Interview: Newt Gingrich, former Speaker of the U.S. House of Representatives and Founder, Center for Health Transformation

"The American health system performs dramatically below what it should be doing, and that's true whether you're rich or poor."

Since retiring from Congress, Newt Gingrich has worked extensively on the issues of health and healthcare. In 2003, he founded the Center for Health Transformation, a collaboration of public and private sector leaders dedicated to the creation of a 21st Century Intelligent Health System that saves lives and saves money. As the architect of the Contract with America, he led the Republican Party to victory in 1994, capturing the majority in the U.S. House for the first time in forty years. During his twenty years in Congress, Speaker Gingrich was committed to improving America's healthcare system, co-chairing the Republican Task Force on Health for four years prior to becoming Speaker. Under his leadership as Speaker, Medicare was improved, investment in medical research was dramatically increased, and FDA reform was enacted to allow for quicker approval and access to new medicines for those with terminal and degenerative illnesses. Time magazine, in naming him Man of the Year for 1995, said, "Leaders make things possible. Exceptional leaders make them inevitable. Newt Gingrich belongs in the category of the exceptional." He has won many health and health care awards and authored numerous health publications, columns and books. WebMD's Washington correspondent, Todd Zwillich, interviewed him on the state of the nation's health care and how the election might affect it.



1) How big an issue is health care for the nation now?

It'll stay a big issue if a candidate can find a solution that will survive being attacked. What happens is candidates tend to come up with solutions that sound really good until somebody analyzes them, and the analysis shows they have a lot of holes in them, and it's too hard to solve all the problems. So gradually the candidate quits talking about it. But I think for the average American, knowing how to have good preventive health and wellness, how to have affordability so that you'll have access to quality care, are really important. They're among the top two or three issues and people would be very, very interested in somebody who had a compelling answer that they believed was doable and was real and they believed could be sustained. From a policy perspective, health is a growing part of federal and state budgets. The Baby Boomers are getting older so they're watching their parents deal with health issues, and they are beginning to deal with their own health issues. There's a real fear of personal loss of access to health coverage. There are people trapped in jobs because of health conditions, and they're afraid if they leave their job they won't be able to get insured. So when you look at all the different pieces, I think they've come together. The American health system has large elements that are dysfunctional, and the cost of that dysfunction has been going up. And because health is so personal, it represents a personal threat to people and their families, not just some kind of abstract political problem.

2) Is the health care system really broken?

The American health system performs dramatically below what it should be doing, and that's true whether you're rich or poor. We have far more infections that we should have, we have far more mistakes than we should have.... I think the gap in expectation of accuracy at places like UPS and FedEx or in the airline industry and the acceptance of sub-par performance in the health system is rivaled only by the collapse of education. I think the healthy system could be 40% less expensive with far better outcomes, with people living longer, and with doctors actually making bigger incomes, with less red tape. But it would be a fundamentally different system than we currently have.

3) How--or should--we go about lowering the number of uninsured?

If I took you to a restaurant and it had no electricity, the chef didn't know how to cook and no one had cleaned the bathroom in a month, it would be hard to figure out which you would fix first. The politicians focus on the uninsured because it's a political number. But the health system I believe is 30 times more complex than national security. Here at the Center for Health Transformation, we've built a four-box model for health reform, and the fourth box is financing. It's an important box, but it's the last box. The first box is the individual. That's because if I can get you involved in your own health and you decide to be engaged, and say take the steps to prevent your at-risk child developing diabetes, we just saved the health system an unbelievable amount of money, with a better life, better productivity, less absenteeism at work. Our second box is culture and society. For example I believe we ought to have mandatory K-12 five-day-a-week physical education. And if you did, you'd begin to reduce childhood obesity and the amount of kids getting diabetes at 16. The New York Times reported that 10% of all Medicaid in the State of New York is fraud. That's $4.4 billion a year. So if you wanted to cover all the uninsured in New York, my guess is you could cover most of them for the cost of fraud in Medicaid. The trouble is, no one is thinking like that.

4) What is the best way to begin to lower health care costs?

I talk about active, healthy aging. I prefer independent living to ending your life with someone taking care of you because you didn't take care of yourself. I was told 25 years ago, 'You're either going to spend x number of hours in the gym or x number of hours in a hospital. You decide which you ought to do.' So I have a bias in favor of how to get you involved in taking care of yourself, and I think we need to start with that value base. If you do, there are a couple of big challenges. We don't have a good model today to pay for your maintenance. We have a pretty good model to pay for repairs. We need to turn the system on its head. Instead of waiting until you're so sick that you need massive intervention, we want early testing, early wellness, early information. We want wireless monitoring systems that let you keep track of yourself all the time. In Florida they experimented with paying Medicaid patients with diabetes a bonus for taking care of themselves. We're going to go to a system where you have real consequences both up and down for taking care of yourself. Every company ought to insist that their employees fill out a health diary every year, and then build a health plan for every year.

