Joyce Frieden

NYC Bans Trans Fat

In a move aimed at improving the healthfulness of restaurant food, the New York City Board of Health recently voted to require that all of the city's restaurants remove artificial trans fats from foods by July 2008. The mandate gives restaurants until July 1, 2007, to switch to oils, margarines, and shortenings that have less than 0.5 g of trans fat per serving by July 1, 2008; all other food items sold in restaurants must meet the same mark. New York is the first city to make such a move. The new mandate was praised by the American Diabetes Association: “When you consider that many American adults—and their children—are eating out several times a week, it is even more difficult to avoid trans fats and maintain a healthy diet,” said Dr. Peter Sheehan, president of the American Diabetes Association's New York City Leadership Council. “For more than 700,000 New York City adults diagnosed with diabetes, the passage of this proposal eliminates a major source of artificial trans fats and should serve as a model for other cities to consider.” In testimony earlier last year before the New York City Board of Health, the New York State Restaurant Association said that although the measure is well intentioned, it will not achieve the health benefits being sought. The 18-month transition does not give restaurateurs enough time to find healthy alternatives, the group said. Many will end up returning to the use of oils high in saturated fats.

Obesity: No. 1 Child Health Issue

Being overweight is seen as the most important issue for children's health, according to the results of a poll commissioned by Research!America and the Endocrine Society. In the poll of 800 adults, 27% of respondents named obesity as the top health issue for children, followed by lack of health care or health insurance (16%) and poor nutrition or an unhealthy diet (9%). When it comes to taking action on the issue, 52% said obesity was a public health issue that society should help solve, whereas 46% said it was a private issue that people should deal with on their own. “Clearly, Americans recognize the obesity epidemic facing this country and our children,” said Endocrine Society president Dr. Leonard Wartofsky. “However, the poll shows that the public thinks we should address obesity as a public health issue to bolster the actions of individuals and families. Health care professionals and researchers need to help convey the importance of a stronger public health response to this epidemic.”

Genes and Metabolic Syndrome

Researchers at the University of Cincinnati have received a grant of more than $1.6 million from the National Institute of Diabetes and Digestive and Kidney Diseases to study the genetic causes of metabolic syndrome. “To combat this complex disease, we need to establish genetic biomarkers, but we also need to understand lifestyle patterns and make necessary changes.” said lead investigator Ranjan Deka, Ph.D., professor of environmental health at the university. Data for the study will come from about 80 large families living in the islands of Croatia, a traditionally isolated society whose inhabitants have a very homogeneous genome. Dr. Deka and his team will collect blood samples, family medical histories, and other demographic information from about 1,200 subjects. Field work is set to begin in March.

Changes to HSA Rules

Legislation signed into law in December eases the use of health savings accounts. Previously, HSA participants could contribute only the amount they were required to pay out of pocket before their high-deductible health insurance policies kicked in. Under the new law, participants can contribute up to $2,700 for individual accounts and $5,450 for family accounts. The measure also allows employers to contribute more to the HSA accounts of non-highly compensated workers, and allows a one-time, tax-free rollover of individual retirement account funds into an HSA. “These provisions will help many Americans find more affordable and tax-preferred ways to pay for health care costs,” said James A. Klein, president of the American Benefits Council, an organization of large employers and health plan administrators.

Von Eschenbach Confirmed for FDA

Almost 9 months after he was nominated to be commissioner of the Food and Drug Administration, Dr. Andrew von Eschenbach was finally confirmed by the Senate in an 80–11 vote. Confirmation came after an 89–6 vote to limit debate on his nomination. The naysayers included Sen. Chuck Grassley (R-Iowa), one of Dr. von Eschenbach's most vocal critics. Sen. Grassley and his staff have been investigating what they call an inappropriate approval of the antibiotic Ketek (telithromycin). Sen. Grassley maintains that Dr. von Eschenbach has stonewalled committee investigators.

NYC Bans Trans Fat

In a move aimed at improving the healthfulness of restaurant food, the New York City Board of Health recently voted to require that all of the city's restaurants remove artificial trans fats from foods by July 2008. The mandate gives restaurants until July 1, 2007, to switch to oils, margarines, and shortenings that have less than 0.5 g of trans fat per serving by July 1, 2008; all other food items sold in restaurants must meet the same mark. New York is the first city to make such a move. The new mandate was praised by the American Diabetes Association: “When you consider that many American adults—and their children—are eating out several times a week, it is even more difficult to avoid trans fats and maintain a healthy diet,” said Dr. Peter Sheehan, president of the American Diabetes Association's New York City Leadership Council. “For more than 700,000 New York City adults diagnosed with diabetes, the passage of this proposal eliminates a major source of artificial trans fats and should serve as a model for other cities to consider.” In testimony earlier last year before the New York City Board of Health, the New York State Restaurant Association said that although the measure is well intentioned, it will not achieve the health benefits being sought. The 18-month transition does not give restaurateurs enough time to find healthy alternatives, the group said. Many will end up returning to the use of oils high in saturated fats.

Obesity: No. 1 Child Health Issue

Being overweight is seen as the most important issue for children's health, according to the results of a poll commissioned by Research!America and the Endocrine Society. In the poll of 800 adults, 27% of respondents named obesity as the top health issue for children, followed by lack of health care or health insurance (16%) and poor nutrition or an unhealthy diet (9%). When it comes to taking action on the issue, 52% said obesity was a public health issue that society should help solve, whereas 46% said it was a private issue that people should deal with on their own. “Clearly, Americans recognize the obesity epidemic facing this country and our children,” said Endocrine Society president Dr. Leonard Wartofsky. “However, the poll shows that the public thinks we should address obesity as a public health issue to bolster the actions of individuals and families. Health care professionals and researchers need to help convey the importance of a stronger public health response to this epidemic.”

Genes and Metabolic Syndrome

Researchers at the University of Cincinnati have received a grant of more than $1.6 million from the National Institute of Diabetes and Digestive and Kidney Diseases to study the genetic causes of metabolic syndrome. “To combat this complex disease, we need to establish genetic biomarkers, but we also need to understand lifestyle patterns and make necessary changes.” said lead investigator Ranjan Deka, Ph.D., professor of environmental health at the university. Data for the study will come from about 80 large families living in the islands of Croatia, a traditionally isolated society whose inhabitants have a very homogeneous genome. Dr. Deka and his team will collect blood samples, family medical histories, and other demographic information from about 1,200 subjects. Field work is set to begin in March.

Changes to HSA Rules

Legislation signed into law in December eases the use of health savings accounts. Previously, HSA participants could contribute only the amount they were required to pay out of pocket before their high-deductible health insurance policies kicked in. Under the new law, participants can contribute up to $2,700 for individual accounts and $5,450 for family accounts. The measure also allows employers to contribute more to the HSA accounts of non-highly compensated workers, and allows a one-time, tax-free rollover of individual retirement account funds into an HSA. “These provisions will help many Americans find more affordable and tax-preferred ways to pay for health care costs,” said James A. Klein, president of the American Benefits Council, an organization of large employers and health plan administrators.

Von Eschenbach Confirmed for FDA

Almost 9 months after he was nominated to be commissioner of the Food and Drug Administration, Dr. Andrew von Eschenbach was finally confirmed by the Senate in an 80–11 vote. Confirmation came after an 89–6 vote to limit debate on his nomination. The naysayers included Sen. Chuck Grassley (R-Iowa), one of Dr. von Eschenbach's most vocal critics. Sen. Grassley and his staff have been investigating what they call an inappropriate approval of the antibiotic Ketek (telithromycin). Sen. Grassley maintains that Dr. von Eschenbach has stonewalled committee investigators.

NYC Bans Trans Fat

In a move aimed at improving the healthfulness of restaurant food, the New York City Board of Health recently voted to require that all of the city's restaurants remove artificial trans fats from foods by July 2008. The mandate gives restaurants until July 1, 2007, to switch to oils, margarines, and shortenings that have less than 0.5 g of trans fat per serving by July 1, 2008; all other food items sold in restaurants must meet the same mark. New York is the first city to make such a move. The new mandate was praised by the American Diabetes Association: “When you consider that many American adults—and their children—are eating out several times a week, it is even more difficult to avoid trans fats and maintain a healthy diet,” said Dr. Peter Sheehan, president of the American Diabetes Association's New York City Leadership Council. “For more than 700,000 New York City adults diagnosed with diabetes, the passage of this proposal eliminates a major source of artificial trans fats and should serve as a model for other cities to consider.” In testimony earlier last year before the New York City Board of Health, the New York State Restaurant Association said that although the measure is well intentioned, it will not achieve the health benefits being sought. The 18-month transition does not give restaurateurs enough time to find healthy alternatives, the group said. Many will end up returning to the use of oils high in saturated fats.

Obesity: No. 1 Child Health Issue

Being overweight is seen as the most important issue for children's health, according to the results of a poll commissioned by Research!America and the Endocrine Society. In the poll of 800 adults, 27% of respondents named obesity as the top health issue for children, followed by lack of health care or health insurance (16%) and poor nutrition or an unhealthy diet (9%). When it comes to taking action on the issue, 52% said obesity was a public health issue that society should help solve, whereas 46% said it was a private issue that people should deal with on their own. “Clearly, Americans recognize the obesity epidemic facing this country and our children,” said Endocrine Society president Dr. Leonard Wartofsky. “However, the poll shows that the public thinks we should address obesity as a public health issue to bolster the actions of individuals and families. Health care professionals and researchers need to help convey the importance of a stronger public health response to this epidemic.”

Genes and Metabolic Syndrome

Researchers at the University of Cincinnati have received a grant of more than $1.6 million from the National Institute of Diabetes and Digestive and Kidney Diseases to study the genetic causes of metabolic syndrome. “To combat this complex disease, we need to establish genetic biomarkers, but we also need to understand lifestyle patterns and make necessary changes.” said lead investigator Ranjan Deka, Ph.D., professor of environmental health at the university. Data for the study will come from about 80 large families living in the islands of Croatia, a traditionally isolated society whose inhabitants have a very homogeneous genome. Dr. Deka and his team will collect blood samples, family medical histories, and other demographic information from about 1,200 subjects. Field work is set to begin in March.

