Newt Gingrich:

We need a fundamentally new approach to rethinking the health system.

There are three fundamental changes which will revolutionize our approach to a better health system for all Americans.

First, we need to adopt a health based health reform approach.

Second, we need to commit to a 21st century electronic health system for every American and pay for it with the fraud which such a system would stop.

Third, we must revise the Budget Act to create a 21st Century Science, Technology and Infrastructure investment budget which would liberate us to focus resources where they will do the most good.

First, it is clear that many hospitals and doctors are developing dramatic breakthroughs in better outcomes and that many of these better outcomes are at lower cost.

It is also clear that the system at large is very very slow to adopt these new better practices.

The result is people die unnecessarily, stay sick longer than necessary and the system costs substantially more than is necessary.

The next Congress should hold hearings with the people who are succeeding on a variety of approaches. Their new, better models should be analyzed and the federal government as the largest single purchaser of healthcare should develop a system of rewarding breakthroughs that provide better outcomes at lower cost, subsidize the transition of every willing system to the new better practices and financially punishing systems which refuse to save lives and save money by adopting better practices.

Second, we should establish a goal of every American having an electronic health record by December, 2012. That is 51 months from now. The United States won the entire Second World War in 44 months (December 7, 1941 to August 1945). What Americans accomplished in that short time far surpasses the effort and cost required to enact a major upgrade to our health care system by 2012. Surely we can implement an interoperable system in an additional seven months longer than it took to win World War II.

This transition to an electronic health system should be subsidized by the federal government as a health purchaser but implemented on a local, decentralized basis with a requirement for interoperability but very wide latitude on the details and the method of achievement.

The money to pay for this should come from the fraud which is currently rampant in the system and which could be detected and prevented by an electronic system with expert system overlays.

The scale of fraud in government financed healthcare should be a national scandal. .

Medicare will spend just under $500 billion in FY 2008. Up to $60 billion of that could be fraud according to Malcolm Sparrow of Harvard. Even if it is only half that amount, $30 billion per year is a significant down payment toward making sure we are paper free by 2012. Fraud, waste, and abuse in New York’s Medicaid program alone may easily exceed $10 billion according to a 2005 New York Times study and might be dramatically more according to a private study completed in 2006. A USA Today article on October 6th was titled, “Rampant Medicare Fraud suspected in Miami” and cited the fact that home health care costs have increased 1,300% in just five years. Miami is also home to remarkable amounts of fraud with its non-existent infusion clinics. This staggering amount of fraud does not exist in any other industry in America.

Completing an all-electronic system will do wonders for immediately spotting and weeding out fraud. It also will dramatically increase care coordination and the accuracy of treatments. This will go a very along way toward eliminating medical errors that literally kills tens of thousands Americans annually and costs billions unnecessarily.

Changing the Budget Act to enable us to count money saved from fraud as a savings will enable us to apply these savings to pay for the investment in information technology. If the RAND Corporation study is correct and this electronic health system actually saves $80 billion a year in no-fraud improvements then we will have saved enough money to finance the vast majority of the cost of providing a tax credit or voucher to enable every American to participate in a 300 million payer health insurance system.

Third, the Federal Government must learn to distinguish between cost and investment. Every American understands investing in a 30 year mortgage for a home or taking out a student loan to go to college or graduate school.

Americans understand the difference between borrowing to start a small business and borrowing to go on vacation. The first is an investment. The second is consumption.

Today the Congressional Budget Office and the Office of Management and Budget cannot distinguish between annual expenses and investments. The result is an underinvestment in the future and an overinvestment in this years short term activities.

In 2008 politicians have responded to a weakening economy with a $182 billion stimulus package (essentially giving people back their own money through long term borrowing), a $300 billion plus housing bailout and a $700 billion Wall Street bailout.

Yet at a time when politicians could add $$1.2 trillion to an already $3.1 trillion annual budget they could not find extra money for research on cancer, Alzheimer’s, or Diabetes.