5) What should be done to cut prescription drug costs?

Prescription drugs are not a big driver of health costs. Bad health is a big driver of health cost. I have been saying that what you really need is a "Travelocity"-type approach to drugs. You and your doctor ought to be able to pull up a screen, and every possible drug for your needs should be listed along with price. And you and your doctor should be able to talk about it. And what you discover is, when doctors know price, they order less expensive drugs. It's an interesting phenomenon. People are talking more now about "comparative effectiveness", having an objective way to compare the effectiveness of drugs and other treatments. I am very much for it, if it is done in an open-source manner. I am very much opposed to what the State of Oregon does, which is essentially comparison based on cheapness. And on the issue of direct to consumer advertising, I think it's fine, as long as you know the price. I propose an after-pay model instead of a co-pay model for drugs. The government or insurers should agree to pay for the least expensive and effective drug, 100%. If you see some great commercial, and the drug is $273 more, then fine. It's an after-pay, you're an American, so write the check. People respond to price. So I don't care if they show ads as long as you know the price. What makes it dangerous today is, you don't know the price, the doctor doesn't know the price, and somebody else is paying.

6) How important is prevention to any health care policy we pursue?

Prevention is enormously important to reform. If I could re-center the health system on early testing, prevention, and educated and supported self-management, you would take an enormous amount of cost out. In fact you then combine with it the right to know, price and quality of every aspect of health, I think you'd take 40% of the cost out of the system.

Interview: Former U.S. Surgeon General Richard Carmona, MD

"[Health care] needs to be handled with much more than the usual platitudes that come around during elections."

Richard H. Carmona, MD, MPH, FACS, was the 17th U.S. surgeon general, from 2002-2006. He earned his medical degree at the University of California Medical School. He later got a master's degree in public health from the University of Arizona after realizing that most of his patients' illnesses and injuries were completely preventable. As surgeon general, Carmona focused on prevention, preparedness, health disparities, health literacy, and global health. After completing his term, Carmona became vice chairman for Canyon Ranch, a health and wellness company. He is also the first Distinguished Professor of Public Health at the University of Arizona's Mel and Enid Zuckerman College of Public Health. WebMD's Washington correspondent, Todd Zwillich, interviewed him on the state of the nation's health care and how the election might affect it.

1) How big an issue is health care for the nation now?

It's a tremendous issue for America. The polls show it's the No. 1 domestic issue, and by any other measure, including disease burden or economic burden on society, it is a critical issue. It needs to be handled with much more than the usual platitudes that come around during elections. This is not sustainable, and we simply cannot afford the legacy we are leaving to our children and our grandchildren. I'm talking about both the economic legacy and the disease legacy, by the way. We are spending 16% of our gross domestic product on health care, and three quarters of that goes to treating chronic diseases, many of which are preventable. It seems to me that the handwriting is on the wall.

2) Is the health care system really broken?

I think another way to look at it is that we've outgrown the system we built after World War II. Until recently, health care often wasn't much more complicated that an X-ray, or a blood test once in a while. Now it's an extraordinarily complex environment, both economically and medically. The structures we've invented, Medicare, Medicaid, etc., really don't fit well with 21st century medicine and what we know about disease prevention.

3) How -- or should -- we go about lowering the number of uninsured?

I think a good business case and a good public health case can both be made for improving insurance access for all of our citizens. If for no other reason, we know that disease is disproportionately concentrated in the lower socioeconomic classes, the working poor, and minorities. The fact is, if we ignore that, then the disease burden and economic burden still continue to mount, and ultimately, we all pay. Now, we also have to take shorter term steps to spread access to health insurance. People have come up with all kinds of models for shifting resources around so that people without insurance now can get access to it. That is all fine, and my point is that while that happens, we need to couple it with shifting the culture of medicine and health care toward prevention and wellness. Otherwise, as we spend years arguing over who pays, the disease and economic burden just keeps mounting up. Then we're at 20% of the economy instead of just 16%.

4) What is the best way to begin to lower health care costs?

Lots of candidates have plans for the health system. The fact is none of them can be successful unless we fully embrace prevention. All we're arguing about otherwise is economics: who will pay all these costs as the expenses mount exponentially. Whatever mechanism we choose for short term relief for the uninsured, we must also zealously pursue prevention. Right now our system works by rewarding practitioners for waiting for people to get sick, and then paying them to make patients better again. And often the disease we're paying them to treat was preventable. So what we really need is that cultural transformation, along with an infrastructure change, that allows us to go after optimal health and wellness. Putting prevention first can drastically cut the burden of chronic disease, which in turn drastically cuts costs, and improves the quantity and quality of life. Plans that don't embrace prevention and simply talk about economics are only talking about shifting costs and not going to the heart of the problem in my view.