Changes to HSA Rules

Legislation signed into law in December eases the use of health savings accounts. Previously, HSA participants could contribute only the amount they were required to pay out of pocket before their high-deductible health insurance policies kicked in. Under the new law, participants can contribute up to $2,700 for individual accounts and $5,450 for family accounts. The measure also allows employers to contribute more to the HSA accounts of non-highly compensated workers, and allows a one-time, tax-free rollover of individual retirement account funds into an HSA. “These provisions will help many Americans find more affordable and tax-preferred ways to pay for health care costs,” said James A. Klein, president of the American Benefits Council, an organization of large employers and health plan administrators.

Von Eschenbach Confirmed for FDA

Almost 9 months after he was nominated to be commissioner of the Food and Drug Administration, Dr. Andrew von Eschenbach was finally confirmed by the Senate in an 80–11 vote. Confirmation came after an 89–6 vote to limit debate on his nomination. The naysayers included Sen. Chuck Grassley (R-Iowa), one of Dr. von Eschenbach's most vocal critics. Sen. Grassley and his staff have been investigating what they call an inappropriate approval of the antibiotic Ketek (telithromycin). Sen. Grassley maintains that Dr. von Eschenbach has stonewalled committee investigators.

Bioidentical Hormones Resolution

The American Medical Association has endorsed a resolution calling for tighter regulation of bioidentical hormones. The resolution, passed at the AMA's interim meeting of its House of Delegates last month, calls for the Food and Drug Administration to conduct surveys for purity and dosage accuracy of all bioidentical hormone formulations; require mandatory reporting by drug manufacturers, including compounding pharmacies, of adverse events related to using bioidentical hormones; create a registry of adverse events related to use of compounded bioidentical hormone preparations; require uniform patient information; and prohibit use of the term “bioidentical hormones” unless the preparation has been approved by the FDA. “The Endocrine Society applauds the AMA for helping to bring much-needed oversight to bioidentical hormones,” said Dr. Leonard Wartofsky, president of the society, which cosponsored the resolution along with the American Association of Clinical Endocrinologists and the American Society of Reproductive Medicine. “The inconsistencies and unknown risks of bioidentical hormones are of great concern. Without proper oversight and control, the public has no way of knowing precisely what they're getting or what effect it will have on an individual's body.”

Disparities in Medicare HMO Care

Black Medicare beneficiaries with diabetes fare worse than their white counterparts on four outcome measures of quality, according to a study published in the Oct. 25 issue of the Journal of the American Medical Association. Dr. Amal N. Trivedi, of Brown University and colleagues reviewed 431,000 patient observations from 151 Medicare health plans over a 3-year period. They looked at a combination of hemoglobin A_1c (HbA_1c) levels, low-density lipoprotein (LDL-C) levels, and blood pressure levels in three groups of patients: those with diabetes, those with hypertension, or those with a prior coronary event. They found that 80% of white patients had HbA_1c levels below 9.5% or 9.0% (depending on the year being studied), compared with only 72% of black patients. Fewer black patients with diabetes than white patients had LDL-C levels less than 130 mg/dL (63% vs. 72%, respectively). Nearly three-fourths of the disparity in each outcome was due to disparities in outcomes among beneficiaries in the same plan, as opposed to differences between plans, according to the authors. “Effective measurement within health plans is one cornerstone of improving quality and reducing racial disparities in outcomes,” they wrote.

House Investigates CDC Finances

Members of Congress are looking into alleged financial problems at the Centers for Disease Control and Prevention. In a letter, members of the House Energy and Commerce Committee requested that CDC officials provide an analysis done by Deloitte Consulting L.L.C. detailing “inefficiency and ineffective leadership” in the agency's finance office. Committee Chairman Joe Barton (R-Texas) and chairman of the committee's subcommittee on oversight and investigations, Rep. Ed Whitfield (R-Ky.), also requested information on how CDC manages human tissue samples and laboratory equipment. The congressmen also asked to be briefed on the status of CDC's reorganization, ongoing since June 2003. “Some CDC employees have raised concerns that these changes will make CDC more cumbersome and bureaucratic, taking time and resources away from scientific programs directly benefiting the public,” Rep. Barton and Rep. Whitfield wrote in the letter.

Health IT Gaps

The adoption gap in health information technology continues to widen, with physicians in smaller practices being left behind, according to a report from the Center for Studying Health System Change (HSC). Between 2000–2001 and 2004–2005, physicians in all types of practices increased their use of health IT for accessing patient notes, generating preventive care reminders, exchanging clinical data, obtaining treatment guidelines, and writing prescriptions. But practices with two or fewer physicians increased their use of health IT for writing prescriptions by 5%, compared with 28% among practices with more than 50 physicians. The gaps are likely due to the greater financial resources of larger practices along with more administrative resources and economies of scale. The data in the report are from the HSC Community Tracking Study Physician survey. “Larger practices appear to be gaining critical mass in adopting IT for patient care, but the smallest practices, which account for more than half of all practicing physicians, appear to be at risk of being left behind,” Joy M. Grossman, a coauthor of the report and a senior health researcher at HSC, said in a statement. The report is available at

www.hschange.org/CONTENT/891

Bioidentical Hormones Resolution

The American Medical Association has endorsed a resolution calling for tighter regulation of bioidentical hormones. The resolution, passed at the AMA's interim meeting of its House of Delegates last month, calls for the Food and Drug Administration to conduct surveys for purity and dosage accuracy of all bioidentical hormone formulations; require mandatory reporting by drug manufacturers, including compounding pharmacies, of adverse events related to using bioidentical hormones; create a registry of adverse events related to use of compounded bioidentical hormone preparations; require uniform patient information; and prohibit use of the term “bioidentical hormones” unless the preparation has been approved by the FDA. “The Endocrine Society applauds the AMA for helping to bring much-needed oversight to bioidentical hormones,” said Dr. Leonard Wartofsky, president of the society, which cosponsored the resolution along with the American Association of Clinical Endocrinologists and the American Society of Reproductive Medicine. “The inconsistencies and unknown risks of bioidentical hormones are of great concern. Without proper oversight and control, the public has no way of knowing precisely what they're getting or what effect it will have on an individual's body.”

Disparities in Medicare HMO Care

Black Medicare beneficiaries with diabetes fare worse than their white counterparts on four outcome measures of quality, according to a study published in the Oct. 25 issue of the Journal of the American Medical Association. Dr. Amal N. Trivedi, of Brown University and colleagues reviewed 431,000 patient observations from 151 Medicare health plans over a 3-year period. They looked at a combination of hemoglobin A_1c (HbA_1c) levels, low-density lipoprotein (LDL-C) levels, and blood pressure levels in three groups of patients: those with diabetes, those with hypertension, or those with a prior coronary event. They found that 80% of white patients had HbA_1c levels below 9.5% or 9.0% (depending on the year being studied), compared with only 72% of black patients. Fewer black patients with diabetes than white patients had LDL-C levels less than 130 mg/dL (63% vs. 72%, respectively). Nearly three-fourths of the disparity in each outcome was due to disparities in outcomes among beneficiaries in the same plan, as opposed to differences between plans, according to the authors. “Effective measurement within health plans is one cornerstone of improving quality and reducing racial disparities in outcomes,” they wrote.

House Investigates CDC Finances

Members of Congress are looking into alleged financial problems at the Centers for Disease Control and Prevention. In a letter, members of the House Energy and Commerce Committee requested that CDC officials provide an analysis done by Deloitte Consulting L.L.C. detailing “inefficiency and ineffective leadership” in the agency's finance office. Committee Chairman Joe Barton (R-Texas) and chairman of the committee's subcommittee on oversight and investigations, Rep. Ed Whitfield (R-Ky.), also requested information on how CDC manages human tissue samples and laboratory equipment. The congressmen also asked to be briefed on the status of CDC's reorganization, ongoing since June 2003. “Some CDC employees have raised concerns that these changes will make CDC more cumbersome and bureaucratic, taking time and resources away from scientific programs directly benefiting the public,” Rep. Barton and Rep. Whitfield wrote in the letter.

Health IT Gaps

The adoption gap in health information technology continues to widen, with physicians in smaller practices being left behind, according to a report from the Center for Studying Health System Change (HSC). Between 2000–2001 and 2004–2005, physicians in all types of practices increased their use of health IT for accessing patient notes, generating preventive care reminders, exchanging clinical data, obtaining treatment guidelines, and writing prescriptions. But practices with two or fewer physicians increased their use of health IT for writing prescriptions by 5%, compared with 28% among practices with more than 50 physicians. The gaps are likely due to the greater financial resources of larger practices along with more administrative resources and economies of scale. The data in the report are from the HSC Community Tracking Study Physician survey. “Larger practices appear to be gaining critical mass in adopting IT for patient care, but the smallest practices, which account for more than half of all practicing physicians, appear to be at risk of being left behind,” Joy M. Grossman, a coauthor of the report and a senior health researcher at HSC, said in a statement. The report is available at

www.hschange.org/CONTENT/891

Bioidentical Hormones Resolution

The American Medical Association has endorsed a resolution calling for tighter regulation of bioidentical hormones. The resolution, passed at the AMA's interim meeting of its House of Delegates last month, calls for the Food and Drug Administration to conduct surveys for purity and dosage accuracy of all bioidentical hormone formulations; require mandatory reporting by drug manufacturers, including compounding pharmacies, of adverse events related to using bioidentical hormones; create a registry of adverse events related to use of compounded bioidentical hormone preparations; require uniform patient information; and prohibit use of the term “bioidentical hormones” unless the preparation has been approved by the FDA. “The Endocrine Society applauds the AMA for helping to bring much-needed oversight to bioidentical hormones,” said Dr. Leonard Wartofsky, president of the society, which cosponsored the resolution along with the American Association of Clinical Endocrinologists and the American Society of Reproductive Medicine. “The inconsistencies and unknown risks of bioidentical hormones are of great concern. Without proper oversight and control, the public has no way of knowing precisely what they're getting or what effect it will have on an individual's body.”