The stimulus package alone would have allowed a 400 per cent increase in the National Institutes of Health Budget.

We are in an era of massive scientific progress. In the next 25 years there will be four to seven times as much new science as in the last 25 years.

This new science will enable us to create enormous breakthroughs in health, energy, the environment, learning, national security and virtually every aspect of life.

Today we are dramatically under investing in math and science education and under investing in new research.

The CBO and OMB budget process minimizes investment in a better future while maximizing investment in current consumption.

This is the opposite of sound public policy.

Take the case of Alzheimer’s as an investment opportunity.

Alzheimer’s is a terrible long term disease with painful consequences for the entire family.

It is currently projected that as the Baby Boomers age they will encounter $1.2 trillion in federal health costs for Alzheimer’s.

Even if we cannot find a cure for Alzheimer’s simply postponing its onset by 5 years saves half that amount of money. The older you are when Alzheimer’s begins the shorter the time you will have the disease and the less expensive it will be.

Today Brain science and knowledge of the mind is one of the most rapidly expanding fields of scientific endeavor. We now have instruments for studying living brains. Every day we are learning new things. Yet research is underfunded and most young researchers find it very, very difficult to get a research grant. In a rapidly changing field this is especially frustrating because it is precisely the younger researchers who are likely to have the big breakthrough insights.

What if we reversed our current model of investing in science?

What if instead of asking how much is left over to invest in a better future after we have spent on everything politicians feel is needed for reelection we had a separate budget for scientific research?

What if that separate budget were driven by two questions?

First, what is a reasonable investment if a 5 year delay in Alzheimer’s onset would save $600 billion for this generation? What would a reasonable investment rate be for a potential $600 billion return?

Second, what is the optimum amount of research money the brain sciences community could absorb annually and what is the right trajectory of investment over the next decade to maximize new knowledge?

This “science based investment budget” would lead to dramatic breakthroughs in every field and would lead to a surging American economy, a much better energy economy, a much better health system, a much better environment, and a much stronger system of national security.

These three changes:
1. a health based approach to health reform
2. a 21st century electronic health system paid for by fraud avoidance
3. a science based investment budget

would revolutionize our current debate about health and healthcare and lead to dramatic improvements in our health system and significant declines in cost.

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The cost of failing to reform our struggling health system is high and rising. We must take action not in spite of our current economic crisis but precisely because of health care’s financial impact on American families and businesses.

We should think about two things: 1) the cost of health reform relative to our economy and how health reform could actually free up money over time to invest in other national priorities, and 2) what is the economic impact if we do not act.

On the first point, credible estimates suggest that covering all Americans will cost about 1 percent of GDP (roughly $140 billion). We also know that many analysts agree that as much as 30 percent of what we spend on health care does not go towards treatments that add clinical value. Think about it: if we were able to reduce spending that does not add clinical value by just 10 percent per year for 10 years, total health spending would be $900 billion lower. That is $900 private and public dollars that we could spend on the uninsured, education, infrastructure, defense, and other national priorities.

On the flip side, the economic losses from the uninsured as a result of their diminished health and shorter lifespan were between $102 and $204 billion in 2006 (according to Institute of Medicine estimates updated to reflect 2006 realities). We also know that we are losing more and more good jobs to other countries because of the part of the growing employer health care burden that cannot be shifted backward onto workers or forward into prices in the short run. This is why employers are so engaged in reform conversations in anticipation of 2009-10. The cost of inaction is great, and it is not going away.

As we move forward there are a couple of additional issues I think we must consider. First, the unprecedented capital market interventions first advocated by and now undertaken by a relatively “hands off” administration suggest we did indeed face what appeared to all reasonable minds to be an existential threat to economic life as we know it. Existential threats, like war, have to be financed, but the cost might properly be amortized over a longer horizon than one year’s budget cycle, as we did for WWII. Second, we do not know how much this “rescue” package will really cost our budget, and increasingly it looks like we are more likely to take more of an equity position from which we might recoup much, if not all, of our initial outlay. Only time will help us properly assess this.

