Remember Harry and Louise? You know, that fictional couple featured in devastatingly effective insurance industry ads that spelled the end for Bill and Hillary Clinton style health care reform in the 1990s.

They’re baaaack.

This time Harry and Louise will star in ads slated to run during the Democratic and Republican presidential nominating conventions. They’re coming to us this time courtesy of what’s described as a broad stakeholder’s coalition, of groups such as the American Cancer Society, the American Hospital Association, the Catholic Health Association, Families USA.

But Harry and Louise have had a change of heart.

Last time they were out to bury reform (at least the Clinton plan). This time they’re promoting it. Their message? No matter who becomes the next president, health care reform should be at the top of the domestic agenda.

The time’s they are a’changing.

With the whole state budget headed for a crash diet in next week's legislative session, health care for the poor has once again landed on the table.

Paterson’s proposed cuts would slice the growth in Medicaid spending by more than $500 million for the rest of this fiscal year, followed by about $1 billion in 2009-2010. The proposal would target funding for hospitals, nursing homes and medications, as well as public programs like Family Health Plus.

No one would deny that Medicaid costs a lot; the state spends more per person on Medicaid than many other states, and the governor estimates that spending increases will account for about one quarter of the budget shortfall for the 2009-10 fiscal year. But critics argue that there are better ways for Albany to save money than scrimping on health care for low-income people.

There's a fine line between taking an interest in people's safety and making money from tragedy. This summer, the tally of people drowned off Long Island and city beaches -- along with a high number of pool deaths -- has prompted swim instructors to post on Craigslist and send advertisements by e-mail.

"Don't you think it's time to finally learn how to swim this summer?" asks a Craigslist poster named Jen on the Long Island "childcare" page. This post went up Aug. 4, after a particularly bad weekend during which seven people drowned in the ocean.

One company, Saf-T-Swim, sent helpful information to subscribers about rip tides, which were a concern in Long Beach. One e-mail blast carried the subject line, "Long Island Drownings." The content was all very tasteful, but the subtext was unmistakable: If you don't know how to swim, you should stop by for lessons.

One of the Long Island pool drownings involved a nanny who jumped in to save the 3-year-old in her charge. Should she really have been working in a home with a backyard pool if she couldn't swim?

What do you think? Is it irresponsible, somehow, to never learn to swim? Are parents obliged to see that their children -- and the caregivers watching them -- have the basic skills?

In the 1980s, AIDS exploded as a national issue, as people recognized that the crisis loomed larger, and closer to home, than we originally thought--not just relegated to "fringe" segments of society. Today, it seems, medical science and greater awareness have helped overcome the worst of the epidemic in the United States, while the government turns its attention to fighting the disease in other countries.

The Bush administration recently signed into law an unprecedented investment in the global effort to address HIV/AIDS: the President’s Emergency Plan for AIDS Relief provides $48 billion toward worldwide treatment and prevention programs for AIDS, tuberculosis and malaria.

But while the President's initiative was lauded as a major step against AIDS on a global scale, other news raises questions about how far we are from stemming the epidemic at home.

Last week's news had two stories of man succumbing to nature in a public space: three people drowning in the ocean off Long Beach, and two men struck by lightning in Cantiague Park in Hicksville. The lightning victims were standing under a tree for protection during a rainstorm. The swimmers were out after the lifeguards had left for the day.

All might well have known better. You swim at your own risk when the lifeguard’s gone: How many signs are posted on beaches saying precisely that? You’re in much greater danger of being hit by lightning if you’re under a tree. That's drilled into children way before they've ever heard of Benjamin Franklin and his kite.

Memory loss is touching a growing number of minds. Researchers revealed yesterday that more people are slipping toward dementia associated with aging than previously estimated, and medical science is just starting to grapple with treatment options for this emerging disorder.

Researchers with the Mayo Clinic reported that mild memory impairment will hit nearly one million Americans each year. Men were more likely than women to develop the "pre-dementia" condition, which involves a significant erosion of memory abilities, though not as severe as Alzheimer's. Meanwhile, an additional half a million will develop full-blown Alzheimer’s and related dementia disorders.

As comprehensive treatment for the crisis may be far off, the influx in people with memory impairment means communities will have to find more immediate ways to accommodate them--and appreciate their presence. Newsday’s recent op-ed feature explored the experiences of people dealing with memory loss as they work to maintain vital social connections.

The Bush-era Environmental Protection Agency has often been deeply disappointing. But the EPA is taking a smart step to protect our food and our farm workers.

