Joyce Frieden

WASHINGTON — Anyone who asks Rep. Dennis Kucinich (D-Ohio) about health care policy should be prepared for the conversation to evolve into other areas—like the Iraq war.

"Health care spending does not occur in a vacuum," Rep. Kucinich said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. "You cannot separate this from war."

Rep. Kucinich, who is seeking the Democratic nomination for president, noted that the amount spent on the war in Iraq is estimated to be $1.5 trillion, according to a report he cited from the Congressional Budget Office. This is money not being spent on education and health care, he said at the forum, part of a series of forums with the presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

Although he sometimes connects health care policy with other topics, the fifth-term congressman and former Cleveland mayor is very direct when it comes to universal health care coverage for Americans: He is the only candidate who supports a single-payer system financed by the government. "Is health care a right or a privilege? If it's a right, then it's appropriate for the government to have a role" in providing it, he said. "If it's a privilege, and it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck. And you know what—47 million [uninsured] Americans are now out of luck."

He noted that studies show health care debt is responsible for half of bankruptcies in the United States. "The median income is $48,000 per year, and some families are paying $12,000 a year for health insurance; that's a quarter of their gross. I'm talking about breaking the shackles insurance companies have on American families."

Under Rep. Kucinich's proposal, which has been introduced in Congress as H.R. 676, all for-profit health care entities would be converted to nonprofit entities, with shareholders being compensated by the government. That compensation would be financed through treasury bonds, he said. Physicians would continue to have private practices, but they, along with hospitals and other providers, would be paid by the federal government, which would disseminate federal funds through a series of regional budgets. There would also be separate budgets for capital expenditures and for medical education. Coverage under Rep. Kucinich's plan would include inpatient and outpatient services as well as dental care, vision care, mental health care, and long-term care. There would be no deductibles or cost sharing.

When a reporter pointed out that other countries with government-financed health care ended up seeing a private system develop alongside the public one for those who could afford it, Rep. Kucinich said that was no surprise. "Privatizers are at work in every country," he said. "If health care is such a losing proposition, why are these companies trying to privatize it? Because there's huge amounts of money to be made."

Another government-run system that people are trying to privatize is Medicare, Rep. Kucinich said. "Right now, Medicare is discouraging doctors by cutting their fees. There's a strategy to privatize Medicare by getting doctors to walk away from [it]." The passage of the Medicare prescription drug benefit was another part of that plan, he added.

A for-profit system puts the wrong pressure on physicians, Rep. Kucinich said in an interview after the forum. "Doctors are under pressure from private insurance not to provide health care," he said. And when that collides with efforts such as Medicare's pay-for-performance initiative, "there's built-in inertia. Of course we want to encourage doctors to improve their performance, but under a for-profit system, doctors have cost pressures."

During the forum, Rep. Kucinich contrasted his proposal with those offered by two other Democratic presidential candidates, Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.). Under their proposals, Americans would be required to purchase health insurance; they could choose from a variety of private health care plans as well as a public plan modeled after Medicare. "If you can't afford it under the current system, how are you going to afford it under [their] system?" he said.

"And if you do buy it, you're forced into plans that inevitably are going to have extraordinary copays and deductibles, and a limited level of coverage," he continued. "I'm talking about a plan where everyone's covered, [and it] covers everything. And the fact is, we're already paying for it—we're just not getting it."

If 'it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck.' REP. KUCINICH

WASHINGTON — Anyone who asks Rep. Dennis Kucinich (D-Ohio) about health care policy should be prepared for the conversation to evolve into other areas—like the Iraq war.

"Health care spending does not occur in a vacuum," Rep. Kucinich said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. "You cannot separate this from war."

Rep. Kucinich, who is seeking the Democratic nomination for president, noted that the amount spent on the war in Iraq is estimated to be $1.5 trillion, according to a report he cited from the Congressional Budget Office. This is money not being spent on education and health care, he said at the forum, part of a series of forums with the presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

Although he sometimes connects health care policy with other topics, the fifth-term congressman and former Cleveland mayor is very direct when it comes to universal health care coverage for Americans: He is the only candidate who supports a single-payer system financed by the government. "Is health care a right or a privilege? If it's a right, then it's appropriate for the government to have a role" in providing it, he said. "If it's a privilege, and it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck. And you know what—47 million [uninsured] Americans are now out of luck."

He noted that studies show health care debt is responsible for half of bankruptcies in the United States. "The median income is $48,000 per year, and some families are paying $12,000 a year for health insurance; that's a quarter of their gross. I'm talking about breaking the shackles insurance companies have on American families."

Under Rep. Kucinich's proposal, which has been introduced in Congress as H.R. 676, all for-profit health care entities would be converted to nonprofit entities, with shareholders being compensated by the government. That compensation would be financed through treasury bonds, he said. Physicians would continue to have private practices, but they, along with hospitals and other providers, would be paid by the federal government, which would disseminate federal funds through a series of regional budgets. There would also be separate budgets for capital expenditures and for medical education. Coverage under Rep. Kucinich's plan would include inpatient and outpatient services as well as dental care, vision care, mental health care, and long-term care. There would be no deductibles or cost sharing.

When a reporter pointed out that other countries with government-financed health care ended up seeing a private system develop alongside the public one for those who could afford it, Rep. Kucinich said that was no surprise. "Privatizers are at work in every country," he said. "If health care is such a losing proposition, why are these companies trying to privatize it? Because there's huge amounts of money to be made."

Another government-run system that people are trying to privatize is Medicare, Rep. Kucinich said. "Right now, Medicare is discouraging doctors by cutting their fees. There's a strategy to privatize Medicare by getting doctors to walk away from [it]." The passage of the Medicare prescription drug benefit was another part of that plan, he added.

A for-profit system puts the wrong pressure on physicians, Rep. Kucinich said in an interview after the forum. "Doctors are under pressure from private insurance not to provide health care," he said. And when that collides with efforts such as Medicare's pay-for-performance initiative, "there's built-in inertia. Of course we want to encourage doctors to improve their performance, but under a for-profit system, doctors have cost pressures."

During the forum, Rep. Kucinich contrasted his proposal with those offered by two other Democratic presidential candidates, Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.). Under their proposals, Americans would be required to purchase health insurance; they could choose from a variety of private health care plans as well as a public plan modeled after Medicare. "If you can't afford it under the current system, how are you going to afford it under [their] system?" he said.

"And if you do buy it, you're forced into plans that inevitably are going to have extraordinary copays and deductibles, and a limited level of coverage," he continued. "I'm talking about a plan where everyone's covered, [and it] covers everything. And the fact is, we're already paying for it—we're just not getting it."

If 'it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck.' REP. KUCINICH

WASHINGTON — Anyone who asks Rep. Dennis Kucinich (D-Ohio) about health care policy should be prepared for the conversation to evolve into other areas—like the Iraq war.

"Health care spending does not occur in a vacuum," Rep. Kucinich said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. "You cannot separate this from war."

Rep. Kucinich, who is seeking the Democratic nomination for president, noted that the amount spent on the war in Iraq is estimated to be $1.5 trillion, according to a report he cited from the Congressional Budget Office. This is money not being spent on education and health care, he said at the forum, part of a series of forums with the presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

Although he sometimes connects health care policy with other topics, the fifth-term congressman and former Cleveland mayor is very direct when it comes to universal health care coverage for Americans: He is the only candidate who supports a single-payer system financed by the government. "Is health care a right or a privilege? If it's a right, then it's appropriate for the government to have a role" in providing it, he said. "If it's a privilege, and it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck. And you know what—47 million [uninsured] Americans are now out of luck."

He noted that studies show health care debt is responsible for half of bankruptcies in the United States. "The median income is $48,000 per year, and some families are paying $12,000 a year for health insurance; that's a quarter of their gross. I'm talking about breaking the shackles insurance companies have on American families."

Under Rep. Kucinich's proposal, which has been introduced in Congress as H.R. 676, all for-profit health care entities would be converted to nonprofit entities, with shareholders being compensated by the government. That compensation would be financed through treasury bonds, he said. Physicians would continue to have private practices, but they, along with hospitals and other providers, would be paid by the federal government, which would disseminate federal funds through a series of regional budgets. There would also be separate budgets for capital expenditures and for medical education. Coverage under Rep. Kucinich's plan would include inpatient and outpatient services as well as dental care, vision care, mental health care, and long-term care. There would be no deductibles or cost sharing.

When a reporter pointed out that other countries with government-financed health care ended up seeing a private system develop alongside the public one for those who could afford it, Rep. Kucinich said that was no surprise. "Privatizers are at work in every country," he said. "If health care is such a losing proposition, why are these companies trying to privatize it? Because there's huge amounts of money to be made."

Another government-run system that people are trying to privatize is Medicare, Rep. Kucinich said. "Right now, Medicare is discouraging doctors by cutting their fees. There's a strategy to privatize Medicare by getting doctors to walk away from [it]." The passage of the Medicare prescription drug benefit was another part of that plan, he added.

A for-profit system puts the wrong pressure on physicians, Rep. Kucinich said in an interview after the forum. "Doctors are under pressure from private insurance not to provide health care," he said. And when that collides with efforts such as Medicare's pay-for-performance initiative, "there's built-in inertia. Of course we want to encourage doctors to improve their performance, but under a for-profit system, doctors have cost pressures."

During the forum, Rep. Kucinich contrasted his proposal with those offered by two other Democratic presidential candidates, Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.). Under their proposals, Americans would be required to purchase health insurance; they could choose from a variety of private health care plans as well as a public plan modeled after Medicare. "If you can't afford it under the current system, how are you going to afford it under [their] system?" he said.

"And if you do buy it, you're forced into plans that inevitably are going to have extraordinary copays and deductibles, and a limited level of coverage," he continued. "I'm talking about a plan where everyone's covered, [and it] covers everything. And the fact is, we're already paying for it—we're just not getting it."

If 'it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck.' REP. KUCINICH

WASHINGTON — According to Sen. Hillary Rodham Clinton (D-N.Y.), primary care physicians don't get enough pay or respect, and there aren't enough of them. Her response to the problem? The federal government should try to help increase the supply of primary care doctors, but in the meantime nurses, pharmacists, and others should fill the gaps in care.

“I'm intrigued by the fact that a lot of states are permitting pharmacists to give vaccines,” Sen. Clinton, a candidate for the Democratic presidential nomination, said at a health policy forum sponsored by Families USA and the Federation of American Hospitals. “What other functions can we delegate out, given appropriate oversight and training?”

For example, she said, “I think nurses have a great opportunity to do much more than they're doing. If we're not going to be able to quickly increase the number of primary care physicians, we need more advanced practice nurses, and they've got to be given the authority to make some of these [treatment] decisions, because otherwise people will go without care.”

Sen. Clinton, who is in her second Senate term, said that health care would be her top domestic priority if she were elected president. “This is, for me, a moral question and an economic one,” she said. “Do we want to continue to be so unequal and unfair that, if you are uninsured and you go into the hospital with someone who is insured, you are more likely to die?”

Sen. Clinton said she learned a lot from her experience in her husband's first presidential term when she led his efforts to develop a universal health care plan.

“The fact that the White House took on the responsibility of writing the legislation turned out to be something of a mistake,” she said at the forum, part of a series of presidential candidate health policy forums underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. She said that now she sees the president's role on health care as “setting the goals and framework but not getting into the details.”

Further, the Clinton plan of the early 1990s was just too complicated, she said. “It was a source of concern to a lot of Americans who didn't understand how it could work, and it certainly wasn't presented in the best way.”

This time, Sen. Clinton has a different plan. The “American Health Choices Plan” would allow people to keep their current insurance coverage, but if they didn't like their current insurance or were uninsured, they could choose from a variety of plans similar to those offered to federal employees. They would also have the option of enrolling in a public plan similar to Medicare.

Sen. Clinton said coverage under her plan would be affordable and fully portable, and that insurers would be barred from discriminating against enrollees based on preexisting conditions. Large employers would be required to offer coverage or help pay for employee health care; small businesses would not be required to offer coverage, but would be given tax credits to encourage them to do so.

She estimated the cost of her plan at $110 billion per year and said it would be paid for by rolling back tax breaks for Americans who make more than $250,000 annually.

Sen. Clinton said critics who called her plan a back door to a single-payer, government-run health care system were either misinformed or were misrepresenting her proposal. “I've included the public plan option because a lot of Americans want it,” she said. “It will not create a new bureaucracy; it will not create a government-run system unless you think Medicare is government run. In Medicare, you choose your doctor, you choose your hospital—you have tremendous choice.”

Sen. Clinton predicted that a lot of people would still choose a private plan because “if the private plans are competitive and smart, they'll offer a lot of new features. What are we afraid of? Let's see where competition leads us.”

Sen. Clinton also expressed her support of the increased use of electronic health records to make the health care system more organized. “It's very hard to think about having a system when you don't have any way for people to move [their records with them] from place to place and job to job.”

Paying providers based on their outcomes was another recent innovation mentioned by Sen. Clinton. She lauded the Bush Administration for announcing that the Medicare program would no longer pay for care occurring as a result of medical errors.

The recent increase in cases of nosocomial infections such as methicillin-resistant Staphylococcus aureus “should be a wake-up call for everybody,” Sen. Clinton said. “A couple of hospitals I'm aware of have changed their infection control policies; they have cut the rate of hospital-borne infections. Everybody should be expected to do that.

“When you look at some of the disparities and disorganization, it's because we don't have a good system to disseminate evidence-based clinically proven treatments,” she continued. “It takes 17 years for something that is proven in the lab to be broadly disseminated. It should take 17 hours—17 seconds. With the Internet, why are we so far behind?”