What we do not need time to tell us, however, is that the price tag for health reform increases every day that we wait. America will recover from the current economic downturn and when it does the U.S. will still be hampered by a crumbling health system. The time to act is now.

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As a number of the previous comments have argued, the collapse of financial markets and the deterioration in the economy make fundamental health reform an even more urgent priority. Nevertheless, the challenge, never an easy one, has become much more difficult if not impossible for several reasons. First, fiscal resources that might have been devoted to the unavoidable short run costs of health reform will be needed to stimulate the economy and shore up the financial system. Second, while the ranks of the uninsured will almost certainly expand, the majority who remain covered by an employer/union sponsored policy will be even more fearful that reform might threaten their existing arrangements. And third, the new administration and congress will have to expend the limited amount of political capital they enter office with dealing with the economy and the financial meltdown as well as issues that recent polls suggest Americans view as more pressing and immediate than health care like Iraq/Afghanistan, and energy prices. The pool political capital left available for health reform will be very shallow.

While some might take comfort in the Marist College Institute for Public Opinion poll showing that, in September, large majorities of Americans express a willingness to forgo tax cuts or increase national debt to “deal with the health care crisis” three cautions are in order. First, this poll was fielded on September 24 and 25, when the S+P 500 was 21% higher than yesterday’s close and many had not focused on the impact that the financial crisis was going to have on their immediate lives and their hopes for a secure retirement. Second, a majority in that poll thought the top health care priority should be “making health care more affordable”-- that is cost control—not expanding access which has motivated most activists. And, third, while Americans may be willing to increase the nation’s debt to reform health care, the question will have to be put to foreign lenders who over the past seven years have financed over 80 percent of the net increase in our privately held public debt. Interest rates on federal debt may rise significantly if our lenders do not view our exploding spending as essential.

The challenge for policymakers in 2009 will be to push incremental measures that advance the goals of fundamental reform and build the infrastructure that a reformed system will require.

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Both presidential candidates were put on the spot at last night's debate when asked to prioritize energy, health care reform and entitlement reform. Sen. McCain said he would tackle all three issues simultaneously. Sen. Obama ranked energy his top priority, with health care coming in second.

Edited on Oct. 9, 12:38 p.m.

One of the many things we learned in the nineties is that when polls tell us that most Americans believe that "dealing with the healthcare crisis" should be a high priority for the next President it doesn't mean that there is consensus on how to do it. Big steps in social policy are only made when there is consensus about the problem and the solution. That is the hurdle--easier said than done.

Is progress on health care possible amidst the financial crisis? Absolutely, yes! Some of our nation’s greatest social achievements have come during a crisis. Both Social Security and Medicare were enacted during times of turmoil. That thought may cause conservatives to cringe and progressives to cheer, but even if a GOP meltdown delivers a second Hoover moment, Democrats would start with only the opportunity to forge a national consensus on health care and other major problems.

The key to success for the next administration is to restore confidence in government. Fixing major problems like the financial crisis and health care would go a long way to show Americans that the government is once again on their side. But it will take a series of confidence building steps to show the government can take action on health care without taking over. Here’s how:

Go after high health care costs. The U.S. doesn’t get good value for all it spends on health care and the public knows it. The challenge is to show the nation how it can save money on health care without sacrificing quality. The Mayo Clinic is a powerful example. It delivers some of the best care in the world for bargain prices. The Dartmouth Atlas shows that Mayo costs the government 17 percent less than the national average for treating Medicare patients with a major chronic disease. Mayo Clinic care for all should be the new rallying cry.

Spend only what you have.The fiscal picture for the next administration will be grim. Maybe coverage for children will make the first cut in a new budget, but money for covering adults will have to come the old-fashioned way: we’ll have to earn it. CBO Director Peter Orszag estimates that $700 billion per year goes for tests and procedures that do not improve health outcomes. Let’s tap those savings and use a pay-as-you approach to expand coverage for adults.

