Joyce Frieden

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.

“The problem is created when cases are filed in the legal system that should never be there. [I would] put more responsibility on the lawyers,” he said.

In his ideal world, before a medical malpractice case could be filed, the plaintiff's lawyer would have to conduct a complete investigation, to “determine that the case is, first, meritorious, and second, serious. Then you require the lawyer to certify 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.

After the markets were set up and other provisions put in place—including tax credits and limits on premiums for low- and moderate-income families—a mandate requiring all citizens to obtain health insurance would go into effect. The penalty for those who don't sign up would likely be “losing your individual tax exemption or some [other] tax consequence,” Sen. Edwards said at a press conference later. “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, to get care you will be signed up.”

He said Medicare beneficiaries should have a “medical home” with a single provider coordinating chronic care “so we don't have overlapping care or unnecessary care.”

He favors three steps to lower prescription drug costs in the Medicare program: using the bargaining power of government to negotiate prices, allowing prescription drugs to be “safely imported,” 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.”

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,” he said, noting that some say that with single-payer systems such as those in Canada and the United Kingdom, people sometimes have to wait too long.

“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 the cost of his plan was estimated at between $90 billion to $120 billion, and that 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, which was released in September and contains many provisions similar to Sen. Edwards' plan.

“[She] appears to believe you can take money from health insurance and drug company lobbyists [by negotiating] a compromise. I absolutely reject that. You get it done by convincing the American people about the rightness of what you want to do.”

You get things done by convincing the American people about the rightness of what you want to do. SEN. EDWARDS

Editor's Note on This Series

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 that have been 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.

“The problem is created when cases are filed in the legal system that should never be there. [I would] put more responsibility on the lawyers,” he said.

In his ideal world, before a medical malpractice case could be filed, the plaintiff's lawyer would have to conduct a complete investigation, to “determine that the case is, first, meritorious, and second, serious. Then you require the lawyer to certify 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.

After the markets were set up and other provisions put in place—including tax credits and limits on premiums for low- and moderate-income families—a mandate requiring all citizens to obtain health insurance would go into effect. The penalty for those who don't sign up would likely be “losing your individual tax exemption or some [other] tax consequence,” Sen. Edwards said at a press conference later. “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, to get care you will be signed up.”

He said Medicare beneficiaries should have a “medical home” with a single provider coordinating chronic care “so we don't have overlapping care or unnecessary care.”

He favors three steps to lower prescription drug costs in the Medicare program: using the bargaining power of government to negotiate prices, allowing prescription drugs to be “safely imported,” 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.”

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,” he said, noting that some say that with single-payer systems such as those in Canada and the United Kingdom, people sometimes have to wait too long.

“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 the cost of his plan was estimated at between $90 billion to $120 billion, and that 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, which was released in September and contains many provisions similar to Sen. Edwards' plan.

“[She] appears to believe you can take money from health insurance and drug company lobbyists [by negotiating] a compromise. I absolutely reject that. You get it done by convincing the American people about the rightness of what you want to do.”

You get things done by convincing the American people about the rightness of what you want to do. SEN. EDWARDS

Editor's Note on This Series

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 that have been 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.

“The problem is created when cases are filed in the legal system that should never be there. [I would] put more responsibility on the lawyers,” he said.

In his ideal world, before a medical malpractice case could be filed, the plaintiff's lawyer would have to conduct a complete investigation, to “determine that the case is, first, meritorious, and second, serious. Then you require the lawyer to certify 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.

After the markets were set up and other provisions put in place—including tax credits and limits on premiums for low- and moderate-income families—a mandate requiring all citizens to obtain health insurance would go into effect. The penalty for those who don't sign up would likely be “losing your individual tax exemption or some [other] tax consequence,” Sen. Edwards said at a press conference later. “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, to get care you will be signed up.”

He said Medicare beneficiaries should have a “medical home” with a single provider coordinating chronic care “so we don't have overlapping care or unnecessary care.”

He favors three steps to lower prescription drug costs in the Medicare program: using the bargaining power of government to negotiate prices, allowing prescription drugs to be “safely imported,” 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.”

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,” he said, noting that some say that with single-payer systems such as those in Canada and the United Kingdom, people sometimes have to wait too long.

“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 the cost of his plan was estimated at between $90 billion to $120 billion, and that 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, which was released in September and contains many provisions similar to Sen. Edwards' plan.

“[She] appears to believe you can take money from health insurance and drug company lobbyists [by negotiating] a compromise. I absolutely reject that. You get it done by convincing the American people about the rightness of what you want to do.”

You get things done by convincing the American people about the rightness of what you want to do. SEN. EDWARDS

Editor's Note on This Series

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 that have been 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 way to solve the malpractice insurance crisis is to put the onus on … the malpractice attorneys.

“The bulk of the problem is created when cases are filed in the legal system that should never be there, said the former senator from North Carolina.

In Sen. Edwards' ideal world, before a medical malpractice case could be filed, the plaintiff's lawyer would have to conduct a complete investigation, including 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 and limits on premiums for low- and moderate-income families—a mandate would go into effect requiring all citizens to obtain health insurance, Sen. Edwards said at a press briefing 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.”

Sen. Edwards said Medicare 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 prescription drug costs in the Medicare program: using the bargaining power of government to negotiate prices, 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 say that with single-payer systems like those in Canada and the United Kingdom, 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 the cost of his plan was estimated at $90-$120 billion, and it would be paid for by rolling back tax cuts for Americans making over $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's plan, released in September, contains 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.

“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.

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.

Sen. John Edwards' universal coverage plan includes Medicaid and Medicare.

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

“The bulk of the problem is created when cases are filed in the legal system that should never be there, said the former senator from North Carolina.

In Sen. Edwards' ideal world, before a medical malpractice case could be filed, the plaintiff's lawyer would have to conduct a complete investigation, including 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 and limits on premiums for low- and moderate-income families—a mandate would go into effect requiring all citizens to obtain health insurance, Sen. Edwards said at a press briefing 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.”

Sen. Edwards said Medicare 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 prescription drug costs in the Medicare program: using the bargaining power of government to negotiate prices, 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 say that with single-payer systems like those in Canada and the United Kingdom, 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 the cost of his plan was estimated at $90-$120 billion, and it would be paid for by rolling back tax cuts for Americans making over $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's plan, released in September, contains 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.

“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.

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.

Sen. John Edwards' universal coverage plan includes Medicaid and Medicare.

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

“The bulk of the problem is created when cases are filed in the legal system that should never be there, said the former senator from North Carolina.

In Sen. Edwards' ideal world, before a medical malpractice case could be filed, the plaintiff's lawyer would have to conduct a complete investigation, including 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 and limits on premiums for low- and moderate-income families—a mandate would go into effect requiring all citizens to obtain health insurance, Sen. Edwards said at a press briefing 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.”

Sen. Edwards said Medicare 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 prescription drug costs in the Medicare program: using the bargaining power of government to negotiate prices, 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 say that with single-payer systems like those in Canada and the United Kingdom, 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 the cost of his plan was estimated at $90-$120 billion, and it would be paid for by rolling back tax cuts for Americans making over $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's plan, released in September, contains 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.

“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.

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.

Sen. John Edwards' universal coverage plan includes Medicaid and Medicare.

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 that have been 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 that 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.

Once the markets were set up, a mandate would require all citizens to obtain health insurance. 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 that have been 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 that 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.

Once the markets were set up, a mandate would require all citizens to obtain health insurance. 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 that have been 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 that 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.

Once the markets were set up, a mandate would require all citizens to obtain health insurance. SEN. EDWARDS

Hospitalization Varies by Income

Diabetes patients living in areas where the average annual income is less than $37,000 are 80% more likely to be hospitalized for treatment of diabetes or its complications than are those who live where the average income is $61,000 or more, according to 2005 data from the Agency for Healthcare Research and Quality. In that year, there were nearly 2,800 diabetes-related hospitalizations per 100,000 people in the lowest-income communities, compared with 1,561 per 100,000 people from higher-income communities. Admissions for patients with diabetes increased by 85% between 1993 and 2005; diabetes admissions accounted for 17% of all hospital cases. Among patients 65 years and older, 10,000 per 100,000 patients—roughly five times the national average—were hospitalized for diabetes or diabetes complications. Regional rates also varied, with the diabetes hospitalization rate in the West at 1,585 per 100,000 people, nearly 40% lower than the rate for all other regions of the country.