If we can't quickly increase the number of primary care physicians, we need more advanced practice nurses. SEN. CLINTON

WASHINGTON — According to Sen. Hillary Rodham Clinton (D-N.Y.), primary care physicians don't get enough pay or respect, and there aren't enough of them. Her response to the problem? The federal government should try to help increase the supply of primary care doctors, but in the meantime nurses, pharmacists, and others should fill the gaps in care.

“I'm intrigued by the fact that a lot of states are permitting pharmacists to give vaccines,” Sen. Clinton, a candidate for the Democratic presidential nomination, said at a health policy forum sponsored by Families USA and the Federation of American Hospitals. “What other functions can we delegate out, given appropriate oversight and training?”

For example, she said, “I think nurses have a great opportunity to do much more than they're doing. If we're not going to be able to quickly increase the number of primary care physicians, we need more advanced practice nurses, and they've got to be given the authority to make some of these [treatment] decisions, because otherwise people will go without care.”

Sen. Clinton, who is in her second Senate term, said that health care would be her top domestic priority if she were elected president. “This is, for me, a moral question and an economic one,” she said. “Do we want to continue to be so unequal and unfair that, if you are uninsured and you go into the hospital with someone who is insured, you are more likely to die?”

Sen. Clinton said she learned a lot from her experience in her husband's first presidential term when she led his efforts to develop a universal health care plan.

“The fact that the White House took on the responsibility of writing the legislation turned out to be something of a mistake,” she said at the forum, part of a series of presidential candidate health policy forums underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. She said that now she sees the president's role on health care as “setting the goals and framework but not getting into the details.”

Further, the Clinton plan of the early 1990s was just too complicated, she said. “It was a source of concern to a lot of Americans who didn't understand how it could work, and it certainly wasn't presented in the best way.”

This time, Sen. Clinton has a different plan. The “American Health Choices Plan” would allow people to keep their current insurance coverage, but if they didn't like their current insurance or were uninsured, they could choose from a variety of plans similar to those offered to federal employees. They would also have the option of enrolling in a public plan similar to Medicare.

Sen. Clinton said coverage under her plan would be affordable and fully portable, and that insurers would be barred from discriminating against enrollees based on preexisting conditions. Large employers would be required to offer coverage or help pay for employee health care; small businesses would not be required to offer coverage, but would be given tax credits to encourage them to do so.

She estimated the cost of her plan at $110 billion per year and said it would be paid for by rolling back tax breaks for Americans who make more than $250,000 annually.

Sen. Clinton said critics who called her plan a back door to a single-payer, government-run health care system were either misinformed or were misrepresenting her proposal. “I've included the public plan option because a lot of Americans want it,” she said. “It will not create a new bureaucracy; it will not create a government-run system unless you think Medicare is government run. In Medicare, you choose your doctor, you choose your hospital—you have tremendous choice.”

Sen. Clinton predicted that a lot of people would still choose a private plan because “if the private plans are competitive and smart, they'll offer a lot of new features. What are we afraid of? Let's see where competition leads us.”

Sen. Clinton also expressed her support of the increased use of electronic health records to make the health care system more organized. “It's very hard to think about having a system when you don't have any way for people to move [their records with them] from place to place and job to job.”

Paying providers based on their outcomes was another recent innovation mentioned by Sen. Clinton. She lauded the Bush Administration for announcing that the Medicare program would no longer pay for care occurring as a result of medical errors.

The recent increase in cases of nosocomial infections such as methicillin-resistant Staphylococcus aureus “should be a wake-up call for everybody,” Sen. Clinton said. “A couple of hospitals I'm aware of have changed their infection control policies; they have cut the rate of hospital-borne infections. Everybody should be expected to do that.

“When you look at some of the disparities and disorganization, it's because we don't have a good system to disseminate evidence-based clinically proven treatments,” she continued. “It takes 17 years for something that is proven in the lab to be broadly disseminated. It should take 17 hours—17 seconds. With the Internet, why are we so far behind?”

If we can't quickly increase the number of primary care physicians, we need more advanced practice nurses. SEN. CLINTON

WASHINGTON — According to Sen. Hillary Rodham Clinton (D-N.Y.), primary care physicians don't get enough pay or respect, and there aren't enough of them. Her response to the problem? The federal government should try to help increase the supply of primary care doctors, but in the meantime nurses, pharmacists, and others should fill the gaps in care.

“I'm intrigued by the fact that a lot of states are permitting pharmacists to give vaccines,” Sen. Clinton, a candidate for the Democratic presidential nomination, said at a health policy forum sponsored by Families USA and the Federation of American Hospitals. “What other functions can we delegate out, given appropriate oversight and training?”

For example, she said, “I think nurses have a great opportunity to do much more than they're doing. If we're not going to be able to quickly increase the number of primary care physicians, we need more advanced practice nurses, and they've got to be given the authority to make some of these [treatment] decisions, because otherwise people will go without care.”

Sen. Clinton, who is in her second Senate term, said that health care would be her top domestic priority if she were elected president. “This is, for me, a moral question and an economic one,” she said. “Do we want to continue to be so unequal and unfair that, if you are uninsured and you go into the hospital with someone who is insured, you are more likely to die?”

Sen. Clinton said she learned a lot from her experience in her husband's first presidential term when she led his efforts to develop a universal health care plan.

“The fact that the White House took on the responsibility of writing the legislation turned out to be something of a mistake,” she said at the forum, part of a series of presidential candidate health policy forums underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. She said that now she sees the president's role on health care as “setting the goals and framework but not getting into the details.”

Further, the Clinton plan of the early 1990s was just too complicated, she said. “It was a source of concern to a lot of Americans who didn't understand how it could work, and it certainly wasn't presented in the best way.”

This time, Sen. Clinton has a different plan. The “American Health Choices Plan” would allow people to keep their current insurance coverage, but if they didn't like their current insurance or were uninsured, they could choose from a variety of plans similar to those offered to federal employees. They would also have the option of enrolling in a public plan similar to Medicare.

Sen. Clinton said coverage under her plan would be affordable and fully portable, and that insurers would be barred from discriminating against enrollees based on preexisting conditions. Large employers would be required to offer coverage or help pay for employee health care; small businesses would not be required to offer coverage, but would be given tax credits to encourage them to do so.

She estimated the cost of her plan at $110 billion per year and said it would be paid for by rolling back tax breaks for Americans who make more than $250,000 annually.

Sen. Clinton said critics who called her plan a back door to a single-payer, government-run health care system were either misinformed or were misrepresenting her proposal. “I've included the public plan option because a lot of Americans want it,” she said. “It will not create a new bureaucracy; it will not create a government-run system unless you think Medicare is government run. In Medicare, you choose your doctor, you choose your hospital—you have tremendous choice.”

Sen. Clinton predicted that a lot of people would still choose a private plan because “if the private plans are competitive and smart, they'll offer a lot of new features. What are we afraid of? Let's see where competition leads us.”

Sen. Clinton also expressed her support of the increased use of electronic health records to make the health care system more organized. “It's very hard to think about having a system when you don't have any way for people to move [their records with them] from place to place and job to job.”

Paying providers based on their outcomes was another recent innovation mentioned by Sen. Clinton. She lauded the Bush Administration for announcing that the Medicare program would no longer pay for care occurring as a result of medical errors.

The recent increase in cases of nosocomial infections such as methicillin-resistant Staphylococcus aureus “should be a wake-up call for everybody,” Sen. Clinton said. “A couple of hospitals I'm aware of have changed their infection control policies; they have cut the rate of hospital-borne infections. Everybody should be expected to do that.

“When you look at some of the disparities and disorganization, it's because we don't have a good system to disseminate evidence-based clinically proven treatments,” she continued. “It takes 17 years for something that is proven in the lab to be broadly disseminated. It should take 17 hours—17 seconds. With the Internet, why are we so far behind?”

If we can't quickly increase the number of primary care physicians, we need more advanced practice nurses. SEN. CLINTON

WASHINGTON — Sen. Joseph R. Biden Jr. (D-Del.) will tell you right up front that health care would not be his top priority if he were elected president.

“Ending the war in Iraq will be my single highest priority, and preventing war in Iran will be one of my highest priorities as well,” the senator, a candidate for the Democratic presidential nomination, said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

That said, the sixth-term senator added that there is no reason he couldn't put several elements of his health care plan into motion in the first 6 months of his presidency.

Unlike Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.), Sen. Biden said he would not mandate that every citizen obtain health insurance. Instead, he would encourage employers to continue offering coverage by guaranteeing that the federal government would pay 75% of catastrophic health care that exceeded $50,000 for an individual employee.

“The carrot is that [employers] get reinsurance, but the stick is they have to insure everybody,” he said at the forum, one in a series with presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

One reason politicians have backed away from proposing catastrophic health care coverage is that they remember what happened 20 years ago with the Medicare Catastrophic Coverage Act, the senator noted.

That law, signed by President Reagan in 1988, gave Medicare beneficiaries full coverage for hospital stays of any length after a $560 deductible for hospital costs and a $1,370 deductible for doctor bills. It was repealed in 1989 because Medicare beneficiaries were concerned about the additional premiums they would have to pay. But “that was a different world, and a lot has changed,” Sen. Biden said.

Another part of Sen. Biden's plan for the first 6 months of his administration would be getting all children covered. He would start by expanding the State Children's Health Insurance Program (SCHIP) to include children in families making up to $60,000 per year.

“Anyone who thinks a couple who makes $60,000 a year and has four kids … is willing to spend $1,400 per month for health insurance, ought to get out more,” the senator said.

He also proposes allowing the public to buy into the Federal Employees Health Benefits Program, even though he admits it may not be the best health insurance program available. “It's there, everybody understands it, and there's a sense of confidence about it—'If my senator has this, it must be good enough for me.'”

Another part of Sen. Biden's health care proposal includes letting anyone 55 years and older buy into Medicare. The government would provide subsidies for low-income citizens who couldn't afford to pay the Medicare premium.

He estimates the cost of all these proposals at $90-$110 billion annually, which he said can be partly achieved by rolling back tax breaks for the richest 1% of Americans. He would also eliminate tax breaks on capital gains and dividends, and end tax loopholes for hedge fund managers and private equity partners.

In addition to his health insurance proposal, Sen. Biden said he would like to see the federal government put more emphasis on prevention, although he admitted such an investment might not pay off for a while. “That's one reason I want to insure children at the front end. You have children who don't have health insurance, and parents not being able to take them to a regular physician … they build up problems, so they end up being less healthy by [the] time they're 21 years old.”

Sen. Biden continued, “The whole notion is changing the paradigm—front end, costs; back end, significant savings.

“One of the problems with the mentality of American businesses and insurance companies is that they always think about the next quarter. Very seldom does anyone think about the next year or 5 years or 7 years. If we're going to get these costs under control, then it seems to me that you have got to be investing now.”

Medicare costs will grow dramatically over the next decade, as the Baby Boom generation retires, Sen. Biden said. He offered three suggestions for cutting Medicare costs.

First, “we should be reimbursing private insurers [who participate in the Medicare Advantage program] the same way we reimburse everyone else. We're reimbursing them about $10 billion a year beyond what we're reimbursing others.”

Second, “being able to negotiate price relative to cost of drugs, [as] we do in the Veterans Administration, would significantly reduce the cost.”

Third, if he is able to increase the focus on prevention, “by the time people [who are now in their 30s and 40s] hit the Medicare system, they'll have much more control of these chronic diseases.”

If other cost cuts are needed, then “in the first year, I think I [will be able to] cut the Defense Department by over $160 billion by ending the war in Iraq” and implementing other savings there, the senator said.

'The whole notion is changing the paradigm—front end, costs; back end, significant savings.' SEN. BIDEN

WASHINGTON — Sen. Joseph R. Biden Jr. (D-Del.) will tell you right up front that health care would not be his top priority if he were elected president.

“Ending the war in Iraq will be my single highest priority, and preventing war in Iran will be one of my highest priorities as well,” the senator, a candidate for the Democratic presidential nomination, said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

That said, the sixth-term senator added that there is no reason he couldn't put several elements of his health care plan into motion in the first 6 months of his presidency.

Unlike Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.), Sen. Biden said he would not mandate that every citizen obtain health insurance. Instead, he would encourage employers to continue offering coverage by guaranteeing that the federal government would pay 75% of catastrophic health care that exceeded $50,000 for an individual employee.

“The carrot is that [employers] get reinsurance, but the stick is they have to insure everybody,” he said at the forum, one in a series with presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

One reason politicians have backed away from proposing catastrophic health care coverage is that they remember what happened 20 years ago with the Medicare Catastrophic Coverage Act, the senator noted.

That law, signed by President Reagan in 1988, gave Medicare beneficiaries full coverage for hospital stays of any length after a $560 deductible for hospital costs and a $1,370 deductible for doctor bills. It was repealed in 1989 because Medicare beneficiaries were concerned about the additional premiums they would have to pay. But “that was a different world, and a lot has changed,” Sen. Biden said.

Another part of Sen. Biden's plan for the first 6 months of his administration would be getting all children covered. He would start by expanding the State Children's Health Insurance Program (SCHIP) to include children in families making up to $60,000 per year.

“Anyone who thinks a couple who makes $60,000 a year and has four kids … is willing to spend $1,400 per month for health insurance, ought to get out more,” the senator said.

He also proposes allowing the public to buy into the Federal Employees Health Benefits Program, even though he admits it may not be the best health insurance program available. “It's there, everybody understands it, and there's a sense of confidence about it—'If my senator has this, it must be good enough for me.'”