Engage the states and businesses as partners in reform.The federal government can’t solve the problem alone. States and businesses would make natural allies because they are also hemorrhaging from runaway health care costs. To make changes across today’s fragmented payment and delivery system, Washington should create regional, public-private partnerships with the nation’s 60 employer-led coalitions, which already cover 34 million Americans and the nation’s governors, some of whom like Washington State Gov. Christine Gregoire have already launched their own efforts to drive toward high quality, economical care.

None of this will be easy or quick, but the crisis will strengthen the nation’s resolve. Now is exactly the right time to confront entrenched problems.

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As voters across our great country anticipate the upcoming election and the significant changes it could bring, they are rightly asking themselves critical questions about the policy and budgetary priorities of the next Congress and Administration, including those related to healthcare reform.

Although some in policy circles – and on Main Street America – may contend that meaningful reform will be impossible in the short term in light of our growing economic challenges, America’s pharmaceutical research companies believe this economic turmoil is one more reason why reform of our healthcare system is more important than ever before. If responsible healthcare reform is accomplished, it could not only help Americans access necessary health coverage and affordable healthcare services, it could also help strengthen our nation’s economy.

The American people have been asked to sacrifice a great deal to help get our economy back on track. The financial burden that we as Americans have had to undertake is extraordinary, but so is the burden of disease that affects millions of patients in small and large towns across the U.S.

Chronic disease is the leading cause of death and the leading driver of healthcare costs in the U.S. Chronic disease rates are rising at a rapid and troubling rate: cancer now affects more than 10 million Americans; nearly 60 million Americans are living with some form of mental illness; and more than 19 million Americans suffer from heart disease.

We believe that the best weapon to fight these life-threatening diseases is a collaborative effort by all healthcare stakeholders – including America’s pharmaceutical research and biotechnology companies – and local, state and federal governments. The good news is that important work is already being done in this area through the Partnership to Fight Chronic Disease (PFCD). PhRMA joined the PFCD to help raise awareness of chronic diseases and the policies and practices that save lives and reduce health costs through more effective prevention and management of serious diseases and conditions.

Medicines also play an important role in helping reduce healthcare costs by helping keep patients suffering from chronic disease out of the hospital. More importantly, life-enhancing medicines can help patients win their battle against disease. Patients should know that America’s pharmaceutical research companies are currently developing more than 1,000 new medicines that help them combat chronic diseases such as cancer, heart disease and diabetes.

Above all else, we must find a comprehensive solution to tackle America’s uninsured problem. To help bridge the ever expanding healthcare gap, we believe there should be responsible healthcare reform that can help assure that all Americans have access to high-quality, affordable health insurance coverage. Expanding good coverage is critical to assuring patient access to better health care and financial security for uninsured and underinsured Americans.

Reflecting our continuing commitment to improve the health and well-being of all Americans, PhRMA recently unveiled its Platform for a Healthy America http://www.phrma.org/platform_for_a_healthy_america/ . The Platform includes a series of initiatives to reduce costs and improve the quality and value of patient care. It supports a dual approach that focuses on expanding private health insurance while improving access to public programs such as Medicaid and the State Children’s Healthcare Insurance Program.

We certainly face hefty challenges in the months and years ahead, but if we all work together, I believe we can find common sense solutions to the difficult healthcare issues in America. We look forward to working with all stakeholders and the next Congress and Administration on these very important issues.

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Health reform can and must be accomplished in a fiscally responsible way. As CBO Director Peter Orszag has noted, fixing health care is not just a human imperative, it is also the nation’s greatest economic reform opportunity. Key leaders, including Barack Obama, Senator Max Baucus, and Senator Kent Conrad, recognize that such reform is an essential part of economic recovery.

One clear impact from the financial crisis is that regulation, carried out responsibly, is no longer a dirty word. Because of non-regulation, the nation’s health insurance market for individuals has endured a decades-long market meltdown. Just one example: in most states it’s legal for an insurance company to deny coverage for pre-existing conditions – and in nine states it’s legal to deny coverage to a woman because of the precondition she was the victim of domestic violence.

