Let's talk about the issues! Warning: Long Post

I thought it might be helpful to put all candidates’ stances on issues in one thread (one issue at a time) for discussion. This one will be for healthcare:


Joe Biden:

• Joe Biden believes that to protect jobs, compete in a global economy and strengthen families we have to have to address out-dated health care system. The next president will have to deal with two challenges: containing the growing costs of health care and providing access to the 47 million Americans who don't have health insurance.
• Joe Biden believes we need to take three steps to contain the cost of health care: modernize the system, simplify the system and reduce errors. He supports the transition to secure electronic records so that people can provide their doctors and nurses with vital medical information in real time. He believes there should be a uniform, efficient system to submit claims.
• Joe Biden believes the path toward a 21st century health care system starts with the most vulnerable in our society. He would expand health insurance for children and relieve families and businesses of the burden of expensive catastrophic cases. He supports states that are pursuing innovative alternatives to make sure that everyone has access to health care and believes we should use data from these states to evaluate what works best in providing affordable access to health care for all.
http://www.joebiden.com/issues/



Hillary Clinton:
Senator Clinton laid out a major plank in her framework for providing affordable, quality health coverage for all Americans: her 7-step strategy for lowering spiraling costs. The rising cost of health care is threatening working families, American businesses, and the nation’s economic competitiveness. Premiums have almost doubled since 2000 - up 87 percent - four times higher than wages. And if left unattended, health care spending will double to $4 trillion per year over the next 10 years. Senator Clinton stressed that the necessary commitment to cover all Americans will require the reform of our often irrational, inefficient and wasteful policies.
Senator Clinton proposed a series of initiatives that will cut the spiraling rate of growth by one-third over time. Her health care modernization strategy achieves this by targeting the drivers of health care costs, including (1) our back-ended coverage of health care that gives short-shift to prevention, (2) the nation’s reliance on an antiquated, wasteful, costly and even dangerous paper-based medical records system, (3) unmanaged chronic illnesses such as diabetes and heart disease which account for over 75 percent of health care spending, (4) the over-utilization of medical interventions that provide little added value and the under-utilization of those that do, (5) and excessive insurance, drug, and malpractice costs.
Senator Clinton’s proposals would reduce costs and improve quality in the health care system. Taken together they would lower national health spending by at least $120 billion dollars a year. If businesses received a proportionate reduction in their health benefits spending, they would achieve at least $25 billion in savings in 2004 dollars. Families would substantially benefit as well. In fact, Business Roundtable has estimated $2,200 in national health savings for the typical family. And these savings would be reinvested in the system to help cover the 45 million uninsured.
To achieve this goal, Senator Clinton’s strategy would:
1. A Groundbreaking National Prevention Initiative to Reduce the Incidence of Such Diseases as Diabetes and Cancer that Impose Huge Human and Financial Costs
2. Institute a New "Paperless" Health Information Technology System
3. Transform Care of Today’s Chronically Ill Population to Improve Outcomes and Decrease Costs
4. Ending Insurance Discrimination to Help Reduce Administrative Costs
5. Create an Independent "Best Practices" Institute to Empower Consumers, Providers and Health Plans to Make the Right Care Choices
6. Implement Smart Purchasing Initiatives to Constrain Excess Prescription Drug and Managed Care Expenditures
7. Put in Place Common-Sense Medical Malpractice

http://www.hillaryclinton.com/feature/healthcare/


Chris Dodd:

Chris Dodd has worked to ensure that every American has health care coverage, regardless of their economic status. He understands that we simply can’t afford to fail again when it comes to ensuring that all Americans have access to affordable, quality health care. Dodd brought together Republicans and Democrats to pass the landmark Family and Medical Leave Act to ensure that Americans never have to make the choice between the job they need and the family they love. As a result, 50 million people have been able to take up to 12 weeks of unpaid leave to care for a new child or a sick family member. The problems are known and so are the solutions – what we need is the kind of bold leadership Chris Dodd will bring to the White House to meet the health care challenge. He’ll get the job done.
• Universal Responsibility: Ensure universal affordable quality coverage by creating a Health Care General Fund (HCGF) to serve all Americans. Then, require employers to either cover their employees or contribute to the fund. Individual Americans not covered by employers will be required to purchase insurance from the HCGF at a price based on his/her fixed percentage above poverty. With universal responsibility, no American will be turned away.
• Assisting Small Businesses: Exempt businesses employing less than 10 workers from contributing to the HCGF. Provide federal assistance to businesses employing between 10 and 30 workers.
• Focusing On Prevention: Integrate clinical information tools, monitoring technologies, and care management into the system, and encourage screenings, timely visits to the doctor, and early treatments that keep chronic diseases under control.
• Building On What Works: Extend Medicaid to adults who make 100 percent above the poverty line and to children whose family’s income is up to 300 percent of the poverty line.
• Driving Down Costs: There is enough money in the system to solve the health care crisis. We will utilize 21st century technology to give hospitals comprehensive diagnostic and treatment data, so as to avoid duplicative and unnecessary treatment and services that waste precious resources and drive up costs.