5) What should be done to cut prescription drug costs?

It is a very expensive and difficult proposition to get a drug from the development phase to the patient who actually needs it. We've heard the statistics: it takes 15 years and on average something like a billion dollars to develop a novel drug. There are a number of spots along the drug development path where we could intervene to try and cut costs. There are groups popping up with an eye toward increasing the speed and efficiency with which drugs reach the market. Those could help cut the cost of our pharmaceuticals but not impede the rich and robust pharmaceutical research industry we have. People raise the issue of direct-to-consumer advertising of drugs. As with all things in public health, I think the answer is moderation, not deprivation. In some cases advertising is good, it can make the public more aware of disease and convince them to get help. In some cases it can also go overboard. It can increase awareness of disease, but at what cost? If companies are spending a big part of their budgets on advertising and marketing, at what point do you cross the line? This is the subject of many debates.

6) How important is prevention to any health care policy we pursue?

Prevention has been absent from the national health agenda. Period. And it needs to be the cornerstone of all of our health policy. Prevention is cost effective, it improves quality of life, and it improves quantity of life. The data tells us that 75 cents of every health care dollar are going to chronic disease, much of which is preventable, because of poor eating, smoking, not enough exercise, not wearing a seatbelt or helmet, you name it. We have to come to the terms with the fact that we spend most of our money on things that are preventable. We need that cultural transformation I've talked about that prioritizes health and wellness. Any health policy that doesn't address is really missing something in my opinion.

Interview: Bill Novelli, CEO of AARP

"For the first time in decades we appear to be moving toward action."

Bill Novelli is the CEO of AARP, a membership organization of more than 38 million people age 50 and older. Prior to joining AARP, Mr. Novelli was President of the Campaign for Tobacco-Free Kids, and before that he was the executive vice president of CARE, the world's largest private relief and development organization. Novelli also co-founded one of the world's largest public relations firms, Porter Novelli. He holds a B.A. from the University of Pennsylvania and an M.A. from Penn's Annenberg School for Communication. His book, 50+: Igniting a Revolution to Reinvent America, was published in 2006. Answers from Novelli on the state of the nation's health care and how the election might affect it were provided to WebMD's Washington correspondent, Todd Zwillich.


How big an issue is health care for the nation now?

Domestically, health care is the biggest issue for the nation right now. Too many Americans -- 47 million -- don't have health insurance. That number is climbing, not falling. As health care costs rise, we're spending more on health care than any other industrialized nation, but we are not getting our money's worth, and throwing more money at the problem is not the solution. Even for those who have health insurance, costs are skyrocketing: people in Medicare have seen their premiums double since the beginning of the decade.

Americans are feeling the pain, both physically and financially. In poll after poll, they name health care as a top domestic issue. We're seeing the presidential candidates, Congress, statehouses and even the White House acknowledge the magnitude of the problem. States like Massachusetts and Vermont are implementing systems that could universally cover their residents. California and others are burning the midnight oil to do the same. A lot of the health care debate is rhetoric, but for the first time in decades we appear to be moving toward action.

Is the health care system really broken?

Look at the facts: 47 million Americans are uninsured. Many employers can't afford to offer coverage to their workers and some that do are beginning to cut back on benefits. People who have insurance are struggling. Many don't have as much coverage as they really need. Others are afraid to leave their jobs, start a business, or retire early because they know they won't be able to afford insurance outside of their current employer. Even Medicare covers only about half of an older person's medical care.

We're spending 16% of our economic output on health care, but we have health outcomes below much of the industrialized world. The costs of prescription drugs continue to rise at twice the rate of inflation. The government has made some strides -- we now have prescription drug coverage in Medicare. But more often than not, whenever the government tries to make improvements -- even to popular programs like the State Children's Health Insurance Program (SCHIP) -- they come to a standstill. A few states are making strides toward significant progress, but we haven't fixed the problems, yet.

How -- or should -- we go about lowering the number of uninsured?

We can start with the children. The State Children's Health Insurance Program passed overwhelmingly in Congress but was immediately vetoed by the White House. The strengthened SCHIP would have ensured that 10 million children had health coverage. Congress and the White House need to come together now to pass a strengthened SCHIP and cover more of these kids. It's the smart, affordable and responsible thing to do.

But the biggest obstacle is the cost of health care. We need to work together -- business, individuals and government -- to stop the rising price of health care in this country. Only by slowing the growth in health care costs can we begin to make health care affordable for more Americans.

What is the best way to begin to lower health care costs?

There are many ways. One is to bring down costs by implementing health information technology in our system. Health IT has startup costs, but it could be a huge cost-saver in the long term. And Health IT won't only save money; it will improve the quality of health care.