The harm done to millions of Americans by current insurance industry practices has affected many more persons than the mortgage foreclosure crisis. But because these practices only harm middle and lower-income individuals and families – and not Wall Street titans – many look away, saying, what’s the big deal?

The problems facing our health care system are immense and have been ignored for too long. We can’t walk away from this challenge, and we won’t.

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I still expect a healthy debate about health reform in the new Congress, but any honest analysis would begin with the obvious: the economic meltdown makes the passage of comprehensive health reform legislation tougher. The meltdown and the budget pressures Congress will face increases the odds of incremental rather than sweeping legislation or that something might pass that will be phased in over a number of years. It increases the odds that nothing will pass as well. The problem is not so much the cost of the bailout, the additional payments on interest on the debt are not that large, but rather that preoccupation with economic issues as well as two wars will suck up all the available air and money on the issue agenda, pushing health reform to the side while the clock runs out on the short window of opportunity there will be to deal with health before the press of the next election cycle makes it too difficult.

For significant health reform legislation to happen the new president will need to make health and early and top priority and exercise strong and skillful leadership. The Congress and the President will have to find the new money to pay for expanding coverage in a very challenging budgetary environment, and in a form scoreable by the umpires at CBO. And most of all there will have to be an appetite for a bipartisan deal in the Congress that bridges the policy and ideological divide in health that has prevented action on health reform in Washington for many years.

Our tracking polls show that the American people view the problems they are having paying for health care and health insurance as one of their top economic issues, believe it or not ranking them ahead of problems like losing money in the stock market or paying the rent or mortgage or credit card debt. But you don't hear health care mentioned much in the context of economic rescue plans. If elected officials start to view dealing with health reform as the public does, as part of addressing the public's economic problems rather than as a separate competing issue, the odds of action - whether incremental or more than that - will go up.

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Voters, meanwhile, indicated in a new poll from the Marist College Institute for Public Opinion that they are willing to increase government debt to “deal with the health care crisis.” In a survey of about 800 voters nationwide in September, 78 percent said they were willing to accept more government debt.

Support from the Democratic side was higher (90 percent of Democratic respondents said they were willing), although even 67 percent of Republican voters and 73 percent of Independents agreed.

Most voters also said they preferred addressing health care to cutting taxes. A total of 81 percent of Democratic voters responded that they preferred “dealing with the health care crisis” to cutting taxes, and 56 percent of Republicans and 72 percent of Independents agreed.

Still, Marist gave no definition of what it meant to “deal with the health care crisis.” Does this mean lowering costs? Reducing the numbers of uninsured? Both? What do these results mean?

It’s clear that the national economy is deteriorating rapidly. The 2009 federal deficit baseline (not including any of the $1 trillion for the liquidity crisis) will start at $600 billion, and both CBO and OMB are likely to revise that baseline estimate significantly upward in January-February with the new budget submissions. Similarly, the fiscal situation in states is also deteriorating rapidly, and rather than expanding coverage, it is likely many states will have to enact significant cuts in Medicaid to address budget deficits.

Given these budget realities, and the fact that health care spending already accounts for nearly 1/6 of the nation’s GDP, it seems that the focus for the next President and Congress should be on implementing a small, incremental health care package that focuses on enhancing quality and making the delivery system more efficient. Alternatively, this means focusing on cost control not coverage expansions. This can be done by eliminating the fragmentation of the current system for Medicare and Medicaid dual-eligible populations and accelerating the implementation of health IT by providing appropriate federal standards as well as financial incentive for implementation. Specifically, such a package should address these elements:

Dual Eligible Problem – More than 7 million individuals, generally low-income, frail seniors and younger adults with disabilities, are insured by both Medicare and Medicaid. These individuals, known as dual eligibles, generally have lower incomes and need more assistance than other Medicare recipients, yet they are placed in a largely fragmented, uncoordinated and inefficient system of care. The different rules of the two programs lead to poor quality of care, confusion and cost shifting. It is unacceptable that these individuals, who are most in need of comprehensive and coordinated plans of care, are often those who receive the worst treatment our health system provides. Major reform in necessary, but as a simple first step. Congress needs to create a federal-state task force or working group to recommend administrative changes for this population based on a number of state and other demonstrations.