Another part of Sen. Biden's health care proposal includes letting anyone 55 years and older buy into Medicare. The government would provide subsidies for low-income citizens who couldn't afford to pay the Medicare premium.

He estimates the cost of all these proposals at $90-$110 billion annually, which he said can be partly achieved by rolling back tax breaks for the richest 1% of Americans. He would also eliminate tax breaks on capital gains and dividends, and end tax loopholes for hedge fund managers and private equity partners.

In addition to his health insurance proposal, Sen. Biden said he would like to see the federal government put more emphasis on prevention, although he admitted such an investment might not pay off for a while. “That's one reason I want to insure children at the front end. You have children who don't have health insurance, and parents not being able to take them to a regular physician … they build up problems, so they end up being less healthy by [the] time they're 21 years old.”

Sen. Biden continued, “The whole notion is changing the paradigm—front end, costs; back end, significant savings.

“One of the problems with the mentality of American businesses and insurance companies is that they always think about the next quarter. Very seldom does anyone think about the next year or 5 years or 7 years. If we're going to get these costs under control, then it seems to me that you have got to be investing now.”

Medicare costs will grow dramatically over the next decade, as the Baby Boom generation retires, Sen. Biden said. He offered three suggestions for cutting Medicare costs.

First, “we should be reimbursing private insurers [who participate in the Medicare Advantage program] the same way we reimburse everyone else. We're reimbursing them about $10 billion a year beyond what we're reimbursing others.”

Second, “being able to negotiate price relative to cost of drugs, [as] we do in the Veterans Administration, would significantly reduce the cost.”

Third, if he is able to increase the focus on prevention, “by the time people [who are now in their 30s and 40s] hit the Medicare system, they'll have much more control of these chronic diseases.”

If other cost cuts are needed, then “in the first year, I think I [will be able to] cut the Defense Department by over $160 billion by ending the war in Iraq” and implementing other savings there, the senator said.

'The whole notion is changing the paradigm—front end, costs; back end, significant savings.' SEN. BIDEN

WASHINGTON — Sen. Joseph R. Biden Jr. (D-Del.) will tell you right up front that health care would not be his top priority if he were elected president.

“Ending the war in Iraq will be my single highest priority, and preventing war in Iran will be one of my highest priorities as well,” the senator, a candidate for the Democratic presidential nomination, said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

That said, the sixth-term senator added that there is no reason he couldn't put several elements of his health care plan into motion in the first 6 months of his presidency.

Unlike Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.), Sen. Biden said he would not mandate that every citizen obtain health insurance. Instead, he would encourage employers to continue offering coverage by guaranteeing that the federal government would pay 75% of catastrophic health care that exceeded $50,000 for an individual employee.

“The carrot is that [employers] get reinsurance, but the stick is they have to insure everybody,” he said at the forum, one in a series with presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

One reason politicians have backed away from proposing catastrophic health care coverage is that they remember what happened 20 years ago with the Medicare Catastrophic Coverage Act, the senator noted.

That law, signed by President Reagan in 1988, gave Medicare beneficiaries full coverage for hospital stays of any length after a $560 deductible for hospital costs and a $1,370 deductible for doctor bills. It was repealed in 1989 because Medicare beneficiaries were concerned about the additional premiums they would have to pay. But “that was a different world, and a lot has changed,” Sen. Biden said.

Another part of Sen. Biden's plan for the first 6 months of his administration would be getting all children covered. He would start by expanding the State Children's Health Insurance Program (SCHIP) to include children in families making up to $60,000 per year.

“Anyone who thinks a couple who makes $60,000 a year and has four kids … is willing to spend $1,400 per month for health insurance, ought to get out more,” the senator said.

He also proposes allowing the public to buy into the Federal Employees Health Benefits Program, even though he admits it may not be the best health insurance program available. “It's there, everybody understands it, and there's a sense of confidence about it—'If my senator has this, it must be good enough for me.'”

Another part of Sen. Biden's health care proposal includes letting anyone 55 years and older buy into Medicare. The government would provide subsidies for low-income citizens who couldn't afford to pay the Medicare premium.

He estimates the cost of all these proposals at $90-$110 billion annually, which he said can be partly achieved by rolling back tax breaks for the richest 1% of Americans. He would also eliminate tax breaks on capital gains and dividends, and end tax loopholes for hedge fund managers and private equity partners.

In addition to his health insurance proposal, Sen. Biden said he would like to see the federal government put more emphasis on prevention, although he admitted such an investment might not pay off for a while. “That's one reason I want to insure children at the front end. You have children who don't have health insurance, and parents not being able to take them to a regular physician … they build up problems, so they end up being less healthy by [the] time they're 21 years old.”

Sen. Biden continued, “The whole notion is changing the paradigm—front end, costs; back end, significant savings.

“One of the problems with the mentality of American businesses and insurance companies is that they always think about the next quarter. Very seldom does anyone think about the next year or 5 years or 7 years. If we're going to get these costs under control, then it seems to me that you have got to be investing now.”

Medicare costs will grow dramatically over the next decade, as the Baby Boom generation retires, Sen. Biden said. He offered three suggestions for cutting Medicare costs.

First, “we should be reimbursing private insurers [who participate in the Medicare Advantage program] the same way we reimburse everyone else. We're reimbursing them about $10 billion a year beyond what we're reimbursing others.”

Second, “being able to negotiate price relative to cost of drugs, [as] we do in the Veterans Administration, would significantly reduce the cost.”

Third, if he is able to increase the focus on prevention, “by the time people [who are now in their 30s and 40s] hit the Medicare system, they'll have much more control of these chronic diseases.”

If other cost cuts are needed, then “in the first year, I think I [will be able to] cut the Defense Department by over $160 billion by ending the war in Iraq” and implementing other savings there, the senator said.

'The whole notion is changing the paradigm—front end, costs; back end, significant savings.' SEN. BIDEN

WASHINGTON — Sen. Joseph R. Biden Jr. (D-Del.) will tell you right up front that health care would not be his top priority if he were elected president.

“Ending the war in Iraq will be my single highest priority, and preventing war in Iran will be one of my highest priorities as well,” the senator, a candidate for the Democratic presidential nomination, said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

That said, the sixth-term senator added that he could put several elements of his health care plan into motion quickly.

Unlike Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.), Sen. Biden said he would not mandate that every citizen obtain health insurance. Instead, he would encourage employers to continue offering coverage by guaranteeing that the federal government would pay 75% of catastrophic health costs that exceed $50,000 for one employee, he said at the forum, one in a series underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

One reason politicians have backed away from proposing catastrophic health coverage is they remember what happened 20 years ago with the Medicare Catastrophic Coverage Act, the senator noted. That law, signed by President Reagan in 1988, gave Medicare beneficiaries full coverage for hospital stays after a $560 deductible for hospital costs and a $1,370 deductible for doctor bills. It was repealed in 1989 due to beneficiaries' concern over the additional premiums they would have to pay. But “that was a different world, and a lot has changed,” Sen. Biden said.

Sen. Biden would also expand the State Children's Health Insurance Program (SCHIP) to include children in families making up to $60,000 per year. “Anyone who thinks a couple who makes $60,000 a year and has four kids [can] spend $1,400 per month for health insurance, they ought to get out more,” the senator said.

Sen. Biden also proposes allowing the public to buy into the Federal Employees Health Benefits Program, even though he admits it may not be the best health insurance program available. “My wife is a teacher, and when I was hospitalized, we used her insurance because it was better” than the federal employee health plan, he said. But “it's there, everybody understands it, and there's a sense of confidence about it—'If my senator has this, it must be good enough for me.'”

Using the federal employees' plan is an example of the consensus-building that Sen. Biden said he hopes to do as president. “This is about whether or not you're going to be able to, as president, generate a national consensus, because if you're a Democrat, you're going to have to get 15%-20% of Republicans to vote for it; you can't do it with just Democrats. And you're going to have to be able to convince the American people that this is understandable.”

Another part of Sen. Biden's health care proposal includes letting anyone 55 years and older buy into Medicare. The government would provide subsidies for low-income citizens who couldn't afford to pay the Medicare premium.

He estimates the cost of all these proposals at $90-$110 billion annually, which he said can be partly achieved by rolling back tax breaks for the richest 1% of Americans, tax breaks “that they didn't ask for and don't need.” He would also eliminate tax breaks on capital gains and dividends, and end tax loopholes for hedge fund managers and private equity partners.

Sen. Biden said he would like to see more emphasis on preventive care, although he admitted such an investment might not pay off for a while. “That's one reason I want to insure children at the front end,” he said. Without insurance, “they end up being less healthy by [the] time they're 21 years old.”

Sen. Biden continued, “The whole notion is changing the paradigm—front end, costs; back end, significant savings. One of the problems with the mentality of American businesses and insurance companies is that they always think about the next quarter. Very seldom does anyone think about next year or 5 years or 7 years. If we're going to get these costs under control, it seems to me you've got to be investing now.”

Medicare costs will grow dramatically over the next decade as the Baby Boom generation retires, Sen. Biden said. He offered three suggestions for cutting costs.

First, “we should be reimbursing private insurers [who participate in the Medicare Advantage program] the same way we reimburse everyone else. We're reimbursing them about $10 billion a year beyond what we're reimbursing others.” Second, “being able to negotiate price relative to cost of drugs … would significantly reduce the cost.” Third, with an increased focus on prevention, “by the time people hit the Medicare system who are now in their 30s and 40s, they'll have much more control of these chronic diseases.”

If other cost cuts are needed, “in the first year, I think I can cut the Defense Department by over $160 billion by ending the war in Iraq,” the senator said.

'The whole notion is changing the paradigm—front end, costs; back end, significant savings.' SEN. BIDEN

WASHINGTON — Sen. Joseph R. Biden Jr. (D-Del.) will tell you right up front that health care would not be his top priority if he were elected president.

“Ending the war in Iraq will be my single highest priority, and preventing war in Iran will be one of my highest priorities as well,” the senator, a candidate for the Democratic presidential nomination, said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

That said, the sixth-term senator added that he could put several elements of his health care plan into motion quickly.

Unlike Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.), Sen. Biden said he would not mandate that every citizen obtain health insurance. Instead, he would encourage employers to continue offering coverage by guaranteeing that the federal government would pay 75% of catastrophic health costs that exceed $50,000 for one employee, he said at the forum, one in a series underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

One reason politicians have backed away from proposing catastrophic health coverage is they remember what happened 20 years ago with the Medicare Catastrophic Coverage Act, the senator noted. That law, signed by President Reagan in 1988, gave Medicare beneficiaries full coverage for hospital stays after a $560 deductible for hospital costs and a $1,370 deductible for doctor bills. It was repealed in 1989 due to beneficiaries' concern over the additional premiums they would have to pay. But “that was a different world, and a lot has changed,” Sen. Biden said.

Sen. Biden would also expand the State Children's Health Insurance Program (SCHIP) to include children in families making up to $60,000 per year. “Anyone who thinks a couple who makes $60,000 a year and has four kids [can] spend $1,400 per month for health insurance, they ought to get out more,” the senator said.

Sen. Biden also proposes allowing the public to buy into the Federal Employees Health Benefits Program, even though he admits it may not be the best health insurance program available. “My wife is a teacher, and when I was hospitalized, we used her insurance because it was better” than the federal employee health plan, he said. But “it's there, everybody understands it, and there's a sense of confidence about it—'If my senator has this, it must be good enough for me.'”

Using the federal employees' plan is an example of the consensus-building that Sen. Biden said he hopes to do as president. “This is about whether or not you're going to be able to, as president, generate a national consensus, because if you're a Democrat, you're going to have to get 15%-20% of Republicans to vote for it; you can't do it with just Democrats. And you're going to have to be able to convince the American people that this is understandable.”

Another part of Sen. Biden's health care proposal includes letting anyone 55 years and older buy into Medicare. The government would provide subsidies for low-income citizens who couldn't afford to pay the Medicare premium.

He estimates the cost of all these proposals at $90-$110 billion annually, which he said can be partly achieved by rolling back tax breaks for the richest 1% of Americans, tax breaks “that they didn't ask for and don't need.” He would also eliminate tax breaks on capital gains and dividends, and end tax loopholes for hedge fund managers and private equity partners.

Sen. Biden said he would like to see more emphasis on preventive care, although he admitted such an investment might not pay off for a while. “That's one reason I want to insure children at the front end,” he said. Without insurance, “they end up being less healthy by [the] time they're 21 years old.”

Sen. Biden continued, “The whole notion is changing the paradigm—front end, costs; back end, significant savings. One of the problems with the mentality of American businesses and insurance companies is that they always think about the next quarter. Very seldom does anyone think about next year or 5 years or 7 years. If we're going to get these costs under control, it seems to me you've got to be investing now.”

Medicare costs will grow dramatically over the next decade as the Baby Boom generation retires, Sen. Biden said. He offered three suggestions for cutting costs.

First, “we should be reimbursing private insurers [who participate in the Medicare Advantage program] the same way we reimburse everyone else. We're reimbursing them about $10 billion a year beyond what we're reimbursing others.” Second, “being able to negotiate price relative to cost of drugs … would significantly reduce the cost.” Third, with an increased focus on prevention, “by the time people hit the Medicare system who are now in their 30s and 40s, they'll have much more control of these chronic diseases.”

If other cost cuts are needed, “in the first year, I think I can cut the Defense Department by over $160 billion by ending the war in Iraq,” the senator said.