http://www.chrisdodd.com/issues/healthcare


John Edwards:

John Edwards believes that we must achieve universal health coverage as quickly as possible. To get there, all parts of our society must share responsibility. Edwards will make a historic effort to make insurance affordable and easy to obtain through new regional Health Care Markets, tax credits, and expanded Medicaid and children’s health insurance programs. In return, employers must contribute their fair share and individuals must take responsibility for themselves and their families by signing up for an affordable plan. John Edwards’ vision for health care reform is built on four steps:

First: Business Responsibility. Businesses have a responsibility to support their employees’ health. They will be required to either provide a comprehensive health plan to their employees or to contribute to the cost of covering them through Health Care Markets. In return, the Edwards plan will make it easier for businesses to offer insurance by reducing costs and creating new choices. Covering all Americans will eliminate the cost of uncompensated care. Businesses can also choose to purchase care through Health Care Markets, which will offer quality plans at low prices and with minimal administrative burdens.

Second: Government Responsibility. Government also has a responsibility to help families obtain insurance. Families cannot be left on their own. To help make insurance affordable, Edwards will:

• Offer New Health Insurance Tax Credits: Edwards will create a new tax credit to subsidize insurance purchased through Health Care Markets, making premiums affordable for all families. The tax credit will be available on a sliding scale to middle class families and refundable to help families without income tax liability.

• Expand Medicaid and SCHIP: Medicaid and the State Children’s Health Insurance Program
(SCHIP) play essential roles in helping low-income Americans getting the health care they need. Edwards will strengthen the federal partnership with states supporting these programs, committing the necessary federal resources to allow states to expand Medicaid and SCHIP to serve all adults under the poverty line and all children and parents under 250 percent of the poverty line (about $50,000 for a family of four).

• Require Fair Terms for Health Insurance: Edwards will require insurers to keep plans open to everyone and charge fair premiums, regardless of preexisting conditions, medical history, age, job, and other characteristics. No longer will insurance companies be able to game the system to cover only healthy people. Several states – including New Jersey, New York, and Washington – have led
the way on similar community rating and guaranteed issue reforms. In addition, new national standards will ensure that all health insurance policies offer preventive and chronic care with minimal cost-sharing.

• Secure the Health Care Safety Net: Even in a system of universal coverage, a health care safety net including public hospitals, clinics, and community health centers remains necessary. Public hospitals are critical for valuable trauma and emergency care, to respond to a public health crisis or bioterrorist attack, and as the backbone of our medical education system.

Third: New Health Care Markets. The U.S. government will help states and groups of states create regional Health Care Markets, non-profit purchasing pools that offer a choice of competing insurance plans. At least one plan would be a public program based upon Medicare. All plans will include comprehensive benefits, including full mental health benefits. Families and businesses could choose to supplement their coverage with additional benefits. The markets will be available to everyone who does not get comparable insurance from their jobs or a public program and to employers that choose to join rather than offer their own insurance plans. The benefits of Health Care Markets include:

• Freedom and Security: Health Care Markets will give participants a choice among affordable, quality plans. Americans can keep Health Care Market plans when they change or lose their jobs, start new businesses, or take time off for caregiving.

• Choice between Public and Private Insurers: Health Care Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve
toward a single-payer approach if individuals and businesses prefer the public plan.

• Promoting Affordable Care: Health Care Markets will negotiate low premiums through their economies of scale so they can get a better deal than individuals and many businesses can get on their own. Health Care Markets will also hold down administrative costs by reducing the need for underwriting and marketing activities (two-thirds of private insurers’ overhead), centrally collecting premiums, and exercising leadership to reduce costs on billing practices, claims processing, and electronic medical records. Finally, they will be able to work with insurers to
adopt cost-effective approaches to health care like preventive care and to collect the data necessary to drive quality improvement.

• Reducing Burdens for Businesses: By assuming the administrative role of negotiating benefit plans with insurers and collecting premiums, Health Care Markets will minimize administrative burdens for participating businesses and other employers. Businesses that opt into the markets will only have to make financial contributions to the cost of covering their employees through markets, similar to their role in Social Security and Medicare.

Finally: Individual Responsibility. Once insurance is affordable, everyone will be expected to take responsibility for themselves and their families by obtaining health coverage. Some Americans will obtain coverage from public programs like Medicare, Medicaid, and SCHIP and others will get coverage through their jobs. Other families can buy insurance through the regional Health Care Markets. Special exemptions will be available in cases of extreme financial hardship or religious beliefs. The emphasis on shared responsibility builds on Edwards’ past proposals to insure all children through shared responsibility and contain health care costs. In 2004, his plan would have made children’s health insurance affordable and required parents to purchase coverage for their children. Today, he proposes to expand that approach to make coverage universal.

