Just in time for season premiere week

John McCain hits the airwaves. He's up with his first ads of the campaign season in New Hampshire. You can see the ads here.

2008 Presidential Election Project Talks Policy

In the past two weeks, NACo has taken the 2008 Presidential Election Project on the road. NACo launched the Election Project to get county officials more involved in the Presidential Election process and to educate the candidates about county issues.

To reach that goal, NACo Executive Director Larry Naake and Legislative Director Ed Rosado have recently traveled to meet with policy staff for Mitt Romney and Barack Obama. In Boston, the NACo team met with Mitt Romney’s Policy Director Sally Canfield and the Director of Policy Development Jim Bognet. Jim came to the Romney campaign from Governor Schwartznegger’s office and was very familiar with the rols of counties due to the work of CSAC.

Representing Obama’s campaign were Deputy Policy Directors Danielle Gray and Carlos Monje as well as Madhuri Kommareddi. Both Carlos and Madhuri had previously worked in Obama’s Senate office.

Both meetings went very well and served as a starting point to open the dialogue between the campaigns and NACo policy experts. The campaigns seem receptive to NACo’s issues and to working together to restore the partnership. While the meetings focused largely on health care, infrastructure and justice, both campaigns said that they looked forward to working with NACo on an array of issues. Naake encouraged the campaigns to use NACo as a resource offering the same help that we’ve offered other candidates – research, demographic data, background on county issues and connecting them to our members to discuss how their policies would affect county governments.

Naake and Rosado have previously met with representatives of the McCain and Clinton campaigns. Efforts have been made to reach out to other policy staff and we continue to work on scheduling those meetings.

320 endorsements and growing...

Over 320 county officials have made their pick for President. Have you? If so, shoot an email to krogers@naco.org and let us know!

Biden
Mary Maloney, Auditor - Polk Co, IA
Jim Hancock, Supervisor - Scott Co, IA
Roxanna Moritz, Supervisor - Scott Co, IA
Denise Dolan, Auditor - Dubuque Co, IA
James London, County Council - Pickens Co, SC
Damon Jeter, County Council - Richland Co, SC
Leon Lott, Sheriff - Richland Co, SC
Brad Morris, Clerk of Courts - Union, SC

Clinton
Mary Rose Garrido Wilcox, Supervisor - Maricopa Co, AZ
Sharon Bock, Clerk - Palm Beach Co, FL
Pat Frank, Clerk of Circuit Courts - Hillsborough Co, FL
Anne Gannon, Tax Collector - Palm Beach Co, FL
Sue Gunzburger, Commissioner - Broward Co, FL
Sally Heyman, Commissioner - Miami-Dade Co, FL
Ken Keechl, Commissioner - Broward Co, FL
John Rodstrom, Commissioner - Broward Co, FL
Katy Sorenson, Commissioner - Miami-Dade Co, FL
Diana Wasserman-Rubin, Commissioner - Broward Co, FL
Paul Beneke, Supervisor - Pocahontas Co, IA
Ric Gerard, Supervisor - Iowa Co, IA
Julie Haggerty, Recorder - Polk Co, IA
Jeff Heland, Supervisor - Des Moines Co, IA
Janet Lyness, Attorney - Johnson Co, IA
Kim Painter, Recorder - Johnson Co, IA
Sally Stutsman, Supervisor - Johnson Co, IA
Rita Vargas, Recorder - Scott Co, IA
Linda Yoder, Supervisor - Iowa Co, IA
Andrea Cabral, Sheriff - Suffolk Co, MA
Valerie Ervin, Council Member - Montgomery Co, MD
Nancy Floreen, Council Member - Montgomery Co, MD
Peggy Magee, Clerk of the Circuit Court - Prince Georges Co, MD
Duchy Trachtenberg, Council Member - Montgomery Co, MD
Jewel Ware, County Commission Chair - Wayne Co, MI
Susan Gaertner, County Attorney - Ramsey Co, MN
Colleen Landkamer, Commissioner - Blue Earth Co, MN
Mike Sanders, County Executive - Jackson Co, MO
Joe DiVincenzo, County Executive - Essex Co, NJ
Brian Hughes, County Executive - Mercer Co, NJ
Joanne Rajoppi, Clerk - Union Co, NJ
Armondo Fontoura, Sheriff - Essex Co, NJ
Jerry Speziale, Sheriff - Passaic Co, NJ
Ralph Froehlich, Sheriff - Union Co, NJ
Chris Pappas, Treasurer - Hillsborough Co, NH
Chris Giuchigliani, Commissioner - Clark Co, NV
Roger Mancebo, Commissioner - Pershing Co, NV
Rory Reid, Commissioner - Clark Co, NV
Paula Brooks, Commissioner - Franklin Co, OH
Don Cunningham, County Executive - Lehigh Co, PA
Bernice Scott, County Council - Richland Co, SC
Henry Darby, County Council - Charleston Co, SC
Teddy Pryor, Sr, County Council - Charleston Co, SC
Sergio De Leon, Constable - Tarrant Co, TX
Frutoso Garza, Clerk - Falfirrias Co, TX
Ysidro Gutierrez, Commissioner - Lubbock Co, TX
Alfred Isassi, Attorney - Kingsville Co, TX
Oscar Lopez, Sheriff - Alice Co, TX
Manuel Reyes, Treasurer - Eagle Pass Co, TX
Lucilla Reynolds, Tax Collector - Alice Co, TX
Jack Kennedy, Clerk of Courts -- Wise Co, VA
Barbara Favola, County Board Member -- Arlington Co, VA
Gerry Hyland, Commissioner - Fairfax Co, VA
Ron Sims, County Executive - King Co, WA
Kathleen Falk, County Executive - Dane Co, WI

Dodd
Pat Harney, Supervisor - Johnson Co, IA
Kevin Middleswart, Supervisor - Warren Co, IA
Cynthia Sweeney, Treasurer - Sullivan Co, NH
Anna Tilton, Register of Probate - Cheshire Co, NH
Paul Livingston, County Council - Richland Co, SC

Edwards
Dennis Anderson, Sheriff - Polk Co, IA
Bill Behnken, Supervisor - Cass Co, IA
Doug Bishop, Treasurer - Jasper Co, IA
Diane Curry, Recorder - Buchanan Co, IA
Ron George, Sheriff - Keokuk Co, IA
Paul Gronback, Sheriff - Kossuth Co, IA
Peter Hart, County Attorney - Palo Alto Co, IA
Tena Henkel, Recorder -- Monona Co, IA
Jan Horton, Treasurer -- Webster Co, IA
Kas Kelly, Supervisor -- Muscatine Co, IA
Billy Kerns, Sheriff - Clarke Co, IA
Tom Kriz, Treasurer - Johnson Co, IA
Steve MacDonald, Sheriff - Fremont Co, IA
Joel Miller, Auditor - Linn Co, IA
Terry Neuzil, Supervisor - Johnson Co, IA
Ernie Schiller, Supervisor - Lee Co, IA
Peggy Smalley, Treasurer - Audubon Co, IA
Ellie Snook, Supervisor - Poweshiek Co, IA
Wayne Shoultz, Supervisor - Muscatine Co, IA
Pat Wegman, County Attorney - Chickasaw Co, IA
Ron Wheeler, County Attorney - Clarke Co, IA
Donald Zeller, Sheriff - Linn Co, IA
Beth White, Clerk - Marion Co, IN
James DiPaola, Sheriff - Middlesex Co, MA
John O'Brien, Registrar of Deeds - Essex Co, MA
Brian Brdak, Commissioner - Macomb Co, MI
Ed Bruley, Commissioner -Macomb Co, MI
David Flynn, Commissioner -Macomb Co, MI
Joan Flynn, Commissioner -Macomb Co, MI
Paul Gieleghem, Commissioner -Macomb Co, MI
Mark Hackel, Sheriff - Macomb Co, MI
Howard Heidemann, Commissioner - St. Clair Co, MI
Tim Killeen, Commissioner - Wayne Co, MI
Robert Mijac, Commissioner -Macomb Co, MI
Sarah Roberts, Commissioner -Macomb Co, MI
Tim Soule, Commissioner - Ingham Co, MI
John Switalski, Commissioner -Macomb Co, MI
Kathy Tocco, Commissioner -Macomb Co, MI
Ted Wahby, Treasurer -Macomb Co, MI
Gail Dorfman, Commissioner - Hennepin Co, MN
Leo Lessard, Registrar of Deeds - Strafford Co, NH
Bill Mason, Prosecutor - Cuyahoga Co, OH
Cort Flint, County Council - Greenville Co, SC
Frank O'Leary, Treasurer -- Arlington Co, VA
Chris Zimmerman, County Board -- Arlington Co, VA
Jimmy Warren, Clerk of the Court -- Smyth Co, VA
Fred Parker, Treasurer -- Washington Co, VA
Mary Ann King, Supervisor - Chippewa Co, WI