'The whole notion is changing the paradigm—front end, costs; back end, significant savings.' SEN. BIDEN

WASHINGTON — Sen. Joseph R. Biden Jr. (D-Del.) will tell you right up front that health care would not be his top priority if he were elected president.

“Ending the war in Iraq will be my single highest priority, and preventing war in Iran will be one of my highest priorities as well,” the senator, a candidate for the Democratic presidential nomination, said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

That said, the sixth-term senator added that he could put several elements of his health care plan into motion quickly.

Unlike Sen. Hillary Rodham Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.), Sen. Biden said he would not mandate that every citizen obtain health insurance. Instead, he would encourage employers to continue offering coverage by guaranteeing that the federal government would pay 75% of catastrophic health costs that exceed $50,000 for one employee, he said at the forum, one in a series underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

One reason politicians have backed away from proposing catastrophic health coverage is they remember what happened 20 years ago with the Medicare Catastrophic Coverage Act, the senator noted. That law, signed by President Reagan in 1988, gave Medicare beneficiaries full coverage for hospital stays after a $560 deductible for hospital costs and a $1,370 deductible for doctor bills. It was repealed in 1989 due to beneficiaries' concern over the additional premiums they would have to pay. But “that was a different world, and a lot has changed,” Sen. Biden said.

Sen. Biden would also expand the State Children's Health Insurance Program (SCHIP) to include children in families making up to $60,000 per year. “Anyone who thinks a couple who makes $60,000 a year and has four kids [can] spend $1,400 per month for health insurance, they ought to get out more,” the senator said.

Sen. Biden also proposes allowing the public to buy into the Federal Employees Health Benefits Program, even though he admits it may not be the best health insurance program available. “My wife is a teacher, and when I was hospitalized, we used her insurance because it was better” than the federal employee health plan, he said. But “it's there, everybody understands it, and there's a sense of confidence about it—'If my senator has this, it must be good enough for me.'”

Using the federal employees' plan is an example of the consensus-building that Sen. Biden said he hopes to do as president. “This is about whether or not you're going to be able to, as president, generate a national consensus, because if you're a Democrat, you're going to have to get 15%-20% of Republicans to vote for it; you can't do it with just Democrats. And you're going to have to be able to convince the American people that this is understandable.”

Another part of Sen. Biden's health care proposal includes letting anyone 55 years and older buy into Medicare. The government would provide subsidies for low-income citizens who couldn't afford to pay the Medicare premium.

He estimates the cost of all these proposals at $90-$110 billion annually, which he said can be partly achieved by rolling back tax breaks for the richest 1% of Americans, tax breaks “that they didn't ask for and don't need.” He would also eliminate tax breaks on capital gains and dividends, and end tax loopholes for hedge fund managers and private equity partners.

Sen. Biden said he would like to see more emphasis on preventive care, although he admitted such an investment might not pay off for a while. “That's one reason I want to insure children at the front end,” he said. Without insurance, “they end up being less healthy by [the] time they're 21 years old.”

Sen. Biden continued, “The whole notion is changing the paradigm—front end, costs; back end, significant savings. One of the problems with the mentality of American businesses and insurance companies is that they always think about the next quarter. Very seldom does anyone think about next year or 5 years or 7 years. If we're going to get these costs under control, it seems to me you've got to be investing now.”

Medicare costs will grow dramatically over the next decade as the Baby Boom generation retires, Sen. Biden said. He offered three suggestions for cutting costs.

First, “we should be reimbursing private insurers [who participate in the Medicare Advantage program] the same way we reimburse everyone else. We're reimbursing them about $10 billion a year beyond what we're reimbursing others.” Second, “being able to negotiate price relative to cost of drugs … would significantly reduce the cost.” Third, with an increased focus on prevention, “by the time people hit the Medicare system who are now in their 30s and 40s, they'll have much more control of these chronic diseases.”

If other cost cuts are needed, “in the first year, I think I can cut the Defense Department by over $160 billion by ending the war in Iraq,” the senator said.

'The whole notion is changing the paradigm—front end, costs; back end, significant savings.' SEN. BIDEN

Chronic Disease: $1 Trillion a Year

Seven chronic diseases—cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness—have a total impact on the economy of $1.3 trillion annually, including $1.1 trillion in lost productivity, according to a study by the Milken Institute. That figure could be nearly $6 trillion by midcentury, the report said. “By investing in good health, we can add billions of dollars in economic growth in the coming decades,” said Ross C. DeVol, the institute's director of regional economics and principal author of the report. He noted that much of this cost was avoidable. “With moderate improvements in prevention and early intervention … the savings to the economy would be enormous.” West Virginia, Tennessee, Arkansas, Kentucky, and Mississippi have the highest rates of chronic disease. Utah, Alaska, Colorado, New Mexico, and Arizona have the lowest.

Senate Committee Knocks GSK Actions on Avandia

The Senate Finance Committee has issued a report criticizing GlaxoSmithKline for its alleged efforts to tone down one of the more prominent critics of its drug rosiglitazone (Avandia). The report referred to “what appears to be an orchestrated plan to stifle the opinion of Dr. John Buse,” the current president of the American Diabetes Association. The report looked back to 1999, when Dr. Buse raised the possibility that rosiglitazone could have the potential to increase cardiovascular events in those who took it. GlaxoSmithKline eventually had Dr. Buse sign a letter clarifying some of his earlier statements. The committee called the company's behavior “less than stellar” and said that the public good “would have been better served” if Dr. Buse had been allowed to continue voicing his concerns. In a statement, the company said it disagreed with the committee's findings and said that it did not require Dr. Buse to sign a legal document restricting his comments. Instead, the company said it was “trying to correct inaccuracies about data on Avandia in a continuing medical education presentation by Dr. Buse. … Ultimately, GSK staff communicated their concerns to Dr. Buse and his supervisor. Dr. Buse clarified and corrected his statements, which the company appreciated.” The statement noted that “GSK understands that there is a fundamental difference between engaging in scientific debate to ensure the accuracy of public statements, and trying to inappropriately influence or silence a critic…. The company does not support or condone efforts to silence critics.”

Heart Drugs Skewing Younger

More people aged 20–44 years are taking prescription medications for cardiac conditions—and their ranks are growing faster than those aged 45 or older who use the therapies, according to Medco Health Solutions. Extrapolating data from 2.5 million Medco drug benefit users, the company estimated that nationally 4.2 million patients aged 20–44 years took lipid-lowering drugs in 2006—a 68% increase from 2001—and 8.5 million took antihypertensives, a 21% rise from 2001. The rate of increase for new users of lipid-lowering drugs was 37% higher for those younger than 45 years than for patients 45–64 years. “The bad news is that these conditions are showing up in patients at younger ages,” Medco chief medical officer Dr. Robert Epstein said in a statement.

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or below basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Adult Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. “Our findings suggest that low health literacy exacts enormous costs on both the health system and society,” lead author John A. Vernon, Ph.D., said in a statement. The report, “Low Health Literacy: Implications for National Health Policy,” was supported by a grant from Pfizer Inc.

Medicare Out-of-Pocket Spending Rises

The percentage of income that Medicare beneficiaries spend on out-of-pocket health care costs is rising, according to a study published in the November/December issue of Health Affairs. The median amount of income that Medicare beneficiaries spent out of pocket was 12% in 1997, but rose to 16% in 2003. Study authors Patricia Neuman, Sc.D., of the Henry J. Kaiser Family Foundation, and colleagues noted that in 2003, the 25% of beneficiaries with the highest out-of-pocket expenses spent at least 30% of their income on health care, while the top 10% spent at least 58%. “Our findings suggest that giving elderly and disabled Medicare beneficiaries more 'skin in the game' could make health care less affordable and accessible for all but the highest-income beneficiaries,” the researchers said.

Chronic Disease: $1 Trillion a Year

Seven chronic diseases—cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness—have a total impact on the economy of $1.3 trillion annually, including $1.1 trillion in lost productivity, according to a study by the Milken Institute. That figure could be nearly $6 trillion by midcentury, the report said. “By investing in good health, we can add billions of dollars in economic growth in the coming decades,” said Ross C. DeVol, the institute's director of regional economics and principal author of the report. He noted that much of this cost was avoidable. “With moderate improvements in prevention and early intervention … the savings to the economy would be enormous.” West Virginia, Tennessee, Arkansas, Kentucky, and Mississippi have the highest rates of chronic disease. Utah, Alaska, Colorado, New Mexico, and Arizona have the lowest.

Senate Committee Knocks GSK Actions on Avandia

The Senate Finance Committee has issued a report criticizing GlaxoSmithKline for its alleged efforts to tone down one of the more prominent critics of its drug rosiglitazone (Avandia). The report referred to “what appears to be an orchestrated plan to stifle the opinion of Dr. John Buse,” the current president of the American Diabetes Association. The report looked back to 1999, when Dr. Buse raised the possibility that rosiglitazone could have the potential to increase cardiovascular events in those who took it. GlaxoSmithKline eventually had Dr. Buse sign a letter clarifying some of his earlier statements. The committee called the company's behavior “less than stellar” and said that the public good “would have been better served” if Dr. Buse had been allowed to continue voicing his concerns. In a statement, the company said it disagreed with the committee's findings and said that it did not require Dr. Buse to sign a legal document restricting his comments. Instead, the company said it was “trying to correct inaccuracies about data on Avandia in a continuing medical education presentation by Dr. Buse. … Ultimately, GSK staff communicated their concerns to Dr. Buse and his supervisor. Dr. Buse clarified and corrected his statements, which the company appreciated.” The statement noted that “GSK understands that there is a fundamental difference between engaging in scientific debate to ensure the accuracy of public statements, and trying to inappropriately influence or silence a critic…. The company does not support or condone efforts to silence critics.”

Heart Drugs Skewing Younger

More people aged 20–44 years are taking prescription medications for cardiac conditions—and their ranks are growing faster than those aged 45 or older who use the therapies, according to Medco Health Solutions. Extrapolating data from 2.5 million Medco drug benefit users, the company estimated that nationally 4.2 million patients aged 20–44 years took lipid-lowering drugs in 2006—a 68% increase from 2001—and 8.5 million took antihypertensives, a 21% rise from 2001. The rate of increase for new users of lipid-lowering drugs was 37% higher for those younger than 45 years than for patients 45–64 years. “The bad news is that these conditions are showing up in patients at younger ages,” Medco chief medical officer Dr. Robert Epstein said in a statement.

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or below basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Adult Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. “Our findings suggest that low health literacy exacts enormous costs on both the health system and society,” lead author John A. Vernon, Ph.D., said in a statement. The report, “Low Health Literacy: Implications for National Health Policy,” was supported by a grant from Pfizer Inc.

Medicare Out-of-Pocket Spending Rises

The percentage of income that Medicare beneficiaries spend on out-of-pocket health care costs is rising, according to a study published in the November/December issue of Health Affairs. The median amount of income that Medicare beneficiaries spent out of pocket was 12% in 1997, but rose to 16% in 2003. Study authors Patricia Neuman, Sc.D., of the Henry J. Kaiser Family Foundation, and colleagues noted that in 2003, the 25% of beneficiaries with the highest out-of-pocket expenses spent at least 30% of their income on health care, while the top 10% spent at least 58%. “Our findings suggest that giving elderly and disabled Medicare beneficiaries more 'skin in the game' could make health care less affordable and accessible for all but the highest-income beneficiaries,” the researchers said.

Chronic Disease: $1 Trillion a Year

Seven chronic diseases—cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness—have a total impact on the economy of $1.3 trillion annually, including $1.1 trillion in lost productivity, according to a study by the Milken Institute. That figure could be nearly $6 trillion by midcentury, the report said. “By investing in good health, we can add billions of dollars in economic growth in the coming decades,” said Ross C. DeVol, the institute's director of regional economics and principal author of the report. He noted that much of this cost was avoidable. “With moderate improvements in prevention and early intervention … the savings to the economy would be enormous.” West Virginia, Tennessee, Arkansas, Kentucky, and Mississippi have the highest rates of chronic disease. Utah, Alaska, Colorado, New Mexico, and Arizona have the lowest.

Senate Committee Knocks GSK Actions on Avandia

The Senate Finance Committee has issued a report criticizing GlaxoSmithKline for its alleged efforts to tone down one of the more prominent critics of its drug rosiglitazone (Avandia). The report referred to “what appears to be an orchestrated plan to stifle the opinion of Dr. John Buse,” the current president of the American Diabetes Association. The report looked back to 1999, when Dr. Buse raised the possibility that rosiglitazone could have the potential to increase cardiovascular events in those who took it. GlaxoSmithKline eventually had Dr. Buse sign a letter clarifying some of his earlier statements. The committee called the company's behavior “less than stellar” and said that the public good “would have been better served” if Dr. Buse had been allowed to continue voicing his concerns. In a statement, the company said it disagreed with the committee's findings and said that it did not require Dr. Buse to sign a legal document restricting his comments. Instead, the company said it was “trying to correct inaccuracies about data on Avandia in a continuing medical education presentation by Dr. Buse. … Ultimately, GSK staff communicated their concerns to Dr. Buse and his supervisor. Dr. Buse clarified and corrected his statements, which the company appreciated.” The statement noted that “GSK understands that there is a fundamental difference between engaging in scientific debate to ensure the accuracy of public statements, and trying to inappropriately influence or silence a critic…. The company does not support or condone efforts to silence critics.”