Lawmakers OK Rx Rule Delay

Coming down to the wire on a new federal mandate requiring the use of tamper-resistant prescription pads for all Medicaid prescriptions as of Oct. 1, lawmakers in the House and the Senate passed legislation in late September that would delay the mandate's start until March 31, 2008. At press time, President Bush was expected to sign the legislation, although it was not clear whether he would sign it by Oct. 1, National Community Pharmacists Association spokesman John Norton told this newspaper. The tamper-proof prescription pad mandate delay was bundled with extensions on several programs due to expire Sept. 30, including an abstinence education initiative that the Bush administration supports, Mr. Norton said. The original mandate, passed as part of war funding legislation earlier this year, requires all Medicaid prescriptions be written on “tamper resistant” paper to be eligible for federal reimbursement. Even though many states have similar requirements, pharmacists' organizations have maintained that most physicians do not currently use these types of pads, nor are supplies readily available.

WHI Results Still Confusing

Just 18% of physicians say they have “no confusion at all” regarding the results of the Women's Health Initiative study, according to an online survey of more than 400 physicians conducted for The Hormone Foundation. The survey also found only 15% of physicians say they believe their patients accurately understand the risks of hormone therapy. “The results of this survey underscore the importance of physicians' role in educating patients and calls for more public education on menopause management,” said Hormone Foundation director Paula Correa. But Dr. Nanette Santoro, director of the division of reproductive endocrinology at the Albert Einstein College of Medicine/Montefiore Medical Center, New York, said that the complexity of the study's results “has been a blessing in disguise. Physicians are spending more time than ever discussing the risks and benefits of hormone therapy with their patients and are focused on individualizing the hormone therapy regimen to the specific needs of the patient.” The survey, which was sponsored by Novogyne Pharmaceuticals, also found that 74% of physicians still consider hormone therapy as a first-line treatment for menopause symptoms. Novogyne manufactures the hormone therapy patches, Vivelle-Dot, Vivelle, and CombiPatch.

Medco Buys Diabetes Supplier

Pharmacy benefit management company Medco Health Solutions announced in August that it was buying PolyMedica, a supplier of blood glucose testing materials, for $1.5 billion in cash. The market for diabetes care, estimated at $25 billion annually, is one of the fastest-growing segments of the health care market, and is expected to overtake cholesterol medications as the fastest-growing therapeutic category by 2009, Medco, based in Franklin Lakes, N.J., noted in a statement. “Combining Medco's clinical care solutions with our patient-centric service model enables us to deliver a gold standard of care to patients with diabetes,” said Patrick T. Ryan, PolyMedica's chief executive officer.

Rise in Adverse Drug Event Reports

The number of serious and fatal adverse drug events (ADEs) reported to the Food and Drug Administration more than doubled between 1998 and 2005, according to a report in the Sept. 10 issue of Archives of Internal Medicine. The agency defines a serious adverse event as an event resulting in death, a birth defect, disability, hospitalization, or that requires intervention. During the 8-year period, 467,809 serious events met the inclusion criteria. The number of reported serious ADEs increased from 34,966 in 1998 to 89,842 in 2005, a 2.6-fold increase; the number of reported deaths during that time increased 2.7-fold, from 5,519 to 15,107.

Hospitalization Varies by Income

Diabetes patients living in areas where the average annual income is less than $37,000 are 80% more likely to be hospitalized for treatment of diabetes or its complications than are those who live where the average income is $61,000 or more, according to 2005 data from the Agency for Healthcare Research and Quality. In that year, there were nearly 2,800 diabetes-related hospitalizations per 100,000 people in the lowest-income communities, compared with 1,561 per 100,000 people from higher-income communities. Admissions for patients with diabetes increased by 85% between 1993 and 2005; diabetes admissions accounted for 17% of all hospital cases. Among patients 65 years and older, 10,000 per 100,000 patients—roughly five times the national average—were hospitalized for diabetes or diabetes complications. Regional rates also varied, with the diabetes hospitalization rate in the West at 1,585 per 100,000 people, nearly 40% lower than the rate for all other regions of the country.

Lawmakers OK Rx Rule Delay

Coming down to the wire on a new federal mandate requiring the use of tamper-resistant prescription pads for all Medicaid prescriptions as of Oct. 1, lawmakers in the House and the Senate passed legislation in late September that would delay the mandate's start until March 31, 2008. At press time, President Bush was expected to sign the legislation, although it was not clear whether he would sign it by Oct. 1, National Community Pharmacists Association spokesman John Norton told this newspaper. The tamper-proof prescription pad mandate delay was bundled with extensions on several programs due to expire Sept. 30, including an abstinence education initiative that the Bush administration supports, Mr. Norton said. The original mandate, passed as part of war funding legislation earlier this year, requires all Medicaid prescriptions be written on “tamper resistant” paper to be eligible for federal reimbursement. Even though many states have similar requirements, pharmacists' organizations have maintained that most physicians do not currently use these types of pads, nor are supplies readily available.

WHI Results Still Confusing

Just 18% of physicians say they have “no confusion at all” regarding the results of the Women's Health Initiative study, according to an online survey of more than 400 physicians conducted for The Hormone Foundation. The survey also found only 15% of physicians say they believe their patients accurately understand the risks of hormone therapy. “The results of this survey underscore the importance of physicians' role in educating patients and calls for more public education on menopause management,” said Hormone Foundation director Paula Correa. But Dr. Nanette Santoro, director of the division of reproductive endocrinology at the Albert Einstein College of Medicine/Montefiore Medical Center, New York, said that the complexity of the study's results “has been a blessing in disguise. Physicians are spending more time than ever discussing the risks and benefits of hormone therapy with their patients and are focused on individualizing the hormone therapy regimen to the specific needs of the patient.” The survey, which was sponsored by Novogyne Pharmaceuticals, also found that 74% of physicians still consider hormone therapy as a first-line treatment for menopause symptoms. Novogyne manufactures the hormone therapy patches, Vivelle-Dot, Vivelle, and CombiPatch.

Medco Buys Diabetes Supplier

Pharmacy benefit management company Medco Health Solutions announced in August that it was buying PolyMedica, a supplier of blood glucose testing materials, for $1.5 billion in cash. The market for diabetes care, estimated at $25 billion annually, is one of the fastest-growing segments of the health care market, and is expected to overtake cholesterol medications as the fastest-growing therapeutic category by 2009, Medco, based in Franklin Lakes, N.J., noted in a statement. “Combining Medco's clinical care solutions with our patient-centric service model enables us to deliver a gold standard of care to patients with diabetes,” said Patrick T. Ryan, PolyMedica's chief executive officer.

Rise in Adverse Drug Event Reports

The number of serious and fatal adverse drug events (ADEs) reported to the Food and Drug Administration more than doubled between 1998 and 2005, according to a report in the Sept. 10 issue of Archives of Internal Medicine. The agency defines a serious adverse event as an event resulting in death, a birth defect, disability, hospitalization, or that requires intervention. During the 8-year period, 467,809 serious events met the inclusion criteria. The number of reported serious ADEs increased from 34,966 in 1998 to 89,842 in 2005, a 2.6-fold increase; the number of reported deaths during that time increased 2.7-fold, from 5,519 to 15,107.

Hospitalization Varies by Income

Diabetes patients living in areas where the average annual income is less than $37,000 are 80% more likely to be hospitalized for treatment of diabetes or its complications than are those who live where the average income is $61,000 or more, according to 2005 data from the Agency for Healthcare Research and Quality. In that year, there were nearly 2,800 diabetes-related hospitalizations per 100,000 people in the lowest-income communities, compared with 1,561 per 100,000 people from higher-income communities. Admissions for patients with diabetes increased by 85% between 1993 and 2005; diabetes admissions accounted for 17% of all hospital cases. Among patients 65 years and older, 10,000 per 100,000 patients—roughly five times the national average—were hospitalized for diabetes or diabetes complications. Regional rates also varied, with the diabetes hospitalization rate in the West at 1,585 per 100,000 people, nearly 40% lower than the rate for all other regions of the country.

Lawmakers OK Rx Rule Delay

Coming down to the wire on a new federal mandate requiring the use of tamper-resistant prescription pads for all Medicaid prescriptions as of Oct. 1, lawmakers in the House and the Senate passed legislation in late September that would delay the mandate's start until March 31, 2008. At press time, President Bush was expected to sign the legislation, although it was not clear whether he would sign it by Oct. 1, National Community Pharmacists Association spokesman John Norton told this newspaper. The tamper-proof prescription pad mandate delay was bundled with extensions on several programs due to expire Sept. 30, including an abstinence education initiative that the Bush administration supports, Mr. Norton said. The original mandate, passed as part of war funding legislation earlier this year, requires all Medicaid prescriptions be written on “tamper resistant” paper to be eligible for federal reimbursement. Even though many states have similar requirements, pharmacists' organizations have maintained that most physicians do not currently use these types of pads, nor are supplies readily available.

