the time lawmakers leave on vacation at the end of July, she hedged for the first time at the news conference.

“We have to see what the Senate will do,” she said, before suggesting that changing the bill to produce more savings might require additional time.

For now, she emphasized, “we are on our schedule to bring up legislation before the break and we continue to be on that schedule.”

She spoke not long after six senators, three Democrats, one independent and two Republicans, announced their opposition to “timelines which prevent us from achieving the best result.”

“We believe that taking additional time to achieve a bipartisan result is critical,” they said in a letter to the Senate leaders of both parties.

The letter was signed by Democratic Sens. Ben Nelson of Nebraska, Ron Wyden of Oregon and Mary Landrieu of Louisiana, as well as Maine Republican Sens. Susan Collins and Olympia Snowe and independent Sen. Joe Lieberman of Connecticut.

Snowe has been deeply involved in talks in recent days aimed at drafting bipartisan legislation.

Those talks have been led by Sen. Max Baucus, D-Mont., the chairman of the Senate Finance Committee, but they recessed on Thursday for the weekend without any indication that an agreement is at hand.

Reid, like Pelosi, has said he wants legislation on the Senate floor before lawmakers go home for the summer.

Hate Crimes Passes, Faces Veto

The Senate voted 63-28 Thursday night to end discussion on the Matthew Shepard Hate Crimes Prevention Act, which was subsequently adopted by unanimous consent as an amendment to the Department of Defense authorization bill.

“The Senate made a strong statement this evening that hate crimes have no place in America,” said Democratic Senate Majority Leader Harry Reid. “This is a victory for all Americans – particularly those like Judy Shepard who has endured what no mother should ever have to.”

Though the amendment garnered three votes more than necessary to reach cloture, the fate of the hate crimes measure is now partially linked to $1.75 billion in funding for F-22 fighter jets that is also included in the DOD legislation.

President Barack Obama and Secretary of Defense Robert Gates both oppose the F-22 program and a White House spokesperson said the president will not sign a DOD bill that continues to fund the program.

“The President has long supported the hate crimes bill and gave his personal commitment to Judy Shepard that we will enact an inclusive bill,” said Shin Inouye, referring to Shepard’s Oval Office visit with the president earlier this year. “Unfortunately, the President will have to veto the Defense Authorization bill if it includes wasteful spending for additional F-22s. The collective judgment of the Service Chiefs and Secretaries of the military departments is that the current program is sufficient to meet operational requirements. A Presidential veto would not indicate any change in President Obama’s commitment to seeing the hate crimes bill enacted.”

Senators Carl Levin and John McCain have offered a bi-partisan amendment to remove the F-22 funding that is scheduled for a vote Monday, but insiders say the count is unclear.

If the amendment fails and President Obama vetoes the bill, it will be sent back to the Senate for a rewrite. A Democratic Senate aide said Senator Reid was optimistic, nonetheless, that hate crimes would ultimately make the final version of DOD authorization.

“This was a good vote,” said the aide. “Senator Reid is hopeful that we can keep this language in the final bill.”

David Smith, vice president of the Human Rights Campaign, also indicated that hate crimes stood a good chance of being signed into law despite the F-22 snag.

“We are very confident that the Matthew Shepard Hate Crimes Prevention Act is going to get to the president’s desk,” Smith said. “There might be some bumps along the way but it will eventually get there.”

The hate-crimes measure would broaden a federal statute that already protects citizens against bias crimes based on their race, color, national origin, or religion to include crimes committed against citizens for their actual or perceived gender, gender identity, sexual orientation, or disability. It would also allow the federal government to provide assistance to local law authorities investigating a bias crime and to step in where local authorities are themselves unable or unwilling to prosecute a hate crime.

Signs of Alzheimer’s Seen Earlier Than Thought

Giving scientists insight into the origins of a devastating illness, new research suggests that people with a genetic propensity to develop Alzheimer’s disease start experiencing memory loss as early as their 50s.

Unfortunately, scientists don’t know of any way to prevent Alzheimer’s. But an accompanying study finds that nearly everyone told of their high genetic risk of the disease was glad that they had been informed.