Health IT – Most experts agree that a fully operational electronic health care system in the U.S. will result in potentially significant savings in both the short and long term. The federal government needs to set certain standards or protocols and provide some incentives to states and the private sector to implement a system. Although regional groups, states, and hospital networks have had significant demonstrations, federal leadership is required to make the system operational.

Health Care Quality – The U.S. health care system has evolved into a system with different performance and quality standards for different federal programs. But one comprehensive system that implements consistent performance and quality measures across all payers and programs would improve system performance and result in patient-centered care, and, ultimately, better patient outcomes.

Such a package by necessity must be incremental but would enhance quality and reduce the rate of cost growth so that coverage expansions can be done when the federal and state fiscal situations improve.

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For millions of Americans, the economic crisis that our country is facing is tied closely to our health crisis. Approximately 46 million Americans don't have health insurance. Even for Americans with health insurance, insurance premiums are rising faster than wages. Small business owners and self-insured working families agonize over how to balance their budgets and still afford health insurance premiums. Catastrophic accidents and illnesses are forcing more American families into bankruptcy.

As the costs go up and up and up, it is clear: we can't afford to wait any longer to enact real health care reform.

Some say the best way to make sure that every American has health care is for the government to collect even higher taxes and then run the U.S. health care system. The government would tell doctors how much they could earn, it would tell you which doctors you could see, and a bureaucrat in Washington – not you and your doctor – would decide which services and procedures you could receive.

I think this is the wrong approach. The answer isn't for the government to take more of the people's money to pay for Washington-run health care. The answer is to reduce health care costs through substantial reforms, and then let you keep more of the money you earn so you can choose the health care plan you want and need.

The federal government is spending too much money. Deficits are high. Congress recently approved a $700 billion bailout plan. This is not the time to create another large, wasteful, expensive federal bureaucracy to run our health care system. Instead, we need to be looking at ways to getter better value when we purchase health care. We need to promote more innovation and work collaboratively with the government and the private sector to encourage the use of health information technology, adopt preventive care, and promote higher quality and medical justice reform. We need to make health insurance more affordable through market-based reforms, and not ask the taxpayers to fork over more money to the federal government.

I have introduced a comprehensive plan, 10 Steps to Transform Health Care in America, to make sure that every American can have the health care coverage they need. I urge you to visit my website, enzi.senate.gov, to learn about my proposal. My plan isn't free, but it's affordable. We could enact any one of these steps today and produce real results tomorrow. If we enact each step, we can ensure access to affordable health care for every American.

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It's all well and good in the middle of a financial and budgetary crisis to say that now more than ever we must strengthen our commitment to health expansion. I'm sure that there are blogs being written right now urging the same recommitment to spending on education, on renewable energy, on infrastructure, you name it.

But it borders on the delusional, I'm afraid, to argue that we should just plunge forward in the current climate, making commitments and just hoping we can find those constantly elusive savings and efficiency that will cover the cost. Or that new health programs themselves will somehow pay for themselves through health improvements. That is the health care equivalent of "tax cuts will pay for themselves" – a view that would be no doubt be derided by most commentators on this blog.

Faced with almost unprecedented fiscal and economic constraints, the first course of action should be to take steps to make sure we spend existing resources in a far more targeted and rational way. Let's start with the tax side. We spend over $200 billion annually in health tax breaks that give most help to upper-income income households with already generous coverage. You may not like the way McCain would fix this, but let's at least commit to retargeting that tax expenditure to those who really need it.