WHI Results Still Confusing

Just 18% of physicians say they have “no confusion at all” regarding the results of the Women's Health Initiative study, according to an online survey of more than 400 physicians conducted for The Hormone Foundation. The survey also found only 15% of physicians say they believe their patients accurately understand the risks of hormone therapy. “The results of this survey underscore the importance of physicians' role in educating patients and calls for more public education on menopause management,” said Hormone Foundation director Paula Correa. But Dr. Nanette Santoro, director of the division of reproductive endocrinology at the Albert Einstein College of Medicine/Montefiore Medical Center, New York, said that the complexity of the study's results “has been a blessing in disguise. Physicians are spending more time than ever discussing the risks and benefits of hormone therapy with their patients and are focused on individualizing the hormone therapy regimen to the specific needs of the patient.” The survey, which was sponsored by Novogyne Pharmaceuticals, also found that 74% of physicians still consider hormone therapy as a first-line treatment for menopause symptoms. Novogyne manufactures the hormone therapy patches, Vivelle-Dot, Vivelle, and CombiPatch.

Medco Buys Diabetes Supplier

Pharmacy benefit management company Medco Health Solutions announced in August that it was buying PolyMedica, a supplier of blood glucose testing materials, for $1.5 billion in cash. The market for diabetes care, estimated at $25 billion annually, is one of the fastest-growing segments of the health care market, and is expected to overtake cholesterol medications as the fastest-growing therapeutic category by 2009, Medco, based in Franklin Lakes, N.J., noted in a statement. “Combining Medco's clinical care solutions with our patient-centric service model enables us to deliver a gold standard of care to patients with diabetes,” said Patrick T. Ryan, PolyMedica's chief executive officer.

Rise in Adverse Drug Event Reports

The number of serious and fatal adverse drug events (ADEs) reported to the Food and Drug Administration more than doubled between 1998 and 2005, according to a report in the Sept. 10 issue of Archives of Internal Medicine. The agency defines a serious adverse event as an event resulting in death, a birth defect, disability, hospitalization, or that requires intervention. During the 8-year period, 467,809 serious events met the inclusion criteria. The number of reported serious ADEs increased from 34,966 in 1998 to 89,842 in 2005, a 2.6-fold increase; the number of reported deaths during that time increased 2.7-fold, from 5,519 to 15,107.

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 mid-century, 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 the Center for Health Economics and principal author of the report. He noted much of this cost was avoidable. “With moderate improvements in prevention and early intervention, such as reducing the rate of obesity, 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.

Spinal Muscular Atrophy Legislation

Sen. Debbie Stabenow (D-Mich.) and Rep. Johnny Isakson (R-Ga.) introduced the Spinal Muscular Atrophy Treatment Acceleration Act of 2007, which would require the National Institutes of Health to establish a clinical trial network and a data coordinating center for spinal muscular atrophy (SMA). The bill would require the NIH to “ensure that such [a] network conducts coordinated, multisite, clinical trials of pharmacological approaches to the treatment of SMA, and rapidly and efficiently disseminates scientific findings to the field.” The law calls for a national registry and a coordinating committee.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research & Educational Trust. But experts said the slowdown is temporary and isn't providing relief to individuals or employers. The 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage is $12,106; workers pay about $3,281 for their share. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For details, visit

www.kff.org/insurance/7672

New Numbers on Uninsured

According to a report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked coverage, 71% were employed full time 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 Census Bureau statistics include only those uninsured for a full year. The report is at

www.familiesusa.org

N.J. Task Force Examines MD Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation is examining payments and gifts to physicians from the drug and device industry. The task force also will consider public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have laws requiring some form of reporting of payments made to physicians by pharmaceutical and medical device companies. In response, Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment inappropriate and says any gifts should support medical practice and be less than $100.

Taxing Health Benefits

Proposals to cap tax deductions employers and employees can take regarding health insurance could spell the end of employer-based health benefits, according to a report from the Employee Benefit Research Institute. Currently, employers may deduct the cost of the health insurance coverage they provide to their workers with no limits and workers are not taxed on the value of the health coverage they receive. Capping these tax exclusions could cause young, healthy workers to seek insurance outside of their employers' offering, leaving the employer-based pool with an older, sicker group of patients, the EBRI report said. The full report is available online at

www.ebri.org

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 mid-century, 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 the Center for Health Economics and principal author of the report. He noted much of this cost was avoidable. “With moderate improvements in prevention and early intervention, such as reducing the rate of obesity, 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.

Spinal Muscular Atrophy Legislation

Sen. Debbie Stabenow (D-Mich.) and Rep. Johnny Isakson (R-Ga.) introduced the Spinal Muscular Atrophy Treatment Acceleration Act of 2007, which would require the National Institutes of Health to establish a clinical trial network and a data coordinating center for spinal muscular atrophy (SMA). The bill would require the NIH to “ensure that such [a] network conducts coordinated, multisite, clinical trials of pharmacological approaches to the treatment of SMA, and rapidly and efficiently disseminates scientific findings to the field.” The law calls for a national registry and a coordinating committee.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research & Educational Trust. But experts said the slowdown is temporary and isn't providing relief to individuals or employers. The 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage is $12,106; workers pay about $3,281 for their share. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For details, visit

www.kff.org/insurance/7672

New Numbers on Uninsured

According to a report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked coverage, 71% were employed full time 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 Census Bureau statistics include only those uninsured for a full year. The report is at

www.familiesusa.org

N.J. Task Force Examines MD Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation is examining payments and gifts to physicians from the drug and device industry. The task force also will consider public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have laws requiring some form of reporting of payments made to physicians by pharmaceutical and medical device companies. In response, Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment inappropriate and says any gifts should support medical practice and be less than $100.

Taxing Health Benefits

Proposals to cap tax deductions employers and employees can take regarding health insurance could spell the end of employer-based health benefits, according to a report from the Employee Benefit Research Institute. Currently, employers may deduct the cost of the health insurance coverage they provide to their workers with no limits and workers are not taxed on the value of the health coverage they receive. Capping these tax exclusions could cause young, healthy workers to seek insurance outside of their employers' offering, leaving the employer-based pool with an older, sicker group of patients, the EBRI report said. The full report is available online at

www.ebri.org

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 mid-century, 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 the Center for Health Economics and principal author of the report. He noted much of this cost was avoidable. “With moderate improvements in prevention and early intervention, such as reducing the rate of obesity, 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.

Spinal Muscular Atrophy Legislation

Sen. Debbie Stabenow (D-Mich.) and Rep. Johnny Isakson (R-Ga.) introduced the Spinal Muscular Atrophy Treatment Acceleration Act of 2007, which would require the National Institutes of Health to establish a clinical trial network and a data coordinating center for spinal muscular atrophy (SMA). The bill would require the NIH to “ensure that such [a] network conducts coordinated, multisite, clinical trials of pharmacological approaches to the treatment of SMA, and rapidly and efficiently disseminates scientific findings to the field.” The law calls for a national registry and a coordinating committee.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research & Educational Trust. But experts said the slowdown is temporary and isn't providing relief to individuals or employers. The 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage is $12,106; workers pay about $3,281 for their share. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For details, visit

www.kff.org/insurance/7672

New Numbers on Uninsured

According to a report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked coverage, 71% were employed full time 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 Census Bureau statistics include only those uninsured for a full year. The report is at

www.familiesusa.org

N.J. Task Force Examines MD Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation is examining payments and gifts to physicians from the drug and device industry. The task force also will consider public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have laws requiring some form of reporting of payments made to physicians by pharmaceutical and medical device companies. In response, Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment inappropriate and says any gifts should support medical practice and be less than $100.

Taxing Health Benefits

Proposals to cap tax deductions employers and employees can take regarding health insurance could spell the end of employer-based health benefits, according to a report from the Employee Benefit Research Institute. Currently, employers may deduct the cost of the health insurance coverage they provide to their workers with no limits and workers are not taxed on the value of the health coverage they receive. Capping these tax exclusions could cause young, healthy workers to seek insurance outside of their employers' offering, leaving the employer-based pool with an older, sicker group of patients, the EBRI report said. The full report is available online at

www.ebri.org

WASHINGTON — The number of physicians choosing to specialize in geriatrics will not be anywhere near enough to meet the needs of the elderly patients of the future, Dr. Christine Cassel said at a meeting jointly sponsored by the American Thyroid Association and Johns Hopkins University.

In 1987, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine created a certificate of added qualification (CAQ) in geriatric medicine.