Disparities in Medicare HMO Care

Black Medicare beneficiaries with diabetes fare worse than their white counterparts on four outcome measures of quality, according to a study published in the Oct. 25 issue of the Journal of the American Medical Association. Dr. Amal N. Trivedi, of Brown University and colleagues reviewed 431,000 patient observations from 151 Medicare health plans over a 3-year period. They looked at a combination of hemoglobin A_1c (HbA_1c) levels, low-density lipoprotein (LDL-C) levels, and blood pressure levels in three groups of patients: those with diabetes, those with hypertension, or those with a prior coronary event. They found that 80% of white patients had HbA_1c levels below 9.5% or 9.0% (depending on the year being studied), compared with only 72% of black patients. Fewer black patients with diabetes than white patients had LDL-C levels less than 130 mg/dL (63% vs. 72%, respectively). Nearly three-fourths of the disparity in each outcome was due to disparities in outcomes among beneficiaries in the same plan, as opposed to differences between plans, according to the authors. “Effective measurement within health plans is one cornerstone of improving quality and reducing racial disparities in outcomes,” they wrote.

House Investigates CDC Finances

Members of Congress are looking into alleged financial problems at the Centers for Disease Control and Prevention. In a letter, members of the House Energy and Commerce Committee requested that CDC officials provide an analysis done by Deloitte Consulting L.L.C. detailing “inefficiency and ineffective leadership” in the agency's finance office. Committee Chairman Joe Barton (R-Texas) and chairman of the committee's subcommittee on oversight and investigations, Rep. Ed Whitfield (R-Ky.), also requested information on how CDC manages human tissue samples and laboratory equipment. The congressmen also asked to be briefed on the status of CDC's reorganization, ongoing since June 2003. “Some CDC employees have raised concerns that these changes will make CDC more cumbersome and bureaucratic, taking time and resources away from scientific programs directly benefiting the public,” Rep. Barton and Rep. Whitfield wrote in the letter.

Health IT Gaps

The adoption gap in health information technology continues to widen, with physicians in smaller practices being left behind, according to a report from the Center for Studying Health System Change (HSC). Between 2000–2001 and 2004–2005, physicians in all types of practices increased their use of health IT for accessing patient notes, generating preventive care reminders, exchanging clinical data, obtaining treatment guidelines, and writing prescriptions. But practices with two or fewer physicians increased their use of health IT for writing prescriptions by 5%, compared with 28% among practices with more than 50 physicians. The gaps are likely due to the greater financial resources of larger practices along with more administrative resources and economies of scale. The data in the report are from the HSC Community Tracking Study Physician survey. “Larger practices appear to be gaining critical mass in adopting IT for patient care, but the smallest practices, which account for more than half of all practicing physicians, appear to be at risk of being left behind,” Joy M. Grossman, a coauthor of the report and a senior health researcher at HSC, said in a statement. The report is available at

www.hschange.org/CONTENT/891

The changes in leadership brought about by the November mid-term elections are likely to result in significant shifts in the way Congress approaches health policy issues, according to several experts.

One change many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula. Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association (AMA) board of trustees, said in an interview at press time.

Such an immediate fix would not address the underlying problem: that the physician fee schedule relies on the flawed sustainable growth rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, executive director of Families USA, a liberal consumer group based in Washington, thought the new Congress would look at the payment formula.

“I think the Democrats probably do want to deal with that—whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story. “The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” he said.

“[The strategy of] placing caps on damage awards probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement.”

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, stated malpractice reform “is not going anywhere and that's a welcome development, because the Constitution doesn't give Congress any authority to play any role in that area,” he said. “The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms.”

Covering the uninsured is another area that the AMA hopes will move to the front burner under the Democrats, Dr. Wilson said. “We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that bans the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies. “We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement.

Removal of that prohibition would be a welcome change, according to Mr. Pollack, of Families USA. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Cato's Mr. Cannon had a different take. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for drug companies, he said.

Another thing the Democrats will consider doing with the Part D plan is to close the doughnut hole—the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly. Analysts are anticipating a new direction in health policy in the new Congress because the presumed new chairs of the committees and subcommittees dealing with health care are considered quite liberal.

This group includes Rep. Charles Rangel (D-N.Y.), expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to head the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955. “We will see if they just try to go for moderate Democrat ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone. They're not moderates, and they're not shrinking violets. They don't seem like the kind who are going to take orders; they seem to want to run their own show.”

The upcoming reauthorization of the State Children's Health Insurance Program (SCHIP) is one example of legislation the Democrats could put their stamp on, according to Mr. Pollack. SCHIP is a program financed by both the federal government and state governments which provides health insurance to children in families with incomes too high for Medicaid but too low to be able to afford private insurance coverage.

“Due to its broad, bipartisan support, SCHIP no doubt will be reauthorized,” he said. “However, since approximately 9 million children continue to be uninsured, the real question before the Congress is whether the reauthorization process will expand health coverage and provide adequate SCHIP funding for those children who don't have coverage and whose families can't afford it. A simple reauthorization will be a major disappointment.”

The changes in leadership brought about by the November mid-term elections are likely to result in significant shifts in the way Congress approaches health policy issues, according to several experts.

One change many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula. Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association (AMA) board of trustees, said in an interview at press time.

Such an immediate fix would not address the underlying problem: that the physician fee schedule relies on the flawed sustainable growth rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, executive director of Families USA, a liberal consumer group based in Washington, thought the new Congress would look at the payment formula.

“I think the Democrats probably do want to deal with that—whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story. “The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” he said.

“[The strategy of] placing caps on damage awards probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement.”

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, stated malpractice reform “is not going anywhere and that's a welcome development, because the Constitution doesn't give Congress any authority to play any role in that area,” he said. “The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms.”

Covering the uninsured is another area that the AMA hopes will move to the front burner under the Democrats, Dr. Wilson said. “We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that bans the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies. “We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement.

Removal of that prohibition would be a welcome change, according to Mr. Pollack, of Families USA. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Cato's Mr. Cannon had a different take. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for drug companies, he said.

Another thing the Democrats will consider doing with the Part D plan is to close the doughnut hole—the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly. Analysts are anticipating a new direction in health policy in the new Congress because the presumed new chairs of the committees and subcommittees dealing with health care are considered quite liberal.

This group includes Rep. Charles Rangel (D-N.Y.), expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to head the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955. “We will see if they just try to go for moderate Democrat ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone. They're not moderates, and they're not shrinking violets. They don't seem like the kind who are going to take orders; they seem to want to run their own show.”

The upcoming reauthorization of the State Children's Health Insurance Program (SCHIP) is one example of legislation the Democrats could put their stamp on, according to Mr. Pollack. SCHIP is a program financed by both the federal government and state governments which provides health insurance to children in families with incomes too high for Medicaid but too low to be able to afford private insurance coverage.

“Due to its broad, bipartisan support, SCHIP no doubt will be reauthorized,” he said. “However, since approximately 9 million children continue to be uninsured, the real question before the Congress is whether the reauthorization process will expand health coverage and provide adequate SCHIP funding for those children who don't have coverage and whose families can't afford it. A simple reauthorization will be a major disappointment.”

The changes in leadership brought about by the November mid-term elections are likely to result in significant shifts in the way Congress approaches health policy issues, according to several experts.

One change many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula. Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association (AMA) board of trustees, said in an interview at press time.

Such an immediate fix would not address the underlying problem: that the physician fee schedule relies on the flawed sustainable growth rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, executive director of Families USA, a liberal consumer group based in Washington, thought the new Congress would look at the payment formula.

“I think the Democrats probably do want to deal with that—whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story. “The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” he said.

“[The strategy of] placing caps on damage awards probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement.”

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, stated malpractice reform “is not going anywhere and that's a welcome development, because the Constitution doesn't give Congress any authority to play any role in that area,” he said. “The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms.”

Covering the uninsured is another area that the AMA hopes will move to the front burner under the Democrats, Dr. Wilson said. “We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that bans the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies. “We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement.

Removal of that prohibition would be a welcome change, according to Mr. Pollack, of Families USA. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Cato's Mr. Cannon had a different take. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for drug companies, he said.

Another thing the Democrats will consider doing with the Part D plan is to close the doughnut hole—the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly. Analysts are anticipating a new direction in health policy in the new Congress because the presumed new chairs of the committees and subcommittees dealing with health care are considered quite liberal.

This group includes Rep. Charles Rangel (D-N.Y.), expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to head the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955. “We will see if they just try to go for moderate Democrat ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone. They're not moderates, and they're not shrinking violets. They don't seem like the kind who are going to take orders; they seem to want to run their own show.”

The upcoming reauthorization of the State Children's Health Insurance Program (SCHIP) is one example of legislation the Democrats could put their stamp on, according to Mr. Pollack. SCHIP is a program financed by both the federal government and state governments which provides health insurance to children in families with incomes too high for Medicaid but too low to be able to afford private insurance coverage.

“Due to its broad, bipartisan support, SCHIP no doubt will be reauthorized,” he said. “However, since approximately 9 million children continue to be uninsured, the real question before the Congress is whether the reauthorization process will expand health coverage and provide adequate SCHIP funding for those children who don't have coverage and whose families can't afford it. A simple reauthorization will be a major disappointment.”

The changes in leadership brought about by the November mid-term elections are likely to result in significant shifts in the way Congress approaches health policy issues, according to several experts.

One change many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula. Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association board of trustees, said in an interview.

Such an immediate fix would not address the underlying problem, which is that the physician fee schedule relies on the flawed Sustainable Growth Rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, executive director of Families USA, a liberal consumer group based in Washington, voiced optimism that the new Congress would look at the payment formula. “I think the Democrats probably do want to deal with that—whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story, Mr. Pollack said.

“The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” he said.

“[The strategy of] placing caps on damage awards probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement,” Mr. Pollack said.

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, was even more negative. Malpractice reform “is not going anywhere and that's a welcome development, because the Constitution does not give Congress any authority to play any role in that area,” he said. “The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms.”

Covering the uninsured is another area that could move to the front burner under the Democrats, Dr. Wilson said.

“We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that bans the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies.