Heart Drugs Skewing Younger

More people aged 20–44 years are taking prescription medications for cardiac conditions—and their ranks are growing faster than those aged 45 or older who use the therapies, according to Medco Health Solutions. Extrapolating data from 2.5 million Medco drug benefit users, the company estimated that nationally 4.2 million patients aged 20–44 years took lipid-lowering drugs in 2006—a 68% increase from 2001—and 8.5 million took antihypertensives, a 21% rise from 2001. The rate of increase for new users of lipid-lowering drugs was 37% higher for those younger than 45 years than for patients 45–64 years. “The bad news is that these conditions are showing up in patients at younger ages,” Medco chief medical officer Dr. Robert Epstein said in a statement.

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or below basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Adult Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. “Our findings suggest that low health literacy exacts enormous costs on both the health system and society,” lead author John A. Vernon, Ph.D., said in a statement. The report, “Low Health Literacy: Implications for National Health Policy,” was supported by a grant from Pfizer Inc.

Medicare Out-of-Pocket Spending Rises

The percentage of income that Medicare beneficiaries spend on out-of-pocket health care costs is rising, according to a study published in the November/December issue of Health Affairs. The median amount of income that Medicare beneficiaries spent out of pocket was 12% in 1997, but rose to 16% in 2003. Study authors Patricia Neuman, Sc.D., of the Henry J. Kaiser Family Foundation, and colleagues noted that in 2003, the 25% of beneficiaries with the highest out-of-pocket expenses spent at least 30% of their income on health care, while the top 10% spent at least 58%. “Our findings suggest that giving elderly and disabled Medicare beneficiaries more 'skin in the game' could make health care less affordable and accessible for all but the highest-income beneficiaries,” the researchers said.

WASHINGTON — According to Democratic presidential candidate and malpractice attorney John Edwards, the best way to solve the malpractice insurance crisis is to put the onus on the malpractice attorneys.

The former senator from North Carolina spoke at the first of a series of health policy forums with presidential candidates sponsored by Families USA and the Federation of American Hospitals.

“I think that the bulk of the problem is created when cases are filed in the legal system that should never be there,” he said. “The result is years of litigation and costs incurred by the health care provider that should not have been incurred. What I would do is put more responsibility on the lawyers.”

In Sen. Edwards' ideal world, before a medical malpractice case could be filed, the plaintiff's lawyer would have to conduct a complete investigation, which would include independent review by at least two experts in the field “who determine that the case is, first, meritorious, and second, serious,” he said. “Then you require the lawyer to certify that that has been done as part of the filing. … If they fail to certify, the lawyer should bear the cost. If they do it three times, it's three strikes and you're out; you lose your right as a lawyer to file these cases.”

The bigger topic at the forum, though, was covering the uninsured. In February, Sen. Edwards unveiled a universal coverage plan, which calls for expanding both the State Children's Health Insurance Program and Medicaid, and for keeping Medicare in place. Employers would be required either to provide coverage to employees or to contribute to a system of regional Health Care Markets—nonprofit purchasing pools offering a choice of insurance plans. At least one of the plans would be a public plan based on the Medicare program.

Once the markets were set up and other provisions put in place—including tax credits to help people purchase policies and limits on premium contributions for low- and moderate-income families—an individual mandate would go into effect requiring all citizens to obtain health insurance. The penalty for people who didn't sign up for coverage would likely be “losing your individual tax exemption or some [other] tax consequence for not signing up,” Sen. Edwards said at a press conference after the forum. “Anybody who comes into contact with the health care system or any public agency will be signed up. If you go into the emergency room and are not part of the system, in order to get care you will be signed up.”

To help save costs in Medicare, Sen. Edwards said beneficiaries should have a “medical home” with a single provider responsible for coordinating chronic care “so we don't have overlapping care or unnecessary care.”

He also said that he favors three steps to lower the cost of prescription drugs in the Medicare program: using the bargaining power of government to negotiate prices with pharmaceutical companies, allowing prescription drugs to be “safely imported” into the United States, and “[doing] what we can constitutionally to control drug company ads on television.”

This universal coverage plan “was not intended to take us from where we are today directly to [a single-payer system],” Sen. Edwards said at the forum. “It was intended to allow Americans to decide whether they want government-run health care, or whether they want to continue the private system they have today.”

He noted that there are “real benefits to single-payer [systems]. The administrative cost associated with [government-run systems like] Medicare is 3%–4%, compared with 30%–40% profit and overhead in private insurance companies.” But some people hate single-payer systems like those in Canada and the United Kingdom, and they say that people have to wait too long for some procedures, he added.

“We're going to let Americans make that decision” by choosing which type of plan they prefer, he said. “Over time, we will see in which direction this system gravitates. It will be an extraordinary American model for what works and what doesn't work.”

Sen. Edwards said that the cost of his plan was estimated at $90 billion to $120 billion, and he would pay for it by rolling back tax cuts for Americans making more than $200,000 per year.

A reporter asked Sen. Edwards about the differences between his plan and that of Sen. Hillary Rodham Clinton (D-N.Y.), another Democratic presidential candidate. Sen. Clinton released her plan in September, and it contained many provisions similar to Sen. Edwards' plan, such as an array of private plans for people to choose from as well as a public plan similar to Medicare.

“One difference [is] … how big a priority you made this and how early you came out with a comprehensive plan,” he said. “It's a huge priority to me, and I will not bend on universal [coverage].” Further, “Sen. Clinton appears to believe that you can take money from health insurance and drug company lobbyists and sit at the table with them and negotiate a compromise. I absolutely reject that. The way you get it done is to convince the American people about the rightness of what you want to do,” Sen. Edwards said.

By allowing prescription drugs to be 'safely imported' into the United States, the government would save on Medicare. SEN. EDWARDS

Editor's Note:

This look at the health care proposals of former Sen. John Edwards (D-N.C.) is the first in an occasional series highlighting the health policy views of those seeking to be our next president. Each article is based on a 1-hour health policy forum with an individual candidate held at the Kaiser Family Foundation in Washington, D.C., and sponsored by Families USA and the Federation of American Hospitals. Forums announced so far feature Sen. Hillary Clinton (D-N.Y.), Rep. Dennis Kucinich (D-Ohio), Sen. Joe Biden (D-Del.), Sen. John McCain (R-Ariz.), Sen. Christopher Dodd (D-Conn.), former Gov. Mike Huckabee (R-Ark.), Gov. Bill Richardson (D-N.M.), and Rep. Ron Paul (R-Tex.).

WASHINGTON — According to Democratic presidential candidate and malpractice attorney John Edwards, the best way to solve the malpractice insurance crisis is to put the onus on the malpractice attorneys.

The former senator from North Carolina spoke at the first of a series of health policy forums with presidential candidates sponsored by Families USA and the Federation of American Hospitals.

“I think that the bulk of the problem is created when cases are filed in the legal system that should never be there,” he said. “The result is years of litigation and costs incurred by the health care provider that should not have been incurred. What I would do is put more responsibility on the lawyers.”

In Sen. Edwards' ideal world, before a medical malpractice case could be filed, the plaintiff's lawyer would have to conduct a complete investigation, which would include independent review by at least two experts in the field “who determine that the case is, first, meritorious, and second, serious,” he said. “Then you require the lawyer to certify that that has been done as part of the filing. … If they fail to certify, the lawyer should bear the cost. If they do it three times, it's three strikes and you're out; you lose your right as a lawyer to file these cases.”

The bigger topic at the forum, though, was covering the uninsured. In February, Sen. Edwards unveiled a universal coverage plan, which calls for expanding both the State Children's Health Insurance Program and Medicaid, and for keeping Medicare in place. Employers would be required either to provide coverage to employees or to contribute to a system of regional Health Care Markets—nonprofit purchasing pools offering a choice of insurance plans. At least one of the plans would be a public plan based on the Medicare program.

Once the markets were set up and other provisions put in place—including tax credits to help people purchase policies and limits on premium contributions for low- and moderate-income families—an individual mandate would go into effect requiring all citizens to obtain health insurance. The penalty for people who didn't sign up for coverage would likely be “losing your individual tax exemption or some [other] tax consequence for not signing up,” Sen. Edwards said at a press conference after the forum. “Anybody who comes into contact with the health care system or any public agency will be signed up. If you go into the emergency room and are not part of the system, in order to get care you will be signed up.”

To help save costs in Medicare, Sen. Edwards said beneficiaries should have a “medical home” with a single provider responsible for coordinating chronic care “so we don't have overlapping care or unnecessary care.”

He also said that he favors three steps to lower the cost of prescription drugs in the Medicare program: using the bargaining power of government to negotiate prices with pharmaceutical companies, allowing prescription drugs to be “safely imported” into the United States, and “[doing] what we can constitutionally to control drug company ads on television.”

This universal coverage plan “was not intended to take us from where we are today directly to [a single-payer system],” Sen. Edwards said at the forum. “It was intended to allow Americans to decide whether they want government-run health care, or whether they want to continue the private system they have today.”

He noted that there are “real benefits to single-payer [systems]. The administrative cost associated with [government-run systems like] Medicare is 3%–4%, compared with 30%–40% profit and overhead in private insurance companies.” But some people hate single-payer systems like those in Canada and the United Kingdom, and they say that people have to wait too long for some procedures, he added.

“We're going to let Americans make that decision” by choosing which type of plan they prefer, he said. “Over time, we will see in which direction this system gravitates. It will be an extraordinary American model for what works and what doesn't work.”

Sen. Edwards said that the cost of his plan was estimated at $90 billion to $120 billion, and he would pay for it by rolling back tax cuts for Americans making more than $200,000 per year.

A reporter asked Sen. Edwards about the differences between his plan and that of Sen. Hillary Rodham Clinton (D-N.Y.), another Democratic presidential candidate. Sen. Clinton released her plan in September, and it contained many provisions similar to Sen. Edwards' plan, such as an array of private plans for people to choose from as well as a public plan similar to Medicare.

“One difference [is] … how big a priority you made this and how early you came out with a comprehensive plan,” he said. “It's a huge priority to me, and I will not bend on universal [coverage].” Further, “Sen. Clinton appears to believe that you can take money from health insurance and drug company lobbyists and sit at the table with them and negotiate a compromise. I absolutely reject that. The way you get it done is to convince the American people about the rightness of what you want to do,” Sen. Edwards said.

By allowing prescription drugs to be 'safely imported' into the United States, the government would save on Medicare. SEN. EDWARDS

Editor's Note:

This look at the health care proposals of former Sen. John Edwards (D-N.C.) is the first in an occasional series highlighting the health policy views of those seeking to be our next president. Each article is based on a 1-hour health policy forum with an individual candidate held at the Kaiser Family Foundation in Washington, D.C., and sponsored by Families USA and the Federation of American Hospitals. Forums announced so far feature Sen. Hillary Clinton (D-N.Y.), Rep. Dennis Kucinich (D-Ohio), Sen. Joe Biden (D-Del.), Sen. John McCain (R-Ariz.), Sen. Christopher Dodd (D-Conn.), former Gov. Mike Huckabee (R-Ark.), Gov. Bill Richardson (D-N.M.), and Rep. Ron Paul (R-Tex.).

WASHINGTON — According to Democratic presidential candidate and malpractice attorney John Edwards, the best way to solve the malpractice insurance crisis is to put the onus on the malpractice attorneys.

The former senator from North Carolina spoke at the first of a series of health policy forums with presidential candidates sponsored by Families USA and the Federation of American Hospitals.

“I think that the bulk of the problem is created when cases are filed in the legal system that should never be there,” he said. “The result is years of litigation and costs incurred by the health care provider that should not have been incurred. What I would do is put more responsibility on the lawyers.”

In Sen. Edwards' ideal world, before a medical malpractice case could be filed, the plaintiff's lawyer would have to conduct a complete investigation, which would include independent review by at least two experts in the field “who determine that the case is, first, meritorious, and second, serious,” he said. “Then you require the lawyer to certify that that has been done as part of the filing. … If they fail to certify, the lawyer should bear the cost. If they do it three times, it's three strikes and you're out; you lose your right as a lawyer to file these cases.”

The bigger topic at the forum, though, was covering the uninsured. In February, Sen. Edwards unveiled a universal coverage plan, which calls for expanding both the State Children's Health Insurance Program and Medicaid, and for keeping Medicare in place. Employers would be required either to provide coverage to employees or to contribute to a system of regional Health Care Markets—nonprofit purchasing pools offering a choice of insurance plans. At least one of the plans would be a public plan based on the Medicare program.

Once the markets were set up and other provisions put in place—including tax credits to help people purchase policies and limits on premium contributions for low- and moderate-income families—an individual mandate would go into effect requiring all citizens to obtain health insurance. The penalty for people who didn't sign up for coverage would likely be “losing your individual tax exemption or some [other] tax consequence for not signing up,” Sen. Edwards said at a press conference after the forum. “Anybody who comes into contact with the health care system or any public agency will be signed up. If you go into the emergency room and are not part of the system, in order to get care you will be signed up.”

To help save costs in Medicare, Sen. Edwards said beneficiaries should have a “medical home” with a single provider responsible for coordinating chronic care “so we don't have overlapping care or unnecessary care.”

He also said that he favors three steps to lower the cost of prescription drugs in the Medicare program: using the bargaining power of government to negotiate prices with pharmaceutical companies, allowing prescription drugs to be “safely imported” into the United States, and “[doing] what we can constitutionally to control drug company ads on television.”

This universal coverage plan “was not intended to take us from where we are today directly to [a single-payer system],” Sen. Edwards said at the forum. “It was intended to allow Americans to decide whether they want government-run health care, or whether they want to continue the private system they have today.”

He noted that there are “real benefits to single-payer [systems]. The administrative cost associated with [government-run systems like] Medicare is 3%–4%, compared with 30%–40% profit and overhead in private insurance companies.” But some people hate single-payer systems like those in Canada and the United Kingdom, and they say that people have to wait too long for some procedures, he added.