To date, 7,422 such CAQs have been issued, including 263 in 2006, said Dr. Cassel, ABIM president. "That rate is not nearly enough to keep up with the predictions" of the number of geriatric specialists needed, she said.

Geriatrics is challenging because "it's not about mastering one area in great depth, but being comfortable enough dealing with a wide range of specialties—not just subspecialties of internal medicine, but other specialties [such as]… orthopedics, urology, and psychiatry—that you will be referring to," she noted. The physician must also understand the difference between disease and aging, and know how to evaluate physiologic age.

In addition, "no geriatrician thinks you can be a solo practitioner in an office by yourself." Instead, geriatric medicine specialists need to know how to integrate advanced practice professionals, social workers, pharmacists, and others into the practice team, Dr. Cassel said. In effect, what elderly patients will need are generalist physicians.

"That generalist discipline, which is rapidly disappearing from American medicine, is necessary to solve this problem of coordination of care and reduced costs and better quality," she said.

Dr. Cassel quoted ABIM data that showed that in 1997, only 43% of internal medicine residents went into subspecialties; by 2005, that figure was 60%. The data that the board is seeing today suggest that only 15% of internists are becoming general internists, "and of that 15%, more than half are [becoming] hospitalists," she said. "It really is the very rare person who wants to do [generalist] practice in the community."

Dr. Cassel pointed out that "our health care payment system has made it virtually impossible to do that [kind of medicine]. It has put huge barriers in the way of people who want to [go into general practice], and created great incentives for people who want to do more procedural, more highly specialized work."

Internists who specialize in procedures will often argue that specialists "are pushing innovation. [They say], 'That's why America has the best health care in the world, because we have all these specialists,'" she continued. "But the evidence is quite to the contrary … The United States is somewhere between 15th and 20th in the world in terms of numbers of older people and higher life expectancy."

Dr. Cassel noted that Japan, Germany, and Sweden—countries where life expectancy for males and females is higher than in the United States—not only provide universal health insurance for the entire population, but also, within the last 10 years, have enacted universal, government-funded long-term care insurance. "Somehow they managed to do this and still spend less money than we do," she said. "This idea that the United States provides the best quality of care is getting less and less defensible."

The lesson to be learned from these other countries "is not that we should, in a wholesale way, adopt one or another of these systems; the message is that there has to be a way to figure out how to provide comprehensive, affordable, good care with an aging population," Dr. Cassel said. "Germany, Sweden, and Japan are probably where we're going to be 15 to 20 years from now, so as we look ahead, we can probably learn some lessons from them."

The U.S. payment system puts huge barriers in the way of people who want to go into general practice. DR. CASSEL

WASHINGTON — The number of physicians choosing to specialize in geriatrics will not be anywhere near enough to meet the needs of the elderly patients of the future, Dr. Christine Cassel said at a meeting jointly sponsored by the American Thyroid Association and Johns Hopkins University.

In 1987, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine created a certificate of added qualification (CAQ) in geriatric medicine.

To date, 7,422 such CAQs have been issued, including 263 in 2006, said Dr. Cassel, ABIM president. "That rate is not nearly enough to keep up with the predictions" of the number of geriatric specialists needed, she said.

Geriatrics is challenging because "it's not about mastering one area in great depth, but being comfortable enough dealing with a wide range of specialties—not just subspecialties of internal medicine, but other specialties [such as]… orthopedics, urology, and psychiatry—that you will be referring to," she noted. The physician must also understand the difference between disease and aging, and know how to evaluate physiologic age.

In addition, "no geriatrician thinks you can be a solo practitioner in an office by yourself." Instead, geriatric medicine specialists need to know how to integrate advanced practice professionals, social workers, pharmacists, and others into the practice team, Dr. Cassel said. In effect, what elderly patients will need are generalist physicians.

"That generalist discipline, which is rapidly disappearing from American medicine, is necessary to solve this problem of coordination of care and reduced costs and better quality," she said.

Dr. Cassel quoted ABIM data that showed that in 1997, only 43% of internal medicine residents went into subspecialties; by 2005, that figure was 60%. The data that the board is seeing today suggest that only 15% of internists are becoming general internists, "and of that 15%, more than half are [becoming] hospitalists," she said. "It really is the very rare person who wants to do [generalist] practice in the community."

Dr. Cassel pointed out that "our health care payment system has made it virtually impossible to do that [kind of medicine]. It has put huge barriers in the way of people who want to [go into general practice], and created great incentives for people who want to do more procedural, more highly specialized work."

Internists who specialize in procedures will often argue that specialists "are pushing innovation. [They say], 'That's why America has the best health care in the world, because we have all these specialists,'" she continued. "But the evidence is quite to the contrary … The United States is somewhere between 15th and 20th in the world in terms of numbers of older people and higher life expectancy."

Dr. Cassel noted that Japan, Germany, and Sweden—countries where life expectancy for males and females is higher than in the United States—not only provide universal health insurance for the entire population, but also, within the last 10 years, have enacted universal, government-funded long-term care insurance. "Somehow they managed to do this and still spend less money than we do," she said. "This idea that the United States provides the best quality of care is getting less and less defensible."

The lesson to be learned from these other countries "is not that we should, in a wholesale way, adopt one or another of these systems; the message is that there has to be a way to figure out how to provide comprehensive, affordable, good care with an aging population," Dr. Cassel said. "Germany, Sweden, and Japan are probably where we're going to be 15 to 20 years from now, so as we look ahead, we can probably learn some lessons from them."

The U.S. payment system puts huge barriers in the way of people who want to go into general practice. DR. CASSEL

WASHINGTON — The number of physicians choosing to specialize in geriatrics will not be anywhere near enough to meet the needs of the elderly patients of the future, Dr. Christine Cassel said at a meeting jointly sponsored by the American Thyroid Association and Johns Hopkins University.

In 1987, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine created a certificate of added qualification (CAQ) in geriatric medicine.

To date, 7,422 such CAQs have been issued, including 263 in 2006, said Dr. Cassel, ABIM president. "That rate is not nearly enough to keep up with the predictions" of the number of geriatric specialists needed, she said.

Geriatrics is challenging because "it's not about mastering one area in great depth, but being comfortable enough dealing with a wide range of specialties—not just subspecialties of internal medicine, but other specialties [such as]… orthopedics, urology, and psychiatry—that you will be referring to," she noted. The physician must also understand the difference between disease and aging, and know how to evaluate physiologic age.

In addition, "no geriatrician thinks you can be a solo practitioner in an office by yourself." Instead, geriatric medicine specialists need to know how to integrate advanced practice professionals, social workers, pharmacists, and others into the practice team, Dr. Cassel said. In effect, what elderly patients will need are generalist physicians.

"That generalist discipline, which is rapidly disappearing from American medicine, is necessary to solve this problem of coordination of care and reduced costs and better quality," she said.

Dr. Cassel quoted ABIM data that showed that in 1997, only 43% of internal medicine residents went into subspecialties; by 2005, that figure was 60%. The data that the board is seeing today suggest that only 15% of internists are becoming general internists, "and of that 15%, more than half are [becoming] hospitalists," she said. "It really is the very rare person who wants to do [generalist] practice in the community."

Dr. Cassel pointed out that "our health care payment system has made it virtually impossible to do that [kind of medicine]. It has put huge barriers in the way of people who want to [go into general practice], and created great incentives for people who want to do more procedural, more highly specialized work."

Internists who specialize in procedures will often argue that specialists "are pushing innovation. [They say], 'That's why America has the best health care in the world, because we have all these specialists,'" she continued. "But the evidence is quite to the contrary … The United States is somewhere between 15th and 20th in the world in terms of numbers of older people and higher life expectancy."

Dr. Cassel noted that Japan, Germany, and Sweden—countries where life expectancy for males and females is higher than in the United States—not only provide universal health insurance for the entire population, but also, within the last 10 years, have enacted universal, government-funded long-term care insurance. "Somehow they managed to do this and still spend less money than we do," she said. "This idea that the United States provides the best quality of care is getting less and less defensible."

The lesson to be learned from these other countries "is not that we should, in a wholesale way, adopt one or another of these systems; the message is that there has to be a way to figure out how to provide comprehensive, affordable, good care with an aging population," Dr. Cassel said. "Germany, Sweden, and Japan are probably where we're going to be 15 to 20 years from now, so as we look ahead, we can probably learn some lessons from them."