Giuliani
Michael Antonovich, Supervisor - Los Angeles Co, CA
Greg Cox, Supervisor - San Diego Co, CA
Don Knabe, Supervisor - Los Angeles Co, CA
Jim Coats, Sheriff -- Pinellas Co, FL
Jackie Colon, Commissioner - Brevard Co, FL
Rose Ferlita, Commissioner - Hillsborough Co, FL
Carlos Gimenez, Commissioner - Miami-Dade Co, FL
John Morroni, Commissioner--Pineallas Co, FL
Rebecca Sosa, Commissioner - Miami-Dade Co, FL
Loren Knauss, Supervisor - Pottawattamie Co, IA
Rick Lynch, Sheriff - Floyd Co, IA
Nicholas Roggentien, Sheriff - Iowa Co, IA
Brian Lee, Clerk of Courts - Hampden Co, MA
Dawn Marie Addiego, Freeholder -- Burlington Co, NJ
Ralph Bakley, Freeholder -- Cape May Co, NJ
Dan Beyel, Freeholder -- Cape May Co, NJ
Carl Block, Clerk -- Ocean Co, NJ
Joan Bramhall, Clerk -- Morris Co, NJ
Douglas Cabana, Freeholder -- Morris Co, NJ
John Callinan, Sheriff -- Cape May Co, NJ
Bill Chegwidden, Freeholder -- Morris Co, NJ
Jack Ciattarelli, Freeholder -- Somerset Co, NJ
James Curcio, Freeholder - Atlantic Co, NJ
Denise Coyle, Freeholder -- Somerset Co, NJ
Len Desiderio, Freeholder -- Cape May Co, NJ
Gene Feyl, Freeholder -- Morris Co, NJ
Rick Fontana, Freeholder -- Somerset Co, NJ
Philip Haines, Clerk -- Burlington Co, NJ
John Inglesino, Deputy Freeholder Director -- Morris Co, NJ
John Kelly, Freeholder Director -- Ocean Co, NJ
James Lacey, Freeholder --Ocean Co, NJ
Margaret Nordstrom, Freeholder Director -- Morris Co, NJ
Joseph Oxley, Sheriff -- Monmouth Co, NJ
Peter Palmer, Freeholder --Somerset Co, NJ
William Polhemus, Sheriff --Ocean Co, NJ
Frank Provenzano, Sheriff -- Somerset Co, NJ
Bret Radi, Clerk -- Somerset Co, NJ
Jack Schrier, Freeholder -- Morris Co, NJ
Ralph Sheets, Vice Freeholder Director -- Cape May Co, NJ
Sal Simonetti, Sheriff -- Warren Co, NJ
Jerry Thornton, Freeholder -- Ocean Co, NJ
Robert Untig, Sheriff -- Sussex Co, NJ
Joseph Vicari, Freeholder -- Ocean Co, NJ
Bob Zaborowski, Freeholder -- Somerset Co, NJ
Susan Zellman, Freeholder -- Sussex Co, NJ
Darren White, Sheriff - Bernalillo Co, NM
Robert Larkin, Commissioner - Washoe Co, NV
Edward Diana, County Executive -- Orange Co, NY
Gregory Edwards, County Executive -- Chautauqua Co, NY
Joel Giambra, County Executive -- Erie Co, NY
Kathleen Jimino, County Executive -- Rensselaer Co, NY
James Molinaro, County Executive -- Richmond Co, NY
Thomas Santulli, County Executive -- Chemung Co, NY
Scott Vanderhoef, County Executive -- Rockland Co, NY
Robert Larkin, Commissioner -- Washoe Co, NV
Kenneth Ard, Council Member - Florence Co, SC
Tim Callanan, Council Member - Berkeley Co, SC
Christopher Harmon, Auditor - Lexington Co, SC
O'Neal Mintz, Council Member - Spartanburg Co, SC
Michael Montgomery, Council Member - Richland Co, SC
Mike Ryan, County Council -- Horry Co, SC

Huckabee
Wayne Bowen, Justice of the Peace - Clark Co, AR
Wayne Estes, Sheriff - Strafford Co, NH

Hunter
Lois Eargle, Auditor - Horry Co, SC

McCain
Hoss Mack, Sheriff -- Baldwin Co, AL
Wayne Gruenloh, Commissioner -- Baldwin Co, AL
Skip Gruber, Commissioner -- Baldwin Co, AL
Greg White, Commissioner -- Covington Co, AL
Mike Dean, Commissioner -- Mobile Co, AL
Don Stapley, Supervisor - Maricopa Co, AZ
Leroy Baca, Sheriff - Los Angeles Co, CA
Mary McCarty, Commissioner - Palm Beach Co, FL
Carlos Alvarez, Mayor - Miami-Dade Co, FL
Javier Souto, Commissioner -Miami-Dade Co, FL
David Gee, Sheriff -- Hillsborough Co, FL
Mark Sharpe, Commissioner -- Hillsborough Co, FL
Dennis Conrad, Sheriff -- Scott Co, IA
Joe McDonald, Sheriff - Plymouth Co, MA
Ruth Johnson, Clerk - Oakland Co, MI
Mike Anderson, Sheriff - Kalamzoo Co, MI
Dale Gribler, Sheriff - Van Buren Co, MI
Matt Lori, Sheriff - St. Joseph Co, MI
Bill French, Commissioner - Kalamazoo Co, MI
Jeff Heppler, Commissioner - Kalamazoo Co, MI
Bob Bezotte, Sheriff -- Livingston Co, MI
Bruce Woodbury, Commissioner -- Clark Co, NV
Bronwyn Asplund-Walsh, Commissioner -- Merrimack Co, NH
Maureen Barrows, Commissioner -- Rockingham Co, NH
Scott Carr, Sheriff -- Carroll Co, NH
J.D. Colcord, Commissioner -- Merrimack Co, NH
Doug Dutile, Sheriff - Grafton Co, NH
Richard Foote, Sheriff -- Carroll Co, NH
Jim Hardy, Sheriff - Hillsborough Co, NH
Scott Hilliard, Sheriff -- Merrimack Co, NH
Gerald Marcou, Sheriff -- Coos Co, NH
David Sorenson, Commissioner -- Carroll Co, NH
Dan St. Hilarie, Attorney -- Merrimack Co, NH
Donald Stritch, Commissioner -- Rockingham Co, NH
Bruce Woodbury, Commissioner - Clark Co, NV
Ed Carroll, Sheriff - Barnwell Co, SC
PJ Tanner, Sheriff - Beaufort Co, SC
Bill Blanton, Sheriff - Cherokee Co, SC
Lane Cribb, Sheriff - Georgetown Co, SC
Steve Loftis, Sheriff - Greenville Co, SC
Dan Wideman, Sheriff - Greenwood Co, SC
Ricky Chastain, Sheriff - Laurens Co, SC
James Metts, Sheriff - Lexington Co, SC
James Singleton, Sheriff - Oconee Co, SC
Chuck Wright, Sheriff - Spartanburg Co, SC
Rock Adams, County Council -- Spartanburg Co, SC
Billy Baldwin, County Council -- Darlington Co, SC
Wesley Blackwell, County Council -- Darlington Co, SC
Curwood Chappell, County Council -- York Co, SC
Ron Charlton, County Council -- Georgetown Co, SC
Randy Crenshaw, County Council -- Pickens Co, SC
Bob Grabowski, County Council -- Horry Co, SC
Jonny Jeffcoat, County Council -- Lexington Co, SC
Marion Lyles, County Council -- Oconee Co, SC
Bill McAbee, County Council -- Anderson Co, SC
Carl Schwartkopf, County Council -- Horry Co, SC
Buzz Shaw, County Council -- Darlington Co, SC
Mario Suarez, County Council -- Oconee Co, SC
Scott Singer, County Council -- Aiken Co, SC
John Wells, County Council -- Kershaw Co, SC
Bailey Humphries, County Council -- Cherokee Co, SC
Steve Kelly, County Council -- Kershaw Co, SC


Obama
John Dailey, Commissioner - Leon Co, FL
Addie Green, Commissioner - Palm Beach Co, FL
Jeff Koons, Commissioner - Palm Beach Co, FL
Julia Fauci, Board Member - Dekalb Co, IL
Todd Stroger, President - Cook Co, IL
Doug Bailey, Supervisor - Hamilton Co, IA
Lu Barron, Supervisor - Linn Co, IA
Wayne Clinton, Supervisor - Story Co, IA
Karen Fitzsimmons, Auditor - Scott Co, IA
Tom Hockensmith, Supervisor - Polk Co, IA
Charlie Sheridan, Auditor - Clinton Co, IA
Mike Short, Attorney - Lee Co, IA
Rod Sullivan, Supervisor - Johnson Co, IA
Don Zeller, Sheriff - Linn Co, IA
Christopher Rodgers, Commissioner - Douglas Co, NE
Ronald Chagnon, Commissioner - Strafford Co, NH
Jack Pratt, Commissioner - Cheshire Co, NH
Lawrence Weekly, Commissioner - Clark Co, NV
Jon Cooper, Legislator - Suffolk Co, NY
Elie Mystal, Legislator - Suffolk Co, NY
Vivan Viloria-Fisher, Legislator - Suffolk Co, NY
Thomas Drayton, County Council -- Georgetown Co, SC
Macio Williamson, County Council - Dillon Co, SC
Anthony Woods, County Council - Marlboro Co, SC

Richardson
Gloria Molina, Supervisor -- Los Angeles Co, CA
Michael Cryans, Commissioner - Grafton Co, NH
Chris Durkin, Clerk - Essex Co, NJ
David Adams, Treasurer - Richland Co, SC
Peter Corroon, Mayor - Salt Lake County, UT