(5) Improve Productivity with Information Technology. Health care administration costs more than $1,000 per American. It may be the fastest growing part of health care costs.

• Adopt Electronic Medical Records: Many insurers and hospitals still rely on cumbersome paper systems and incompatible computer systems. The outdated “paper chase” causes tragic errors when doctors don't have access to patient information or misread handwritten charts. It creates needless administrative waste recreating and transporting medical papers, performing duplicative
testing, and claiming insurance benefits. Edwards will support the implementation of health information technology while ensuring that patients’ privacy rights are protected. Savings from electronic records could be as great as $160 billion a year, according to a RAND study.

• Support Local Infrastructure: Edwards will provide the resources hospitals need to implement information systems that improve patient safety and hospital efficiency. Steps include:
o Adopting automated medication dispensers that can quickly and accurately fill prescriptions, freeing pharmacists to work more with patients and reducing the risk of prescription errors.

o Developing systems to promote patient-doctor communication, such as email and group consultations and support groups for individuals suffering from the same disorder.

o Creating computerized physician order entry to eliminate lost paperwork and illegible writing.

o Developing computerized patient reminder systems to improve compliance with treatments, such as automatic phone calls home to remind patients to take needed medication to help keep them healthy and out of the hospital.

o Using handheld devices to allow hospital staff to communicate results directly to physicians, instead of wasting time trying to find a doctor with urgent information.

(6) Protect Patients against Dangerous Medicines. Recent drug recalls such as Vioxx have raised concerns about drug safety. Edwards will restrict direct-to-consumer advertising for new drugs to ensure that consumers are not misled about the potential dangers of newly marketed drugs and strengthen the Food and Drug Administration’s ability to monitor new drugs after they reach the
marketplace. He will also ensure that researchers evaluating medical devices and drugs are truly independent.

http://johnedwards.com/about/issues/health-care-overview.pdf


Mike Gravel:

UNIVERSAL HEALTHCARE VOUCHERS
Senator Gravel advocates a universal health-care voucher program in which the federal government would issue annual health care vouchers to Americans based on their projected needs. Under the Senator's plan, all Americans would be fully covered and would be free to use their vouchers to choose their own health care professional. No one would ever be denied health insurance because of their health, wealth, or any other reason. A universal health-care voucher plan will also relieve American businesses of the financial responsibility of insuring their workers while ensuring that their workers get adequate care.
http://www.gravel2008.us/issues#healthcare





Dennis Kucinich:

I believe Dennis is redesigning his website and has nothing posted regarding healthcare, but I am almost 100% sure that he is endorsing a full-fledged single-payer approach…no details to post.
http://www.dennis4president.com/issues


Barack Obama:

BARACK OBAMA’S PLAN FOR A HEALTHY AMERICA
Barack Obama believes when it comes to health care America can and must do better. In
the absence of national leadership, states have been leading the way with health care
reforms that lower costs and provide coverage for all. Obama has a three part plan to
build upon the strengths of the U.S. health care system, including innovative state efforts,
and address its glaring weaknesses, such as affordability. Through partnerships among
federal and state governments, employers, providers and individuals, the Obama plan will
save a typical American family up to $2,500 every year on medical expenditures by:

(1) Providing affordable, comprehensive and portable health coverage for every
American;

(2) Modernizing the U.S. health care system to contain spiraling health care costs and
improve the quality of patient care; and

(3) Promoting prevention and strengthening public health, to prevent disease and
protect against natural and man-made disasters.

Under the Obama plan, the typical family will save up to $2,500 every year through:
�� Health IT investment, which will reduce unnecessary spending in the system that
results from preventable errors and inefficient paper billing systems;
�� Improving prevention and management of chronic conditions;
�� Increasing insurance industry competition and reducing underwriting costs and
profits, which will reduce insurance overhead;
�� Providing reinsurance for catastrophic coverage, which will reduce insurance
premiums; and
�� Making health insurance universal, which will reduce spending on uncompensated
care.

Barack Obama believes that every American has the right to affordable, comprehensive
and portable health coverage. Currently there are nearly 45 million Americans lacking
health insurance, and millions more are at risk of losing their coverage due to rising
costs.13 Rising costs are also a burden on employers, particularly small businesses, which
are increasingly unable to provide health insurance coverage for their employees and
remain competitive. Three million fewer Americans receive health insurance coverage
through their employers now compared to five years ago,14 and this trend shows no sign
of slowing down. It is simply too expensive for individuals and families to buy insurance
directly on the open market and impossible for many with pre-existing conditions.