Move on next to the Medicare drug benefit. Does Warren Buffet really need 75% of the cost of his prescriptions paid for by the rest of us, or can we reshape that enormously expensive program to improve coverage for less fortunate people? Rather than wring our hands that costs for certain Medicare procedures in Florida are almost double those in Iowa, with no discernibly better outcome, maybe it is time to face down the provider lobbies and shift resources to better uses. And isn't it time to give states the ability to let the states propose more radical changes in programs to meet clear goals for coverage improvements? In difficult financial times, the wisest first step is to redeploy the resources you have, not spend money you haven't got.

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One has to assume that the impact of the financial crisis on the American public will be significant. For many individuals, the numbers are yet unknown, but it will likely mean the loss of jobs and employer-related health coverage, the loss of personal wealth and the ability for individuals to cover their out-of-pocket costs, and possibly even diminished access to health care services as practitioners and providers experience fallout from the crisis as well.

Now cannot be the time, therefore, that the nation says it cannot afford to reform health care and provide greater support for those most in need. This is exactly the sort of non-health care originated event that will point out the shortcomings of the current model and call out the need for a national commitment to action. Through the AHA, the nation’s hospitals have been calling for responsible reform and stand ready to help fashion a comprehensive and coordinated strategy to achieve it.

As a top priority, the nation needs consensus on a long-term vision for health reform. Agreement on the major elements of such a vision and the sequencing of steps to achieve the vision would be a major accomplishment. The first and most immediate step of any such framework, however, must be the reauthorization and expansion of SCHIP early next year. From there we can begin to work toward financing and delivery system reform as well as greater coverage and access in ways that extend to more people.

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Health care reform is a priority for the American Medial Association, and we hope to see action by Congress and the next president to increase the number of Americans with health insurance coverage next year. In difficult economic times the problems of the uninsured become even more apparent and are harder to ignore, since access to health care for many Americans is closely tied to the economy. Most privately insured Americans get health insurance through an employer, but as unemployment rises, many are left with few options for health coverage. Recently, the nation's unemployment claims reached the highest level in the past seven years. The most common reason patients have become uninsured this year is because they or someone in their family lost their job.

The cost of doing nothing to reform the nation's health care system is much higher than the alternative. Too often uninsured patients don't get the preventive care they need leading to more difficult and more costly conditions to treat. They live sicker and die younger. The uninsured problem affects each and every one of us, whether it's through limited access to health care or higher health care costs.

They aren't nameless, faceless and forgotten. I know. Once, I was one of them. When I attended graduate school, I was uninsured for two pregnancies. Without coverage, my only option was for my two children to be delivered through public health clinics. When my 14-month-old daughter came down with a fever of nearly 106 degrees, I had to take her to Children's Hospital's emergency department, and because there was no health insurance I was asked to pay before she was admitted to an examining room. For the rest of the month, I had no money for food for my kids. If this can happen to me, it can happen to anyone.

The AMA has a proposal for health care reform that we are sharing with the presidential candidates and members of Congress. Our plan centers on providing more choice to individuals and families, and would give low-income Americans tax credits to purchase coverage. We want to establish fair insurance rules that include protections for high-risk patients and a greater level of individual responsibility. Our plan could be implemented incrementally or in a more comprehensive fashion. For example, the AMA supports individual tax credits for specific target populations and capping the tax exclusion for employment-based health insurance as incremental steps toward implementing our proposal. Reflecting the economic realities and budget constraints by Congress and the next president, the AMA has also suggested ways to fund our plan. Find out more about the AMA proposal at: www.voicefortheuninsured.org.

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The core lesson of the Wall Street meltdown could not be more clear: The longer we wait, the longer we do nothing, the worse it gets.

What's also clear now after all the debate around the bailout bill is that finding the resources to address the problems in this country is really just a question of priorities. Washington has so far prioritized Wall Street over Main Street, and taxpayers and working families will not only foot the $700 billion bill—they'll continue to suffer the consequences.

We have a moment here to imagine a different kind of America.

Will we be a country where people who work hard are forced to choose between paying the rent, buying food, or visiting the doctor? Will we continue to live with the fear that one injury, one illness, or one accident will mean total economic ruin? Or will we demand that every man woman and child has the peace of mind that comes with access to quality, affordable health care?