“We're going to let Americans make that decision” by choosing which type of plan they prefer, he said. “Over time, we will see in which direction this system gravitates. It will be an extraordinary American model for what works and what doesn't work.”

Sen. Edwards said that the cost of his plan was estimated at $90 billion to $120 billion, and he would pay for it by rolling back tax cuts for Americans making more than $200,000 per year.

A reporter asked Sen. Edwards about the differences between his plan and that of Sen. Hillary Rodham Clinton (D-N.Y.), another Democratic presidential candidate. Sen. Clinton released her plan in September, and it contained many provisions similar to Sen. Edwards' plan, such as an array of private plans for people to choose from as well as a public plan similar to Medicare.

“One difference [is] … how big a priority you made this and how early you came out with a comprehensive plan,” he said. “It's a huge priority to me, and I will not bend on universal [coverage].” Further, “Sen. Clinton appears to believe that you can take money from health insurance and drug company lobbyists and sit at the table with them and negotiate a compromise. I absolutely reject that. The way you get it done is to convince the American people about the rightness of what you want to do,” Sen. Edwards said.

By allowing prescription drugs to be 'safely imported' into the United States, the government would save on Medicare. SEN. EDWARDS

Editor's Note:

This look at the health care proposals of former Sen. John Edwards (D-N.C.) is the first in an occasional series highlighting the health policy views of those seeking to be our next president. Each article is based on a 1-hour health policy forum with an individual candidate held at the Kaiser Family Foundation in Washington, D.C., and sponsored by Families USA and the Federation of American Hospitals. Forums announced so far feature Sen. Hillary Clinton (D-N.Y.), Rep. Dennis Kucinich (D-Ohio), Sen. Joe Biden (D-Del.), Sen. John McCain (R-Ariz.), Sen. Christopher Dodd (D-Conn.), former Gov. Mike Huckabee (R-Ark.), Gov. Bill Richardson (D-N.M.), and Rep. Ron Paul (R-Tex.).

New NIH Neuroscience Group

The National Institutes of Health announced last month that it had established the Emerging Neuroscience and Training Integrated Review Group. The new group is designed to “provide advice and recommendations to the [NIH] Director … on the scientific and technical merit of applications for grants-in-aid for research,” as well as advice on contracts related to neuroscience research and training. The committee will continue indefinitely, according to an announcement in the Federal Register. For more information, visit

http://cms.csr.nih.gov/PeerReviewMeetings/CSRIRGDescription/ETTNIRG/

Data on Elderly Glossed Over

Food and Drug Administration regulations for drugmakers conducting clinical trials encourage the inclusion of elderly participants and the reporting of data by age, but the agency is not effective in getting its medical officers to include data on elderly patients in new drug application (NDA) reviews, according to a report by the Government Accountability Office. The report was based on a review of 36 NDAs submitted from January 2001 to June 2004 for drugs to treat diseases that could affect elderly patients. All the NDAs had at least one trial that included elderly participants, but a third of the agency's NDA reviews had no documentation on safety or efficacy for that age group. In addition, reviewers are not required to establish whether there was a sufficient number of elderly patients in a trial, and if they do address sufficiency, they do not have to document their methods.

E-Prescribing Reduces Errors

Electronic prescribing significantly reduced medication errors, according to data from the Southeast Michigan ePrescribing Initiative (SEMI), a coalition of automakers, health plans, health care providers, a drug manufacturer, and a pharmacy benefits manager. The SEMI results show that among a sample of 3.3 million e-prescriptions, a severe or moderate drug-to-drug alert was sent to physicians for about 33%, resulting in a change to or cancellation of 41% of those scripts. In addition, more than 100,000 medication allergy alerts were presented, of which 41% were acted upon. And when a formulary alert was presented, the physician changed the prescription 39% of the time to comply with formulary requirements. “The benefits of e-prescribing are overwhelming in terms of reducing medication errors, lowering prescription drug costs for patients and plans, and decreasing physician practices' administrative costs,” said Marsha Manning, General Motors' manager of Southeast Michigan Community Health Care Initiatives, in a statement.

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or less-than-basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Adult Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. “Our findings suggest that low health literacy exacts enormous costs on both the health system and society,” lead author John A. Vernon, Ph.D., said in a statement. The report, “Low Health Literacy: Implications for National Health Policy,” was supported by a grant from Pfizer Inc.

One-Third of Americans Uninsured

Almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from 30% in 1999–2000, Families USA reported. Of these, 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million people who lacked coverage, 71% had full-time jobs and another 9% were working part time; only 17% were unemployed. The numbers are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because those statistics include only those who were uninsured for a full year. The report is at

www.familiesusa.org

Medicare Out-of-Pocket Spending Up

The percentage of income that Medicare beneficiaries spend on out-of-pocket health care costs is rising, according to a study published in the November/December issue of Health Affairs. The median amount of income that Medicare beneficiaries spent out of pocket was 12% in 1997, but rose to 16% in 2003. Study authors Patricia Neuman, Sc.D., of the Henry J. Kaiser Family Foundation and colleagues noted that in 2003, the 25% of beneficiaries with the highest out-of-pocket expenses spent at least 30% of their income on health care, whereas the top 10% spent at least 58%. “Our findings suggest that giving elderly and disabled Medicare beneficiaries more 'skin in the game' could make health care less affordable and accessible for all but the highest-income beneficiaries,” the researchers said.

New NIH Neuroscience Group

The National Institutes of Health announced last month that it had established the Emerging Neuroscience and Training Integrated Review Group. The new group is designed to “provide advice and recommendations to the [NIH] Director … on the scientific and technical merit of applications for grants-in-aid for research,” as well as advice on contracts related to neuroscience research and training. The committee will continue indefinitely, according to an announcement in the Federal Register. For more information, visit

http://cms.csr.nih.gov/PeerReviewMeetings/CSRIRGDescription/ETTNIRG/

Data on Elderly Glossed Over

Food and Drug Administration regulations for drugmakers conducting clinical trials encourage the inclusion of elderly participants and the reporting of data by age, but the agency is not effective in getting its medical officers to include data on elderly patients in new drug application (NDA) reviews, according to a report by the Government Accountability Office. The report was based on a review of 36 NDAs submitted from January 2001 to June 2004 for drugs to treat diseases that could affect elderly patients. All the NDAs had at least one trial that included elderly participants, but a third of the agency's NDA reviews had no documentation on safety or efficacy for that age group. In addition, reviewers are not required to establish whether there was a sufficient number of elderly patients in a trial, and if they do address sufficiency, they do not have to document their methods.

E-Prescribing Reduces Errors

Electronic prescribing significantly reduced medication errors, according to data from the Southeast Michigan ePrescribing Initiative (SEMI), a coalition of automakers, health plans, health care providers, a drug manufacturer, and a pharmacy benefits manager. The SEMI results show that among a sample of 3.3 million e-prescriptions, a severe or moderate drug-to-drug alert was sent to physicians for about 33%, resulting in a change to or cancellation of 41% of those scripts. In addition, more than 100,000 medication allergy alerts were presented, of which 41% were acted upon. And when a formulary alert was presented, the physician changed the prescription 39% of the time to comply with formulary requirements. “The benefits of e-prescribing are overwhelming in terms of reducing medication errors, lowering prescription drug costs for patients and plans, and decreasing physician practices' administrative costs,” said Marsha Manning, General Motors' manager of Southeast Michigan Community Health Care Initiatives, in a statement.

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or less-than-basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Adult Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. “Our findings suggest that low health literacy exacts enormous costs on both the health system and society,” lead author John A. Vernon, Ph.D., said in a statement. The report, “Low Health Literacy: Implications for National Health Policy,” was supported by a grant from Pfizer Inc.

One-Third of Americans Uninsured

Almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from 30% in 1999–2000, Families USA reported. Of these, 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million people who lacked coverage, 71% had full-time jobs and another 9% were working part time; only 17% were unemployed. The numbers are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because those statistics include only those who were uninsured for a full year. The report is at

www.familiesusa.org

Medicare Out-of-Pocket Spending Up

The percentage of income that Medicare beneficiaries spend on out-of-pocket health care costs is rising, according to a study published in the November/December issue of Health Affairs. The median amount of income that Medicare beneficiaries spent out of pocket was 12% in 1997, but rose to 16% in 2003. Study authors Patricia Neuman, Sc.D., of the Henry J. Kaiser Family Foundation and colleagues noted that in 2003, the 25% of beneficiaries with the highest out-of-pocket expenses spent at least 30% of their income on health care, whereas the top 10% spent at least 58%. “Our findings suggest that giving elderly and disabled Medicare beneficiaries more 'skin in the game' could make health care less affordable and accessible for all but the highest-income beneficiaries,” the researchers said.

New NIH Neuroscience Group

The National Institutes of Health announced last month that it had established the Emerging Neuroscience and Training Integrated Review Group. The new group is designed to “provide advice and recommendations to the [NIH] Director … on the scientific and technical merit of applications for grants-in-aid for research,” as well as advice on contracts related to neuroscience research and training. The committee will continue indefinitely, according to an announcement in the Federal Register. For more information, visit

http://cms.csr.nih.gov/PeerReviewMeetings/CSRIRGDescription/ETTNIRG/

Data on Elderly Glossed Over

Food and Drug Administration regulations for drugmakers conducting clinical trials encourage the inclusion of elderly participants and the reporting of data by age, but the agency is not effective in getting its medical officers to include data on elderly patients in new drug application (NDA) reviews, according to a report by the Government Accountability Office. The report was based on a review of 36 NDAs submitted from January 2001 to June 2004 for drugs to treat diseases that could affect elderly patients. All the NDAs had at least one trial that included elderly participants, but a third of the agency's NDA reviews had no documentation on safety or efficacy for that age group. In addition, reviewers are not required to establish whether there was a sufficient number of elderly patients in a trial, and if they do address sufficiency, they do not have to document their methods.

E-Prescribing Reduces Errors

Electronic prescribing significantly reduced medication errors, according to data from the Southeast Michigan ePrescribing Initiative (SEMI), a coalition of automakers, health plans, health care providers, a drug manufacturer, and a pharmacy benefits manager. The SEMI results show that among a sample of 3.3 million e-prescriptions, a severe or moderate drug-to-drug alert was sent to physicians for about 33%, resulting in a change to or cancellation of 41% of those scripts. In addition, more than 100,000 medication allergy alerts were presented, of which 41% were acted upon. And when a formulary alert was presented, the physician changed the prescription 39% of the time to comply with formulary requirements. “The benefits of e-prescribing are overwhelming in terms of reducing medication errors, lowering prescription drug costs for patients and plans, and decreasing physician practices' administrative costs,” said Marsha Manning, General Motors' manager of Southeast Michigan Community Health Care Initiatives, in a statement.

Low Health Literacy Is Costly

Researchers found that 87 million adults, or 36% of the adult U.S. population, have basic or less-than-basic health literacy skills. Using data from the 2003 Department of Education National Assessment of Adult Health Literacy, they estimated that low health literacy costs the U.S. economy between $106 billion and $236 billion a year. “Our findings suggest that low health literacy exacts enormous costs on both the health system and society,” lead author John A. Vernon, Ph.D., said in a statement. The report, “Low Health Literacy: Implications for National Health Policy,” was supported by a grant from Pfizer Inc.

One-Third of Americans Uninsured

Almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from 30% in 1999–2000, Families USA reported. Of these, 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million people who lacked coverage, 71% had full-time jobs and another 9% were working part time; only 17% were unemployed. The numbers are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because those statistics include only those who were uninsured for a full year. The report is at

www.familiesusa.org

Medicare Out-of-Pocket Spending Up

The percentage of income that Medicare beneficiaries spend on out-of-pocket health care costs is rising, according to a study published in the November/December issue of Health Affairs. The median amount of income that Medicare beneficiaries spent out of pocket was 12% in 1997, but rose to 16% in 2003. Study authors Patricia Neuman, Sc.D., of the Henry J. Kaiser Family Foundation and colleagues noted that in 2003, the 25% of beneficiaries with the highest out-of-pocket expenses spent at least 30% of their income on health care, whereas the top 10% spent at least 58%. “Our findings suggest that giving elderly and disabled Medicare beneficiaries more 'skin in the game' could make health care less affordable and accessible for all but the highest-income beneficiaries,” the researchers said.

WASHINGTON — Rep. Dennis Kucinich (D-Ohio) is very direct when it comes to the issue of universal health care coverage for Americans.

“Is health care a right or a privilege? If it's a right, then it's appropriate for the government to have a role” in providing it, Rep. Kucinich said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

Rep. Kucinich, who is seeking the Democratic nomination for president, is the only candidate who supports a single-payer system financed by the government.

“If it's a privilege, and it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck. And you know what—47 million [uninsured] Americans are now out of luck,” he said at the forum, part of a series of forums with the presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

Under Rep. Kucinich's proposal, which has been introduced in Congress as H.R. 676, all for-profit health care entities would be converted to nonprofit entities, with shareholders being compensated by the government. That compensation would be financed through Treasury bonds, he said. Physicians would continue to have private practices, but they, along with hospitals and other providers, would be paid by the federal government, which would disseminate federal funds through a series of regional budgets. There would also be separate budgets for capital expenditures and for medical education.

Coverage under Rep. Kucinich's plan would include inpatient and outpatient services as well as dental care, vision care, mental health care, and long-term care. There would be no deductibles or cost sharing.