The Obama plan will guarantee coverage for every American through partnerships
among employers, private health plans, the federal government, and the states. The plan
both builds on and improves our current insurance system, which most Americans
continue to rely upon, and leaves Medicare intact for older and disabled Americans.
Under the Obama plan, Americans will be able to maintain their current coverage if they
choose to, and will see the quality of their health care improve and their costs go down.

The Obama plan also addresses the large gaps in coverage that leave 45 million
Americans uninsured. Specifically, the Obama plan will: (1) establish a new public
insurance program, available to Americans who neither qualify for Medicaid or SCHIP
nor have access to insurance through their employers, as well as to small businesses that
want to offer insurance to their employees; (2) create a National Health Insurance
Exchange to help Americans and businesses that want to purchase private health
insurance directly; (3) require all employers to contribute towards health coverage for
their employees or towards the cost of the public plan ; (4) mandate all children have
health care coverage; (5) expand eligibility for the Medicaid and SCHIP programs; and
(6) allow flexibility for state health reform plans.

(1) OBAMA’S PLAN TO COVER THE UNINSURED. Obama will make available a new
national health plan which will give individuals the choice to buy affordable health
coverage that is similar to the plan available to federal employees. The new public plan
will be open to individuals without access to group coverage through their workplace or
current public programs. It will also be available to people who are self-employed and
small businesses that want to offer insurance to their employees.
The plan will have the following features:
�� Guaranteed eligibility. No American will be turned away because of illness or
pre-existing conditions.
�� Comprehensive benefits. The benefit package will be similar to that offered
through the Federal Employees Health Benefits Program (FEHBP), the program
through which Members of Congress get their own health care. The new public
plan will include coverage of all essential medical services, including preventive,
maternity and mental health care. Coverage will include disease management
programs, self management training and care coordination for appropriate
individuals.
�� Affordable premiums, co-pays and deductibles. Participants will be charged
fair premiums and minimal co-pays for deductibles for preventive services.
�� Subsidies. Individuals and families who do not qualify for Medicaid or SCHIP
but still need assistance will receive income-related federal subsidies to keep
health insurance premiums affordable. They can use the subsidy to buy into the
new public plan or purchase a private health care plan.
�� Simplifying paperwork and reining in health costs. The plan will simplify
paperwork for providers and will increase savings to the system overall.
�� Easy enrollment. The new public plan will be simple to enroll in and provide
ready access to coverage.
�� Portability and choice. Participants in the new public plan and the National
Health Insurance Exchange (see below) will be able to move from job to job
without changing or jeopardizing their health care coverage.
�� Quality and efficiency. Participating hospitals and providers that participate in
the new public plan will be required to collect and report data to ensure that
standards for health care quality, health information technology and
administration are being met.

(2) NATIONAL HEALTH INSURANCE EXCHANGE. To provide Americans with additional
options, the Obama plan will make available a National Health Insurance Exchange to
help individuals who wish to purchase a private insurance plan. The Exchange will act as
a watchdog and help reform the private insurance market by creating rules and standards
for participating insurance plans to ensure fairness and to make individual coverage more
affordable and accessible. Through the Exchange, any American will have the
opportunity to enroll in the new public plan or purchase an approved private plan, and
income-based sliding scale subsidies will be provided for people and families who need
it. Insurers would have to issue every applicant a policy, and charge fair and stable
premiums that will not depend upon health status. The Exchange will require that all the
plans offered are at least as generous as the new public plan and meet the same standards
for quality and efficiency. Insurers would be required to justify an above-average
premium increase to the Exchange. The Exchange would evaluate plans and make the
differences among the plans, including cost of services, transparent.

(3) EMPLOYER CONTRIBUTION. Employers that do not offer meaningful coverage or
make a meaningful contribution to the cost of quality health coverage for their employees
will be required to contribute a percentage of payroll toward the costs of the national
plan.

(4) MANDATORY COVERAGE OF CHILDREN. Obama will require that all children have
health care coverage. Obama will expand the number of options for young adults to get
coverage by allowing young people up to age 25 to continue coverage through their
parents’ plans.

(5) EXPANSION OF MEDICAID AND SCHIP. Obama will expand eligibility for the
Medicaid and SCHIP programs and ensure that these programs continue to serve their
critical safety net function.

(6) FLEXIBILITY FOR STATE PLANS. Due to federal inaction, some states have taken the
lead in health care reform. These efforts are laudable and are helping to lead the way
toward meaningful health care reform. The Obama plan is a national one that builds on
these efforts, and it will not replace what states are doing. Indeed, states can continue to
experiment, provided they meet the minimum standards of the national plan.