“We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement regarding that issue.

Removal of that prohibition would be a welcome change, according to Mr. Pollack. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Mr. Cannon had quite a different take on the idea. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower-cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for pharmaceutical companies, he said.

Another thing the Democrats will consider doing with the Part D plan is to close up the “doughnut hole,” the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly.

Analysts are anticipating a new direction in health policy in the new Congress because the presumed new chairs of the committees and subcommittees dealing with health care are considered quite liberal.

This group includes Rep. Charles Rangel (D-N.Y.), expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to head the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955. “We will see if they just try to go for moderate Democratic ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone. They're not moderates, and they're not shrinking violets. They don't seem like the kind who are going to take orders; they seem to want to run their own show.”

The upcoming reauthorization of the State Children's Health Insurance Program (SCHIP), a federal/state program to provide health insurance to children in families with income too high for Medicaid but too low to be able to afford private insurance coverage, is one example of legislation the Democrats could put their stamp on, according to Mr. Pollack.

“Due to its broad, bipartisan support, SCHIP no doubt will be reauthorized,” he said. “However, since approximately 9 million children continue to be uninsured, the real question before the Congress is whether the reauthorization process will expand health coverage and provide adequate SCHIP funding for those children who don't have coverage and whose families can't afford it. A simple reauthorization will be a major disappointment.”

The changes in leadership brought about by the November mid-term elections are likely to result in significant shifts in the way Congress approaches health policy issues, according to several experts.

One change many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula. Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association board of trustees, said in an interview.

Such an immediate fix would not address the underlying problem, which is that the physician fee schedule relies on the flawed Sustainable Growth Rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, executive director of Families USA, a liberal consumer group based in Washington, voiced optimism that the new Congress would look at the payment formula. “I think the Democrats probably do want to deal with that—whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story, Mr. Pollack said.

“The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” he said.

“[The strategy of] placing caps on damage awards probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement,” Mr. Pollack said.

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, was even more negative. Malpractice reform “is not going anywhere and that's a welcome development, because the Constitution does not give Congress any authority to play any role in that area,” he said. “The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms.”

Covering the uninsured is another area that could move to the front burner under the Democrats, Dr. Wilson said.

“We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that bans the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies.

“We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement regarding that issue.

Removal of that prohibition would be a welcome change, according to Mr. Pollack. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Mr. Cannon had quite a different take on the idea. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower-cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for pharmaceutical companies, he said.

Another thing the Democrats will consider doing with the Part D plan is to close up the “doughnut hole,” the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly.

Analysts are anticipating a new direction in health policy in the new Congress because the presumed new chairs of the committees and subcommittees dealing with health care are considered quite liberal.

This group includes Rep. Charles Rangel (D-N.Y.), expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to head the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955. “We will see if they just try to go for moderate Democratic ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone. They're not moderates, and they're not shrinking violets. They don't seem like the kind who are going to take orders; they seem to want to run their own show.”

The upcoming reauthorization of the State Children's Health Insurance Program (SCHIP), a federal/state program to provide health insurance to children in families with income too high for Medicaid but too low to be able to afford private insurance coverage, is one example of legislation the Democrats could put their stamp on, according to Mr. Pollack.

“Due to its broad, bipartisan support, SCHIP no doubt will be reauthorized,” he said. “However, since approximately 9 million children continue to be uninsured, the real question before the Congress is whether the reauthorization process will expand health coverage and provide adequate SCHIP funding for those children who don't have coverage and whose families can't afford it. A simple reauthorization will be a major disappointment.”

The changes in leadership brought about by the November mid-term elections are likely to result in significant shifts in the way Congress approaches health policy issues, according to several experts.

One change many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula. Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association board of trustees, said in an interview.

Such an immediate fix would not address the underlying problem, which is that the physician fee schedule relies on the flawed Sustainable Growth Rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, executive director of Families USA, a liberal consumer group based in Washington, voiced optimism that the new Congress would look at the payment formula. “I think the Democrats probably do want to deal with that—whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story, Mr. Pollack said.

“The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” he said.

“[The strategy of] placing caps on damage awards probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement,” Mr. Pollack said.

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, was even more negative. Malpractice reform “is not going anywhere and that's a welcome development, because the Constitution does not give Congress any authority to play any role in that area,” he said. “The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms.”

Covering the uninsured is another area that could move to the front burner under the Democrats, Dr. Wilson said.

“We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that bans the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies.

“We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement regarding that issue.

Removal of that prohibition would be a welcome change, according to Mr. Pollack. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Mr. Cannon had quite a different take on the idea. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower-cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for pharmaceutical companies, he said.

Another thing the Democrats will consider doing with the Part D plan is to close up the “doughnut hole,” the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly.

Analysts are anticipating a new direction in health policy in the new Congress because the presumed new chairs of the committees and subcommittees dealing with health care are considered quite liberal.

This group includes Rep. Charles Rangel (D-N.Y.), expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to head the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955. “We will see if they just try to go for moderate Democratic ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone. They're not moderates, and they're not shrinking violets. They don't seem like the kind who are going to take orders; they seem to want to run their own show.”

The upcoming reauthorization of the State Children's Health Insurance Program (SCHIP), a federal/state program to provide health insurance to children in families with income too high for Medicaid but too low to be able to afford private insurance coverage, is one example of legislation the Democrats could put their stamp on, according to Mr. Pollack.

“Due to its broad, bipartisan support, SCHIP no doubt will be reauthorized,” he said. “However, since approximately 9 million children continue to be uninsured, the real question before the Congress is whether the reauthorization process will expand health coverage and provide adequate SCHIP funding for those children who don't have coverage and whose families can't afford it. A simple reauthorization will be a major disappointment.”

The changes in leadership brought about by the November midterm elections are likely to result in significant shifts in the way Congress approaches health policy issues, according to several experts.

One change many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula. Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association board of trustees, said in an interview at press time.

Such an immediate fix would not address the underlying problem: that the physician fee schedule relies on the flawed Sustainable Growth Rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, executive director of Families USA, a liberal consumer group based in Washington, voiced optimism that the new Congress would look at the payment formula.

“I think the Democrats probably do want to deal with that—whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story, Mr. Pollack said.

“The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” Mr. Pollack said. “[The strategy of] placing caps on damage awards probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement.”

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, was even more negative. Malpractice reform “is not going anywhere and that's a welcome development, because the Constitution doesn't give Congress any authority to play any role in that area,” he said. “The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms.”

Covering the uninsured is another area that could move to the front burner under the Democrats, Dr. Wilson said.

“We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that bans the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies.

“We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement.

Removal of that prohibition would be a welcome change, according to Mr. Pollack, of Families USA. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Cato's Mr. Cannon had a different take on the idea. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for pharmaceutical companies, he said.

Another thing the Democrats will consider doing with the Part D plan is to close up the doughnut hole—the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly.

Analysts are anticipating a new direction in health policy in the new Congress because the presumed new chairs of the committees and subcommittees dealing with health care are considered quite liberal. This group includes Rep. Charles Rangel (D-N.Y.), expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to head the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955. “We will see if they just try to go for moderate Democrat ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone. They're not moderates, and they're not shrinking violets. They don't seem like the kind who are going to take orders; they seem to want to run their own show.”

The upcoming reauthorization of the State Children's Health Insurance Program (SCHIP), a federal/state program to provide health insurance to children in families with income too high for Medicaid but too low to be able to afford private insurance coverage, is one example of legislation the Democrats could put their stamp on, according to Mr. Pollack.

“Due to its broad bipartisan support, SCHIP no doubt will be reauthorized,” he said. “However, since approximately 9 million children continue to be uninsured, the real question before the Congress is whether the reauthorization process will expand health coverage and provide adequate SCHIP funding for those children who don't have coverage and whose families can't afford it. A simple reauthorization will be a major disappointment.”

The changes in leadership brought about by the November midterm elections are likely to result in significant shifts in the way Congress approaches health policy issues, according to several experts.

One change many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula. Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association board of trustees, said in an interview at press time.

Such an immediate fix would not address the underlying problem: that the physician fee schedule relies on the flawed Sustainable Growth Rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, executive director of Families USA, a liberal consumer group based in Washington, voiced optimism that the new Congress would look at the payment formula.

“I think the Democrats probably do want to deal with that—whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story, Mr. Pollack said.

“The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” Mr. Pollack said. “[The strategy of] placing caps on damage awards probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement.”

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, was even more negative. Malpractice reform “is not going anywhere and that's a welcome development, because the Constitution doesn't give Congress any authority to play any role in that area,” he said. “The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms.”

Covering the uninsured is another area that could move to the front burner under the Democrats, Dr. Wilson said.

“We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that bans the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies.

“We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement.

Removal of that prohibition would be a welcome change, according to Mr. Pollack, of Families USA. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Cato's Mr. Cannon had a different take on the idea. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for pharmaceutical companies, he said.

Another thing the Democrats will consider doing with the Part D plan is to close up the doughnut hole—the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly.

Analysts are anticipating a new direction in health policy in the new Congress because the presumed new chairs of the committees and subcommittees dealing with health care are considered quite liberal. This group includes Rep. Charles Rangel (D-N.Y.), expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to head the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955. “We will see if they just try to go for moderate Democrat ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone. They're not moderates, and they're not shrinking violets. They don't seem like the kind who are going to take orders; they seem to want to run their own show.”

The upcoming reauthorization of the State Children's Health Insurance Program (SCHIP), a federal/state program to provide health insurance to children in families with income too high for Medicaid but too low to be able to afford private insurance coverage, is one example of legislation the Democrats could put their stamp on, according to Mr. Pollack.

“Due to its broad bipartisan support, SCHIP no doubt will be reauthorized,” he said. “However, since approximately 9 million children continue to be uninsured, the real question before the Congress is whether the reauthorization process will expand health coverage and provide adequate SCHIP funding for those children who don't have coverage and whose families can't afford it. A simple reauthorization will be a major disappointment.”

The changes in leadership brought about by the November midterm elections are likely to result in significant shifts in the way Congress approaches health policy issues, according to several experts.