Romney
Joe Arpaio, Sheriff - Maricopa Co, AZ
George Albright, Tax Collector - Marion Co, FL
Bruno Barreiro, Commissioner - Miami-Dade Co, FL
Ann Hildebrand, Commissioner - Pasco Co, FL
David Russell, Jr, Commissioner - Hernando Co, FL
Gary Wheeler, Commissioner - Indian River Co, FL
Sam Olen, Commissioner - Cobb Co, GA
Greg Adamson, Supervisor -- Scott Co, IA
Joni Ernst, Auditor - Montgomery Co, IA
David Jamison, Treasurer - Story Co, IA
Mike King, Supervisor - Union Co, IA
Mary Mosiman, Auditor - Story Co, IA
Frank Cousins, Sheriff - Essex Co, MA
James Cummings, Sheriff - Barnstable Co, MA
Tom Hodgson, Sheriff - Bristol Co, MA
Vaughn Beck, Commissioner -- Bay Co, MI
Karen Buie, Clerk -- Muskegon Co, MI
Bill Bullard, Commissioner -- Oakland Co, MI
Jan Bunting, Commissioner -- Gratiot Co, MI
Sue Ann Douglas, Commissioner -- Oakland Co, MI
David Gorcyca, Prosecutor -- Oakland Co, MI
Scott Haines, Register of Deeds -- Midland Co, MI
Eileen Kowall, Commissioner -- Oakland Co, MI
James Leibeg, Commissioner -- Midland Co, MI
Jerry Nielson, Sheriff -- Midland Co, MI
L. Brooks Patterson, County Executive -- Oakland Co, MI
Mike Rogers, Commissioner -- Oakland Co, MI
Bret Witkowski, Treasurer -- Berrien Co, MI
Dan Collis, Sheriff -- Belknap Co, NH
Peter Heed, County Attorney - Cheshire Co, NH
Carol Holden, Commissioner - Hillsborough Co, NH
Bing Judd, Commissioner - Coos Co, NH
Dan Linehan, Sheriff -- Rockingham Co, NH
Toni Pappas, Commissioner - Hillsborough Co, NH
Jim Reams, County Attorney - Rockingham Co, NH
Chip Maxfield, Commissioner - Clark Co, NV
Jason Booth, Sheriff - Saluda Co, SC
Joe Dill, County Council -- Greenville Co, SC
Henry Fishburne, County Council -- Charleston Co, SC
Paul Thurmond, County Council -- Charleston Co, SC
Alma Adams, Commissioner - Iron Co, UT
Kim Wolfe, Sheriff - Cabell Co, WV

Presidential Policy -- Healthcare

One of the key components of NACo's 2008 Presidential Election Project has been meeting with the presidential campaigns to educate the candidates (and staff) on county issues and the roles that counties play in providing necessary services.

To that end, nacoblog is starting a new element to the page. We'll pick an issue and use this space to provide a one-stop shop to check out all of the candidates' positions. As a disclaimer, NACo is not endorsing a candidate or their policies (at least not yet!), but is providing a campaign summary of where they stand on the issues so our members can make an informed decision.

That said, the first issue to hit the site is health care. The rising costs, accessibility and quality of care make this a pressing county concern. If you want to search the site, all of the candidate's policies are labeled by issue, i.e., you can search "healthcare" and all of the listings will come up. Or take a look at this primer from the Boston Globe.

If a candidate is not listed, it means they have not released a position paper on the issue or have not posted it on their website. The material posted was taken directly from campaign websites.

As always, please send me your comments on what you would like to see on the blog.

Joe Biden: Four Practical Steps Toward Health Care For All
Sam Brownback: Healthcare
Hillary Clinton: Agenda to Lower Health Care Costs
Chris Dodd: Affordable Health for All Americans
John Edwards: Making Health Care Affordable, Accountable and Universal
Mike Huckabee: Health Care Plan
Dennis Kucinich: A Healthy Nation
Barack Obama: Plan for a Healthy America
Ron Paul: Health Freedom
Bill Richardson: Health Plan Summary
Tom Tancredo: Health Care

Ron Paul on Heatlh Care

Health Freedom

Americans are justifiably concerned over the government’s escalating intervention into their freedom to choose what they eat and how they take care of their health.

The Food and Drug Administration (FDA), in order to comply with standards dictated by supra-national organizations such as the UN‘s World Food Code (CODEX), NAFTA, and CAFTA, has been assuming greater control over nutrients, vitamins and natural health care providers to restrict your right to choose the manner in which you manage your health and nutritional needs.

I have been the national leader in preserving Health Freedom.

I have introduced the Health Freedom Protection Act, HR 2117, to ensure Americans can receive truthful health information about supplements and natural remedies.

I support the Access to Medical Treatment Act, H.R. 746, which expands the ability of Americans to use alternative medicine and new treatments.

I oppose legislation that increases the FDA‘s legal powers. FDA has consistently failed to protect the public from dangerous drugs, genetically modified foods, dangerous pesticides and other chemicals in the food supply. Meanwhile they waste public funds attacking safe, healthy foods and dietary supplements

I also opposed the Homeland Security Bill, H.R. 5005, which, in section 304, authorizes the forced vaccination of American citizens against small pox. The government should never have the power to require immunizations or vaccinations.

Tancredo on Health Care

Health Care

The way to address America s heath care problems is not through bigger government programs, litigation, regulation, or additional government spending. Indeed, these things have contributed and continue to contribute to the rising cost of health care.

Another contributing factor is illegal immigration. While illegal immigration isn't generally the first thing Americans think of when they think about health care, it has a significant impact on the cost, availability and quality of health care available to Americans. The millions of uninsured illegal aliens in this country invariably get sick or injured. When they do, they seek what ends up being very expensive treatment in hospital emergency rooms treatment federal law requires
health care personnel to provide. The problem has become so acute that Congress recently allocated $1 billion in taxpayer funds to defray the costs incurred by hospitals treating illegal aliens. This is another good reason for our government to take the problem of illegal immigration seriously.

I believe in market based solutions to health care problems. One solution is the use of Association Health Plans or AHP s. AHP s would assist greatly in improving access to affordable health care without creating a new big government scheme. AHPs would allow small business owners to band together through pre-existing professional associations to purchase health insurance at reduced rates. It will help to reduce the number of uninsured Americans by
giving small business the same accessibility, affordability, and choice in the health care marketplace that Fortune 500 companies and unions now enjoy. Experts estimate that up to 8.5 million uninsured small business workers could gain coverage and small business owners would save up to 25 percent on health insurance enabling more businesses to provide coverage.

Brownback on Heatlh Care

Healthcare
Our healthcare system will thrive with increased consumer choice, consumer control and real competition. I believe it is important that we have price transparency within our health care system. This offers consumers, who are either enrolled in high deductible health plans or who pay out-of-pocket, the ability to shop around for the best prices and plan for health care expenditures. Also, the existing health insurance market forces consumers to pay for extra benefits in their premiums, such as aromatherapy and acupuncture, which tends to increase the cost of coverage. Instead, consumers should be able to choose the from health care coverage plans that are tailored to fit their families' needs and values. Accordingly, individuals should be allowed to purchase health insurance across state lines. Finally, I believe that consumers should have control over the use of their personal health records. I have a proposal that would offer consumers a means to create a lifetime electronic medical record, while, at the same time, ensuring that the privacy of their personal health information is secured and protected.

Over time, the socialized medicine model has shown to deprive consumers of access to life-saving treatments and is downright inconsistent with the spirit of the American people to be free from unwanted government intervention. I will continue to work at the forefront to create a consumer-centered, not government-centered, healthcare model that offer both affordable coverage choices and put the consumer in the driver's seat.

Romney on Health Care

Policy Briefing: Expanding Access To Affordable Health Care

Governor Romney's Plan To Improve America's Health Care System:

Today, In Florida, Governor Mitt Romney Unveiled A Bold Plan To Improve The American Health Care System By Putting Conservative, Market-Based Principles To Work. Governor Romney's health care reform plan is a comprehensive solution to America's health care ills that expands access to affordable, portable, quality, private health insurance. Rather than relying on a one-size-fits-all, government-run system, Governor Romney's plan recognizes the importance of the role of the states in leading reform and the need for innovation in dealing with rising health care costs and the problem of the uninsured.

- Governor Romney's Plan Facilitates The Growth Of The Private Health Insurance Market. Governor Romney believes that by expanding and deregulating the private health insurance market, we can decrease costs and ensure that more Americans have access to affordable, portable, quality, private health insurance.

- Governor Romney Will Preserve The Features Of The American Health Care System That Make It The Envy Of The World. Rather than deconstructing the system we have today or replacing it with a government-run system that squelches innovation, Governor Romney will "do no harm" by leaving in place the elements of the system that work well while targeting change in the parts of the system that do not.

- Click Here To View Governor Romney's PowerPoint Presentation

The Romney Vision: Health Care Reform Goals

Governor Romney Outlined A Health Care Reform Plan That Includes Four Major Goals:

- First, Instituting Reforms That Make Private Health Insurance Affordable. More Americans need access to quality, private health insurance. Governor Romney's reforms will make this a reality by bringing down the cost of private health insurance. He will do this by fostering vibrant and competitive health insurance markets in each of the fifty states, reforming the tax code to make it cheaper for individuals to buy private insurance, and helping the low-income uninsured afford the private coverage of their choice.

- Second, Providing Access To Quality Health Insurance For Every American. Every American should have access to affordable health insurance. Governor Romney will do this by providing them with premium assistance to purchase private health insurance plans. He will also help middle-income Americans by encouraging state-level health insurance market reforms, which will result in more affordable private coverage.

- Third, Enhancing The Portability Of Private Health Insurance. Americans should no longer need to worry about the risk of losing their coverage when, for example, they change jobs. Governor Romney will do this by creating a more robust market for health insurance and helping more Americans get access to affordable insurance.