“In a small group, we didn’t find a lot of harm done,” said study author Dr. Robert Green, an Alzheimer’s specialist. Even those who were told they have a 72 percent risk of developing the disease didn’t tend to be devastated by the news, Green said.

Alzheimer’s disease affects an estimated 5.3 million Americans, and the numbers are expected to grow as the population ages. There’s no cure, although some treatments may reduce the severity of symptoms.

Scientists have known for some time that a genetic variation greatly boosts the risk of the disease, but it’s still not clear how early the illness begins.

In one of the new studies, researchers looked at the genetic profiles of 815 volunteers aged 21 to 97.

Of those, 498 were at a normal genetic risk of developing Alzheimer’s and 317 were at higher risk because of variations in a gene known as APOE. Of those in the latter group, 79 were at especially high risk.

The researchers gave cognitive tests to the volunteers over several years to see if there were any differences between the groups. The results appear in the July 16 issue of the New England Journal of Medicine.

The researchers found that those at higher risk of Alzheimer’s began to score worse on the tests beginning in their mid-50s.

“Normally, your scores improve,” explained study author Dr. Richard Caselli. “We saw that there was some improvement early on in their 40s and early 50s, but that beginning in their mid-50s we started to see changes. They weren’t improving, but were beginning to decline over time.”

Those at the highest risk were most likely to suffer a decline.

Brain scans have suggested that people doomed to get Alzheimer’s begin to show signs of physical problems around age 60, said Caselli, clinical core director at the Arizona Alzheimer’s Disease Center and chair of neurology at the Mayo Clinic.

“Until now, nobody has been able to show that there’s actual cognitive changes that accompany this,” Caselli said.

Still, the mental changes are small and may not even be noticeable. “These are normal, healthy working people,” he said.

In the other study, researchers assigned 162 adults with a parent who had Alzheimer’s to either receive or not receive information about their own genetic risk of the disease.

Contrary to some assumptions, those who learned about their risk understood the information they were given and were glad that they had been informed, said Green, co-director of the Alzheimer’s Disease Clinical & Research Program at Boston University.

“Some people are information-seekers, and they just feel better and more complete when they have more information,” Green said.

Alzheimer’s: What you need to know

In the next few decades the number of Alzheimer’s cases will virtually explode, putting a huge strain on the health care system and American families, experts say. Alzheimer’s disease is estimated to affect as many as 5.2 million Americans now — as many as 16 million by 2050.

Alzheimer’s disease is not a normal part of aging. Scientists say a protein called beta amyloid is responsible for most of the damage to the brain and the symptoms of the disease.

RISE IN ‘EARLY ONSET’ CASES

People younger than age 55 do get dementia, but most of “early onset” cases occur from age 55 to 64. In 2000, there were 24 million boomers 55 to 64 and 2% of them, or almost 500,000, had Alzheimer’s or some other cognitive impairment. By 2030 an estimated 746,100 people 55 to 64 will have Alzheimer’s or some other dementia.

NORMAL LAPSES VS. WARNING SIGNS

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Early Alzheimer’s can manifest itself in different ways, says Darby Morhardt of Northwestern University’s Alzheimer’s Disease Center in Chicago. Though everyone occasionally blanks, some lapses are more cause for concern.

What’s normal	What’s not
Forgetting names and appointments now and then	Forgetting recently learned material
Sometimes forgetting why you came into a room or what you planned to say	Problems staying organized day to day, losing track of steps in making a call or playing a game
Sometimes grasping for the right word	Forgetting simple words more often
Misplacing keys and wallets	Putting things in unusual places, like a watch in the sugar bowl
Trouble balancing a checkbook at times	Paying bills twice or not at all

Sources: Alzheimer’s Association; Darby Morhardt, Northwestern University

PREVENTION

The Alzheimer’s Association and the Centers for Disease Control and Prevention say all adults can take steps to improve or maintain cognition:

• Follow a low-fat diet rich in fruits and vegetables.

• Get out and move most days of the week.

• Play games, do crosswords or take a class.

• Reduce high blood pressure or high cholesterol.

• Adopt an optimistic approach to life.