Greater emphasis on healthy lifestyles and prevention will also play a critical role in lowering health care costs. By preventing illness, we can prevent the costs of treatment. Americans need to get active and take important steps to reduce their own health care costs. Regular physicals, cancer screening and even flu shots are easy and relatively inexpensive ways to prevent illness or find problems before they become serious.

What should be done to cut prescription drug costs?

This is a critical question because lowering drug costs will create a ripple effect, lowering health care costs. We can approach prescription drugs from two angles -- policy and consumers. Individuals can take responsibility for their own drug costs by using their medications wisely. Always ask your doctor about the availability of generics; these drugs are identical to the brand names, but they cost far less. Comparison shopping and talking to your doctors and pharmacist about ways to lower your costs can make an enormous difference.

Policymakers have also put three major proposals on the table in recent years, and we will continue to work to see them enacted into law. The first is prescription drug importation. By allowing Americans to import safe and legal prescription drugs from Canada and other nations, we can significantly lower drug prices.

We also need to allow the Food and Drug Administration to approve generic versions of biologic drugs. These lifesaving therapies are among the most expensive drugs available on the market. They are used to treat cancer, anemia, arthritis and other debilitating illnesses. But, unlike traditional prescription drugs, biologic drugs have no lower-cost generic versions.

Another way to lower costs is to allow Medicare to negotiate drug prices. By giving Medicare the ability to negotiate with the drug manufacturers, we could lower the tremendous cost of prescriptions within Medicare. With older Americans taking an average of four prescriptions daily, secretarial negotiation will have a significant impact on health care costs in the U.S.

How important is prevention to any health care policy we pursue?

Prevention is critical -- it's the way people can take responsibility for their own health. Everyone, but particularly people 50-plus, need to get regular preventive care including physicals and other health screenings. We can also take preventive measures at home by staying active and practicing a healthy lifestyle.

If we encourage prevention, we'll put less strain on the health care system. A regular physical can help catch a problem that might otherwise land a person in the emergency room where care is the most expensive. Individuals have a responsibility to prevent illness, but employers, insurers and the government need to work together to promote and reward people's efforts to get and remain healthy.

In 2000, nearly half of all deaths in the U.S. were caused by bad habits such as tobacco use, poor diet and a lack of physical activity. Healthy habits take pressure off the health care system, save money and help people live better, longer lives.

Interview: Billy Tauzin, president and CEO of PhRMA

"Our industry is committed to helping build a healthier future for all Americans."

Billy Tauzin was named president and chief executive officer of the Pharmaceutical Research and Manufacturers of America (PhRMA) in January 2005, after serving 13 terms as a congressman from Louisiana. Originally elected to the U.S. House in 1980 as a Democrat, his conservative views increasingly led him to vote with GOP House members, so despite his Democratic affiliation, he switched parties in 1995. Later, as chairman of the House Committee on Energy and Commerce, he helped President George W. Bush win passage of a Medicare prescription drug bill. Tauzin received a Bachelor of Arts Degree from Nicholls State University in 1964 and a Law Degree from Louisiana State University in 1967. Answers from Tauzin on the state of the nation's health care and how the election might affect it were provided to WebMD's Washington correspondent, Todd Zwillich.

How big an issue is health care for the nation now?

Access to quality health care -- including new, potentially life-saving medicines -- is an issue of tremendous importance for all Americans. Every patient, no matter what age, should have access to the medicines and health services they need to prevent, cure and treat disease.

Today, prescription medicines play an increasingly critical role in health care in the United States. Medicines have been shown to reduce health care costs, hospital stays and the need for expensive, invasive surgeries. Most significantly, prescription medicines help patients live longer, healthier, more productive lives.

As the population ages and the prevalence of chronic diseases rises, the availability of innovative medicines will be all the more important to help improve health and prevent disease. And at the heart of these ongoing efforts to develop and make available new medicines and health care technologies is one overarching priority: the individual patient.

We are in the midst of a medical revolution that is transforming health care in America and beyond to focus on the medical needs of each patient. Recognizing the central role that medicines play in this process, America's pharmaceutical research companies are committed to meet patients' needs through expanded access to new medicines, enhancing drug safety, inspiring biopharmaceutical innovation, building partnerships with physicians and patients, and educating the public on the value of medicines in health care.

Is the health care system really broken?

Americans are fortunate to have one of the best health care systems in the world -- a system that offers access and choice to a wide array of innovative medicines and medical technologies. However, most people would agree that we can do even better.

As a nation, we need to solve the problem of the uninsured; simply put, every American should have access to quality health care. We must do more to prevent -- and raise awareness of -- chronic disease. And we must deal with the rising cost of health care.

These challenges are great, but so is our resolve. Collectively, we must address the issues before us through innovative, market-based solutions that meet the individual needs of patients.