The U.S. payment system puts huge barriers in the way of people who want to go into general practice. DR. CASSEL

Physical Activity Bill Introduced

U.S. Rep. Zach Wamp (R-Tenn.), Rep. Ron Kind (D-Wis.), and Rep. Jay Inslee (D-Wash.) have introduced a bill to mandate more physical activity for schoolchildren. The Fitness Integrated With Teaching Kids (FIT Kids) Act would add physical education to the ways of determining accountability under the No Child Left Behind Act. States would be graded on how well they worked to meet a target for required physical education of 150 minutes per week in elementary schools and 225 minutes per week for middle- and high-school students. Schools would be required to report their progress, including details on the amount of time students spend in required physical education and the percentage of elementary and secondary school physical education teachers who are state licensed or certified in physical education. “The statistics on childhood obesity are staggering, and we need to get them going in the other direction,” Rep. Wamp said in a statement. “Research shows that healthy children learn more effectively and achieve more academically. The FIT Kids Act would ensure a strong emphasis on physical education to help bolster academic performance and provide students with the physical activity and education to lead healthy lifestyles.”

Proposed Imaging Cuts Decried

The Access to Medical Imaging Coalition, a group that includes the American Association of Clinical Endocrinologists, has asked House members to change a section of the Children's Health and Medicare Protection (CHAMP) Act of 2007 that would impose further cuts on Medicare reimbursement for medical imaging procedures. The proposed cuts would be in addition to a $13 billion cut in imaging payments under the Deficit Reduction Act that went into effect last January. Under those cuts, “access to imaging services, particularly in rural areas, is being limited,” the coalition said in a letter to House Speaker Nancy Pelosi (D-Calif.). For example, “the Community Women's Health Clinic in Charleston, W.Va., has stopped performing osteoporosis screening and treatment services altogether because they can no longer afford to do the procedures. These additional CHAMP Act proposed cuts would also have a harsh impact on underserved populations who have little or no insurance or cannot afford to pay out of pocket for imaging services.” The proposed cuts include a 50% reduction in the technical component for certain imaging services. The House and Senate both passed legislation to reauthorize children's health care in August; a conference committee is expected to reconcile the different bills this month.

Small Practices Decline

Physicians are shying away from solo and two-physician practices, according to a new report from the Center for Studying Health System Change. Although these small practices are still the most common practice arrangements, between 1996–1997 and 2004–2005 researchers saw a shift from solo and 2-person practices to mid-sized, single-specialty groups of 6–50 physicians. The percentage of physicians who practiced in solo and two-person practices fell from 41% in 1996–1997 to 33% in 2004–2005. During the same time period, the percentage of physicians practicing in mid-sized groups rose from 13% to 18%. The biggest declines in physicians who choose small practices have come from medical specialists and surgical specialists, whereas the proportion of primary care physicians in small practices has remained steady at about 36%. “Physicians appear to be organizing in larger, single-specialty practices that present enhanced opportunities to offer more profitable ancillary services rather than organizing in ways that support coordination of care,” Paul B. Ginsburg, president of the Center for Studying Health System Change, said in a statement. The report's findings are based on the group's nationally representative Community Tracking Study Physician Survey.

FDA, DoD to Share Data

The Department of Defense will share data and expertise with the Food and Drug Administration related to the review and use of FDA-regulated drugs, biologics, and medical devices in an effort to identify potential concerns and recognize benefits of products, the two agencies said. The DoD will share general patient data from military health system records with the FDA, although the agencies will protect all personal health information exchanged under the agreement. Among the DoD programs involved in the agreement is TRICARE, which serves 9.1 million members of the uniformed services, military retirees, and their families, and TRICARE prescription data likely will be the first information shared as part of the project. The partnership between the DoD and FDA is part of the FDA's Sentinel Network, a project intended to explore linking private sector and public sector information to create an integrated electronic network.

GAO Finds Medicaid Decline

A law requiring most U.S. citizens applying for Medicaid coverage to document their citizenship has caused eligible citizens to lose Medicaid coverage, and the law costs far more to administer than it saves, according to two government analyses. The law went into effect on July 1, 2006, and affects 30 million children and 16 million parents currently enrolled in Medicaid, as well as millions of new applicants. The first analysis, from the Government Accountability Office, found that half the states are reporting declines in Medicaid coverage because of the requirement, and many of those losing coverage appear to be U.S. citizens. The second analysis, produced by the House Committee on Oversight and Government Reform, found that for every $100 spent by federal taxpayers to implement the documentation requirements in six states, only 14 cents in Medicaid savings can be documented.

Physical Activity Bill Introduced

U.S. Rep. Zach Wamp (R-Tenn.), Rep. Ron Kind (D-Wis.), and Rep. Jay Inslee (D-Wash.) have introduced a bill to mandate more physical activity for schoolchildren. The Fitness Integrated With Teaching Kids (FIT Kids) Act would add physical education to the ways of determining accountability under the No Child Left Behind Act. States would be graded on how well they worked to meet a target for required physical education of 150 minutes per week in elementary schools and 225 minutes per week for middle- and high-school students. Schools would be required to report their progress, including details on the amount of time students spend in required physical education and the percentage of elementary and secondary school physical education teachers who are state licensed or certified in physical education. “The statistics on childhood obesity are staggering, and we need to get them going in the other direction,” Rep. Wamp said in a statement. “Research shows that healthy children learn more effectively and achieve more academically. The FIT Kids Act would ensure a strong emphasis on physical education to help bolster academic performance and provide students with the physical activity and education to lead healthy lifestyles.”

Proposed Imaging Cuts Decried

The Access to Medical Imaging Coalition, a group that includes the American Association of Clinical Endocrinologists, has asked House members to change a section of the Children's Health and Medicare Protection (CHAMP) Act of 2007 that would impose further cuts on Medicare reimbursement for medical imaging procedures. The proposed cuts would be in addition to a $13 billion cut in imaging payments under the Deficit Reduction Act that went into effect last January. Under those cuts, “access to imaging services, particularly in rural areas, is being limited,” the coalition said in a letter to House Speaker Nancy Pelosi (D-Calif.). For example, “the Community Women's Health Clinic in Charleston, W.Va., has stopped performing osteoporosis screening and treatment services altogether because they can no longer afford to do the procedures. These additional CHAMP Act proposed cuts would also have a harsh impact on underserved populations who have little or no insurance or cannot afford to pay out of pocket for imaging services.” The proposed cuts include a 50% reduction in the technical component for certain imaging services. The House and Senate both passed legislation to reauthorize children's health care in August; a conference committee is expected to reconcile the different bills this month.

Small Practices Decline

Physicians are shying away from solo and two-physician practices, according to a new report from the Center for Studying Health System Change. Although these small practices are still the most common practice arrangements, between 1996–1997 and 2004–2005 researchers saw a shift from solo and 2-person practices to mid-sized, single-specialty groups of 6–50 physicians. The percentage of physicians who practiced in solo and two-person practices fell from 41% in 1996–1997 to 33% in 2004–2005. During the same time period, the percentage of physicians practicing in mid-sized groups rose from 13% to 18%. The biggest declines in physicians who choose small practices have come from medical specialists and surgical specialists, whereas the proportion of primary care physicians in small practices has remained steady at about 36%. “Physicians appear to be organizing in larger, single-specialty practices that present enhanced opportunities to offer more profitable ancillary services rather than organizing in ways that support coordination of care,” Paul B. Ginsburg, president of the Center for Studying Health System Change, said in a statement. The report's findings are based on the group's nationally representative Community Tracking Study Physician Survey.

FDA, DoD to Share Data

The Department of Defense will share data and expertise with the Food and Drug Administration related to the review and use of FDA-regulated drugs, biologics, and medical devices in an effort to identify potential concerns and recognize benefits of products, the two agencies said. The DoD will share general patient data from military health system records with the FDA, although the agencies will protect all personal health information exchanged under the agreement. Among the DoD programs involved in the agreement is TRICARE, which serves 9.1 million members of the uniformed services, military retirees, and their families, and TRICARE prescription data likely will be the first information shared as part of the project. The partnership between the DoD and FDA is part of the FDA's Sentinel Network, a project intended to explore linking private sector and public sector information to create an integrated electronic network.

GAO Finds Medicaid Decline

A law requiring most U.S. citizens applying for Medicaid coverage to document their citizenship has caused eligible citizens to lose Medicaid coverage, and the law costs far more to administer than it saves, according to two government analyses. The law went into effect on July 1, 2006, and affects 30 million children and 16 million parents currently enrolled in Medicaid, as well as millions of new applicants. The first analysis, from the Government Accountability Office, found that half the states are reporting declines in Medicaid coverage because of the requirement, and many of those losing coverage appear to be U.S. citizens. The second analysis, produced by the House Committee on Oversight and Government Reform, found that for every $100 spent by federal taxpayers to implement the documentation requirements in six states, only 14 cents in Medicaid savings can be documented.