- Finally, Slowing The Rate Of Inflation In Health Care Spending. He will do this by instituting tax reforms that promote "smart" spending on health care, creating incentives for states to reform their health insurance markets, and supporting medical liability reform.

Linking Goals With Action Steps: The Federalist Approach

Governor Romney's Approach To Health Care Reform Is One That Values The States As Laboratories Of Innovation And Beacons Of Creativity. As Governor of Massachusetts, Governor Romney successfully led the effort for comprehensive health care reform, and he recognizes that the federal government must do what it can to facilitate effective change at the state level. His reforms will give states greater flexibility. But Governor Romney's conservative reforms also make the states true partners in the effort to expand access to affordable, quality health insurance.

The Romney Plan: Six Action Steps

Governor Romney Proposed Six Concrete Steps To Reach His Health Care Reform Goals:

- Step 1: Establish Federal Incentives To Deregulate And Reform State Health Insurance Markets So Market Forces Can Work. Many Americans can't afford private health insurance because state markets are over-regulated and in serious need of reform. Governor Romney will provide federal incentives for states to deregulate and reform their health insurance markets. This will bring down the cost of health insurance and facilitate greater consumer choice, while giving states the power to institute the reforms that suit them best.

- Step 2: Redirect Federal Spending On "Free Care" To Help The Low-Income Uninsured Purchase Private Insurance. Currently, taxpayers subsidize "free care" for millions of uninsured Americans who receive treatment when they need it. Governor Romney will end subsidized care for "free riders" by redirecting these existing federal and state resources to help the low-income uninsured purchase their own private health insurance. States are free to craft their own programs and institute their own eligibility requirements. Most importantly, this can be done without the need for new spending or taxes.

- Step 3: Institute Health Savings Account (HSA) Enhancements And The Full Deductibility Of Qualified Medical Expenses. The tax code currently discriminates against those who do not buy their health insurance through an employer and creates incentives for the over-consumption of health care services. Governor Romney will make private insurance more affordable for every American by reforming the tax code. He will expand and grow HSAs. He also supports the full deductibility of qualified medical expenses, which will allow Americans to deduct the cost of their health insurance and out-of-pocket medical expenses, where accompanied by at least catastrophic insurance.

- Step 4: Promote Innovation In Medicaid. States have very little flexibility under current law to enact innovative changes to Medicaid that help more of their citizens while containing costs. Governor Romney will encourage innovation by block-granting federal funds to states and removing the burdensome administrative requirements that prevent them from improving the program. This initiative has the added benefit of helping to constrain runaway entitlement spending.

- Step 5: Implement Medical Liability Reform. Too many doctors are practicing defensive medicine because of frivolous lawsuits and an out-of-control medical liability system. Governor Romney will implement medical liability reform, including federal caps on non-economic and punitive damage awards in medical malpractice cases. He will also encourage states to engage in additional medical liability reforms that will both honor the rights of patients and respect the work of physicians.

- Step 6: Bring Market Dynamics And Modern Technology To Health Care. Consumers are not empowered in the current system to make intelligent decisions about the purchase of health care and many aspects of the health care system remain technologically backwards. Governor Romney will bring health care into the 21st century by enhancing the use of information technology, establishing cost and quality transparency, encouraging more HSAs and co-insurance products, and calling for more provider options.

Huckabee on Health Care

Health Care

• The health care system in this country is irrevocably broken, in part because it is only a "health care" system, not a "health" system.
  
• We don't need universal health care mandated by federal edict.
• We do need to get serious about preventive health care.
• I advocate policies that will encourage the private sector to seek innovative ways to bring down costs.
• I value the states' role as laboratories for new market-based approaches.
• When I'm President, Americans will have more control of their health care options, not less.
• As President, I will work with the private sector, Congress, health care providers, and other concerned parties to lead a complete overhaul of our health care system.
• Our health care system is making our businesses non-competitive in the global economy. It is time to recognize that jobs don't need health care, people do, and move from employer-based to consumer-based health care.
  

The health care system in this country is irrevocably broken, in part because it is only a "health care" system, not a "health" system. We don't need universal health care mandated by federal edict or funded through ever-higher taxes. We do need to get serious about preventive health care instead of chasing more and more dollars to treat chronic disease, which currently gobbles up 80% of our health care costs, and yet is often avoidable. The result is that we'll be able to deliver better care where and when it's needed.

I advocate policies that will encourage the private sector to seek innovative ways to bring down costs and improve the free market for health care services. We have to change a system that happily pays $30,000 for a diabetic to have his foot amputated, but won't pay for the shoes that would save his foot.

We can make health care more affordable by reforming medical liability; adopting electronic record keeping; making health insurance more portable from one job to another; expanding health savings accounts to everyone, not just those with high deductibles; and making health insurance tax deductible for individuals and families as it now is for businesses. Low income families would get tax credits instead of deductions. We don't need all the government controls that would inevitably come with universal health care. When I'm President, Americans will have more control of their health care options, not less.

I also value the states' role as laboratories for new market-based approaches, and I will encourage those efforts. As President I will work with the private sector, Congress, health care providers, and other concerned parties to lead a complete overhaul of our health care system, not more of the same, paid for by Uncle Sam at the expense of hard-working families.

Health care spending is now about $2 trillion a year, which is close to $7,000 for each one of us. It consumes about 17% of our gross domestic product, easily surpassing the few European nations where spending is close to 10% and far higher than any other country in the world. If we reduced our out-of-control health care costs from 17% to 11%, we'd save $700 billion a year, which is about twice our annual national deficit.

Our health care system is making our businesses non-competitive in the global economy. General Motors spends more on health care than it does on steel, $1,500 per car. Starbucks spends more on health care than it does on coffee beans. We have an employer-based system from the 1940's, a system devised not because it was the best way to provide health care, but as a way around World War II wage-and-price controls. Costs have skyrocketed because the party paying for the health care - the employer - and the party using the health care - the employee - are not the same. It is human nature to consume more of something that is essentially free.

Workers complain that their wages are stagnant, but businesses reply that their total compensation costs are rising significantly because they are paying so much more for health care. Health care costs are adversely affecting your paycheck, even if you're healthy. Some Americans are afraid to change jobs or start their own businesses because they're afraid of losing their health insurance. It is time to recognize that jobs don't need health insurance, people do, and to ease the burden on our businesses. Our employer-based system has outlived its usefulness, but the answer is a consumer-based system, not socialized medicine.

Kucinich on Health Care

A Healthy Nation

Health care in the US is too expensive and leaves 46 million Americans without insurance and millions more underinsured. Dennis Kucinich is the only candidate for President with a plan for a Universal, Single-Payer, Not-for-Profit health care system. America's patchwork of for-profit, private insurers waste billions of dollars on spending that has nothing to do with paying for care. Elaborate underwriting, billing, sales and marketing divert huge amounts of money away from delivering health care. Huge profits and staggering compensation for the insurance companies' top executives and CEO's. To cope with the endless bureaucracy of private insurers, health care providers maintain huge administrative staffs. The administration of the health care system today consumers approximately 31% of the money spent for health care. The potential savings, as much as $350 billion per year, are enough to provide comprehensive coverage to every American without paying any more than we already do. In Congress, Representative Dennis Kucinich has co-authored HR 676, legislation which would establish Medicare for All - a universal, single-payer, not-for-profit health care system that leaves no American behind.

Richardson on Health Care

Richardson Health Plan Executive Summary

Affordable and secure health coverage for every American should be our national goal. America's core values of opportunity and security demand no less. By covering all Americans, Bill Richardson's plan would save the average family up to 10% off their private coverage.

Bill Richardson's health care plan will focus on the three critical areas of coverage, cost, and care, to reach the goal of affordable coverage for all Americans:

• Coverage: Guaranteed Coverage for All Americans With Real Choices.
  
• Costs: Making Health Care Affordable for All.
  
• Care: Improving the Quality of Care.

1. Coverage: Guaranteed coverage for all Americans with real choices.

Bill Richardson believes that there is no one-size-fits-all approach to providing this affordable health coverage for all Americans. Nor does he believe in creating new bureaucracies. Under Richardson's plan:

• All Americans will have the choice to keep their current coverage if they are satisfied with it.
  
• Americans will have affordable coverage choices through
  
  1. the same plan as members of Congress;
  2. Medicare for those 55-64;
  3. Medicaid and SCHIP for lower income families;
  4. existing family coverage for young adults up to age 25; and
  5. a Heroes Health Card and stronger Veterans Administration for veterans.
• Insurance companies will be required to end unfair coverage denials due to pre-existing conditions.

2. Costs: Making Health Care Affordable for All

A. Affordable Coverage through Shared Responsibility

Under Richardson's plan: 1) All Americans will have personal responsibility for obtaining coverage, 2) Employers will be required to do their fair share to contribute to a healthy and covered work force; 3) A sliding-scale tax credit will be available for Americans who need help affording coverage; 4) American families will get immediate relief from high interest rates for medical debt placed on credit cards.