The success of the Medicare prescription drug benefit illustrates how policymakers, federal agencies and the private sector can work together to solve a difficult health care problem. Over 90% of seniors now have prescription drug coverage. And as a result of the competitive market system, the program is keeping prices down and saving money for patients and taxpayers alike.

America's pharmaceutical research companies share a goal to provide the right medicine to the right patient at the right time. This means treating every patient as an individual, making sure that patients have access to a wide range of treatment options and preserving incentives to foster continued innovation of medicines and medical technologies.

Medicines will play a critical role as we work with other stakeholders to improve an already sound health care system. Our industry is committed to helping build a healthier future for all Americans.

How--or should--we go about lowering the number of uninsured?

Good health insurance coverage is essential to the health care and well-being of all Americans. Yet, unfortunately, far too many patients throughout America are either uninsured or underinsured and are not getting the quality health care they need and deserve.

This is a problem that must be addressed because with good coverage, we can prevent and more effectively manage an array of chronic medical conditions, which account for 75% of all health care costs, according to the Centers for Disease Control and Prevention.

Meaningful strides have been made in recent years to help patients in need. As a result of Medicare Part D, over 39 million seniors and disabled Americans now have comprehensive prescription drug coverage. Those enrolled in Part D are saving, on average, $1,200 a year on their drug costs. Today, over 90% of seniors now have prescription drug coverage.

America's pharmaceutical research companies also are playing a critical role in helping improve patient access to medicines through the Partnership for Prescription Assistance (PPA), a clearinghouse of information about patient assistance programs. In just two years, the program has helped more than four million Americans across the country find programs that provide free or nearly prescription medicines.

In addition, America's pharmaceutical research companies support the reauthorization of the State Children's Health Insurance Program (SCHIP) to ensure that children have access to health coverage, including those low-income children who are eligible, but not enrolled in SCHIP or Medicaid. SCHIP has helped more than six million low-income children last year alone get the health care they need, and the program must be reauthorized in a timely manner to assure the program can continue to meet the health care needs of low-income children.

What is the best way to begin to lower health care costs?

The best chance to address any problem is to confront its root cause. In the case of health care costs in the U.S., this means reducing the prevalence of chronic disease.

Chronic diseases such as cancer, diabetes and heart disease account for seven out of 10 deaths and 75% of health care spending in America today, according to the CDC.
In fact, recent research shows that about two-thirds of the increase in health care spending over the past 20 years is due to the rise of prevalence of treatable chronic disease, and nearly 30% of that increase is related to the doubling of obesity since 1987 alone.

Yet, many chronic conditions and illnesses are preventable or manageable with proper care, treatment and appropriate lifestyle/behavioral changes. Expanding access to new medicines through programs such as Medicare Part D and the Partnership for Prescription Assistance has made a significant difference for millions of people, but there are many more patients who need help to get the medicines they need.

All of us with a stake in Americans' health -- providers, innovative research companies, the government, employers and individual patients -- need to do a better job of coordinating care, and preventing and managing chronic diseases.

With this goal in mind, PhRMA is a proud partner in the Partnership to Fight Chronic Disease, a national, bipartisan coalition of health care experts and stakeholders from across the country dedicated to fighting the number one driver of rising health costs: preventable chronic disease.

What should be done to cut prescription drug costs?

According to the most recent data from the Centers for Medicare and Medicaid Services (CMS), spending for prescription medicines accounted for less than 1/10th of the overall growth in health care costs in 2005. Importantly, the focus should not be on the price of medicines, but rather the value they deliver -- both to the individual patient and the overall health care system.

Although spending on prescription drugs has increased along with use, medicines comprise only a small share of total health spending -- about 10 cents of every health care dollar spent in 2005, according to CMS .

At the same time, the availability of innovative medicines is playing an increasingly prominent role in controlling health care costs. Appropriate use of prescription drugs saves money by reducing the need for lengthy hospitalizations and costly surgeries. In addition, medicines have been shown to help strengthen the economy by enabling workers to return to their jobs sooner after an illness and improving productivity.

Developing a new drug is a long, complex and costly process, and as a result, some medicines can indeed be expensive. However, a potentially lifesaving medicine does no one any good if it sits on a pharmacy shelf. That's why America's pharmaceutical research companies created and continue to sponsor the Partnership for Prescription Assistance (PPA). As an industry, we are committed to helping ensure that safe and effective medicines are available to all patients in need.

How important is prevention to any health care policy we pursue?

Prevention is critically important to any health care policy we pursue in America. As noted earlier, 75% of health care spending in the U.S. is related to chronic diseases -- such as cancer, diabetes, heart disease and asthma -- many of which can be prevented. The U.S. Centers for Disease Control and Prevention (CDC) estimates that eliminating three risk factors -- poor diet, inactivity and smoking -- would prevent 80% of heart disease and stroke, 80% of Type 2 diabetes, and 40% of cancer.