Health care spending is expected to double within the next decade.15 Though Americans
spend almost twice as much per person as citizens of other industrialized countries,16
their health status is no better and by many measures actually worse. Americans die
younger, and their newborns die more frequently than in other developed nations.17
Inefficient and poor quality care costs the nation at least $50 to $100 billion every year.18
Billions more are wasted on administration and overhead because of inefficiencies in the
health care system.19 America has the best health care technology in the world, but it is
often not used well, and due to varying practices, it is often wasted.

A growing body of research points to substantial opportunities to improve quality while
reducing the costs of care. Some researchers estimate that as much as 30 percent of
health care is not contributing materially to patient outcomes.20 Health care systems in
many parts of the country deliver high quality care to the populations they serve at half of
the costs of other equally renowned academic medical centers in other parts of the
country.21 The key is to provide information, incentives, and support to help physicians
and others work together to improve quality while reducing costs.

Barack Obama believes we must dramatically redesign our health system to reduce
inefficiency and waste and improve health care quality, which will drive down costs for
families and individuals. The Obama plan will improve efficiency and lower costs in the
health care system by: (1) offering federal reinsurance to employers to help ensure that
unexpected or catastrophic illnesses do not make health insurance unaffordable or out of
reach for businesses and their employees (2) ensuring that patients receive and providers
deliver the best possible care; (3) adopting state-of-the-art health information technology
systems; and (4) reforming our market structure to increase competition.

(1) REDUCING COSTS OF CATASTROPHIC ILLNESSES FOR EMPLOYERS AND THEIR
EMPLOYEES. Catastrophic health expenditures account for a high percentage of medical
expenses for private insurers.22 In fact, the most recent data available reveals that the top
five percent of people with the greatest health care expenses in the U.S. spent 49 percent
of the overall health care dollar.23 For small businesses, having a single employee with
catastrophic expenditures can make insurance unaffordable to all of the workers in the
firm. The Obama plan would reimburse employer health plans for a portion of the
catastrophic costs they incur above a threshold if they guarantee such savings are used to
reduce the cost of workers' premiums. Offsetting some of the catastrophic costs would
make health care more affordable for employers, workers and their families.

(2) LOWERING COSTS BY ENSURING PATIENTS RECEIVE AND PROVIDERS DELIVER
QUALITY CARE. Experts agree that several steps should be taken immediately to help
patients get the care they need and to help providers improve medical practice. Obama
will expand and support these and other efforts to lower costs and improve health
outcomes.

HELPING PATIENTS
�� Support disease management programs. Over seventy-five percent of total
health care dollars are spent on patients with one or more chronic conditions, such
as diabetes, heart disease, and high blood pressure.24 Many patients with chronic
diseases benefit greatly from disease management programs, which help patients
manage their condition and get the care they need.25 Obama will require that
plans that participate in the new public plan, Medicare or the Federal Employee
Health Benefits Program (FEHBP) utilize proven disease management programs.
This will improve quality of care and lower costs, as well.

�� Coordinate and integrate care. Rates of chronic diseases have skyrocketed in
the last 2 decades.26 Over 133 million Americans have at least one chronic
disease.27 With proper care, the onset and progression of these diseases can be
contained for many years. In addition to the needless suffering and early death
they cause, these chronic conditions cost a staggering $1.7 trillion yearly.28 More
than half of Americans with serious chronic conditions have 3 or more different
physicians,29 leading to duplicate testing, conflicting treatment advice and
prescription drugs that are contraindicated. Obama will support providers to put
in place care management programs and encourage team care through
implementation of medical home type models, that will improve coordination and
integration of care of those with chronic conditions.

�� Require full transparency about quality and costs. Health care quality and
costs can vary tremendously among hospitals and providers; however, patients
have limited access to this information.30 Obama will require hospitals and
providers to collect and publicly report measures of health care costs and quality,
including data on preventable medical errors, nurse staffing ratios, hospital acquired
infections, and disparities in care, and costs. Health plans will be
required to disclose the percentage of premiums that actually goes to paying for
patient care as opposed to administrative costs.

ENSURING PROVIDERS DELIVER QUALITY CARE

�� Promoting patient safety. Obama will require providers to report preventable
medical errors, and support hospital and physician practice improvement to
prevent future occurrences.