B. Overall Cost Savings for a Balanced Budget Health Plan

Bill Richardson's health care plan to achieve affordable coverage for all will cost an estimated $104-110 billion per year. As President, Richardson will save the government up to $110 billion per year to invest in quality, affordable health coverage for all Americans, by:

• Streamlining health care administration, including:
  
  1. Investing in health information technology through 21st Century Health Care Bonds, saving $22 billion per year;
  2. Negotiating prescription drug prices through Medicare and allowing seniors to buy prescriptions directly from Medicare, saving $34 billion per year;
  3. Eliminating the tax shelter for high-risk health plans, saving $3 billion per year;
  4. Placing cost controls on insurance companies so they spend at least 85% of their revenue on direct health care rather than administration;
  5. Requiring insurance companies and providers to standardize their forms;
  6. Simplifying reporting requirements for physicians and hospitals;
  7. Improving coordination of care and reducing bureaucracy for millions of seniors and persons with disabilities enrolled in both Medicare and Medicaid; and
  8. Limiting overpayments to private Medicare Advantage Plans.
• Investing in Prevention, including:
  1. Paying for up-front coverage now to avoid emergency care later, saving $9 billion per year;
  2. Promoting coordinated care and disease management, saving $38 billion per year;
  3. Increasing the use of generic drugs, saving $5 billion per year;
  4. Requiring that all health plans cover a standard set of proven preventive services;
  5. Supporting local, state, and regional efforts to prevent and manage chronic diseases;
  6. Providing incentives to businesses to invest in their employees' health;
  7. Asking the American people to do what they can within their own lives to help stem the tide of chronic diseases;
  8. Instituting a nationwide ban on smoking in workplaces; and
  9. Preparing for natural and man-made disasters.

3. Care: Improving Quality of Care for all Americans

Bill Richardson believes that all Americans deserve access to affordable, high-quality health care. Richardson will work to improve quality of care for all Americans by:

1. Promoting evidence-based care and comparative effectiveness research;
2. Promoting transparency on price and quality of health care;
3. Restructuring incentives for high-quality care;
4. Improving patient safety;
5. Ensuring an adequate health care workforce; and
6. Reducing health disparities.

Obama on Health Care

BARACK OBAMA’S PLAN FOR A HEALTHY AMERICA
Lowering health care costs and ensuring affordable, high-quality health care for all

The U.S. spends over $2 trillion on health care every year, and offers the best medical technology and scientific research in the world. Yet, the benefits of the American health care system come at a price that an increasing number of individuals and families, employers and employees, and public and private providers cannot afford. Millions of Americans are uninsured or underinsured because of rising medical costs. Nearly 45 million Americans—including 9 million children—lack health insurance.

Health care costs are skyrocketing. Health insurance premiums have risen 4 times faster than wages over the past 6 years. Lack of affordable health care is compounded by serious flaws in our health care delivery system. About 100,000 Americans die from medical errors in hospitals every year.

Too little is spent on prevention and public health. The nation faces epidemics of obesity and chronic diseases as well as new threats of pandemic flu and bioterrorism. Yet despite all of this less than 4 cents of every health care dollar is spent on prevention and public health.

Obama’s plan will provide affordable, comprehensive and portable health coverage for all Americans by:
• Making available a new national health program that will allow individuals and small businesses to buy affordable health care similar to that available to federal employees. No one will be turned away or charged more due to illness, and everyone who needs it will receive a subsidy for their premiums.
• Making available a National Health Insurance Exchange to reform the private insurance market. Any American could enroll in participating private plans, which would have to provide comprehensive benefits, issue every applicant a policy, and charge fair and stable premiums.
• Ensuring all of the 9 million currently uninsured children have affordable, high-quality health coverage
• Expanding Medicaid and SCHIP and ensuring they continue to serve their critical safety net function.
• Requiring employers to make a meaningful contribution to the health coverage of their employees.

Obama’s plan will reduce costs and save a typical American family up to $2,500 each year:
• Driving adoption of state-of-the-art health information technology systems
• Improving access to preventive care and chronic disease management programs
• Requiring hospitals to collect and report health care cost and quality data
• Reforming our market structure to increase competition in the insurance and drug markets
• Reducing the costs of catastrophic illnesses for employers and their employees
• Lowering drug costs by allowing importation of safe medicines from other developed countries and increasing use of generics in public programs

Obama’s plan will promote public health by:
• Requiring coverage of preventive services
• Increasing state and local preparedness for terrorist attacks and natural disasters.

For a more detailed look at the plan, click here.

Edwards on Health Care

Making Health Care Affordable, Accountable, And Universal

Americans don't get the quality of health care they pay for and too often can't afford the cost of the care they receive. The United States spends more per person on health care than any other country. Yet, 33 other countries have lower infant mortality rates and 28 other countries have longer life expectancies. Health care costs have grown faster than inflation every year since 1970. John Edwards has proposed a comprehensive plan to strengthen our health care system and guarantee quality affordable health care for every American by 2012. Today's announcement details his principles of creating an affordable and accountable health care system, announced in February 2007. [KFF, 2001; HRET, 2006; CHCF, 2006]

Reform The Insurance Industry

Edwards will make sure insurance companies help people by:

• Ensuring that Premiums Help Patients: Without new rules, insurance companies could continue to charge hardworking families excessive premiums, pocketing the savings from health care reform instead of delivering more to patients. Building on state efforts, Edwards will set national accounting standards requiring insurers to spend at least 85 percent of their premiums on patient care. The standards will also create a more efficient system. Today, thirty cents of every dollar spent on health care goes toward administration and system waste. [Woolhandler, et al., 2003]
• Making Private Insurers Compete with a Public Plan: Edwards will offer individuals in Health Care Markets a choice of insurance plans including a public plan based on Medicare. Private insurers will operate in a more competitive market that will hold down costs and improve care.
• Protecting Consumers: Edwards will establish strong national "truth-in-insuring" rules to explain private insurance plans and create standards for billing. He will order the Justice Department to conduct an antitrust review of the health insurance market. And he will enact a Patients' Bill of Rights for insurance companies and managed care.
• Stopping Overpayments to Medicare Private Plans: Medicare overpays private plans for the services delivered to beneficiaries. Edwards will stop the privatization of Medicare and the overpayments and expand its services for low-income beneficiaries. [CBPP, 2007]

A New Era In Chronic And Preventive Care

Chronic diseases account for three-quarters of national health care spending. Helping patients and providers to manage these illnesses and avoid unnecessary hospitalizations can improve health and dramatically reduce health care costs. Additionally, less than 5 percent of total U.S. health care spending goes toward prevention. [AAFP, 2007; Kelley, et al., 2004]

As president, Edwards will cut the cost of and improve treatment for chronic conditions by:

• Creating Patient-Centered Medical Homes: Ninety percent of Medicare dollars are spent on people with three or more conditions, who usually see multiple specialists. At the same time, the number of new family practitioners has dropped 50 percent, in part because we don't properly value primary care. Starting with Medicare and other public plans, Edwards will help transform how health care is delivered by changing reimbursement rules to emphasize primary care. Primary care physicians will guide care for patients to make sure they are getting proven treatment from a coordinated team. [Bodenheimer, 2006]
• Revolutionizing Chronic Care Management and Requiring Prevention: Edwards will require Health Care Markets and public plans to pro-actively monitor chronically-ill patients' health to reduce complications and hospitalizations, and he will offer private plans incentives to do the same. Vermont is demonstrating that this kind of new approach to managing chronic care can improve patients' health and save money. He will also require preventive care coverage, with public plans offering preventive care without co-payments, and provide incentives for patients to participate. [Washington Post, 6/3/07]
• Helping Doctors Communicate: Edwards will help doctors avoid duplicate tests and conflicting prescriptions, using case managers and technology to improve communication among providers and with patients, in addition to creating a medical home. [Thorpe & Howard, 2006]
• Supporting Healthy Lifestyles: Obesity is now epidemic in the United States. Edwards will boost public health funding, work with schools to remove unhealthy foods, invest in physical education, and promote wellness and fitness in communities and workplaces. [CDC, 2005]

Improve Care With Technology And Empower Providers To Deliver The Best Care

Fewer than one out of every four hospitals have health information technology systems. Nearly one-third of patients experience medical mistakes, medication errors, or lab problems. Overall, better, more consistent quality could save 100,000 to 150,000 lives and $50 billion to $100 billion a year. [Hillestad, et al., 2005; Gauthier & Serber, 2005; Commonwealth Fund, 2006]

As president, Edwards will help providers implement technology and practice medicine that works by:

• Adopting Electronic Medical Records: Electronic records could save the system as much as $162 billion annually. Edwards will require providers to use interoperable information technology that protects privacy, bring the private sector together to establish standards, and provide targeted help with implementation where necessary. [Hillestad, 2006]
• Helping Providers Use Technology and Evaluate Quality: Only one out of 16 doctors routinely uses electronic tools to help make medical decisions. Edwards will help doctors use handheld Paid for by John Edwards for President. devices, electronic prescribing, and order entry systems in exchange for reporting on key quality measures. [Audet, et al., 2004]
• Promoting Evidence-Based Medicine and Transparency: Edwards will create a new independent research institute to analyze new devices and treatments and disseminate its findings. He will develop partnerships among academic medical centers, Medicare, and other agencies to make high-quality medicine contagious. A health care Consumer Reports-type publication will help patients make better choices and drive providers to offer better services for lower costs.
• Providing Incentives for Quality and Reducing Medical Errors: Under the fee-for-service model, a hospital that makes a medical error is often paid for the error and then paid again to fix it. Under Edwards' plan, Medicare and other federal programs will lead the way in paying for performance.
• Containing Malpractice Costs: Edwards will reduce the cost of practicing medicine with common-sense reforms that help doctors and patients. Edwards supports mandatory sanctions for lawyers who file frivolous cases, stronger state medical disciplinary boards, and a knowledge bank that encourages doctors to report medical errors voluntarily, making others aware of preventable mistakes.