Physical Activity Bill Introduced

U.S. Rep. Zach Wamp (R-Tenn.), Rep. Ron Kind (D-Wis.), and Rep. Jay Inslee (D-Wash.) have introduced a bill to mandate more physical activity for schoolchildren. The Fitness Integrated With Teaching Kids (FIT Kids) Act would add physical education to the ways of determining accountability under the No Child Left Behind Act. States would be graded on how well they worked to meet a target for required physical education of 150 minutes per week in elementary schools and 225 minutes per week for middle- and high-school students. Schools would be required to report their progress, including details on the amount of time students spend in required physical education and the percentage of elementary and secondary school physical education teachers who are state licensed or certified in physical education. “The statistics on childhood obesity are staggering, and we need to get them going in the other direction,” Rep. Wamp said in a statement. “Research shows that healthy children learn more effectively and achieve more academically. The FIT Kids Act would ensure a strong emphasis on physical education to help bolster academic performance and provide students with the physical activity and education to lead healthy lifestyles.”

Proposed Imaging Cuts Decried

The Access to Medical Imaging Coalition, a group that includes the American Association of Clinical Endocrinologists, has asked House members to change a section of the Children's Health and Medicare Protection (CHAMP) Act of 2007 that would impose further cuts on Medicare reimbursement for medical imaging procedures. The proposed cuts would be in addition to a $13 billion cut in imaging payments under the Deficit Reduction Act that went into effect last January. Under those cuts, “access to imaging services, particularly in rural areas, is being limited,” the coalition said in a letter to House Speaker Nancy Pelosi (D-Calif.). For example, “the Community Women's Health Clinic in Charleston, W.Va., has stopped performing osteoporosis screening and treatment services altogether because they can no longer afford to do the procedures. These additional CHAMP Act proposed cuts would also have a harsh impact on underserved populations who have little or no insurance or cannot afford to pay out of pocket for imaging services.” The proposed cuts include a 50% reduction in the technical component for certain imaging services. The House and Senate both passed legislation to reauthorize children's health care in August; a conference committee is expected to reconcile the different bills this month.

Small Practices Decline

Physicians are shying away from solo and two-physician practices, according to a new report from the Center for Studying Health System Change. Although these small practices are still the most common practice arrangements, between 1996–1997 and 2004–2005 researchers saw a shift from solo and 2-person practices to mid-sized, single-specialty groups of 6–50 physicians. The percentage of physicians who practiced in solo and two-person practices fell from 41% in 1996–1997 to 33% in 2004–2005. During the same time period, the percentage of physicians practicing in mid-sized groups rose from 13% to 18%. The biggest declines in physicians who choose small practices have come from medical specialists and surgical specialists, whereas the proportion of primary care physicians in small practices has remained steady at about 36%. “Physicians appear to be organizing in larger, single-specialty practices that present enhanced opportunities to offer more profitable ancillary services rather than organizing in ways that support coordination of care,” Paul B. Ginsburg, president of the Center for Studying Health System Change, said in a statement. The report's findings are based on the group's nationally representative Community Tracking Study Physician Survey.

FDA, DoD to Share Data

The Department of Defense will share data and expertise with the Food and Drug Administration related to the review and use of FDA-regulated drugs, biologics, and medical devices in an effort to identify potential concerns and recognize benefits of products, the two agencies said. The DoD will share general patient data from military health system records with the FDA, although the agencies will protect all personal health information exchanged under the agreement. Among the DoD programs involved in the agreement is TRICARE, which serves 9.1 million members of the uniformed services, military retirees, and their families, and TRICARE prescription data likely will be the first information shared as part of the project. The partnership between the DoD and FDA is part of the FDA's Sentinel Network, a project intended to explore linking private sector and public sector information to create an integrated electronic network.

GAO Finds Medicaid Decline

A law requiring most U.S. citizens applying for Medicaid coverage to document their citizenship has caused eligible citizens to lose Medicaid coverage, and the law costs far more to administer than it saves, according to two government analyses. The law went into effect on July 1, 2006, and affects 30 million children and 16 million parents currently enrolled in Medicaid, as well as millions of new applicants. The first analysis, from the Government Accountability Office, found that half the states are reporting declines in Medicaid coverage because of the requirement, and many of those losing coverage appear to be U.S. citizens. The second analysis, produced by the House Committee on Oversight and Government Reform, found that for every $100 spent by federal taxpayers to implement the documentation requirements in six states, only 14 cents in Medicaid savings can be documented.

WASHINGTON – The number of physicians choosing to specialize in geriatrics will not be anywhere near enough to meet the needs of the elderly patients of the future, Dr. Christine Cassel said at a meeting jointly sponsored by the American Thyroid Association and Johns Hopkins University.

In 1987, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine created a certificate of added qualification (CAQ) in geriatric medicine. To date, 7,422 such CAQs have been issued, including 263 in 2006, said Dr. Cassel, ABIM president. “That rate is not nearly enough to keep up with the predictions” of the number of geriatric specialists needed, she said.

Geriatrics is challenging because “it's not about mastering one area in great depth, but being comfortable enough dealing with a wide range of specialties–not just subspecialties of internal medicine, but other specialties [such as] orthopedics, urology, and psychiatry–that you will be referring to,” she noted.

Geriatric medicine specialists need to know how to integrate advanced practice professionals, social workers, pharmacists, and others into the practice team, Dr. Cassel said. In effect, what elderly patients will need are generalist physicians.

“That generalist discipline, which is rapidly disappearing from American medicine, is necessary to solve this problem of coordination of care and reduced costs and better quality,” she said.

Dr. Cassel quoted ABIM data that showed that in 1997, only 43% of internal medicine residents went into subspecialties; by 2005, that figure was 60%. The data that the board is seeing today suggest that only 15% of internists are becoming general internists, “and of that 15%, more than half are [becoming] hospitalists,” she said.

Dr. Cassel pointed out that “our health care payment system has made it virtually impossible to do that [kind of medicine]. It has put huge barriers in the way of people who want to [go into general practice], and created great incentives for people who want to do more procedural, more highly specialized work.”

Internists who specialize in procedures often argue that specialists “are pushing innovation. [They say], 'That's why America has the best health care in the world, because we have all these specialists,'” she continued. “But the evidence is quite to the contrary. … The United States is somewhere between 15th and 20th in the world in terms of numbers of older people and higher life expectancy.”

Dr. Cassel noted that Japan, Germany, and Sweden–countries where life expectancy for males and females is higher than in the United States–not only provide universal health insurance for the entire population, but also, within the last 10 years, have enacted universal, government-funded long-term care insurance. “Somehow they managed to do this and still spend less money than we do,” she said. “This idea that the United States provides the best quality of care is getting less and less defensible.”

The lesson to be learned from these other countries “is not that we should, in a wholesale way, adopt one or another of these systems; the message is that there has to be a way to figure out how to provide comprehensive, affordable, good care with an aging population,” Dr. Cassel said. “Germany, Sweden, and Japan are probably where we're going to be 15–20 years from now, so as we look ahead, we can probably learn some lessons from them.”

The U.S. payment system 'has put huge barriers in the way of people who want to' go into general practice. DR. CASSEL

WASHINGTON – The number of physicians choosing to specialize in geriatrics will not be anywhere near enough to meet the needs of the elderly patients of the future, Dr. Christine Cassel said at a meeting jointly sponsored by the American Thyroid Association and Johns Hopkins University.

In 1987, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine created a certificate of added qualification (CAQ) in geriatric medicine. To date, 7,422 such CAQs have been issued, including 263 in 2006, said Dr. Cassel, ABIM president. “That rate is not nearly enough to keep up with the predictions” of the number of geriatric specialists needed, she said.

Geriatrics is challenging because “it's not about mastering one area in great depth, but being comfortable enough dealing with a wide range of specialties–not just subspecialties of internal medicine, but other specialties [such as] orthopedics, urology, and psychiatry–that you will be referring to,” she noted.

Geriatric medicine specialists need to know how to integrate advanced practice professionals, social workers, pharmacists, and others into the practice team, Dr. Cassel said. In effect, what elderly patients will need are generalist physicians.

“That generalist discipline, which is rapidly disappearing from American medicine, is necessary to solve this problem of coordination of care and reduced costs and better quality,” she said.

Dr. Cassel quoted ABIM data that showed that in 1997, only 43% of internal medicine residents went into subspecialties; by 2005, that figure was 60%. The data that the board is seeing today suggest that only 15% of internists are becoming general internists, “and of that 15%, more than half are [becoming] hospitalists,” she said.