One change many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula. Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association board of trustees, said in an interview at press time.

Such an immediate fix would not address the underlying problem: that the physician fee schedule relies on the flawed Sustainable Growth Rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, executive director of Families USA, a liberal consumer group based in Washington, voiced optimism that the new Congress would look at the payment formula.

“I think the Democrats probably do want to deal with that—whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story, Mr. Pollack said.

“The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” Mr. Pollack said. “[The strategy of] placing caps on damage awards probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement.”

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, was even more negative. Malpractice reform “is not going anywhere and that's a welcome development, because the Constitution doesn't give Congress any authority to play any role in that area,” he said. “The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms.”

Covering the uninsured is another area that could move to the front burner under the Democrats, Dr. Wilson said.

“We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that bans the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies.

“We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement.

Removal of that prohibition would be a welcome change, according to Mr. Pollack, of Families USA. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Cato's Mr. Cannon had a different take on the idea. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for pharmaceutical companies, he said.

Another thing the Democrats will consider doing with the Part D plan is to close up the doughnut hole—the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly.

Analysts are anticipating a new direction in health policy in the new Congress because the presumed new chairs of the committees and subcommittees dealing with health care are considered quite liberal. This group includes Rep. Charles Rangel (D-N.Y.), expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to head the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955. “We will see if they just try to go for moderate Democrat ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone. They're not moderates, and they're not shrinking violets. They don't seem like the kind who are going to take orders; they seem to want to run their own show.”

The upcoming reauthorization of the State Children's Health Insurance Program (SCHIP), a federal/state program to provide health insurance to children in families with income too high for Medicaid but too low to be able to afford private insurance coverage, is one example of legislation the Democrats could put their stamp on, according to Mr. Pollack.

“Due to its broad bipartisan support, SCHIP no doubt will be reauthorized,” he said. “However, since approximately 9 million children continue to be uninsured, the real question before the Congress is whether the reauthorization process will expand health coverage and provide adequate SCHIP funding for those children who don't have coverage and whose families can't afford it. A simple reauthorization will be a major disappointment.”

The changes in leadership brought about by the November midterm elections are likely to result in significant shifts in the way Congress approaches health policy issues, according to several experts.

One change that many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula.

Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association board of trustees, said in an interview at press time.

Such an immediate fix would not address the underlying problem: that the physician fee schedule relies on the flawed Sustainable Growth Rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, who is executive director of Families USA, a liberal consumer group that is based in Washington, voiced optimism that the new Congress would look at the payment formula.

“I think the Democrats probably do want to deal with that–whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story, Mr. Pollack said.

“The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” Mr. Pollack said. “[The strategy of] placing caps on damage awards probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement.”

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, was even more negative.

Malpractice reform “is not going anywhere and that's a welcome development, because the Constitution doesn't give Congress any authority to play any role in that area,” he said.

“The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms,” Mr. Cannon said.

Covering the uninsured is another area that could move to the front burner under the Democrats, Dr. Wilson said.

“We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that prevents the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies.

“We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement.

Removal of that prohibition would be a welcome change, according to Mr. Pollack, of Families USA. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Cato's Mr. Cannon had a different take on the idea. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for pharmaceutical companies, he said.

Another thing the Democrats will consider doing with the Part D plan is to close up the doughnut hole–the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly.

Analysts are anticipating a new direction in health policy in the new Congress because the presumed new chairs of the committees and subcommittees dealing with health care are considered quite liberal.

This group includes Rep. Charles Rangel (D-N.Y.), who is expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to become chariman of the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955.

“We will see if they just try to go for moderate Democrat ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone. They're not moderates, and they're not shrinking violets. They don't seem like the kind who are going to take orders; they seem to want to run their own show,” Mr. Cannon said.

The upcoming reauthorization of the State Children's Health Insurance Program (SCHIP), a federal and state program that provides health insurance to children in families with income too high for Medicaid but too low to be able to afford private insurance coverage, is one example of legislation the Democrats could put their stamp on, Mr. Pollack said.

“Due to its broad, bipartisan support, SCHIP no doubt will be reauthorized,” he said. “However, since approximately 9 million children continue to be uninsured, the real question before the Congress is whether the reauthorization process will expand health coverage and provide adequate SCHIP funding for those children who don't have coverage and whose families can't afford it. A simple reauthorization will be a major disappointment.”

The changes in leadership brought about by the November midterm elections are likely to result in significant shifts in the way Congress approaches health policy issues, according to several experts.

One change that many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula.

Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association board of trustees, said in an interview at press time.

Such an immediate fix would not address the underlying problem: that the physician fee schedule relies on the flawed Sustainable Growth Rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, who is executive director of Families USA, a liberal consumer group that is based in Washington, voiced optimism that the new Congress would look at the payment formula.

“I think the Democrats probably do want to deal with that–whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story, Mr. Pollack said.

“The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” Mr. Pollack said. “[The strategy of] placing caps on damage awards probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement.”

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, was even more negative.

Malpractice reform “is not going anywhere and that's a welcome development, because the Constitution doesn't give Congress any authority to play any role in that area,” he said.

“The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms,” Mr. Cannon said.

Covering the uninsured is another area that could move to the front burner under the Democrats, Dr. Wilson said.

“We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that prevents the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies.

“We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement.

Removal of that prohibition would be a welcome change, according to Mr. Pollack, of Families USA. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Cato's Mr. Cannon had a different take on the idea. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for pharmaceutical companies, he said.

Another thing the Democrats will consider doing with the Part D plan is to close up the doughnut hole–the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly.

Analysts are anticipating a new direction in health policy in the new Congress because the presumed new chairs of the committees and subcommittees dealing with health care are considered quite liberal.

This group includes Rep. Charles Rangel (D-N.Y.), who is expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to become chariman of the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955.

“We will see if they just try to go for moderate Democrat ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone. They're not moderates, and they're not shrinking violets. They don't seem like the kind who are going to take orders; they seem to want to run their own show,” Mr. Cannon said.

The upcoming reauthorization of the State Children's Health Insurance Program (SCHIP), a federal and state program that provides health insurance to children in families with income too high for Medicaid but too low to be able to afford private insurance coverage, is one example of legislation the Democrats could put their stamp on, Mr. Pollack said.

“Due to its broad, bipartisan support, SCHIP no doubt will be reauthorized,” he said. “However, since approximately 9 million children continue to be uninsured, the real question before the Congress is whether the reauthorization process will expand health coverage and provide adequate SCHIP funding for those children who don't have coverage and whose families can't afford it. A simple reauthorization will be a major disappointment.”

The changes in leadership brought about by the November midterm elections are likely to result in significant shifts in the way Congress approaches health policy issues, according to several experts.

One change that many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula.

Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association board of trustees, said in an interview at press time.

Such an immediate fix would not address the underlying problem: that the physician fee schedule relies on the flawed Sustainable Growth Rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, who is executive director of Families USA, a liberal consumer group that is based in Washington, voiced optimism that the new Congress would look at the payment formula.

“I think the Democrats probably do want to deal with that–whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story, Mr. Pollack said.

“The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” Mr. Pollack said. “[The strategy of] placing caps on damage awards probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement.”

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, was even more negative.

Malpractice reform “is not going anywhere and that's a welcome development, because the Constitution doesn't give Congress any authority to play any role in that area,” he said.

“The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms,” Mr. Cannon said.

Covering the uninsured is another area that could move to the front burner under the Democrats, Dr. Wilson said.

“We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that prevents the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies.

“We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement.

Removal of that prohibition would be a welcome change, according to Mr. Pollack, of Families USA. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Cato's Mr. Cannon had a different take on the idea. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for pharmaceutical companies, he said.

Another thing the Democrats will consider doing with the Part D plan is to close up the doughnut hole–the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly.

Analysts are anticipating a new direction in health policy in the new Congress because the presumed new chairs of the committees and subcommittees dealing with health care are considered quite liberal.

This group includes Rep. Charles Rangel (D-N.Y.), who is expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to become chariman of the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955.

“We will see if they just try to go for moderate Democrat ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone. They're not moderates, and they're not shrinking violets. They don't seem like the kind who are going to take orders; they seem to want to run their own show,” Mr. Cannon said.

The upcoming reauthorization of the State Children's Health Insurance Program (SCHIP), a federal and state program that provides health insurance to children in families with income too high for Medicaid but too low to be able to afford private insurance coverage, is one example of legislation the Democrats could put their stamp on, Mr. Pollack said.

“Due to its broad, bipartisan support, SCHIP no doubt will be reauthorized,” he said. “However, since approximately 9 million children continue to be uninsured, the real question before the Congress is whether the reauthorization process will expand health coverage and provide adequate SCHIP funding for those children who don't have coverage and whose families can't afford it. A simple reauthorization will be a major disappointment.”

Changes in leadership brought about by the November mid-term elections are likely to change the way Congress approaches health policy issues, according to several experts.

One change many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula. Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association board of trustees, said in an interview at press time.

Such an immediate fix would not address the underlying problem: The physician fee schedule relies on the flawed Sustainable Growth Rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, executive director of Families USA, a liberal consumer group based in Washington, voiced optimism that the new Congress would look at the payment formula. “The Democrats probably do want to deal with that—whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story, Mr. Pollack said.

“The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” Mr. Pollack said. The strategy of placing caps on damage awards “probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement.”

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, was even more negative. Malpractice reform “is not going anywhere and that's a welcome development, because the Constitution does not give Congress any authority to play any role in that area,” he said. “The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms.”

Covering the uninsured is another area that could move to the front burner under the Democrats, Dr. Wilson said. “We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that bans the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies.

“We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement.

Removal of that prohibition would be a welcome change, according to Mr. Pollack, of Families USA. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Cato's Mr. Cannon had a different view. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for pharmaceutical companies, he said.

The Democrats also will consider closing up the Part D doughnut hole—the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly.

Analysts anticipate a new direction in health policy in the new Congress because the presumed new committee chairs concerned with health care are considered quite liberal. This group includes Rep. Charles Rangel (D-N.Y.), expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to head the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955. “We will see if they just try to go for moderate Democrat ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone.”