Make Prescription Drugs More Affordable

Drug costs have risen three times faster than inflation since 1994. Top companies spend twice as much on marketing and administration as they do on R&D. [KFF, 2007; Families USA, 2007]

Edwards will fight for affordable prescription drugs by:

• Improving the Patent System and the FDA: The patent system sometimes encourages greater investment in profitable but minor innovation ("me-too drugs") than in the costly and speculative research that generates true breakthroughs. In 2005, only 20 percent of FDA approved drugs were new molecular entities. In addition, the patent system gives companies long-term monopolies that can make life-saving drugs prohibitively costly for patients. Edwards will convene an expert panel to explore whether there are certain key disorders where prizes for breakthroughs – as an alternative to patent monopolies—would offer new incentives to researchers, guaranteed gains to companies, and lower costs to patients. Prizes would supplement, but not replace, the current patent system. Additionally, Edwards will eliminate loopholes and trade obstacles that block generic drugs and let the FDA approve biogenerics, saving up to $43 billion over 10 years. [Woolley, 2006; Stiglitz, 2005; CAGW, 2007]
• Protect Patients against Dangerous Medicines: Edwards will restrict direct-to-consumer advertising for new drugs, strengthen the FDA, and ensure evaluation research is truly independent.
• Getting a Fair Deal for Taxpayers: Edwards will repeal the law preventing Medicare from negotiating drug costs with drug makers and empower states to use Medicaid's leverage to purchase drugs at lower prices, with safeguards to preserve access. He will give Medicare beneficiaries the choice to pick a public plan for their prescription drugs.
• Allowing Reimportation: Edwards has long supported the safe reimportation of prescription drugs from Canada, which could save consumers $50 billion over 10 years. [Washington Post, 5/3/07]

Additional Investments In Quality To Save Money

Edwards will support infrastructure that is focused on quality and efficiency by:

• Addressing the Nursing Crisis: Edwards will improve work conditions to bring back 50,000 nurses who have left the profession and recruit 50,000 young people into nursing. Hiring more nurses could save 6,700 lives in hospitals and reduce 4 million days of hospital care. [Needleman, et al., 2006]
• Providing Choice and Dignity in Long-Term Care: To help Americans who need long-term care and to contain costs, Edwards will reform the long-term care system to emphasize choice for older Americans and people with disabilities, provide home and community care whenever possible, and promote dignity and respect for families and workers.
• Investing in Telemedicine for Rural Areas: Small-town America should have access to the same high-quality health care available in big cities. Edwards will help rural hospitals invest in telemedicine, support 15 Regional Telemedicine Centers across the country to share best practices, and cut red tape that limits patient access to the full benefits of telemedicine.

Dodd on Health Care

Chris Dodd knows that we need a health care system that provides universal, affordable coverage. Under Chris Dodd's leadership, every American will have affordable health coverage, regardless of their employment status, health status or income level. America deserves a health care system that provides universal, affordable coverage through universal responsibility shared by employers, individuals, insurance companies and the government.

• The Dodd plan will ensure all Americans will have quality, affordable health coverage.
• The Dodd plan will create a health insurance marketplace called Universal HealthMart that is based on, and parallel to, the Federal Employees Health Benefits Plan (FEHBP).
• Individuals and businesses will contribute to Universal HealthMart based on their ability to pay.
• Premiums will be affordable based on leveraged negotiating power, spreading risk, reduced administrative costs, and incentives for technology and preventive care.
• Coverage will be portable – insurance purchased in Universal HealthMart will follow individuals, not jobs.
• The Dodd Health Care plan will phase in universal, affordable coverage to all Americans over four years.

The Dodd Plan:

• Universal HealthMart. The Dodd plan will create a health insurance marketplace called the Universal HealthMart that is based on, and parallel to, the Federal Employees Health Benefits Plan (FEHBP). Individuals and businesses will pay for coverage within Universal HealthMart based on their ability to pay. Universal HealthMart will offer a variety of comprehensive plans and entitle every American to the same benefits and types of plans as Members of Congress.
• Universal, Affordable Coverage. Coverage will flow automatically to all Americans and will follow people, not their jobs. Enrollment will be automatic or individuals and employers can directly enroll in Universal HealthMart or their existing arrangements. Coverage will be phased in over four years. As more and more Americans participate, Universal HealthMart will gain increasing leverage to negotiate premiums and lower costs. Price and coverage discrimination based on condition will be eliminated.
• Lower Costs for Employers. In addition to realizing the benefits of reduced premiums made possible by the bargaining power of Universal HealthMart, employers who participate in Universal HealthMart will no longer be required to negotiate insurance premiums or shoulder the costly task of administering health plans.
• Focus on Prevention. People who make personal choices to improve their health through smoking cessation, weight loss, and improved fitness will have access to plan rewards and incentives. The savings realized as a result of better health will further reduce premium costs.
• The Power of Technology. The Dodd plan will lower administrative costs and eliminate inefficiency by investing in information technology and data collection for better care. In addition to improving quality and enhancing the coordination of care, incentives for using technology will also result in further cost savings and lower premiums.
• Better Care for Kids: Under the Dodd Plan, every child in America will have guaranteed health insurance equivalent to health coverage Members of Congress have for their children. All children will have access to preventive health screenings including vision, hearing, autism and other neurological disorders.
• Funding. Universal coverage will not require a new tax. Instead, much of the plan can be paid for by eliminating the existing inefficiencies in the system. Universal HealthMart will be financed primarily by employer and individual premiums and contributions. Other revenue streams such as those that would result from ending the war in Iraq will be identified for transition costs.

Clinton on Health Care

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

This century’s plague is chronic illness including diabetes, heart conditions, obesity and other chronic conditions. Obesity rates have doubled among adults over the past 20 years; in fact Medicare could save over a trillion dollars over 25 years if obesity among seniors could be returned to levels in the 1980s. One out of three children born in 2000 is at risk of developing diabetes, and today’s children are at risk of having shorter life spans than their parents - for the first time in our nation’s history. Chronic illness accounts for 75 percent of health costs, and two-thirds of recent cost growth. Only half of recommended clinical preventive services are provided to adults, and less than half of adults had their doctors provide them advice on weight, nutrition, or exerciseⁱ. Only 38 percent of adults receive recommended colorectal screening and roughly 20 percent of children do not receive recommended immunizations.ⁱⁱ

Senator Clinton will:

• Require all insurers participating in federal programs to cover prevention priorities: Senator Clinton would make it a condition of doing business with the Federal government that health plans cover high-priority preventive services. Covered services would be based on recommendations from the U.S. Prevention Services Task Force. Insurers would provide both individuals and providers with the financial incentives, such as eliminating copays for high-priority prevention services. This approach is being taken by such businesses as Safeway, which not only covers all preventive services but provides an integrated health promotion model for many of it employees.
• Target prevention by coordinating and pooling public funding: Senator Clinton would coordinate public spending on prevention across federal programs in the Department of Health and Human Services to maximize high-priority prevention. A public-private collaboration would ensure that prevention is pushed outside of the boundaries of the health care system and into schools, workplace, supermarkets and communities through free provision of preventive benefits. It would enlist a new prevention workforce including pharmacists, church leaders and others who can best use funds to ensure 100 percent use of cost-effective prevention.

Billions of dollars and millions of mistakes result from the use of an outdated, paper-based medical records and billing systems. Modernizing our health care system through the use of information technology will empower doctors and other healthcare providers to communicate electronically and will reduce waste and redundancy while improving safety and quality by reducing medical errors. Today, 75 percent of health care claims are submitted electronically. However, only 71 percent of these claims are automatically adjudicated (i.e. processed without any manual intervention). Paper claims that are clean (no manual intervention) cost about $1.60 per claim; however, electronic claims cost almost half that amount ($0.85)ⁱⁱⁱ. And claims that require manual intervention/adjudication cost 40 percent more than an electronic claims.

Senator Clinton will:

• Create system-wide savings from full use of health information technology and bring a paperless revolution to health care: Require providers participating in federal programs to adopt private, secure, and interoperable technology
• Provide one-time financial assistance: An up-front and phased-out $3 billion a year investment fund would be provided to help hospitals and doctor’s offices to adopt and implement HIT.
• Maximize use and improve quality: Health IT is a critical tool for ensuring patients receive the highest quality care. The proposal will give doctors financial incentives to adopt health IT and facilitate adoption of a system where high quality care and better patient outcomes can be rewarded.
• Reduce 200,000 adverse drug events: If all hospitals used a computerized physician order entry system, the tragic results of medication errors could be avoided and roughly $1 billion per year could be saved^iv.
• Save $77 billion: RAND estimates net savings to be $77 billion per year. If IT impacted the nation's healthcare system as much as it impacted the wholesale and retail industry - savings could be as high as $346 billion annually according to the series of RAND studies-over 15 percent of health care spending^v.

The largest driver of health care costs in the nation is related to the small numbers of Americans who incur catastrophic expenditures, usually for the care of chronic diseases. These diseases, such as cardiovascular disease and diabetes, account for 75 percent of our total national health expenditures and are the leading causes of death in the U.S^vi. In fact, the 23 percent of Medicare beneficiaries who suffer from five or more chronic illnesses account for 68 percent of total spending in the Medicare program^vii. A recent RAND study projected nearly $30 billion in national health expenditure savings per year after implementing disease and lifestyle management programs. Combined with prevention and health information technology, with full participation, the U.S. health system could save $147 billion alone for better care of this vulnerable population^viii.