In 2006, the EPA said it would cancel registration of the pesticide carbofuran, because it has nasty effects on people and is lethal to birds. But the manufacturer went to court to block that cancellation. Now, the agency proposes to revoke regulations that allow residues of this pesticide in food. This revocation will pretty much mean that carbofuran won't be able to be sold in the domestic market.

This pesticide is extremely deadly to birds. The American Bird Conservancy estimates that it has killed millions of wild birds since it first entered the market in 1967. It's also not so healthy for the farm workers who have to apply it and those who buy food or drink water contaminated with carbofuran residue.

On other occasions, we've criticized the EPA for not doing what it should. So it's our pleasant duty to tip our hat to the agency now for doing the right thing.

Faced with runaway medical spending and tightening resources, communities across the country are finding themselves with no choice but to get back to basics: investing in primary care and front-end measures to stop costly problems before they start.

In some states, insurers and government funders are experimenting with cost-cutting schemes that invest in frontline primary care services, which traditionally pay less than downstream specialty care. The programs focus on giving physicians extra funding to boost frontline care and creating a "medical home" for families to maintain good health, rather than just treat sickness.

On Long Island, the concept is inspiring Nassau Healthcare Corporation's nascent NuCare program--a system of care that gives sustained support to underinsured and uninsured people, treating them like long-term rather than one-time patients.

Albany has begun to respond, with a plan to shift Medicaid funding from inpatient care to cheaper, less intensive preventative and primary care services. The state budget also seeded a program to offer tuition reimbursement for doctors who commit to providing primary care in underserved areas for several years.

The debate over a controversial form of autism treatment reveals just how little is known about the developmental disorder's origins--as well as the political and scientific complexities of exploring possible solutions.

Earlier this week, an Associated Press story by Carla Johnson titled “Fringe autism treatment could get federal study", questioned a new form of therapy for autistic children known as chelation. Some parents and health authorities are advocating for a study to test the effectiveness and safety of the treatment, which involves removing metals from the body.

Critics believe chelation is unproven and too risky, citing the death of one child following chelation therapy in 2005 and a general lack of scientific research on potential health hazards. Describing the opposition's perspective, the AP article uses the term “voodoo medicine” and refers to parents pushing for the study as “desperate.”

The piece touches on a widespread but hotly debated belief among many affected families—that autism is caused by a mercury-based ingredient in some vaccines known as thimerosal.

So far, scientific research has not yielded clear proof of an autism-vaccine link, and the government has rejected the arguments of many autism parents-turned-advocates. But with autism-spectrum disorders affecting about one of every 150 children, families keep struggling for answers.

With those odds, is chelation worth the risk?

Barbara Fischkin, a former Newsday journalist whose 20 year-old son has autism, sent us a letter voicing her frustration with the AP article. Her son is receiving a form of chelation treatment on Long Island, she says, and is showing some signs of improvement. On a personal level:

“These kinds of treatments come from the same scientists and doctors who dare to look outside the box in an attempt to do something about an epidemic that now affects more than one in 150 children. If we call what they are doing 'voodoo' or 'fringe'—instead of progressive—our kids will never get better.”

The showdown between private insurance providers and physicians in Washington centers on payments to doctors. But as today's editorial points out, the proposed Medicare legislation is more about leveling costs between special private plans and their traditional Medicare cousins.

According to the Center on Budget and Policy Priorities, a liberal think tank, special breaks offered by current Medicare policies have spurred the aggressive expansion of "private fee-for-service" plans under Medicare Advantage, and "slowing their rapid growth would achieve savings [cost offsets] for Medicare while improving beneficiary access to health care providers."

If you bristle at the idea of regulating the private sector, new findings from the Government Accountability Office are telling. A recent audit indicates that although Medicare Advantage was originally sold as a way to rein in medical costs, it has generally increased spending--perhaps not the soundest way to salve a growing healthcare crisis.

So the stage is set for another lobbying war between physicians and insurance companies, both of whom are worried about getting paid for what they give consumers. But where does that leave patients--and future generations of patients, for that matter?

Whatever the armed forces are doing to screen service members for signs of post-traumatic stress disorder, it's not enough.

So we like new legislation sponsored by Sen. Charles Fuschillo (R-Merrick), which provides funding to train the state's mental health workers to recognize PTSD and traumatic brain injury (TBI). It's a major step on the way to making sure these life-changing afflictions get treated adequately. The bill passed both the Senate and the Assembly and is awaiting Gov. David Paterson's signature.

By all accounts, the sheer numbers of young men and women coming back from Iraq and Afghanistan suffering suffering from PTSD is frightening. Fuschillo cites a Rand Corporation study finding that the percentage of service members suffering from major depression or PTSD is one in five, and a report from The Journal of the American Medical Association that PTSD rates are nearly 25 percent among National Guard and Reserve troops serving in Iraq.