�� Aligning incentives for excellence. Both public and private insurers tend to pay
providers based on the volume of services provided, rather than the quality or
effectiveness of care.31 Obama will accelerate efforts to develop and disseminate
best practices, and align reimbursement with provision of high quality health care.
Providers who see patients enrolled in the new public plan, the National Health
Insurance Exchange, Medicare and FEHB will be rewarded for achieving
performance thresholds on physician-validated outcome measures.
Paid for by Obama for America

�� Comparative effectiveness reviews and research. The U.S. provides some of
the best health care and most sophisticated medical technologies in the world, but
at a cost that is making the effort to expand access to care ever more difficult. In
order to be able to provide health care coverage for all, we need to deliver the
same quality of care at much lower cost. This is possible because there is
considerable waste in our health care system and, at the same time, we are failing
to provide highly effective services to patients who should have them. One of the
keys to eliminating waste and missed opportunities is to increase our investment
in comparative effectiveness reviews and research. Comparative effectiveness
studies provide crucial information about which drugs, devices and procedures are
the best diagnostic and treatment options for individual patients. This information
is developed by reviewing existing literature, analyzing electronic health care
data, and conducting simple, real world studies of new technologies.
Obama will establish an independent institute to guide reviews and research on comparative
effectiveness, so that Americans and their doctors will have accurate and
objective information to make the best decisions for their health and well-being.

�� Tackling disparities in health care. Although all Americans are affected by
problems with our health care delivery system, an overwhelming body of
evidence demonstrates that certain populations are significantly more likely to
receive lower quality health care than others. Minority Americans are less likely
to receive early and timely health care for many conditions such as cancer, when
such conditions could be treatable.32 Further, minority patients are less likely to
receive recommended care that meets accepted standards of medical practice,
which similarly has a negative impact on health outcomes.33 Other patient
populations, including female34 and rural35 populations, experience disparities in
health care as well. Obama will tackle the root causes of health disparities by
addressing differences in access to health coverage and promoting prevention and
public health (see below), both of which play a major role in addressing
disparities. He will also challenge the medical system to eliminate inequities in
health care by requiring hospitals and health plans to collect, analyze and report
health care quality for disparity populations and holding them accountable for any
differences found; diversifying the workforce to ensure culturally effective care;
implementing and funding evidence-based interventions, such as patient navigator
programs; and supporting and expanding the capacity of safety-net institutions,
which provide a disproportionate amount of care for underserved populations with
inadequate funding and technical resources.

�� Reforming medical malpractice while preserving patient rights. Increasing
medical malpractice insurance rates are making it harder for doctors to practice
medicine36 and raising the costs of health care for everyone37. Barack Obama will
strengthen antitrust laws to prevent insurers from overcharging physicians for
their malpractice insurance. Obama will also promote new models for addressing
physician errors that improve patient safety, strengthen the doctor-patient
relationship, and reduce the need for malpractice suits.

(3) LOWERING COSTS THROUGH INVESTMENT IN ELECTRONIC HEALTH INFORMATION
TECHNOLOGY SYSTEMS. Most medical records are still stored on paper, which makes
them difficult to use to coordinate care, measure quality, or reduce medical errors.
Processing paper claims also costs twice as much as processing electronic claims.38
Obama will invest $10 billion a year over the next five years to move the U.S. health care
system to broad adoption of standards-based electronic health information systems,
including electronic health records. He will also phase in requirements for full
implementation of health IT and commit the necessary federal resources to make it
happen. Obama will ensure that these systems are developed in coordination with
providers and frontline workers, including those in rural and underserved areas. Obama
will ensure that patients’ privacy is protected. A study by the Rand Corporation found
that if most hospitals and doctors offices adopted electronic health records, up to $77
billion of savings would be realized each year through improvements such as reduced
hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug
utilization, and other efficiencies.39

(4) LOWERING COSTS BY INCREASING COMPETITION IN THE INSURANCE AND DRUG
MARKETS. It is not right that Americans families are paying skyrocketing premiums
while drug and insurance industries are enjoying record profits. These companies benefit
most from the status quo, and in many cases are the greatest obstacles to reform. The
Obama plan will tackle needless waste and spiraling costs by increasing competition in
the insurance and drug markets.

�� Increasing competition. The insurance business today is dominated by a small
group of large companies that has been gobbling up their rivals. In recent years,
for-profit companies have bought up not-for-profit insurers around the country.
Other not-for-profits found business so lucrative, they converted to for-profit
companies. There have been over 400 health care mergers in the last 10 years,
and just two companies dominate a full third of the national market.40 The
American Medical Association reports that 95% of insurance markets in the
United States are highly concentrated41 and the number of insurers has fallen by
just under 20% since 2000.42

These changes were supposed to make the industry more efficient, but instead
premiums have skyrocketed, increasing over 87 percent over the past six years.43
Over the same time period, insurance administrative overhead has been the
fastest-growing component of health spending. The 2007 Commonwealth Fund
Commission on a High Performance Health System reported that between 2000
and 2005, administrative overhead – including both administrative expenses and
insurance industry profits – increased 12.0 percent per year, 3.4 percentage points
faster than the average health expenditure growth of 8.6 percent.44

And while health care costs continue to rise for families, CEOs of these insurance
companies have received multi-million dollar bonuses.45 Barack Obama will
prevent companies from abusing their monopoly power through unjustified price
increases. In markets where the insurance business is not competitive, his plan
will force insurers to pay out a reasonable share of their premiums for patient care
instead of keeping exorbitant amounts for profits and administration. Obama’s
new National Health Insurance Exchange will help increase competition by
insurers.