When a reporter pointed out that other countries with government-financed health care ended up seeing a private system develop alongside the public one for those who could afford it, Rep. Kucinich, a fifth-term congressman and former mayor of Cleveland, said that was no surprise. “Privatizers are at work in every country,” he said. “If health care is such a losing proposition, why are these companies trying to privatize it? Because there's huge amounts of money to be made. But the minute you have a for-profit system, you're going to have people cut out of it.” Another government-run system that people are trying to privatize is Medicare, Rep. Kucinich said. “Right now, Medicare is discouraging doctors by cutting their fees. There's a strategy to privatize Medicare by getting doctors to walk away from [it].”

The passage of the Medicare prescription drug benefit was another part of that plan, he added. “We want to encourage doctors to improve their performance, but under a for-profit system, doctors have cost pressures. That's sure not to encourage the results you want.”

During the forum, Rep. Kucinich said “Years ago, when I was a city councilman in Cleveland, I had a proposal I thought would do a lot to protect the environment. I proposed free [public] transit,” he said. “And the people who attacked the idea threw up their arms and said, 'My God! If we have free transit, everyone's going to be riding the bus!' Exactly. That's what we want. You want people to use the health care system, so that they're healthy.”

'If … it's a market-based thing, then we're left to the predictions of the market … if you can't pay for it, you're out of luck.' REP. KUCINICH

WASHINGTON — Rep. Dennis Kucinich (D-Ohio) is very direct when it comes to the issue of universal health care coverage for Americans.

“Is health care a right or a privilege? If it's a right, then it's appropriate for the government to have a role” in providing it, Rep. Kucinich said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

Rep. Kucinich, who is seeking the Democratic nomination for president, is the only candidate who supports a single-payer system financed by the government.

“If it's a privilege, and it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck. And you know what—47 million [uninsured] Americans are now out of luck,” he said at the forum, part of a series of forums with the presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

Under Rep. Kucinich's proposal, which has been introduced in Congress as H.R. 676, all for-profit health care entities would be converted to nonprofit entities, with shareholders being compensated by the government. That compensation would be financed through Treasury bonds, he said. Physicians would continue to have private practices, but they, along with hospitals and other providers, would be paid by the federal government, which would disseminate federal funds through a series of regional budgets. There would also be separate budgets for capital expenditures and for medical education.

Coverage under Rep. Kucinich's plan would include inpatient and outpatient services as well as dental care, vision care, mental health care, and long-term care. There would be no deductibles or cost sharing.

When a reporter pointed out that other countries with government-financed health care ended up seeing a private system develop alongside the public one for those who could afford it, Rep. Kucinich, a fifth-term congressman and former mayor of Cleveland, said that was no surprise. “Privatizers are at work in every country,” he said. “If health care is such a losing proposition, why are these companies trying to privatize it? Because there's huge amounts of money to be made. But the minute you have a for-profit system, you're going to have people cut out of it.” Another government-run system that people are trying to privatize is Medicare, Rep. Kucinich said. “Right now, Medicare is discouraging doctors by cutting their fees. There's a strategy to privatize Medicare by getting doctors to walk away from [it].”

The passage of the Medicare prescription drug benefit was another part of that plan, he added. “We want to encourage doctors to improve their performance, but under a for-profit system, doctors have cost pressures. That's sure not to encourage the results you want.”

During the forum, Rep. Kucinich said “Years ago, when I was a city councilman in Cleveland, I had a proposal I thought would do a lot to protect the environment. I proposed free [public] transit,” he said. “And the people who attacked the idea threw up their arms and said, 'My God! If we have free transit, everyone's going to be riding the bus!' Exactly. That's what we want. You want people to use the health care system, so that they're healthy.”

'If … it's a market-based thing, then we're left to the predictions of the market … if you can't pay for it, you're out of luck.' REP. KUCINICH

WASHINGTON — Rep. Dennis Kucinich (D-Ohio) is very direct when it comes to the issue of universal health care coverage for Americans.

“Is health care a right or a privilege? If it's a right, then it's appropriate for the government to have a role” in providing it, Rep. Kucinich said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals.

Rep. Kucinich, who is seeking the Democratic nomination for president, is the only candidate who supports a single-payer system financed by the government.

“If it's a privilege, and it's a market-based thing, then we're left to the predations of the market, which is, if you can't pay for it, you're out of luck. And you know what—47 million [uninsured] Americans are now out of luck,” he said at the forum, part of a series of forums with the presidential candidates underwritten by the California Endowment and the Ewing Marion Kauffman Foundation.

Under Rep. Kucinich's proposal, which has been introduced in Congress as H.R. 676, all for-profit health care entities would be converted to nonprofit entities, with shareholders being compensated by the government. That compensation would be financed through Treasury bonds, he said. Physicians would continue to have private practices, but they, along with hospitals and other providers, would be paid by the federal government, which would disseminate federal funds through a series of regional budgets. There would also be separate budgets for capital expenditures and for medical education.

Coverage under Rep. Kucinich's plan would include inpatient and outpatient services as well as dental care, vision care, mental health care, and long-term care. There would be no deductibles or cost sharing.

When a reporter pointed out that other countries with government-financed health care ended up seeing a private system develop alongside the public one for those who could afford it, Rep. Kucinich, a fifth-term congressman and former mayor of Cleveland, said that was no surprise. “Privatizers are at work in every country,” he said. “If health care is such a losing proposition, why are these companies trying to privatize it? Because there's huge amounts of money to be made. But the minute you have a for-profit system, you're going to have people cut out of it.” Another government-run system that people are trying to privatize is Medicare, Rep. Kucinich said. “Right now, Medicare is discouraging doctors by cutting their fees. There's a strategy to privatize Medicare by getting doctors to walk away from [it].”

The passage of the Medicare prescription drug benefit was another part of that plan, he added. “We want to encourage doctors to improve their performance, but under a for-profit system, doctors have cost pressures. That's sure not to encourage the results you want.”

During the forum, Rep. Kucinich said “Years ago, when I was a city councilman in Cleveland, I had a proposal I thought would do a lot to protect the environment. I proposed free [public] transit,” he said. “And the people who attacked the idea threw up their arms and said, 'My God! If we have free transit, everyone's going to be riding the bus!' Exactly. That's what we want. You want people to use the health care system, so that they're healthy.”

'If … it's a market-based thing, then we're left to the predictions of the market … if you can't pay for it, you're out of luck.' REP. KUCINICH

WASHINGTON — According to Sen. Hillary Rodham Clinton (D-N.Y.), primary care physicians don't get enough pay or respect, and there aren't enough of them. Her response to the problem? The federal government should try to help increase the supply of primary care doctors, but in the meantime, nurses, pharmacists, and others should fill the gaps in care.

“I'm intrigued by the fact that a lot of states are permitting pharmacists to give vaccines,” Sen. Clinton, a candidate for the Democratic presidential nomination, said at a health policy forum sponsored by Families USA and the Federation of American Hospitals.

“What other functions can we delegate out, given appropriate oversight and training?” the Senator added. For example, she said, “I think nurses have a great opportunity to do much more than they're doing. If we're not going to be able to quickly increase the number of primary care physicians, we need more advanced practice nurses, and they've got to be given the authority to make some of these [treatment] decisions, because otherwise people will go without care.”

Sen. Clinton, who is in her second Senate term, said that health care would be her top domestic priority if she were elected president.

“This is, for me, a moral question and an economic one,” she said. “Do we want to continue to be so unequal and unfair that, if you are uninsured and you go into the hospital with someone who is insured, you are more likely to die?”

Sen. Clinton said she learned a lot from her experience in her husband's first presidential term when she led his efforts to develop a universal health care plan.

“The fact that the White House took on the responsibility of writing the legislation turned out to be something of a mistake,” she said at the forum, part of a series of presidential candidate health policy forums underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. She said that now she sees the president's role on health care as “setting the goals and framework but not getting into the details.”

Further, the Clinton plan of the early 1990s was just too complicated, she said. “It was a source of concern to a lot of Americans who didn't understand how it could work, and it certainly wasn't presented in the best way.”

This time, Sen. Clinton has a different plan. The “American Health Choices Plan” would allow people to keep their current insurance coverage, but if they didn't like their current insurance or were uninsured, they could choose from a variety of plans similar to those offered to federal employees. They would also have the option of enrolling in a public plan similar to Medicare.

Sen. Clinton said coverage under her plan would be affordable and fully portable, and that insurers would be barred from discriminating against enrollees based on preexisting conditions. Large employers would be required to offer coverage or help pay for employee health care; small businesses would not be required to offer coverage, but would be given tax credits to encourage them to do so.

She estimated the cost of her plan at $110 billion per year and said it would be paid for by rolling back tax breaks for Americans who make more than $250,000 annually.

Sen. Clinton said critics who called her plan a back door to a single-payer, government-run health care system were either misinformed or were misrepresenting her proposal.

“I've included the public plan option because a lot of Americans want it,” she said. “It will not create a new bureaucracy; it will not create a government-run system unless you think Medicare is government run. In Medicare, you choose your doctor, you choose your hospital—you have tremendous choice.”

Sen. Clinton also expressed her support of the increased use of electronic health records to make the health care system more organized. “It's very hard to think about having a system when you don't have any way for people to move [their records with them] from place to place and job to job.”

Paying providers based on their outcomes was another recent innovation mentioned by Sen. Clinton. She lauded the Bush Administration for announcing that the Medicare program would no longer pay for care occurring as a result of medical errors. “That kind of connection between pay and performance, quality and results … makes sense. It's hard to do, but we have to experiment.”

The recent increase in cases of nosocomial infections such as methicillin-resistant Staphylococcus aureus “should be a wake-up call for everybody,” Sen. Clinton said.

Clinton said her plan 'will not create a new bureaucracy; it will not create a government-run system.' SENATOR CLINTON

WASHINGTON — According to Sen. Hillary Rodham Clinton (D-N.Y.), primary care physicians don't get enough pay or respect, and there aren't enough of them. Her response to the problem? The federal government should try to help increase the supply of primary care doctors, but in the meantime, nurses, pharmacists, and others should fill the gaps in care.

“I'm intrigued by the fact that a lot of states are permitting pharmacists to give vaccines,” Sen. Clinton, a candidate for the Democratic presidential nomination, said at a health policy forum sponsored by Families USA and the Federation of American Hospitals.

“What other functions can we delegate out, given appropriate oversight and training?” the Senator added. For example, she said, “I think nurses have a great opportunity to do much more than they're doing. If we're not going to be able to quickly increase the number of primary care physicians, we need more advanced practice nurses, and they've got to be given the authority to make some of these [treatment] decisions, because otherwise people will go without care.”

Sen. Clinton, who is in her second Senate term, said that health care would be her top domestic priority if she were elected president.

“This is, for me, a moral question and an economic one,” she said. “Do we want to continue to be so unequal and unfair that, if you are uninsured and you go into the hospital with someone who is insured, you are more likely to die?”

Sen. Clinton said she learned a lot from her experience in her husband's first presidential term when she led his efforts to develop a universal health care plan.

“The fact that the White House took on the responsibility of writing the legislation turned out to be something of a mistake,” she said at the forum, part of a series of presidential candidate health policy forums underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. She said that now she sees the president's role on health care as “setting the goals and framework but not getting into the details.”

Further, the Clinton plan of the early 1990s was just too complicated, she said. “It was a source of concern to a lot of Americans who didn't understand how it could work, and it certainly wasn't presented in the best way.”

This time, Sen. Clinton has a different plan. The “American Health Choices Plan” would allow people to keep their current insurance coverage, but if they didn't like their current insurance or were uninsured, they could choose from a variety of plans similar to those offered to federal employees. They would also have the option of enrolling in a public plan similar to Medicare.

Sen. Clinton said coverage under her plan would be affordable and fully portable, and that insurers would be barred from discriminating against enrollees based on preexisting conditions. Large employers would be required to offer coverage or help pay for employee health care; small businesses would not be required to offer coverage, but would be given tax credits to encourage them to do so.

She estimated the cost of her plan at $110 billion per year and said it would be paid for by rolling back tax breaks for Americans who make more than $250,000 annually.

Sen. Clinton said critics who called her plan a back door to a single-payer, government-run health care system were either misinformed or were misrepresenting her proposal.

“I've included the public plan option because a lot of Americans want it,” she said. “It will not create a new bureaucracy; it will not create a government-run system unless you think Medicare is government run. In Medicare, you choose your doctor, you choose your hospital—you have tremendous choice.”

Sen. Clinton also expressed her support of the increased use of electronic health records to make the health care system more organized. “It's very hard to think about having a system when you don't have any way for people to move [their records with them] from place to place and job to job.”

Paying providers based on their outcomes was another recent innovation mentioned by Sen. Clinton. She lauded the Bush Administration for announcing that the Medicare program would no longer pay for care occurring as a result of medical errors. “That kind of connection between pay and performance, quality and results … makes sense. It's hard to do, but we have to experiment.”

The recent increase in cases of nosocomial infections such as methicillin-resistant Staphylococcus aureus “should be a wake-up call for everybody,” Sen. Clinton said.

Clinton said her plan 'will not create a new bureaucracy; it will not create a government-run system.' SENATOR CLINTON

WASHINGTON — According to Sen. Hillary Rodham Clinton (D-N.Y.), primary care physicians don't get enough pay or respect, and there aren't enough of them. Her response to the problem? The federal government should try to help increase the supply of primary care doctors, but in the meantime, nurses, pharmacists, and others should fill the gaps in care.

“I'm intrigued by the fact that a lot of states are permitting pharmacists to give vaccines,” Sen. Clinton, a candidate for the Democratic presidential nomination, said at a health policy forum sponsored by Families USA and the Federation of American Hospitals.