Senator Clinton will:

• Ensure higher quality and better coordination of care: Senator Clinton proposes using state-of-the-art chronic care coordination models within federally-funded programs such as Medicare and the Federal Employees Health Benefits Program (FEHBP), to provide care for Americans afflicted with these costly, multi-faceted and difficult to manage illnesses. Based on the concepts promoted by primary care physician groups, Senator Clinton would permit multi-specialty clinics (such as the Mayo Clinic), private plans (such as Evercare and the On Lok program in San Francisco), and provider-sponsored organizations to bid on and provide coordinated care services.
• Provide incentives for participation in chronic care management programs: Services provided would include: care coordination among and between providers, drug management, diet and exercise counseling, lifestyle management, and the promotion of patient responsibility for self-management. Medicare beneficiaries and federal employees could choose to opt-in to this program and many would do so because of the additional services (many of which would have no cost-sharing requirements) and the potential for higher-quality care and outcomes. Physicians providing services within these programs would receive management bonus payments to compensate for their cost-effective coordination services.

Insurance is about spreading risk across a group of enrollees, yet insurance companies in the U.S. often discriminate against those with expensive, pre-existing conditions. A recent study showed that insurance companies in America spend tens of billions of dollars per year avoiding costly beneficiaries. Insurance companies’ profits skyrocket by steering clear of expensive beneficiaries and misusing utilization management techniques for plan enrollees. Further, recent research has shown that health administrative costs in the U.S. total at least $294 billion, and the overhead for private insurers averaged 11.7 percent -- exceeding Medicare (3.6%) and Medicaid (6.8%)^ix. In a reformed system where all Americans are covered and risk is spread extensively, administrative costs could be reduced by billions of dollars.

Senator Clinton will:

• End discriminatory insurance practices: A "guarantee issue" system will build on the concept of shared responsibility by allowing anyone to join a plan. It would not relegate high-cost people to separate plans or public programs. In addition, insurance companies would not be allowed to carve out benefits or charge higher rates to people with health problems or at risk of them.
• Reduce marketing costs and improve value for the premium dollar: Insurers would compete on low costs and high quality, not on successful underwriting and deceptive marketing practices. By insuring all Americans through accountable public and private plans, we can wring out administrative costs that do nothing but add to the bottom line.
• Enact uniquely American and bipartisan health reform for all: Success in covering all Americans will not only provide desperately needed coverage and security, but also reduce administrative costs in U.S. by as much as $20-30 billion a year^x.

Patients, providers and payers would benefit from getting better information on what works in health care and how treatments compare to one another. Little is known about how these procedures stack up, so we end up paying for them all, even when they may do nothing to improve health. Researchers at Dartmouth have found that more care is not better care, and that inefficient care may do more harm than good. Health care providers and patients are being bombarded with information. In the past decade, there has been an 80 percent growth in the number of drugs prescribed, 100 percent growth in new device patents, 300 percent growth in teaching hospital procedures, and 1,500 percent growth in diseases with gene tests^xi.

Senator Clinton will:

• Create a Best Practices Institute: A new Institute would be created, funded by both the private and public sectors, since its results will benefit all payers. Research will compare the effectiveness of alternative treatments such as pharmaceuticals, devices, and surgical interventions. For example, information supplied by organizations such as the Drug Effectiveness Review Project (DERP) has been used in North Carolina to educate providers and improve quality of care, saving the state an estimated $80 million in 2003. According to Congressional Budget Office Director Orszag, there is "an amazing opportunity in this long-term fiscal challenge to take cost out of the system without harming health...and that opportunity is remarkable." This research will facilitate the development of quality and outcomes measures.

Americans pay the highest prices in the world for drugs, and no other nation spends what we do for health insurance. In the last decade, prescription drugs accounted for 15 percent of the total increase in health spending, despite the fact that they account for only about 10 percent of all health spending^xii. When Congress passed the Medicare prescription drug benefit, language was included to explicitly prohibit the Secretary of HHS from using the purchasing power of the federal government to negotiate lower prescription drug prices. Excess expenditures are not limited to prescription drugs. MedPAC, a non-partisan congressional advisory committee, reports that Medicare pays private managed care plans, on average, 12 percent more than traditional Medicare pays to providers to treat the same beneficiaries. This has raised Medicare premiums by $24 for all beneficiaries, even those not enrolled in these private plans^xiii. The Medicare actuaries report that these overpayments are accelerating the depletion of the Medicare Trust Fund by 2 years.

Senator Clinton will:

• Remove barriers to generic competition: Eliminate loopholes in federal law that allow drug companies use the courts to prevent generic competitors from coming market. Increase funding for the Office of Generic Drugs at FDA to eliminate the backlog of generic drug applications. A one percent increase in the use of generic drugs could yield $4 billion in government savings^xiv.
• Create a pathway for biogeneric competition: Give FDA the authority to approve safe and effective biogeneric drugs -- ending the monopoly currently enjoyed by large biopharmaceutical companies. Creating biogeneric competition will spur innovation resulting in lower costs and more choices for patients, providers and employers. Providing such competition will save $5-7 billion per year^xv.
• Allow Medicare to negotiate lower drug prices. Eliminate the prohibition in federal law that prohibits the Secretary of HHS from negotiating prescription drug prices in Medicare.
• Provide more oversight of drug advertising, marketing excesses and inappropriate financial relationships with providers. Limit direct-to-consumer advertising, institute reporting requirement for financial arrangements between providers and manufactures, and protect physician prescribing data from being sold to pharmaceutical manufacturers. In 2000, for every dollar spent on direct-to-consumer advertising, pharmaceutical sales increased by $4.20^xvi.
• Medicare to crack down on overpayments to private plans: Reduce overpayments to private managed care plans and move toward a level playing field in the reimbursement of traditional Medicare and private managed care plans.

In order to ensure greater stability and predictability for physicians to continue to practice, we need common-sense medical malpractice reforms. While some have overstated the role that malpractice insurance plays in the health care crisis, it is clear that we have to find a way that works for everyone, doctors and patients alike.

Senator Clinton will:

• Promote medical error disclosure and provider-patient trust:Senator Clinton has introduced the National Medical Error Disclosure and Compensation (MEDiC) Act. It would encourage the adoption of a model that provides liability protections for physicians who disclose medical errors to patients and who offer to enter into negotiations for fair compensation. Overall, these policies have resulted in greater patient trust and satisfaction, more patients being compensated for injuries, fewer numbers of malpractice suits being filed, and significantly reduced administrative and legal defense costs. At the University of Michigan, this program has saved $1-3 million in litigation costs.

Overall Health Costs Crisis and Impact of Reform

• Costs are high and rising: U.S. health care costs are the highest in the world, now total $2 trillion and expected to double to $4.1 trillion in 2016^xvii. In that year, health spending will comprise nearly one-fifth of the entire economy.
• U.S. spends more for less: On a per-person basis, this is 50 percent higher than the next nation, and twice the average of competitor nations. Our spending if $6,100 in 2004 was significantly higher than that of the next most expensive nation, Switzerland, where the average life expectancy is 3 years longer^xviii. A recent analysis found that, controlling for income, the U.S. spends $477 billion more than peer nations on health care.
• Impact on businesses: In 2005, businesses financed $367 billion of private health insurance premiums^xx; by 2008, with current cost trends, this could climb to $450 billion. One analysis found that health costs in Fortune 500 companies could exceed their profits by 2008^xxi.
• Impact on families: Premiums for employer-sponsored insurance have risen 87 percent since 2000, compared to a 20 percent increase in wages. The average family premium in 2006 was $11,480^xxii. Median income in the U.S. dropped by nearly $1,300 between 2000 and 2005^xxiii.
• Generally, reform lowers national health spending: Comprehensive reform plans have the potential to reduce national health spending, even with the federal investment in insuring all Americans^xxiv.