Right now, the U.S. health care system does not adequately support prevention but instead focuses on treating incidence of disease only after a patient is sick. Health care policy can and should better support efforts that improve prevention by offering incentives to health providers who offer quality preventive care to patients and by promoting a more integrated care system in which providers are more actively engaged with their patients at regular intervals.

Additionally, health care policy should encourage individuals to be more proactive by offering tools, incentives, and education to help Americans prevent, detect and manage chronic disease.

Efforts such as the bipartisan Partnership to Fight Chronic Disease, which aims to raise awareness of policies that foster more effective prevention and management of chronic disease, is a promising step in the right direction.

Expanding access to medicines also is vitally important. America's pharmaceutical research companies lead the world in researching and developing new, innovative treatments to fight disease and help patients stay healthy, but they also are fully committed to helping ensure that all patients -- no matter their financial status --have access to the medicines they need, when they need them.

Interview: American Medical Association's Edward Langston, MD

"One in seven uninsured is one too many."

Edward Langston, MD, is the board chairman for the American Medical Association. He is a practicing family doctor from Lafayette, Ind. Since 2005, he has also served as a commissioner on the Joint Commission on Accreditation of Healthcare Organizations. The commission evaluates and accredits nearly 15,000 health care organizations and programs in the U.S. In addition, he is a clinical assistant professor at the Purdue School of Pharmacy. Answers from Langston on the state of the nation's health care and how the election might affect it were provided to WebMD's Washington correspondent, Todd Zwillich.



How big an issue is health care for the nation now?

Polls show that health care now ranks as the top domestic issue, and this renewed national interest likely reflects the frustration many Americans feel when they have to deal with the bureaucracy of the health care system. Employers have to manage increasing health insurance costs against what they can offer their employees, those without insurance see that they are paying higher out-of-pocket costs than those with insurance, and even patients with government provided health insurance like Medicare and Medicaid have to endure long waits to get the care they need. Employer-provided health care remains the most prevalent form of health care coverage in our nation, yet 40% of employers do not offer health insurance. There's a growing realization even among those with health insurance that our system needs to be fixed.

Is the health care system really broken?

It's important to keep in mind that America is a health care leader the world over. Breakthroughs in how to treat diseases are made every day, and innovations in medicine and top-quality care are provided by health care professionals. There are some serious stressors on the system though, and they must be addressed by our lawmakers. Our health care system is uniquely American -- it's in essence a patchwork quilt with different solutions for different populations. We don't want to change what is working in our system, but we can make vast improvements, like insurance market reforms and providing health care coverage for all, to improve the overall system.

How -- or should -- we go about lowering the number of uninsured?

The AMA ardently believes that one in seven uninsured is one too many. Multiplied out nationwide, that's now 47 million uninsured. The bottom line is that for many Americans, regular access to health care is out of reach simply because they don't have health insurance. The AMA's new campaign, Voice for the Uninsured, is a three-year campaign with the ultimate goal of enacting legislation to cover the uninsured. Our plan rests on three key principles:

1. Provide all Americans with the means to purchase health care coverage.


2. Give individuals the choice to select the appropriate coverage for them and their families.


3. Promote market reforms that enable this approach.

In this, the first year of our campaign we are focusing our efforts in early primary states to educate voters about the problem of the uninsured and the AMA's solution, and urge voters to raise the issue with candidates for president. Next year the campaign will expand nationally and will focus on influencing Americans to vote with the issue of the uninsured in mind. The final year of Voice for the Uninsured campaign will focus on urging members of Congress to pass legislation to fix this national problem.

What is the best way to begin to lower health care costs?

Decisions related to health and health care should be framed in terms of value, with benefits being balanced with costs. After all, the ultimate goal is achieving better value for health care spending, rather than cost-reduction per se.

Health care spending is rising faster than wages and the overall economy, and rising health care costs drive more people into the ranks of the uninsured. Ultimately, health care spending cannot be reined in without reducing the burden of preventable disease. The biggest opportunities to halt the onset of illness and avert injury lie in changing personal behavior, for example, being physically active and eating nutritious foods. The lessons of the successful antismoking movement are starting to be applied to obesity control and other public health efforts. Additional spending may be required, such as paying for lifestyle counseling.

In addition to reducing the need for medical treatment in the first place, we must deliver health care more efficiently, for example, reducing unnecessary use of services, using lower-cost drugs as appropriate, and improving the coordination of care.

What should be done to cut prescription drug costs?

There are several factors driving the increase in drug costs, and a combination of methods will be needed to address the problem. Programs designed to contain the rising costs of prescription drugs must involve physicians and encourage optimum prescribing practices and quality of care. All patients must have access to all prescription drugs necessary to treat their illnesses.