The money for the first year of this three-year training program, $250,000, is already in the current budget. It's a small amount of money that can do a lot of good.

As the uninsured population expands, some policymakers are seeking to rollback health care coverage for immigrants, both documented and undocumented--revealing how new Americans are triaged at the bottom of the country’s health care crisis.

Low-income non-citizens (including both undocumented and green-card holder immigrants, refugees and other categories of the foreign-born) are more likely than their citizen counterparts to lack insurance and be without a consistent health care provider, according to the Kaiser Family Foundation, an independent public health research organization.

But as immigrant households play an increasingly vital role in their communities, some states have provided documented immigrants with health care as a social investment. Health coverage for immigrants in New York spans the gamut from basic emergency care for the undocumented, to more comprehensive coverage for legal residents and special coverage for immigrant children and pregnant women through the State Children's Health Insurance Program.

Elsewhere, however, some state officials have sought to rein in health care spending by rolling back benefits for immigrants.

Post-Traumatic Stress Disorder is different things to different people: for some sufferers, it may be relentless anger, for others, unshakeable anxiety. And for some, PTSD is an emotional deep-freeze, creating a wrenching disconnect from friends and family. In Albany in 2006, however, PTSD was a legislative pawn lost in the political horse-trade, as the insurance industry lobby bucked against New York’s landmark mental health parity bill.

As we noted in today’s editorial, full coverage for PTSD was removed from Timothy’s Law as a legislative trade-off to get the bill passed. So unlike other states with similar laws, New York mandates comprehensive insurance coverage for other mental disorders, like major depression and schizophrenia, but not PTSD specifically. Now, according to recent research, the mental-health needs of soldiers returning from the Iraq and Afghanistan wars could drastically drive up the social costs of the PTSD compromise.

The meat we eat could kill us — but not in the way you may think. It’s not the fat and cholesterol. It’s the antibiotics.

The antibiotics we rely on to combat infections in humans are fed to healthy livestock, not to treat illnesses but so they will grow faster and be able to withstand crowded, unhygienic conditions. So, what’s wrong with that?

Antibiotic resistant infections.

Bacteria, exposed to but not killed by the antibiotics, develop resistance to the drugs. When those bacteria are transferred to humans via food, air or water, the illnesses they cause can’t be treated effectively.

“Antibiotics that once had the power to cure dangerous infections are now often useless, because microbes have become resistant to all but the newest and most expensive drugs — and some ‘superbugs’ are impervious to any weapons in the medical arsenal,” according to Sens. Edward Kennedy (D-Mass) and Olympia Snowe (R-Maine). They’re sponsors of The Preservation of Antibiotics for Medical Treatment Act, which would phase out within two years the use of antibiotics such as penicillin in animal feed.

Is this concern hysterical? Not according to the World Health Organization, which estimated that 14,000 Americans die every year from drug-resistant infections. That’s one death every 38 minutes.

Just in case overweight folks don’t already get enough grief, now researchers are blaming them for an outsized contribution to global warming! Here’s the logic, as presented in the British medical journal, The Lancet by Phil Edwards and Ian Roberts.

Motor transport is 95 percent oil dependent and is also a critical component in growing and moving food around the planet. So demand for food pushes up fuel prices — and the demand for fuel pushes up food prices.

Compounding the problem, overweight people walk less and drive more, which contributes to obesity, which increases the global demand for food, since the obese population consumes about 18 percent more than an equivalent number of the more svelt among us.

To sum up: People who are overweight drive up demand for food and fuel, both of which result in increased greenhouse gas emissions, which speeds global warming.

Makes me want a donut.

I’m not quite sure what to make of the news from Medco Health Solutions Inc. that for the first time ever, more than half of insured Americans are regularly taking one or more prescription drugs.

Are we living longer because we take drugs? Or do we take drugs because we live longer?

Are we healthier thanks to the support of modern pharmaceuticals? Or are we less healthy thanks to the crutch of modern pharmaceuticals? (i.e., Don’t worry about what you eat, what you weigh or how little you exercise. Take a pill.)

Is all this drug taking driven by the availability of better medicines? Or is it driven by better, more pervasive advertising?

High blood pressure and high cholesterol top the list of chronic conditions treated. But depression makes the cut, too. “This data does paint a pretty unhealthy picture of America,” said Dr. Robert Epstein, Medco’s chief medical officer. “But there’s a silver lining; it does show that people are receiving treatment which could prevent more serious health problems down the road.”

Apparently I’m not the only one who’s ambivalent about all this better living through chemistry stuff.