Preventing and Managing Disease

• Epidemic of chronic illness: An estimated 45 percent of Americans had a chronic illness in 2000. This is projected to rise to 50 percent by 2020^xxv.
  • Diabetes: The number of people with diabetes has doubled in the past fifteen years, with the expectation that one-third of the people born in 2000 can expect to have diabetes in his or her lifetime^xxvi. And this trend is even more disturbing for African Americans: the rate of diabetes is 50 to 80 percent higher for this group compared to non-Hispanic whites.
  • Obesity and health: About 24 percent of Americans were obese in 2005, up from 15 percent in 1995^xxvii. Obesity contributes to a wide range of chronic conditions, from diabetes to stroke to cancer. If trends continue, children’s life spans may be shorter than that of their parents for the first time in about a century^xxviii.
• Chronic diseases drive costs. Chronic diseases, some of which can be prevented, account for more about 75 percent of health care costs. In addition, about two-thirds of the rise in health care spending is associated with a rise in the prevalence of treated disease-more diabetics, more pulmonary disorders, etc^xxix. Medicare is particularly affected: chronic diseases account for 68 percent of program costs, and 23 percent of beneficiaries have 5 or more chronic diseasesxxx.
  • Obesity and costs: About 30% of the rise in health care spending is linked to the doubling of obesity among adults over the past 20 years^xxxi. Had the prevalence of obesity remained the same today as it was in 1987, we would spend 10 percent less per person - approximately $200 billion - on health care today.
  • Impact on employers: About 30 percent of total cost of diabetes results from work loss, disability, and premature death and the effects of preventable influenza present a major cost to employers in terms of sick days and reduced productivity^xxxii.
• Proven prevention is underused and undervalued
  • Low use: Only half of recommended clinical preventive services are provided to adults and less than half of adults had their doctors provide them advice on weight, nutrition, or exercise^xxxiii. Only 38 percent of adults receive recommended colorectal screening and roughly 20 percent of children do not receive recommended immunizations^xxxiv. Additionally, the percent of elderly people who received an influenza vaccine in 2003 was 64 percent in the U.S., well below Australia at 79 percent and the United Kingdom at 71 percent^xxxv.
  • Difficult to provide only through insurance: Health insurers typically do not cover the full range of recommended services. An employer survey found that only 57 percent cover flu vaccines, 20 percent cover tobacco cessation services and only 18 percent cover alcohol problem prevention^xxxvi. Since people frequently change insurers, insurers have little incentive to invest in them. The average person in their 40s has already had 11 jobs^xxxvii.
  • Difficult to provide only through doctors: One study estimates that it would take over 7 hours per day to deliver all of the U.S. Preventive Services Task Force-recommended clinical prevention to a typical patient panel of 2,500^xxxviii. Moreover, our payment system does not value prevention. Reimbursement for a diagnostic, surgical, or imaging procedure often is three times as much as a thirty-minute visit with a patient involving management and counseling^xxxix.
  • Low spending: The U.S. spends only an estimated 1 to 3 percent of national health expenditures on preventive health care services and health promotion^xl. This is an estimated $70 billion per year^xli.
• Primary prevention can reduce costs and improve lives
  • Immunization: Fully vaccinating all seniors against the flu could save nearly $1 billion per year^xlii. Full vaccination of seniors against pneumococcal disease could save $10 for every $1 spent^xliii.
  • Obesity intervention: If obesity among the elderly were to return to the level in the 1980s, then savings could total a trillion dollars over a 25 year period^xliv.
  • Workplace wellness: A systematic review of this literature evaluating workplace health promotion programs found that 88% of the 32 studies found that these initiatives reduced healthcare costs, and virtually all found they reduced absenteeism. The mean return on investment of the initiatives was $3.93 for health care costs and $5.07 for absenteeism savings^xlv.
  • Safeway example: Safeway covers all preventive care services appropriate for a patient's age group. It offers other benefits, such as a 24-hour hot line staffed by registered nurses, services to help people manage chronic conditions and incentives designed to promote healthier lifestyles. Safeway has integrated a health promotion/prevention model with care management. According to Safeway’s analysis, overall, health coverage costs for Safeway employees enrolled in the new plan fell 11 percent in 2006, its first year of operation. It has projected that their 2007 spending will be flat^xlvi.
• Chronic care management can produce savings:
  • Example of diabetes care management: A comprehensive program to achieve and maintain weight reduction of 7% among adults with elevated blood sugar produced results so dramatic and quick, randomized trial was stopped a year early. The incidence of diabetes was 58 percent lower among at-risk individuals enrolled in the lifestyle intervention than the control group. The results were most pronounced among those aged 60 and older - a 71 percent reduction in the incidence of diabetes. These results have been replicated in studies in Finland and China^xlvii.
  • Example of warranty for care: Geisinger Clinic has experimented with a model that provides all follow-up care for up to 90 days after surgery through a "warranty". This has resulted in more aggressive follow-up (e.g., ensuring antibiotics or aspirin are used) and fewer subsequent hospitalizations^xlviii.
  • Example of the VA’s use of HIT and chronic care management: Between 1993 and 1999, the VA adopted electronic medical records, developed explicit evidence-based treatment protocols for chronic disease, and provided financial incentives to VA health centers to improve care outcomes. Quality of care indicators improved dramatically: VA patients received 67 percent of clinically recommended care compared to 51 percent nationally^xlix. Moreover, use of hospital services declined dramatically—total hospital bed days declined by:
    • 51 percent for those with chronic obstructive pulmonary disease,
    • 49 percent for those with pneumonia,
    • 43 percent for those with heart failure, and
    • 49 percent among diabetics.

Health Information Technology

• Medical mistakes: In part due to our lack of health information technology, an estimated 195,000 Americans die each year due to medical mistakes. At least 1.5 million people - are ere given the wrong medication each year^li.
• High cost of paper-based payment: Today, 75 percent of health care claims are submitted electronically. However, only 71 percent of these claims are automatically adjudicated (i.e. processed without any manual intervention). Paper claims that are clean (no manual intervention) cost about $1.60 per claim. Claims that require manual intervention/ adjudication cost over $2 per claim. However, it costs 85 cents for an electronic claim^lii.
• Lowers medical errors: If all hospitals used a computerized physician order entry system, an estimated 200,000 fewer adverse drug events would occur, saving roughly $1 billion per year^liii.
• Savings from duplication of tests: A local study in Santa Barbara found that one in five lab tests and x-rays were ordered solely because the previous results could not be found^liv.
• System-wide savings from full use of HIT: RAND estimates net savings of $77 billion per year with 90 percent adoption. If efficiency in the nation's healthcare system increased by an additional 1.5 percent per year - what economists generally agree was the impact of information technology on the wholesale and retail industry - savings could be as high as $346 billion annually-over 15% of health care spending^lv.
• Example of the VA: The HIT system, known as the Veterans Health Information Systems and Technology Architecture (VistA), provides clinical, financial and management systems for the VA. The health record component of VistA, the computerized patient record system (CPRS), is used in outpatient, inpatient, mental health, intensive care unit, emergency department, clinic, home care, nursing home and other settings. CPRS contains all components of a patient’s health record, such as laboratory test results, medical images, bar code medication administration, progress notes, and appointments. CPRS permits VHA clinicians to access a patient's record from anywhere within the health enterprise, at the point of care. The CPRS is fully operational at all medical centers and most other VHA sites of care. The VA efficiently delivers some of the best quality health care in the United States. Between 1999 and 2003, the number of patients enrolled in the VHA system increased by 70 percent, yet funding (not adjusted for inflation) increased by only 41 percent. Health care spending per capita averages $6,300 in the U.S.; at the VA, however, the per-patient cost is $5,000, 21% lower than the national average^lvi.

Reducing Drug and Insurance Costs

• Drugs continue to drive costs: In the last decade, prescription drugs accounted for 15 percent of the total increase in health spending, despite the fact that they account for only about 10 percent of all health spending^lvii. In 2002, patented drugs cost 67 percent more in the U.S. than in Canada^lviii.
• Promoting generic drugs: While 53 percent of all prescriptions are generic medicines, they account for only 12 percent of total pharmaceutical costs. A 1 percent increase in the use of generic drugs could yield $4 billion in government savings^lix.
• Direct-to-consumer advertising: In 2000, for every dollar spent on direct-to-consumer advertising, pharmaceutical sales increased by $4.20^lx.
• Medicare overpayments to private plans: MedPAC has found that private plan payment rates are about 12 percent higher, on average, than traditional Medicare pays to treat the same beneficiaries. This has raised Medicare premiums by $24 for all beneficiaries, even those not enrolled in such plans^lxi. CBO reports that the cost to the budget is $54 billion over 5 years, and about $160 billion over 10 years^lxii. The Medicare actuaries report that the overpayments are depleting the Medicare Trust Fund: and advancing the date that Medicare Hospital Insurance will become insolvent by 2 years.

Research for a Value-Oriented Health System

• Proliferation of options: Health care providers and patients are being bombarded with information. In the past decade, there has been an 80 percent growth in the number of drugs prescribed, 100 percent growth in new device patents, 300 percent growth in teaching hospital procedures, and 1,500 percent growth in diseases with gene tests^lxiii.
• Need for improved quality: Adults get recommended care only about 55 percent of the time^lxiv.
• Use of comparative effectiveness information: Information provided by the Drug Effectiveness Review Project (DERP) has been used by some states in setting policy. For example, North Carolina used this information to educate providers, saving the state an estimated $80 million in 2003^lxv.
• Example of need for comparative effectiveness: Today, more than 45 million people - 26% of adults - are diagnosed with arthritis. That figure is expected to jump to 67 million by 2030. The total costs attributable to arthritis and other rheumatic conditions (AORC) in the United States in 2003 was approximately $80 billion^lxvi. The current therapy for rheumatoid arthritis (RA) is based on disease-modifying antirheumatic drugs (DMARDs). And today, new DMARDs are being developed which offer hope for better prevention and control of the pain and disability associated with rheumatoid arthritis (RA). But we have little information on the safety and effectiveness of new DMARDs as compared to traditional DMARDs.

Administrative costs:

• Administrative costs drive our costs above our competitors: The U.S. pays 6 times more per person on administrative costs ($412 per capita in 2003) than similar nations, partly due to the complexity of and cracks in the system. Of the $98 billion in excess administrative costs, $84 billion came from the private sector, where 64 percent of the administrative costs were incurred due to underwriting health risks, and sale and marketing, costs that aren't in public systems of most OECD countries^lxvii.
• Administrative costs exceed spending on long-term care and public health: In 2007, roughly $167 billion will be spent on administrative and private insurers’ overhead. This is more than will be spent on nursing home care ($132 billion) and public health ($66 billion)^lxviii.
• Significant savings could result from simplified administration: Most estimates of the impact of comprehensive reform plan suggest savings due to pooling and reduced administrative costs for small firms. A recent analysis of one plan suggests that system-wide administrative savings could be $30 billion a year^lxix.

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