Changes in leadership brought about by the November mid-term elections are likely to change the way Congress approaches health policy issues, according to several experts.

One change many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula. Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association board of trustees, said in an interview at press time.

Such an immediate fix would not address the underlying problem: The physician fee schedule relies on the flawed Sustainable Growth Rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, executive director of Families USA, a liberal consumer group based in Washington, voiced optimism that the new Congress would look at the payment formula. “The Democrats probably do want to deal with that—whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story, Mr. Pollack said.

“The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” Mr. Pollack said. The strategy of placing caps on damage awards “probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement.”

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, was even more negative. Malpractice reform “is not going anywhere and that's a welcome development, because the Constitution does not give Congress any authority to play any role in that area,” he said. “The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms.”

Covering the uninsured is another area that could move to the front burner under the Democrats, Dr. Wilson said. “We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that bans the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies.

“We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement.

Removal of that prohibition would be a welcome change, according to Mr. Pollack, of Families USA. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Cato's Mr. Cannon had a different view. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for pharmaceutical companies, he said.

The Democrats also will consider closing up the Part D doughnut hole—the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly.

Analysts anticipate a new direction in health policy in the new Congress because the presumed new committee chairs concerned with health care are considered quite liberal. This group includes Rep. Charles Rangel (D-N.Y.), expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to head the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955. “We will see if they just try to go for moderate Democrat ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone.”

Changes in leadership brought about by the November mid-term elections are likely to change the way Congress approaches health policy issues, according to several experts.

One change many physicians are hoping the new Democratic leadership will make is to fix the Medicare physician payment formula. Under the current payment formula, physicians are facing a 5% payment cut in January. “For the immediate future, we are asking that they cancel the cut and give physicians a positive [payment increase] to reflect inflation, which is slightly over 2%,” Dr. Cecil Wilson, chair of the American Medical Association board of trustees, said in an interview at press time.

Such an immediate fix would not address the underlying problem: The physician fee schedule relies on the flawed Sustainable Growth Rate (SGR).

“Congress needs to do a permanent fix to this problem,” said Dr. Wilson, an internist in Winter Park, Fla. “We will be working very hard on that for this coming year, to ask that they get rid of this formula and move to one that reflects the increased cost of providing care.”

Ron Pollack, executive director of Families USA, a liberal consumer group based in Washington, voiced optimism that the new Congress would look at the payment formula. “The Democrats probably do want to deal with that—whether it will be on a year-by-year basis or on a more permanent basis, I don't know,” he said in an interview. “But I do think the Democrats are inclined to get that fixed.”

Malpractice reform could be another story, Mr. Pollack said.

“The one and perhaps only way that issue is going to move forward will be if there is significant compromise,” Mr. Pollack said. The strategy of placing caps on damage awards “probably makes it difficult to move this forward. On the other hand, to the extent that alternative conflict resolution systems are established that substantially reduce litigation and provide more people with access to grievance mechanisms short of legal proceedings, that certainly has a chance of movement.”

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, was even more negative. Malpractice reform “is not going anywhere and that's a welcome development, because the Constitution does not give Congress any authority to play any role in that area,” he said. “The Republicans never recognized that, but the Democrats, in this instance, are in favor of letting the states deal with that issue, and they are not interested in any federal malpractice reforms.”

Covering the uninsured is another area that could move to the front burner under the Democrats, Dr. Wilson said. “We now know that [the uninsured] are more likely to get sicker and die sooner” than those with insurance, he said. “We'll be trying to increase the visibility of that problem.”

One definite health care priority for Rep. Nancy Pelosi (D-Calif.), who will become Speaker of the House in January, will be to get rid of a prohibition in the Medicare prescription drug coverage law that bans the Centers for Medicare and Medicaid Services from negotiating prices directly with pharmaceutical companies.

“We can and we must make the Medicare prescription drug plan fairer and more cost effective,” Rep. Pelosi said in a statement.

Removal of that prohibition would be a welcome change, according to Mr. Pollack, of Families USA. By bargaining directly with drug companies, the Department of Veterans Affairs “has achieved much lower prices than the lowest prices charged by all Medicare Part D plans,” he said in a statement, noting that the median price difference was 46%.

Cato's Mr. Cannon had a different view. “Democrats are attracted to price controls because it allows them to provide a benefit for current generations through lower cost drugs, while imposing a cost on future generations, which is fewer new drugs being developed” due to declining revenues for pharmaceutical companies, he said.

The Democrats also will consider closing up the Part D doughnut hole—the gap in coverage beneficiaries have when their drug bills exceed a certain amount. Rep. Pelosi has said she plans to do this using the savings achieved through letting Medicare negotiate drug costs directly.

Analysts anticipate a new direction in health policy in the new Congress because the presumed new committee chairs concerned with health care are considered quite liberal. This group includes Rep. Charles Rangel (D-N.Y.), expected to head the Ways and Means Committee; Rep. John Dingell (D-Mich.), expected to head the Energy and Commerce Committee; Rep. George Miller (D-Calif.), expected to head the Education and Workforce Committee; and Rep. Fortney H. “Pete” Stark (D-Calif.), expected to head the Ways and Means health subcommittee.

“It's going to be very interesting to see how these folks approach health care,” said Mr. Cannon, noting that Rep. Dingell has introduced legislation for a single-payer health care system every year since 1955. “We will see if they just try to go for moderate Democrat ideas … or if they really follow their hearts and try to kill health savings accounts, or launch some sort of Clinton-like initiative that aims to provide coverage for everyone.”

Rocket Fuel and Thyroid Deficiency

Environmental trace sources of perchlorate may be contributing to lower thyroid hormone levels in women, according to a study by the National Institute of Environmental Health Sciences. Perchlorate is used to make a variety of products including road flares, explosives, and rocket fuel. Researchers looked at urinary levels of perchlorate and serum levels of thyroid-stimulating hormone and total thyroxine in 2,200 males and females aged 12 years and older. They found that although perchlorate was not a significant predictor of T₄ or TSH levels in men, it was a significant predictor for levels of both in women. “These associations of perchlorate with T₄ and TSH are coherent in direction … but are at perchlorate exposure levels unanticipated based on previous studies,” the authors wrote. The Environmental Working Group, a nonpartisan environmental research organization funded largely by foundations, called the report “alarming” and noted that its own analysis suggests that 44 million American women who are pregnant or thyroid deficient, or who have low iodine levels, are at heightened risk from exposure to the chemical.

Diabetic Nephropathy Genotype?

The Foundation for the National Institutes of Health has awarded the Joslin Diabetes Center one of its first six grants under the Genetic Association Information Network. GAIN is a public-private partnership among the foundation, Pfizer Inc., Affymetrix Inc., Harvard University, and several other companies and institutions aimed at finding the genetic causes of common diseases. Under the project, researchers will use biologic samples already collected from previous studies to evaluate the differences between the genomes of 1,000–2,000 patients with particular conditions and those of 1,000–2,000 healthy volunteers. In the Joslin study, Dr. James Heber Warram and colleagues will analyze the genomes of patients with type 1 diabetes and nephropathy. Pfizer is contributing $5 million to cover the cost of overhead for GAIN, with part of those funds designated to establishing a GAIN database at the National Library of Medicine. Other studies funded in the first round of GAIN include those focussing on psoriasis, attention-deficit hyperactivity disorder, schizophrenia, bipolar disorder, and depression.

Nearly Free Humatrope, Forteo

The Health and Human Services Office of Inspector General has approved a request by Eli Lilly and Co. to provide three drugs—including the growth hormone Humatrope and the osteoporosis drug Forteo—free to beneficiaries enrolled in the Medicare Part D program who are experiencing gaps in their prescription coverage. The other drug covered by the program is Zyprexa, a drug to treat schizophrenia and bipolar disorder. To be eligible for the program, beneficiaries must have an income below 200% of the federal poverty level. To cover some of the administrative costs, patients will be charged a $25 fee for a 30-day supply of the medication, which will be shipped directly to the patient. The company said it expects to begin enrolling patients in the program as early as December. The program “meshes with Medicare Part D, allowing the drug benefit to be successful while still meeting the needs of low-income patients who require more sophisticated medications,” said Deirdre Connelly, Lilly's president of U.S. operations. Patients interested in the program can find information online at

www.lillymedicareanswers.com

Low Adoption of EMRs

Only about one-fourth of office-based physicians are currently using electronic medical records in their offices, according to a study by researchers at Massachusetts General Hospital, Harvard University, and George Washington University. The study, which was funded by the Robert Wood Johnson Foundation and the federal National Coordinator for Health Information Technology, looked at dozens of studies and surveys done by information technology experts. “We are pitifully behind where we should be,” said study coauthor Dr. David Blumenthal of Massachusetts General Hospital. “We must find ways to get more physicians to embrace this technology if we are to make major strides in improving health care quality.” Barriers to EMR adoption include the high cost of systems, uncertainty regarding the return on investment, and the perceived legal burden of compliance with privacy regulations, according to the report.

CMS Curbs Improper Claims

Medicare's on track in 2006 to further reduce the number of fraudulent and inappropriate claims being submitted. CMS is reporting that 4% of claims were improper in 2006, down from 5% the previous year and from 14% in 1996, leading to $11 billion less in improper payments over the last 2 years. To determine the error rate, CMS randomly sampled 160,000 claims submitted from April 2005 to March 2006. Since it has been able to more closely identify errors, CMS has been providing more accurate information to contractors, resulting in improved system edits and updated coverage policies, said the agency in a statement. In a statement, Sen. Chuck Grassley (R-Iowa), chairman of the committee charged with Medicare oversight, said, “I welcome the news that the government's increased attention to oversight of Medicare payments has paid off.” But he added that CMS has work to do, as it is “still paying for medically unnecessary services and undocumented or poorly documented services.”