Physicians must have the freedom to prescribe the most appropriate drugs for the patient and are encouraged to supplement medical judgments with cost considerations in making these choices. The pharmaceutical industry should be encouraged to exercise reasonable restraint in the pricing of prescription drugs, and to support programs whose purpose is to contain the rising costs of prescription drugs. Incentives should be maintained so that pharmaceutical manufacturers have the incentive for research and development of new and innovative prescription drugs.

The AMA has a long-standing policy in support of pluralism and free market competition, and it has concerns with setting prices because of their potential to stifle innovation and increase demand.

How important is prevention to any health care policy we pursue?

Prevention is a vital part of how we keep patients healthy. There's been a real shift in the last few decades as we've learned more about treating diseases early, and as technology has allowed us to screen for diseases before they reach crisis proportions. Female patients can be screened yearly for breast cancer with a mammogram, allowing physicians to catch the disease in an early stage and greatly increasing the chances for a positive outcome.

A low-tech example but equally important is providing patients with counseling to stop smoking. Every year, 440,000 Americans die from diseases caused by tobacco use, which kills more Americans than heroin, PCP, cocaine, alcohol and every other drug combined. Tobacco is responsible for more than $75 billion in health care costs and $92 billion in productivity losses each year. If we can get people to stop smoking, we're having a positive result on the patient, the family, the workplace, and society.

Interview With Grace-Marie Turner: The Galen Institute

'The best way to lower costs is to allow and encourage more competition.'

Grace-Marie Turner is president of the Galen Institute, a nonprofit health and tax policy research organization that she founded in 1995 to promote an informed debate over free-market ideas for health reform. She speaks and writes extensively about incentives to promote a more competitive, consumer-driven marketplace in the health sector. The Galen Institute works toward policy initiatives that transfer power over health care decisions from bureaucracies to individuals. In 2005, Turner was appointed by Health and Human Services Secretary Mike Leavitt to serve on the Medicaid Commission. WebMD's Washington correspondent, Todd Zwillich, interviewed her on the state of the nation's health care and how the election might affect it.



How big an issue is health care to the nation?

Health care is a huge issue for the country. Businesses are saying it's affecting their competitiveness. The recent census figures say 47 million Americans have no insurance. There is growing anxiety in the middle class about the cost of health insurance and fears that if they lose their jobs they won't be able to afford coverage. That's why health care is becoming a first tier issue in the presidential debate.

Is the health care system broken?

I don't think we can say it's broken, but it does need to be modernized to fit with a 21st century economy. But it's distressing to see people tear the system down. When people are sick anywhere in the world, this is where they come for care. We offer the best technology, the best surgeries, and best care on the planet. We do have a vibrant and competitive marketplace in our health care system, but there are many problems that need to be fixed. One is that health care in this country is tied to the workplace. In most other countries that is not the case. The reason we have 47 million uninsured is because people are losing their health care when they lose or change jobs. We need to change the tax structure so people can have insurance that they can own and take with them from job to job. We need to have more visibility of quality and cost in the system so people can look for value and make better decisions about the value of their care. We have way too few incentives to do that now.

What should we do to lower health care costs?

The best way to lower costs is to allow and encourage more competition. Today we have way too many state rules and regulations that dictate the cost of insurance and whom it is sold to. That really dries up competition. It's true competition that could give people more options, more choices, and more affordable coverage. Having price controls is not going to work. They never work because they distort the market. We should allow competition and let people choose and find the best value for their health care. Do that, and you'll see prices come down. That's what we've seen with the Medicare Part D drug plan. The price of the premiums has come down because of competition between plans. The same can happen with private health insurance. If you give consumers more incentives to seek better value in their care, the health care can operate more like the rest of the economy, where buyers seek out faster and better services.

How -- or should -- we try to cover the uninsured?

Every single person with no insurance has anxiety about it. They know if they wind up in accident or an emergency they can go to any hospital, but that is not the same as knowing you have coverage and that you can see a doctor when you need to. But we need to lower the price so more people can afford it. And to do that we need more competition. To do it, we should lift many of the burdens of price controls at the state level that have driven out competition. If we lightened the load of regulation by allowing interstate purchasing of health insurance, just like interstate banking, that would lower the cost of insurance so that more people could afford it. The people at the lower end of the resource scale who cannot afford insurance should have support. They should have refundable tax credits that they use to buy private insurance. We should not expand government programs that are already strained. We should also allow insurance to be more portable by fixing the tax code and letting people get the same tax break to buy insurance on their own that they now get when they get it through their job. That lets people take that benefit with them no matter where they work.

What should we do to make prescription drugs more affordable?