�� Drug reimportation. The second-fastest growing type of health expenses is
prescription drugs.46 Pharmaceutical companies should profit when their research
and development results in a groundbreaking new drug. But some companies are
exploiting Americans by dramatically overcharging U.S. consumers. These
companies are selling the exact same drugs in Europe and Canada but charging
Americans a 67 percent premium.47 Obama will allow Americans to buy their
medicines from other developed countries if the drugs are safe and prices are
lower outside the U.S.

Increasing use of generics. Some drug manufacturers are explicitly paying
generic drug makers not to enter the market so they can preserve their monopolies
and keep charging Americans exorbitant prices for brand name products.48 The
Obama plan will work to ensure that market power does not lead to higher prices
for consumers. His plan will work to increase use of generic drugs in the new
public plan, Medicare, Medicaid, FEHBP and by prohibit large drug companies
from keeping generics out of markets.

Lowering Medicare prescription drug benefit costs. The 2003 Medicare
Prescription Drug Improvement and Modernization Act bans the government
from negotiating down the prices of prescription drugs, even though the
Department of Veterans Affairs’ negotiation of prescription drug prices with
pharmaceutical companies has garnered significant savings for taxpayers.49
Obama will repeal the ban on direct negotiation with drug companies and use the
resulting savings, which could be as high as $30 billion,50 to further invest in
improving health care coverage and quality.

�� Preventing waste and abuse in Medicare. Medicare’s private plan alternative,
called Medicare Advantage, was established to increase competition and reduce
costs. But independent reports show that on average the government pays 12
percent more than it costs to treat comparable beneficiaries through traditional
Medicare.51 These excessive subsidies cost the government billions of dollars
every year and create an incentive structure that has led to fraudulent abuses of
seniors. Obama believes we need to eliminate the excessive subsidies to
Medicare Advantage plans and pay them the same amount it would cost to treat
the same patients under regular Medicare.

Covering the uninsured and modernizing America’s health care system are urgent
priorities, but they are not enough. Simply put, in the absence of a radical shift towards
prevention and public health, we will not be successful in containing medical costs or
improving the health of the American people.

This nation is facing a true epidemic of chronic disease. An increasing number of
Americans are suffering and dying needlessly from diseases such as obesity, diabetes,
heart disease, asthma and HIV/AIDS, all of which can be delayed in onset if not
prevented entirely. One in 3 Americans—133 million—have a chronic condition, and
children are increasingly being affected.52 The Centers for Disease Control and
Prevention has reported that 1 in 3 children born in 2000 will develop diabetes in their
lifetime.53 Five chronic diseases—heart disease, cancer, stroke, chronic obstructive
pulmonary disease, and diabetes—cause over two-thirds of all deaths each year.54
In addition to the tremendous human cost, chronic diseases exact a tremendous financial
toll on our health care resources. Care for patients with diabetes costs $130 billion each
year alone, and this amount is growing.55 Tackling chronic diseases is also straining our
public health departments and finances, which are already stretched too thin carrying out
traditional public health functions, which include ensuring our water is safe to drink, the
air is safe to breathe, and our food is safe to eat. And these traditional public health
functions have evolved to include disaster preparedness and response for both natural and
man-made disasters.

Barack Obama believes that protecting and promoting health and wellness in this nation
is a shared responsibility among individuals and families, school systems, employers, the
medical and public health workforce, and federal and state and local governments. Each
must do their part, as well as collaborate with one another, to create the conditions and
opportunities that will allow and encourage Americans to adopt healthy lifestyles.

(1) EMPLOYERS. Reduced workforce productivity from illness and disability represents
an additional drain on business. To address employee health, an increasing number of
employers are offering worksite health promotion programs, onsite clinical preventive
services such as flu vaccinations, nutritious foods in their cafeterias and vending
machines, and exercise facilities. Equally important, many employers choose insurance
plans that cover preventive services for their employees. Barack Obama believes that
worksite interventions hold tremendous potential to influence health and will expand and
reward these efforts.

(2) SCHOOL SYSTEMS. A generation ago, nearly half of all school-aged children walked
or biked to school.56 Today, nearly 9 out of 10 children are driven to school.57 And once
there, children are not very physically active—only 8 percent of elementary schools
require daily physical education.58 Childhood obesity is nearly epidemic,59 particularly
among minority populations,60 and school systems can play an important role in tackling
this issue. For example, only about a quarter of schools adhere to nutritional standards
for fat content in school lunches.61 Obama will work with schools to create more
healthful environments for children, including assistance with contract policy
development for local vendors, grant support for school-based health screening programs
and clinical services, increased financial support for physical education, and educational
programs for students.