Rocket Fuel and Thyroid Deficiency

Environmental trace sources of perchlorate may be contributing to lower thyroid hormone levels in women, according to a study by the National Institute of Environmental Health Sciences. Perchlorate is used to make a variety of products including road flares, explosives, and rocket fuel. Researchers looked at urinary levels of perchlorate and serum levels of thyroid-stimulating hormone and total thyroxine in 2,200 males and females aged 12 years and older. They found that although perchlorate was not a significant predictor of T₄ or TSH levels in men, it was a significant predictor for levels of both in women. “These associations of perchlorate with T₄ and TSH are coherent in direction … but are at perchlorate exposure levels unanticipated based on previous studies,” the authors wrote. The Environmental Working Group, a nonpartisan environmental research organization funded largely by foundations, called the report “alarming” and noted that its own analysis suggests that 44 million American women who are pregnant or thyroid deficient, or who have low iodine levels, are at heightened risk from exposure to the chemical.

Diabetic Nephropathy Genotype?

The Foundation for the National Institutes of Health has awarded the Joslin Diabetes Center one of its first six grants under the Genetic Association Information Network. GAIN is a public-private partnership among the foundation, Pfizer Inc., Affymetrix Inc., Harvard University, and several other companies and institutions aimed at finding the genetic causes of common diseases. Under the project, researchers will use biologic samples already collected from previous studies to evaluate the differences between the genomes of 1,000–2,000 patients with particular conditions and those of 1,000–2,000 healthy volunteers. In the Joslin study, Dr. James Heber Warram and colleagues will analyze the genomes of patients with type 1 diabetes and nephropathy. Pfizer is contributing $5 million to cover the cost of overhead for GAIN, with part of those funds designated to establishing a GAIN database at the National Library of Medicine. Other studies funded in the first round of GAIN include those focussing on psoriasis, attention-deficit hyperactivity disorder, schizophrenia, bipolar disorder, and depression.

Nearly Free Humatrope, Forteo

The Health and Human Services Office of Inspector General has approved a request by Eli Lilly and Co. to provide three drugs—including the growth hormone Humatrope and the osteoporosis drug Forteo—free to beneficiaries enrolled in the Medicare Part D program who are experiencing gaps in their prescription coverage. The other drug covered by the program is Zyprexa, a drug to treat schizophrenia and bipolar disorder. To be eligible for the program, beneficiaries must have an income below 200% of the federal poverty level. To cover some of the administrative costs, patients will be charged a $25 fee for a 30-day supply of the medication, which will be shipped directly to the patient. The company said it expects to begin enrolling patients in the program as early as December. The program “meshes with Medicare Part D, allowing the drug benefit to be successful while still meeting the needs of low-income patients who require more sophisticated medications,” said Deirdre Connelly, Lilly's president of U.S. operations. Patients interested in the program can find information online at

www.lillymedicareanswers.com

Low Adoption of EMRs

Only about one-fourth of office-based physicians are currently using electronic medical records in their offices, according to a study by researchers at Massachusetts General Hospital, Harvard University, and George Washington University. The study, which was funded by the Robert Wood Johnson Foundation and the federal National Coordinator for Health Information Technology, looked at dozens of studies and surveys done by information technology experts. “We are pitifully behind where we should be,” said study coauthor Dr. David Blumenthal of Massachusetts General Hospital. “We must find ways to get more physicians to embrace this technology if we are to make major strides in improving health care quality.” Barriers to EMR adoption include the high cost of systems, uncertainty regarding the return on investment, and the perceived legal burden of compliance with privacy regulations, according to the report.

CMS Curbs Improper Claims

Medicare's on track in 2006 to further reduce the number of fraudulent and inappropriate claims being submitted. CMS is reporting that 4% of claims were improper in 2006, down from 5% the previous year and from 14% in 1996, leading to $11 billion less in improper payments over the last 2 years. To determine the error rate, CMS randomly sampled 160,000 claims submitted from April 2005 to March 2006. Since it has been able to more closely identify errors, CMS has been providing more accurate information to contractors, resulting in improved system edits and updated coverage policies, said the agency in a statement. In a statement, Sen. Chuck Grassley (R-Iowa), chairman of the committee charged with Medicare oversight, said, “I welcome the news that the government's increased attention to oversight of Medicare payments has paid off.” But he added that CMS has work to do, as it is “still paying for medically unnecessary services and undocumented or poorly documented services.”

Rocket Fuel and Thyroid Deficiency

Environmental trace sources of perchlorate may be contributing to lower thyroid hormone levels in women, according to a study by the National Institute of Environmental Health Sciences. Perchlorate is used to make a variety of products including road flares, explosives, and rocket fuel. Researchers looked at urinary levels of perchlorate and serum levels of thyroid-stimulating hormone and total thyroxine in 2,200 males and females aged 12 years and older. They found that although perchlorate was not a significant predictor of T₄ or TSH levels in men, it was a significant predictor for levels of both in women. “These associations of perchlorate with T₄ and TSH are coherent in direction … but are at perchlorate exposure levels unanticipated based on previous studies,” the authors wrote. The Environmental Working Group, a nonpartisan environmental research organization funded largely by foundations, called the report “alarming” and noted that its own analysis suggests that 44 million American women who are pregnant or thyroid deficient, or who have low iodine levels, are at heightened risk from exposure to the chemical.

Diabetic Nephropathy Genotype?

The Foundation for the National Institutes of Health has awarded the Joslin Diabetes Center one of its first six grants under the Genetic Association Information Network. GAIN is a public-private partnership among the foundation, Pfizer Inc., Affymetrix Inc., Harvard University, and several other companies and institutions aimed at finding the genetic causes of common diseases. Under the project, researchers will use biologic samples already collected from previous studies to evaluate the differences between the genomes of 1,000–2,000 patients with particular conditions and those of 1,000–2,000 healthy volunteers. In the Joslin study, Dr. James Heber Warram and colleagues will analyze the genomes of patients with type 1 diabetes and nephropathy. Pfizer is contributing $5 million to cover the cost of overhead for GAIN, with part of those funds designated to establishing a GAIN database at the National Library of Medicine. Other studies funded in the first round of GAIN include those focussing on psoriasis, attention-deficit hyperactivity disorder, schizophrenia, bipolar disorder, and depression.

Nearly Free Humatrope, Forteo

The Health and Human Services Office of Inspector General has approved a request by Eli Lilly and Co. to provide three drugs—including the growth hormone Humatrope and the osteoporosis drug Forteo—free to beneficiaries enrolled in the Medicare Part D program who are experiencing gaps in their prescription coverage. The other drug covered by the program is Zyprexa, a drug to treat schizophrenia and bipolar disorder. To be eligible for the program, beneficiaries must have an income below 200% of the federal poverty level. To cover some of the administrative costs, patients will be charged a $25 fee for a 30-day supply of the medication, which will be shipped directly to the patient. The company said it expects to begin enrolling patients in the program as early as December. The program “meshes with Medicare Part D, allowing the drug benefit to be successful while still meeting the needs of low-income patients who require more sophisticated medications,” said Deirdre Connelly, Lilly's president of U.S. operations. Patients interested in the program can find information online at

www.lillymedicareanswers.com

Low Adoption of EMRs

Only about one-fourth of office-based physicians are currently using electronic medical records in their offices, according to a study by researchers at Massachusetts General Hospital, Harvard University, and George Washington University. The study, which was funded by the Robert Wood Johnson Foundation and the federal National Coordinator for Health Information Technology, looked at dozens of studies and surveys done by information technology experts. “We are pitifully behind where we should be,” said study coauthor Dr. David Blumenthal of Massachusetts General Hospital. “We must find ways to get more physicians to embrace this technology if we are to make major strides in improving health care quality.” Barriers to EMR adoption include the high cost of systems, uncertainty regarding the return on investment, and the perceived legal burden of compliance with privacy regulations, according to the report.

CMS Curbs Improper Claims

Medicare's on track in 2006 to further reduce the number of fraudulent and inappropriate claims being submitted. CMS is reporting that 4% of claims were improper in 2006, down from 5% the previous year and from 14% in 1996, leading to $11 billion less in improper payments over the last 2 years. To determine the error rate, CMS randomly sampled 160,000 claims submitted from April 2005 to March 2006. Since it has been able to more closely identify errors, CMS has been providing more accurate information to contractors, resulting in improved system edits and updated coverage policies, said the agency in a statement. In a statement, Sen. Chuck Grassley (R-Iowa), chairman of the committee charged with Medicare oversight, said, “I welcome the news that the government's increased attention to oversight of Medicare payments has paid off.” But he added that CMS has work to do, as it is “still paying for medically unnecessary services and undocumented or poorly documented services.”

BALTIMORE — Targeting medicines at particular racial categories “is a misguided approach, and what we should be pursuing is attribute-based medicine,” Sharona Hoffman said at the annual meeting of the American Society of Law, Medicine, and Ethics.

One example of a medicine targeted at racial categories is BiDil (fixed-dose isosorbide dinitrate and hydralazine), an antihypertensive drug that was approved specifically for use in blacks. Some experts have concluded that a good response to BiDil has more to do with attributes and genes than it does with racial identity.

Patient attributes that might be considered relevant for assessing disease vulnerability or treatment responses include genetic variations or alleles that might be more common for people who are of one ancestral origin rather than others but could still cross population lines. “Then there are other factors such as diet, exercise, stress level, and exposure to toxins” that play into treatment response, said Ms. Hoffman, a professor of law at Case Western Reserve University in Cleveland.

“The Human Genome Project showed us that race is not a biologically valid or genetically valid concept, and therefore the emergence of 'race-based' medicine is both perplexing and troubling,” she said at the meeting, which was cosponsored by the University of Maryland. “Race does not mean much of anything” from a genetic perspective because “99.9% of genes are identical for all humans,” and in the remaining 0.1%, 90%–95% of genetic variations are found at equal rates in every population.

Society also has difficulty defining race, with legal definitions of race varying from one state to another, Ms. Hoffman said. The race categories listed in the U.S. Census also change every decade.

“It's very hard to tell what ancestry people have if you don't ask specific questions,” Ms. Hoffman said.

In addition to these problems, using “race-based” medicine may exacerbate health disparities, because “it's possible doctors may try to specialize in treating blacks or whites,” said Ms. Hoffman. That may violate federal or state antidiscrimination laws. Instead of pursuing race-based protocols, she recommended designing attribute-based trial protocols, and having institutional review boards and scientific review boards subject them to special scrutiny.