Medicare Part D has caused private health plans to negotiate with the drug companies to get the best possible price. Premiums have fallen because you have competition in purchasing. If we gave people more options in insurance that encouraged that kind of competition, we would see lower costs. The fact that people are using more prescription drugs is not a bad thing. It can save on other costs. Look at what competition has done at Wal-Mart. They're offering 300 prescriptions for $4 for a month's supply. Other companies offer free antibiotics. You can see competition is beginning to work to get prices down. The last thing we want to do is impose price controls because if we resort to them, the next generation of miracle drugs will dry up.

How important is prevention to any health care policy we pursue?

It's important to not have prevention be a centrally controlled decision. It is a constantly evolving art and science, and we should keep prevention decisions as flexible as possible between doctors and patients. We know childhood immunization is a wonderfully effective strategy. But it should be for the market -- and not the government -- to decide whether or not many of the preventive tests coming out now will be worthwhile. This will be especially important as more genetic tests become available. We don't know what the new generation of preventive care is going to bring, so we don't want to lock it into a centralized government decision-making process.

Interview With Ron Pollack: Families USA

"I think health care has become the No. 1 domestic issue."


Ron Pollack is the founding executive director of Families USA, a national nonprofit, nonpartisan organization for health care consumers. Families USA's stated mission is to achieve high-quality, affordable health coverage for everyone in the U.S. In 1997, Pollack was appointed by President Clinton as the sole consumer representative on the Presidential Advisory Commission on Consumer Protection and Quality in the Health Care Industry. In that capacity, Pollack helped prepare the Patients' Bill of Rights that has been enacted by many state legislatures. WebMD's Washington correspondent, Todd Zwillich, interviewed him on the state of the nation's health care and how the election might affect it.


How big an issue is health care to the nation?

I think health care has become the No. 1 domestic issue and will be treated as such during the elections. We've seen a real transformation of how this issue is being viewed by Americans. Universal health care used to be about altruism, but the debate has now changed. Now it's about self-interest for the public and for businesses. This is because costs are rising much faster than wages and companies' incomes. As a result, more and more people are at risk of becoming uninsured. And the number of people who've been affected is huge. A recent report from Families USA shows that nearly 90 million Americans do not have health coverage for a portion of the last two years. That number is enormous. It constitutes more than a third of the non-elderly population. As more and more people directly experience this problem, this issue is being transformed from one of altruism to one of self interest. People who have significant health problems are likely to bankrupt themselves. From a personal and political standpoint, this issue is becoming huge.

Is the health care system broken?

I would say that it's a disgracefully tiered system whereby those who are well insured and have significant resources are likely to get terrific care but many others are essentially excluded from getting the preventive and primary care they desperately need. For them, the system is broken. For others, they may be satisfied with the care that's available to them. If the standard is that we have an egregiously inequitable system of coverage and care, then I would say the system truly is broken. We have such enormous disparities in care, affordability, and coverage that it simply cannot be a system that we should be proud of.

What should we do to lower health care costs?

I don't think there's any single magic bullet. I do think one of the most important things we can do is make sure there is a far better understanding of the efficacy and efficiency of different kinds of health services, including prescription drugs, technological interventions, or other treatments. We then have to make sure that professionals and patients have a better understanding of what works and what doesn't work. This could help make sure providers are more prudent in what they prescribe and make consumers much more prudent in the care they seek.

How -- or should -- we try to cover the uninsured?

The U.S. Census Bureau reported in August that 47 million Americans lacked health insurance throughout 2006. But, as I mentioned before, if you look at who lacked insurance at any point over the last two years, the figure is more than 89 million. That's simply unacceptable. It's unconscionable for the richest country in the history of the planet to have so many people uninsured. I think this deserves to be the top priority in terms of health reform. But it can only be successfully addressed if we go about it differently than we have in the past. It has got to be a bipartisan effort, it has to gain consensus support of key stakeholders on all sides. To achieve that you can't rely on a method that is exclusively either in the public or private sector. There will have to be a mixture. Finding that consensus has the potential to change the political dynamic so we can once and for all successfully address this problem.

What should we do to make prescription drugs more affordable?

The 2003 Medicare legislation that launched Part D was an enormous opportunity to deal with fast-rising prescription drug costs. If that could be revisited so that Medicare truly bargains for lower prices, it could have a real impact not just for seniors, but for all patients. We need to find a way of objectively analyzing the cost-effectiveness of new drugs before they come to the market. We should continue to expand the use of lower-cost generic drugs and to do more to prevent the abuses that the drug companies use in the legal system to prevent generic drugs coming to market.

How important is prevention to any health care policy we pursue?

Prevention is very important because it improves people's health, and that's a worthy objective irrespective of its impact on cost. I don't know whether improved preventive care and improved responsibility on the part of individual will impact on costs. But insuring we have a healthier population that has the opportunity to live well and longer is something we should pursue.