(3) WORKFORCE. Primary care providers and public health practitioners have and will
continue to lead efforts to protect and promote the nation’s health. Yet, the numbers of
both are dwindling,62 and the existing workforce is further challenged by inadequate
training about new health threats such as bioterrorism and avian flu, antiquated funding
and reimbursement mechanisms, and limited access to real-time information and
technical support. Barack Obama will expand funding—including loan repayment,
adequate reimbursement, grants for training curricula, and infrastructure support to
improve working conditions— to ensure a strong workforce that will champion
prevention and public health activities.

(4) INDIVIDUALS AND FAMILIES. The way Americans live, eat, work and play have real
implications for their health and wellness. Reports show that over half of U.S. adults do
not engage in physical activity at levels consistent with public health recommendations.63
And the Surgeon General’s report has shown that smoking kills an estimated 440,000
Americans each year and costs $75 billion in direct medical costs.64 Preventive care only
works if Americans take personal responsibility for their health and make the right
decisions in their own lives – if they eat the right foods, stay active, and stop smoking.
Individuals and families must have access to essential clinical preventive services such as
cancer screenings and smoking cessation programs, and the Obama health plan will
require coverage of such services in all federally supported health plans, including
Medicare, Medicaid, SCHIP and the new public plan. Americans also benefit from
healthy environments that allow them to pursue healthy choices and behaviors that can
help ward off chronic and preventable diseases. Healthy environments include
sidewalks, biking paths and walking trails; local grocery stores with fruits and vegetables,
restricted advertising for tobacco and alcohol to children; and wellness and educational
campaigns. In addition, Obama will increase funding to expand community based
preventive interventions to help Americans make better choices to improve their health.

(5) FEDERAL, STATE, AND LOCAL GOVERNMENTS. The federal government and state
and local governments play critical roles across the full range of disease prevention and
health promotion activities. First, working together, governments at all levels should
lead the effort to develop a national and regional strategy for public health, and align
funding mechanisms to support its implementation. Second, the field of public health
would benefit from greater research to optimize organization of the 3,000 health
departments in this nation,65 collaborative arrangements between levels of government
and its private partners, performance and accountability indicators, integrated and
interoperable communication networks, and disaster preparedness and response. Third,
the government must invest in workforce recruitment as well as modernizing our physical
structures, particularly our public health laboratories. And finally, the government must
examine its own policies, including agricultural, educational, environmental and health
policies, to assess and improve their effect on public health in this nation. As President,
Barack Obama will prioritize all of these activities, to ensure a 21st century public health
system and healthy America.

http://www.barackobama.com/pdf/HealthPlanFull.pdf

Bill Richardson:
Affordable Health Care for All Americans

American families are struggling under the current system. It’s inefficient and doesn’t address the rising costs of healthcare and health insurance. Americans need affordable, high-quality health care now, and Governor Bill Richardson is committed to getting it done by the end of
his first term in office.

Many families are stretched so thin they are forced to rely on credit cards to pay their medical bills. To provide immediate relief, the Richardson Plan proposes to cap the interest rate that can be charged on necessary medical expenses. Additionally, by withdrawing the troops
from Iraq within a year would free up much needed funds for health care.

This plan can be paid for without raising taxes. When some do not have access to affordable care, all Americans end up paying the price. Additionally, it is important to note that 31% of healthcare expenditures are for administration instead of direct care.

�� Working families and small businesses will be able to purchase coverage through the same plan that members of Congress enjoy. �� Americans 55 and older will be able to purchase coverage through Medicare.

�� Veterans will get access to the high-quality care they deserve, when they need it, without bureaucratic hassles. The conditions at Walter Reed and so many VA facilities are a disgrace.
Richardson’s plan will give every veteran returning from active duty with a Heroes Health Card that provides them with a choice of physicians wherever they live. No one who has served in our
military should have to drive 100 miles to the nearest VA facility just to get care. In addition to making quality healthcare affordable for every American, Richardson’s plan will keep costs under control for families and businesses:

�� Everyone who needs coverage will get an advance refundable tax credit based on income.

�� Richardson will clamp down on banks and credit card companies that charge outrageous interest rates for medical care debt. Lenders need to do their fair share.

�� Like auto insurance, all Americans will have to have health coverage and employers will pay their fair share of employee health care costs.

�� Richardson will invest in prevention, streamline administration, and support healthier lifestyle choices.

Richardson’s health care plan uses new ways to expand proven sources of affordable coverage to all Americans. It guarantees that all Americans will have choices of high quality, affordable
care by giving every American the choice to keep their current coverage or obtain coverage through an existing, well established program.

http://billrichardson.cachefly.net/pdf/issueflyers/HealthCarePlanFlyer.pdf