“Consider the genetic variations and the psychosocial, economic, cultural, environmental, and other factors, which you can measure or ask about—stress, diet, exercise, exposure to toxins, and cultural and religious barriers to treatment compliance,” she said.

“Maybe people aren't doing well because they are not following the protocol—because they either don't understand it [due to] a language barrier, or they have religious beliefs that prevent them from doing some of the things you need them to do,” she added.

BALTIMORE — Targeting medicines at particular racial categories “is a misguided approach, and what we should be pursuing is attribute-based medicine,” Sharona Hoffman said at the annual meeting of the American Society of Law, Medicine, and Ethics.

One example of a medicine targeted at racial categories is BiDil (fixed-dose isosorbide dinitrate and hydralazine), an antihypertensive drug that was approved specifically for use in blacks. Some experts have concluded that a good response to BiDil has more to do with attributes and genes than it does with racial identity.

Patient attributes that might be considered relevant for assessing disease vulnerability or treatment responses include genetic variations or alleles that might be more common for people who are of one ancestral origin rather than others but could still cross population lines. “Then there are other factors such as diet, exercise, stress level, and exposure to toxins” that play into treatment response, said Ms. Hoffman, a professor of law at Case Western Reserve University in Cleveland.

“The Human Genome Project showed us that race is not a biologically valid or genetically valid concept, and therefore the emergence of 'race-based' medicine is both perplexing and troubling,” she said at the meeting, which was cosponsored by the University of Maryland. “Race does not mean much of anything” from a genetic perspective because “99.9% of genes are identical for all humans,” and in the remaining 0.1%, 90%–95% of genetic variations are found at equal rates in every population.

Society also has difficulty defining race, with legal definitions of race varying from one state to another, Ms. Hoffman said. The race categories listed in the U.S. Census also change every decade.

“It's very hard to tell what ancestry people have if you don't ask specific questions,” Ms. Hoffman said.

In addition to these problems, using “race-based” medicine may exacerbate health disparities, because “it's possible doctors may try to specialize in treating blacks or whites,” said Ms. Hoffman. That may violate federal or state antidiscrimination laws. Instead of pursuing race-based protocols, she recommended designing attribute-based trial protocols, and having institutional review boards and scientific review boards subject them to special scrutiny.

“Consider the genetic variations and the psychosocial, economic, cultural, environmental, and other factors, which you can measure or ask about—stress, diet, exercise, exposure to toxins, and cultural and religious barriers to treatment compliance,” she said.

“Maybe people aren't doing well because they are not following the protocol—because they either don't understand it [due to] a language barrier, or they have religious beliefs that prevent them from doing some of the things you need them to do,” she added.

BALTIMORE — Targeting medicines at particular racial categories “is a misguided approach, and what we should be pursuing is attribute-based medicine,” Sharona Hoffman said at the annual meeting of the American Society of Law, Medicine, and Ethics.

One example of a medicine targeted at racial categories is BiDil (fixed-dose isosorbide dinitrate and hydralazine), an antihypertensive drug that was approved specifically for use in blacks. Some experts have concluded that a good response to BiDil has more to do with attributes and genes than it does with racial identity.

Patient attributes that might be considered relevant for assessing disease vulnerability or treatment responses include genetic variations or alleles that might be more common for people who are of one ancestral origin rather than others but could still cross population lines. “Then there are other factors such as diet, exercise, stress level, and exposure to toxins” that play into treatment response, said Ms. Hoffman, a professor of law at Case Western Reserve University in Cleveland.

“The Human Genome Project showed us that race is not a biologically valid or genetically valid concept, and therefore the emergence of 'race-based' medicine is both perplexing and troubling,” she said at the meeting, which was cosponsored by the University of Maryland. “Race does not mean much of anything” from a genetic perspective because “99.9% of genes are identical for all humans,” and in the remaining 0.1%, 90%–95% of genetic variations are found at equal rates in every population.

Society also has difficulty defining race, with legal definitions of race varying from one state to another, Ms. Hoffman said. The race categories listed in the U.S. Census also change every decade.

“It's very hard to tell what ancestry people have if you don't ask specific questions,” Ms. Hoffman said.

In addition to these problems, using “race-based” medicine may exacerbate health disparities, because “it's possible doctors may try to specialize in treating blacks or whites,” said Ms. Hoffman. That may violate federal or state antidiscrimination laws. Instead of pursuing race-based protocols, she recommended designing attribute-based trial protocols, and having institutional review boards and scientific review boards subject them to special scrutiny.

“Consider the genetic variations and the psychosocial, economic, cultural, environmental, and other factors, which you can measure or ask about—stress, diet, exercise, exposure to toxins, and cultural and religious barriers to treatment compliance,” she said.

“Maybe people aren't doing well because they are not following the protocol—because they either don't understand it [due to] a language barrier, or they have religious beliefs that prevent them from doing some of the things you need them to do,” she added.

CHICAGO — Men with prostatic disease often present with symptoms of hypogonadism and are more likely to be hypogonadal, compared with patients who do not have prostatic conditions, Dr. Sherwyn L. Schwartz said in a poster presentation at the annual meeting of the American Association of Clinical Endocrinologists.

As part of the Hypogonadism in Males (HIM) study, Dr. Schwartz, an endocrinologist in private practice in San Antonio, looked at 391 men aged 45 or older who had prostatic disease and made appointments at 95 primary care centers over a 2-week period. Patients included 165 men with serum total testosterone levels of less than 300 ng/dL, defined as hypogonadal levels, and 226 men with normal serum total testosterone levels.

All patients had a single morning blood draw to test for concentrations of total testosterone, free testosterone, bioavailable testosterone, and sex hormone-binding globulin. They were surveyed for comorbid conditions and for signs and symptoms of hypogonadism, such as decline in general feeling of well-being, decline in muscular strength, decrease in sexual desire, and depressed mood. Dr. Schwartz compared study results in this group with results from the overall HIM study population.

In the overall study population, the percentage of hypogonadal men with a medical history of prostatic disease or disorder was 20%, similar to the 17% prevalence seen in eugonadal men. But in the hypogonadal population not receiving testosterone therapy, 21% had prostatic disease, which was statistically significant when compared with the prevalence in eugonadal men.

Similarly, the risk for hypogonadism in the overall study population was comparable for men with and without prostatic disease. But for the untreated population, the risk of hypogonadism in men with prostatic disease was significantly greater than in men with no history of prostatic disease. “Larger studies that examine the relationship between the occurrence of hypogonadal symptoms and the risk of hypogonadism in men aged 45 or older with and without prostatic diseases or disorders are warranted,” he concluded.

CHICAGO — Men with prostatic disease often present with symptoms of hypogonadism and are more likely to be hypogonadal, compared with patients who do not have prostatic conditions, Dr. Sherwyn L. Schwartz said in a poster presentation at the annual meeting of the American Association of Clinical Endocrinologists.

As part of the Hypogonadism in Males (HIM) study, Dr. Schwartz, an endocrinologist in private practice in San Antonio, looked at 391 men aged 45 or older who had prostatic disease and made appointments at 95 primary care centers over a 2-week period. Patients included 165 men with serum total testosterone levels of less than 300 ng/dL, defined as hypogonadal levels, and 226 men with normal serum total testosterone levels.

All patients had a single morning blood draw to test for concentrations of total testosterone, free testosterone, bioavailable testosterone, and sex hormone-binding globulin. They were surveyed for comorbid conditions and for signs and symptoms of hypogonadism, such as decline in general feeling of well-being, decline in muscular strength, decrease in sexual desire, and depressed mood. Dr. Schwartz compared study results in this group with results from the overall HIM study population.

In the overall study population, the percentage of hypogonadal men with a medical history of prostatic disease or disorder was 20%, similar to the 17% prevalence seen in eugonadal men. But in the hypogonadal population not receiving testosterone therapy, 21% had prostatic disease, which was statistically significant when compared with the prevalence in eugonadal men.

Similarly, the risk for hypogonadism in the overall study population was comparable for men with and without prostatic disease. But for the untreated population, the risk of hypogonadism in men with prostatic disease was significantly greater than in men with no history of prostatic disease. “Larger studies that examine the relationship between the occurrence of hypogonadal symptoms and the risk of hypogonadism in men aged 45 or older with and without prostatic diseases or disorders are warranted,” he concluded.

CHICAGO — Men with prostatic disease often present with symptoms of hypogonadism and are more likely to be hypogonadal, compared with patients who do not have prostatic conditions, Dr. Sherwyn L. Schwartz said in a poster presentation at the annual meeting of the American Association of Clinical Endocrinologists.

As part of the Hypogonadism in Males (HIM) study, Dr. Schwartz, an endocrinologist in private practice in San Antonio, looked at 391 men aged 45 or older who had prostatic disease and made appointments at 95 primary care centers over a 2-week period. Patients included 165 men with serum total testosterone levels of less than 300 ng/dL, defined as hypogonadal levels, and 226 men with normal serum total testosterone levels.

All patients had a single morning blood draw to test for concentrations of total testosterone, free testosterone, bioavailable testosterone, and sex hormone-binding globulin. They were surveyed for comorbid conditions and for signs and symptoms of hypogonadism, such as decline in general feeling of well-being, decline in muscular strength, decrease in sexual desire, and depressed mood. Dr. Schwartz compared study results in this group with results from the overall HIM study population.

In the overall study population, the percentage of hypogonadal men with a medical history of prostatic disease or disorder was 20%, similar to the 17% prevalence seen in eugonadal men. But in the hypogonadal population not receiving testosterone therapy, 21% had prostatic disease, which was statistically significant when compared with the prevalence in eugonadal men.

Similarly, the risk for hypogonadism in the overall study population was comparable for men with and without prostatic disease. But for the untreated population, the risk of hypogonadism in men with prostatic disease was significantly greater than in men with no history of prostatic disease. “Larger studies that examine the relationship between the occurrence of hypogonadal symptoms and the risk of hypogonadism in men aged 45 or older with and without prostatic diseases or disorders are warranted,” he concluded.