“What other functions can we delegate out, given appropriate oversight and training?” the Senator added. For example, she said, “I think nurses have a great opportunity to do much more than they're doing. If we're not going to be able to quickly increase the number of primary care physicians, we need more advanced practice nurses, and they've got to be given the authority to make some of these [treatment] decisions, because otherwise people will go without care.”

Sen. Clinton, who is in her second Senate term, said that health care would be her top domestic priority if she were elected president.

“This is, for me, a moral question and an economic one,” she said. “Do we want to continue to be so unequal and unfair that, if you are uninsured and you go into the hospital with someone who is insured, you are more likely to die?”

Sen. Clinton said she learned a lot from her experience in her husband's first presidential term when she led his efforts to develop a universal health care plan.

“The fact that the White House took on the responsibility of writing the legislation turned out to be something of a mistake,” she said at the forum, part of a series of presidential candidate health policy forums underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. She said that now she sees the president's role on health care as “setting the goals and framework but not getting into the details.”

Further, the Clinton plan of the early 1990s was just too complicated, she said. “It was a source of concern to a lot of Americans who didn't understand how it could work, and it certainly wasn't presented in the best way.”

This time, Sen. Clinton has a different plan. The “American Health Choices Plan” would allow people to keep their current insurance coverage, but if they didn't like their current insurance or were uninsured, they could choose from a variety of plans similar to those offered to federal employees. They would also have the option of enrolling in a public plan similar to Medicare.

Sen. Clinton said coverage under her plan would be affordable and fully portable, and that insurers would be barred from discriminating against enrollees based on preexisting conditions. Large employers would be required to offer coverage or help pay for employee health care; small businesses would not be required to offer coverage, but would be given tax credits to encourage them to do so.

She estimated the cost of her plan at $110 billion per year and said it would be paid for by rolling back tax breaks for Americans who make more than $250,000 annually.

Sen. Clinton said critics who called her plan a back door to a single-payer, government-run health care system were either misinformed or were misrepresenting her proposal.

“I've included the public plan option because a lot of Americans want it,” she said. “It will not create a new bureaucracy; it will not create a government-run system unless you think Medicare is government run. In Medicare, you choose your doctor, you choose your hospital—you have tremendous choice.”

Sen. Clinton also expressed her support of the increased use of electronic health records to make the health care system more organized. “It's very hard to think about having a system when you don't have any way for people to move [their records with them] from place to place and job to job.”

Paying providers based on their outcomes was another recent innovation mentioned by Sen. Clinton. She lauded the Bush Administration for announcing that the Medicare program would no longer pay for care occurring as a result of medical errors. “That kind of connection between pay and performance, quality and results … makes sense. It's hard to do, but we have to experiment.”

The recent increase in cases of nosocomial infections such as methicillin-resistant Staphylococcus aureus “should be a wake-up call for everybody,” Sen. Clinton said.

Clinton said her plan 'will not create a new bureaucracy; it will not create a government-run system.' SENATOR CLINTON

WASHINGTON — According to Sen. Hillary Rodham Clinton (D-N.Y.), primary care physicians don't get enough pay or respect, and there aren't enough of them. Her response to the problem? The federal government should try to help increase the supply of primary care doctors, but in the meantime nurses, pharmacists, and others should fill the gaps in care.

“I'm intrigued by the fact that a lot of states are permitting pharmacists to give vaccines,” Sen. Clinton, a candidate for the Democratic presidential nomination, said at a health policy forum sponsored by Families USA and the Federation of American Hospitals. “What other functions can we delegate out, given appropriate oversight and training?”

For example, she said, “I think nurses have a great opportunity to do much more than they're doing. If we're not going to be able to quickly increase the number of primary care physicians, we need more advanced practice nurses, and they've got to be given the authority to make some of these [treatment] decisions, because otherwise people will go without care.”

Sen. Clinton, who is in her second Senate term, said that health care would be her top domestic priority if she were elected president. “Do we want to continue to be so unequal and unfair that, if you are uninsured and you go into the hospital with someone who is insured, you are more likely to die?”

Sen. Clinton said she learned a lot from her experience in her husband's first presidential term when she led his efforts to develop a universal health care plan.

“The fact that the White House took on the responsibility of writing the legislation turned out to be something of a mistake,” she said at the forum, part of a series of presidential candidate health policy forums underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. She said that now she sees the president's role on health care as “setting the goals and framework but not getting into the details.”

Further, the Clinton plan of the early 1990s was just too complicated, she said.

This time, Sen. Clinton has a different plan. The “American Health Choices Plan” would allow people to keep their current insurance coverage, but if they didn't like their current insurance or were uninsured, they could choose from a variety of plans similar to those offered to federal employees. They would also have the option of enrolling in a public plan similar to Medicare.

Sen. Clinton said coverage under her plan would be affordable and fully portable, and that insurers would be barred from discriminating against enrollees based on preexisting conditions. Large employers would be required to offer coverage or help pay for employee health care; small businesses would not be required to offer coverage, but would be given tax credits to encourage them to do so.

She estimated the cost of her plan at $110 billion per year and said it would be paid for by rolling back tax breaks for Americans who make more than $250,000 annually.

Sen. Clinton said critics who called her plan a back door to a single-payer, government-run health care system were either misinformed or were misrepresenting her proposal. “I've included the public plan option because a lot of Americans want it,” she said. “It will not create a new bureaucracy; it will not create a government-run system unless you think Medicare is government run. In Medicare, you choose your doctor, you choose your hospital—you have tremendous choice.”

Sen. Clinton predicted that a lot of people would still choose a private plan because “if the private plans are competitive and smart, they'll offer a lot of new features. What are we afraid of? Let's see where competition leads us.”

Sen. Clinton also expressed her support of the increased use of electronic health records to make the health care system more organized. “It's very hard to think about having a system when you don't have any way for people to move [their records with them] from place to place and job to job.”

Paying providers based on their outcomes was another recent innovation mentioned by Sen. Clinton. She lauded the Bush Administration for announcing that the Medicare program would no longer pay for care occurring as a result of medical errors. “That kind of connection between pay and performance, quality and results … makes sense. It's hard to do, but we have to experiment.”

“When you look at some of the disparities and disorganization, it's because we don't have a good system to disseminate evidence-based clinically proven treatments,” she continued. “It takes 17 years for something that is proven in the lab to be broadly disseminated. It should take 17 hours—17 seconds. With the Internet, why are we so far behind?”

If we can't 'quickly increase the number of primary care physicians, we need more advanced practice nurses.' SEN. CLINTON

WASHINGTON — According to Sen. Hillary Rodham Clinton (D-N.Y.), primary care physicians don't get enough pay or respect, and there aren't enough of them. Her response to the problem? The federal government should try to help increase the supply of primary care doctors, but in the meantime nurses, pharmacists, and others should fill the gaps in care.

“I'm intrigued by the fact that a lot of states are permitting pharmacists to give vaccines,” Sen. Clinton, a candidate for the Democratic presidential nomination, said at a health policy forum sponsored by Families USA and the Federation of American Hospitals. “What other functions can we delegate out, given appropriate oversight and training?”

For example, she said, “I think nurses have a great opportunity to do much more than they're doing. If we're not going to be able to quickly increase the number of primary care physicians, we need more advanced practice nurses, and they've got to be given the authority to make some of these [treatment] decisions, because otherwise people will go without care.”

Sen. Clinton, who is in her second Senate term, said that health care would be her top domestic priority if she were elected president. “Do we want to continue to be so unequal and unfair that, if you are uninsured and you go into the hospital with someone who is insured, you are more likely to die?”

Sen. Clinton said she learned a lot from her experience in her husband's first presidential term when she led his efforts to develop a universal health care plan.

“The fact that the White House took on the responsibility of writing the legislation turned out to be something of a mistake,” she said at the forum, part of a series of presidential candidate health policy forums underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. She said that now she sees the president's role on health care as “setting the goals and framework but not getting into the details.”

Further, the Clinton plan of the early 1990s was just too complicated, she said.

This time, Sen. Clinton has a different plan. The “American Health Choices Plan” would allow people to keep their current insurance coverage, but if they didn't like their current insurance or were uninsured, they could choose from a variety of plans similar to those offered to federal employees. They would also have the option of enrolling in a public plan similar to Medicare.

Sen. Clinton said coverage under her plan would be affordable and fully portable, and that insurers would be barred from discriminating against enrollees based on preexisting conditions. Large employers would be required to offer coverage or help pay for employee health care; small businesses would not be required to offer coverage, but would be given tax credits to encourage them to do so.

She estimated the cost of her plan at $110 billion per year and said it would be paid for by rolling back tax breaks for Americans who make more than $250,000 annually.

Sen. Clinton said critics who called her plan a back door to a single-payer, government-run health care system were either misinformed or were misrepresenting her proposal. “I've included the public plan option because a lot of Americans want it,” she said. “It will not create a new bureaucracy; it will not create a government-run system unless you think Medicare is government run. In Medicare, you choose your doctor, you choose your hospital—you have tremendous choice.”

Sen. Clinton predicted that a lot of people would still choose a private plan because “if the private plans are competitive and smart, they'll offer a lot of new features. What are we afraid of? Let's see where competition leads us.”

Sen. Clinton also expressed her support of the increased use of electronic health records to make the health care system more organized. “It's very hard to think about having a system when you don't have any way for people to move [their records with them] from place to place and job to job.”

Paying providers based on their outcomes was another recent innovation mentioned by Sen. Clinton. She lauded the Bush Administration for announcing that the Medicare program would no longer pay for care occurring as a result of medical errors. “That kind of connection between pay and performance, quality and results … makes sense. It's hard to do, but we have to experiment.”

“When you look at some of the disparities and disorganization, it's because we don't have a good system to disseminate evidence-based clinically proven treatments,” she continued. “It takes 17 years for something that is proven in the lab to be broadly disseminated. It should take 17 hours—17 seconds. With the Internet, why are we so far behind?”

If we can't 'quickly increase the number of primary care physicians, we need more advanced practice nurses.' SEN. CLINTON

WASHINGTON — According to Sen. Hillary Rodham Clinton (D-N.Y.), primary care physicians don't get enough pay or respect, and there aren't enough of them. Her response to the problem? The federal government should try to help increase the supply of primary care doctors, but in the meantime nurses, pharmacists, and others should fill the gaps in care.

“I'm intrigued by the fact that a lot of states are permitting pharmacists to give vaccines,” Sen. Clinton, a candidate for the Democratic presidential nomination, said at a health policy forum sponsored by Families USA and the Federation of American Hospitals. “What other functions can we delegate out, given appropriate oversight and training?”

For example, she said, “I think nurses have a great opportunity to do much more than they're doing. If we're not going to be able to quickly increase the number of primary care physicians, we need more advanced practice nurses, and they've got to be given the authority to make some of these [treatment] decisions, because otherwise people will go without care.”

Sen. Clinton, who is in her second Senate term, said that health care would be her top domestic priority if she were elected president. “Do we want to continue to be so unequal and unfair that, if you are uninsured and you go into the hospital with someone who is insured, you are more likely to die?”

Sen. Clinton said she learned a lot from her experience in her husband's first presidential term when she led his efforts to develop a universal health care plan.

“The fact that the White House took on the responsibility of writing the legislation turned out to be something of a mistake,” she said at the forum, part of a series of presidential candidate health policy forums underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. She said that now she sees the president's role on health care as “setting the goals and framework but not getting into the details.”

Further, the Clinton plan of the early 1990s was just too complicated, she said.

This time, Sen. Clinton has a different plan. The “American Health Choices Plan” would allow people to keep their current insurance coverage, but if they didn't like their current insurance or were uninsured, they could choose from a variety of plans similar to those offered to federal employees. They would also have the option of enrolling in a public plan similar to Medicare.

Sen. Clinton said coverage under her plan would be affordable and fully portable, and that insurers would be barred from discriminating against enrollees based on preexisting conditions. Large employers would be required to offer coverage or help pay for employee health care; small businesses would not be required to offer coverage, but would be given tax credits to encourage them to do so.

She estimated the cost of her plan at $110 billion per year and said it would be paid for by rolling back tax breaks for Americans who make more than $250,000 annually.

Sen. Clinton said critics who called her plan a back door to a single-payer, government-run health care system were either misinformed or were misrepresenting her proposal. “I've included the public plan option because a lot of Americans want it,” she said. “It will not create a new bureaucracy; it will not create a government-run system unless you think Medicare is government run. In Medicare, you choose your doctor, you choose your hospital—you have tremendous choice.”

Sen. Clinton predicted that a lot of people would still choose a private plan because “if the private plans are competitive and smart, they'll offer a lot of new features. What are we afraid of? Let's see where competition leads us.”

Sen. Clinton also expressed her support of the increased use of electronic health records to make the health care system more organized. “It's very hard to think about having a system when you don't have any way for people to move [their records with them] from place to place and job to job.”

Paying providers based on their outcomes was another recent innovation mentioned by Sen. Clinton. She lauded the Bush Administration for announcing that the Medicare program would no longer pay for care occurring as a result of medical errors. “That kind of connection between pay and performance, quality and results … makes sense. It's hard to do, but we have to experiment.”

“When you look at some of the disparities and disorganization, it's because we don't have a good system to disseminate evidence-based clinically proven treatments,” she continued. “It takes 17 years for something that is proven in the lab to be broadly disseminated. It should take 17 hours—17 seconds. With the Internet, why are we so far behind?”

If we can't 'quickly increase the number of primary care physicians, we need more advanced practice nurses.' SEN. CLINTON