Dr. Cassel pointed out that “our health care payment system has made it virtually impossible to do that [kind of medicine]. It has put huge barriers in the way of people who want to [go into general practice], and created great incentives for people who want to do more procedural, more highly specialized work.”

Internists who specialize in procedures often argue that specialists “are pushing innovation. [They say], 'That's why America has the best health care in the world, because we have all these specialists,'” she continued. “But the evidence is quite to the contrary. … The United States is somewhere between 15th and 20th in the world in terms of numbers of older people and higher life expectancy.”

Dr. Cassel noted that Japan, Germany, and Sweden–countries where life expectancy for males and females is higher than in the United States–not only provide universal health insurance for the entire population, but also, within the last 10 years, have enacted universal, government-funded long-term care insurance. “Somehow they managed to do this and still spend less money than we do,” she said. “This idea that the United States provides the best quality of care is getting less and less defensible.”

The lesson to be learned from these other countries “is not that we should, in a wholesale way, adopt one or another of these systems; the message is that there has to be a way to figure out how to provide comprehensive, affordable, good care with an aging population,” Dr. Cassel said. “Germany, Sweden, and Japan are probably where we're going to be 15–20 years from now, so as we look ahead, we can probably learn some lessons from them.”

The U.S. payment system 'has put huge barriers in the way of people who want to' go into general practice. DR. CASSEL

WASHINGTON – The number of physicians choosing to specialize in geriatrics will not be anywhere near enough to meet the needs of the elderly patients of the future, Dr. Christine Cassel said at a meeting jointly sponsored by the American Thyroid Association and Johns Hopkins University.

In 1987, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine created a certificate of added qualification (CAQ) in geriatric medicine. To date, 7,422 such CAQs have been issued, including 263 in 2006, said Dr. Cassel, ABIM president. “That rate is not nearly enough to keep up with the predictions” of the number of geriatric specialists needed, she said.

Geriatrics is challenging because “it's not about mastering one area in great depth, but being comfortable enough dealing with a wide range of specialties–not just subspecialties of internal medicine, but other specialties [such as] orthopedics, urology, and psychiatry–that you will be referring to,” she noted.

Geriatric medicine specialists need to know how to integrate advanced practice professionals, social workers, pharmacists, and others into the practice team, Dr. Cassel said. In effect, what elderly patients will need are generalist physicians.

“That generalist discipline, which is rapidly disappearing from American medicine, is necessary to solve this problem of coordination of care and reduced costs and better quality,” she said.

Dr. Cassel quoted ABIM data that showed that in 1997, only 43% of internal medicine residents went into subspecialties; by 2005, that figure was 60%. The data that the board is seeing today suggest that only 15% of internists are becoming general internists, “and of that 15%, more than half are [becoming] hospitalists,” she said.

Dr. Cassel pointed out that “our health care payment system has made it virtually impossible to do that [kind of medicine]. It has put huge barriers in the way of people who want to [go into general practice], and created great incentives for people who want to do more procedural, more highly specialized work.”

Internists who specialize in procedures often argue that specialists “are pushing innovation. [They say], 'That's why America has the best health care in the world, because we have all these specialists,'” she continued. “But the evidence is quite to the contrary. … The United States is somewhere between 15th and 20th in the world in terms of numbers of older people and higher life expectancy.”

Dr. Cassel noted that Japan, Germany, and Sweden–countries where life expectancy for males and females is higher than in the United States–not only provide universal health insurance for the entire population, but also, within the last 10 years, have enacted universal, government-funded long-term care insurance. “Somehow they managed to do this and still spend less money than we do,” she said. “This idea that the United States provides the best quality of care is getting less and less defensible.”

The lesson to be learned from these other countries “is not that we should, in a wholesale way, adopt one or another of these systems; the message is that there has to be a way to figure out how to provide comprehensive, affordable, good care with an aging population,” Dr. Cassel said. “Germany, Sweden, and Japan are probably where we're going to be 15–20 years from now, so as we look ahead, we can probably learn some lessons from them.”

The U.S. payment system 'has put huge barriers in the way of people who want to' go into general practice. DR. CASSEL

WASHINGTON – The number of physicians choosing to specialize in geriatrics will not be anywhere near enough to meet the needs of the elderly patients of the future, Dr. Christine Cassel said at a meeting sponsored by the American Thyroid Association and Johns Hopkins University.

In 1987, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine created a certificate of added qualification (CAQ) in geriatric medicine. To date, 7,422 such CAQs have been issued, including 263 in 2006, said Dr. Cassel, ABIM president. “That rate is not nearly enough to keep up with the predictions” of the number of geriatric specialists needed, she said.

Geriatrics is challenging because “it's not about mastering one area in great depth, but being comfortable enough dealing with a wide range of specialties … that you will be referring to,” she noted. The physician must also understand the difference between disease and aging, and know how to evaluate physiologic age.

In addition, “no geriatrician thinks you can be a solo practitioner in an office by yourself.” Instead, geriatric medicine specialists need to know how to integrate advanced practice professionals, social workers, pharmacists, and others into the practice team, Dr. Cassel said.

Dr. Cassel noted that Japan, Germany, and Sweden–countries where life expectancy for males and females is higher than in the United States–not only provide universal health insurance for the entire population, but also universal, government-funded long-term care insurance. “Somehow they managed to do this and still spend less money than we do,” she said. “This idea that the United States provides the best quality of care is getting less and less defensible.”

The lesson to be learned from these other countries is that “there has to be a way to figure out how to provide comprehensive, affordable, good care with an aging population,” she said.

WASHINGTON – The number of physicians choosing to specialize in geriatrics will not be anywhere near enough to meet the needs of the elderly patients of the future, Dr. Christine Cassel said at a meeting sponsored by the American Thyroid Association and Johns Hopkins University.

In 1987, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine created a certificate of added qualification (CAQ) in geriatric medicine. To date, 7,422 such CAQs have been issued, including 263 in 2006, said Dr. Cassel, ABIM president. “That rate is not nearly enough to keep up with the predictions” of the number of geriatric specialists needed, she said.

Geriatrics is challenging because “it's not about mastering one area in great depth, but being comfortable enough dealing with a wide range of specialties … that you will be referring to,” she noted. The physician must also understand the difference between disease and aging, and know how to evaluate physiologic age.

In addition, “no geriatrician thinks you can be a solo practitioner in an office by yourself.” Instead, geriatric medicine specialists need to know how to integrate advanced practice professionals, social workers, pharmacists, and others into the practice team, Dr. Cassel said.

Dr. Cassel noted that Japan, Germany, and Sweden–countries where life expectancy for males and females is higher than in the United States–not only provide universal health insurance for the entire population, but also universal, government-funded long-term care insurance. “Somehow they managed to do this and still spend less money than we do,” she said. “This idea that the United States provides the best quality of care is getting less and less defensible.”

The lesson to be learned from these other countries is that “there has to be a way to figure out how to provide comprehensive, affordable, good care with an aging population,” she said.

WASHINGTON – The number of physicians choosing to specialize in geriatrics will not be anywhere near enough to meet the needs of the elderly patients of the future, Dr. Christine Cassel said at a meeting sponsored by the American Thyroid Association and Johns Hopkins University.

In 1987, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine created a certificate of added qualification (CAQ) in geriatric medicine. To date, 7,422 such CAQs have been issued, including 263 in 2006, said Dr. Cassel, ABIM president. “That rate is not nearly enough to keep up with the predictions” of the number of geriatric specialists needed, she said.

Geriatrics is challenging because “it's not about mastering one area in great depth, but being comfortable enough dealing with a wide range of specialties … that you will be referring to,” she noted. The physician must also understand the difference between disease and aging, and know how to evaluate physiologic age.

In addition, “no geriatrician thinks you can be a solo practitioner in an office by yourself.” Instead, geriatric medicine specialists need to know how to integrate advanced practice professionals, social workers, pharmacists, and others into the practice team, Dr. Cassel said.

Dr. Cassel noted that Japan, Germany, and Sweden–countries where life expectancy for males and females is higher than in the United States–not only provide universal health insurance for the entire population, but also universal, government-funded long-term care insurance. “Somehow they managed to do this and still spend less money than we do,” she said. “This idea that the United States provides the best quality of care is getting less and less defensible.”

The lesson to be learned from these other countries is that “there has to be a way to figure out how to provide comprehensive, affordable, good care with an aging population,” she said.

WASHINGTON — The number of physicians choosing to specialize in geriatrics will not be anywhere near enough to meet the needs of the elderly patients of the future, Dr. Christine Cassel said at a meeting jointly sponsored by the American Thyroid Association and Johns Hopkins University.

In 1987, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine created a certificate of added qualification (CAQ) in geriatric medicine. To date, 7,422 such CAQs have been issued, including 263 in 2006, said Dr. Cassel, ABIM president. “That rate is not nearly enough to keep up with the predictions” of the number of geriatric specialists needed, she said.

Geriatrics is challenging because “it's not about mastering one area in great depth, but being comfortable enough dealing with a wide range of specialties—not just subspecialties of internal medicine, but other specialties [such as] … orthopedics, urology, and psychiatry—that you will be referring to,” she noted.

The physician must also understand the difference between disease and aging, and know how to evaluate physiologic age.

In addition, “no geriatrician thinks you can be a solo practitioner in an office by yourself.” Instead, geriatric medicine specialists need to know how to integrate advanced practice professionals, social workers, pharmacists, and others into the practice team, Dr. Cassel said. In effect, what elderly patients will need are generalist physicians.

“That generalist discipline, which is rapidly disappearing from American medicine, is necessary to solve this problem of coordination of care and reduced costs and better quality,” she said.

Dr. Cassel quoted ABIM data that showed that in 1997, only 43% of internal medicine residents went into subspecialties; by 2005, that figure was 60%. The data that the board is seeing today suggest that only 15% of internists are becoming general internists, “and of that 15%, more than half are [becoming] hospitalists,” she said. “It really is the very rare person who wants to do [generalist] practice in the community.”

Dr. Cassel pointed out that “our health care payment system has made it virtually impossible to do that [kind of medicine]. It has put huge barriers in the way of people who want to [go into general practice], and created great incentives for people who want to do more procedural, more highly specialized work.”

Internists who specialize in procedures will often argue that specialists “are pushing innovation. [They say], 'That's why America has the best health care in the world, because we have all these specialists,'” she continued. “But the evidence is quite to the contrary. … The United States is somewhere between 15th and 20th in the world in terms of numbers of older people and higher life expectancy.”

Dr. Cassel noted that Japan, Germany, and Sweden—countries where life expectancy for both males and females is higher than in the United States—not only provide universal health insurance for the entire population, but also, within the last 10 years, have enacted universal, government-funded long-term care insurance.

“Somehow they managed to do this and still spend less money than we do,” she said. “This idea that the United States provides the best quality of care is getting less and less defensible.”

The lesson to be learned from these other countries “is not that we should, in a wholesale way, adopt one or another of these systems; the message is that there has to be a way to figure out how to provide comprehensive, affordable, good care with an aging population,” Dr. Cassel said. “Germany, Sweden, and Japan are probably where we're going to be 15-20 years from now, so as we look ahead, we can probably learn some lessons from them.”

'It really is the very rare person who wants to do [generalist] practice in the community.' DR. CASSEL

WASHINGTON — The number of physicians choosing to specialize in geriatrics will not be anywhere near enough to meet the needs of the elderly patients of the future, Dr. Christine Cassel said at a meeting jointly sponsored by the American Thyroid Association and Johns Hopkins University.

In 1987, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine created a certificate of added qualification (CAQ) in geriatric medicine. To date, 7,422 such CAQs have been issued, including 263 in 2006, said Dr. Cassel, ABIM president. “That rate is not nearly enough to keep up with the predictions” of the number of geriatric specialists needed, she said.

Geriatrics is challenging because “it's not about mastering one area in great depth, but being comfortable enough dealing with a wide range of specialties—not just subspecialties of internal medicine, but other specialties [such as] … orthopedics, urology, and psychiatry—that you will be referring to,” she noted.

The physician must also understand the difference between disease and aging, and know how to evaluate physiologic age.

In addition, “no geriatrician thinks you can be a solo practitioner in an office by yourself.” Instead, geriatric medicine specialists need to know how to integrate advanced practice professionals, social workers, pharmacists, and others into the practice team, Dr. Cassel said. In effect, what elderly patients will need are generalist physicians.

“That generalist discipline, which is rapidly disappearing from American medicine, is necessary to solve this problem of coordination of care and reduced costs and better quality,” she said.

Dr. Cassel quoted ABIM data that showed that in 1997, only 43% of internal medicine residents went into subspecialties; by 2005, that figure was 60%. The data that the board is seeing today suggest that only 15% of internists are becoming general internists, “and of that 15%, more than half are [becoming] hospitalists,” she said. “It really is the very rare person who wants to do [generalist] practice in the community.”

Dr. Cassel pointed out that “our health care payment system has made it virtually impossible to do that [kind of medicine]. It has put huge barriers in the way of people who want to [go into general practice], and created great incentives for people who want to do more procedural, more highly specialized work.”

Internists who specialize in procedures will often argue that specialists “are pushing innovation. [They say], 'That's why America has the best health care in the world, because we have all these specialists,'” she continued. “But the evidence is quite to the contrary. … The United States is somewhere between 15th and 20th in the world in terms of numbers of older people and higher life expectancy.”

Dr. Cassel noted that Japan, Germany, and Sweden—countries where life expectancy for both males and females is higher than in the United States—not only provide universal health insurance for the entire population, but also, within the last 10 years, have enacted universal, government-funded long-term care insurance.

“Somehow they managed to do this and still spend less money than we do,” she said. “This idea that the United States provides the best quality of care is getting less and less defensible.”

The lesson to be learned from these other countries “is not that we should, in a wholesale way, adopt one or another of these systems; the message is that there has to be a way to figure out how to provide comprehensive, affordable, good care with an aging population,” Dr. Cassel said. “Germany, Sweden, and Japan are probably where we're going to be 15-20 years from now, so as we look ahead, we can probably learn some lessons from them.”

'It really is the very rare person who wants to do [generalist] practice in the community.' DR. CASSEL

WASHINGTON — The number of physicians choosing to specialize in geriatrics will not be anywhere near enough to meet the needs of the elderly patients of the future, Dr. Christine Cassel said at a meeting jointly sponsored by the American Thyroid Association and Johns Hopkins University.

In 1987, the American Board of Internal Medicine (ABIM) and the American Board of Family Medicine created a certificate of added qualification (CAQ) in geriatric medicine. To date, 7,422 such CAQs have been issued, including 263 in 2006, said Dr. Cassel, ABIM president. “That rate is not nearly enough to keep up with the predictions” of the number of geriatric specialists needed, she said.

Geriatrics is challenging because “it's not about mastering one area in great depth, but being comfortable enough dealing with a wide range of specialties—not just subspecialties of internal medicine, but other specialties [such as] … orthopedics, urology, and psychiatry—that you will be referring to,” she noted.

The physician must also understand the difference between disease and aging, and know how to evaluate physiologic age.

In addition, “no geriatrician thinks you can be a solo practitioner in an office by yourself.” Instead, geriatric medicine specialists need to know how to integrate advanced practice professionals, social workers, pharmacists, and others into the practice team, Dr. Cassel said. In effect, what elderly patients will need are generalist physicians.

“That generalist discipline, which is rapidly disappearing from American medicine, is necessary to solve this problem of coordination of care and reduced costs and better quality,” she said.

Dr. Cassel quoted ABIM data that showed that in 1997, only 43% of internal medicine residents went into subspecialties; by 2005, that figure was 60%. The data that the board is seeing today suggest that only 15% of internists are becoming general internists, “and of that 15%, more than half are [becoming] hospitalists,” she said. “It really is the very rare person who wants to do [generalist] practice in the community.”

Dr. Cassel pointed out that “our health care payment system has made it virtually impossible to do that [kind of medicine]. It has put huge barriers in the way of people who want to [go into general practice], and created great incentives for people who want to do more procedural, more highly specialized work.”

Internists who specialize in procedures will often argue that specialists “are pushing innovation. [They say], 'That's why America has the best health care in the world, because we have all these specialists,'” she continued. “But the evidence is quite to the contrary. … The United States is somewhere between 15th and 20th in the world in terms of numbers of older people and higher life expectancy.”

Dr. Cassel noted that Japan, Germany, and Sweden—countries where life expectancy for both males and females is higher than in the United States—not only provide universal health insurance for the entire population, but also, within the last 10 years, have enacted universal, government-funded long-term care insurance.

“Somehow they managed to do this and still spend less money than we do,” she said. “This idea that the United States provides the best quality of care is getting less and less defensible.”

The lesson to be learned from these other countries “is not that we should, in a wholesale way, adopt one or another of these systems; the message is that there has to be a way to figure out how to provide comprehensive, affordable, good care with an aging population,” Dr. Cassel said. “Germany, Sweden, and Japan are probably where we're going to be 15-20 years from now, so as we look ahead, we can probably learn some lessons from them.”

'It really is the very rare person who wants to do [generalist] practice in the community.' DR. CASSEL