Making health care more affordable would mean real economic relief for American families struggling to fill their gas tanks and American companies struggling to remain competitive in the global marketplace. Health care costs are already rising at almost double the rate of wage increases for the average American worker, and small businesses are increasingly unable to afford the cost of providing health care coverage to their employees—less than half offer insurance to their employees now. Instead of talking about how impossible it will be to win health care reform now that our economy's in crisis, we should be talking about how impossible it is to continue on the road we're on without making some major changes.

Now more than ever, the cost of doing nothing is simply too great. That's why SEIU and our Change to Win partner unions have proposed a "Main Street" economic recovery plan—at half the cost of the bailout bill—that would launch a new era of hope for working families. Our proposal calls for the country to invest in programs that would improve the lives of tens of millions of hardworking people—including a national health care plan.

We've been talking about the health care crisis in this country for far too long while doing far too little to address the problem. It's time to walk the walk. If we don't, we can be sure the next meltdown America faces will begin in our emergency rooms.

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As we face this financial crisis, it is critical to remember that we also facing a crisis in our health care system. Between 1999 and 2007 the number of uninsured Americans jumped 20 percent. As noted, there are 46 million uninsured today. If there is a serious economic downturn over the next few years, the loss of jobs and employer-sponsored health insurance coverage will mean even more families will struggle with medical bills and go without needed care.

We must recognize that investing in our health care system will pay off in the near- and long-term by helping to keep the American workforce healthy and American families economically stable. What's more, the Commonwealth Fund has estimated that insuring all Americans, if coupled with initiatives to improve health system performance, will ultimately save $1.6 trillion dollars over 10 years. These savings could be achieved through reforms such as implementing health information technology, improving primary care and care coordination, and changing providers' financial incentives so that we reward quality care rather than services.

In the current economic environment, we should approach reform in phases, starting with the highest-value initiatives. The first phase could include expanding the State Children's Health Insurance Program to cover all uninsured children to ensure a healthy workforce for the future. The initial phase could also involve reforms to improve effectiveness and efficiency, such as improved information systems, the establishment of a center for comparative effectiveness, and the dissemination of medical homes, or a usual source of care, to improve access to preventive and chronic disease care and better coordinate care.

The American people have called for an overhaul of the health system. We need a President and a Congress that will make health system reform a priority and work together to ensure more Americans have access to affordable, high-quality care that is delivered efficiently.

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Health reform and coverage is something we cannot afford not to do. As more and more people lose coverage the rest of us cover their emergency and acute care costs in our insurance rates. We are all in this together. Senator Obama could certainly begin by expanding SCHIP(the Children's Health Insurance Plan) where there is bipartisan support and begin the discussion with Congress about a framework for health reform. Most of us believe it is very hard to get significant cost savings without universal coverage.

First, Obama's plan is not going to cost $50 to $60 billion a year. It would cost three times that amount. Remember, Obama is promising people who do not get insurance from an employer they will get the same kind of coverage federal employees have (cost = about $12,000 per family).
Also, Obama is promising that the insurance will be affordable (which to his friends and supporters means premiums can be no more than 5% to 10% of income).

Second, even if there were no economic crisis, Obama has proposed no credible source of funding. Originally he said he would get $60 billion a year from repealing the Bush tax cuts for the rich. But now his economic advisors have completely caved and are promising a tax rate on dividends and capital gains of no more than 20%. Although Obama has talked about a payroll tax on the rich, his advisors now assure us that would be a decade away.

So yes, of course. With or without an econoimc bailout bill, there is no credible way to fund this plan -- unless you impose large taxes on the middle class.

By contrast the McCain plan is revenue nuetral, or mainly revenue nuetral. So it is doable, regardless of overall financial problems.

The best way to understand Senator Obama's views on health care in the context of the current economic crisis is to quote him directly. He spoke to this issue both during his first debate with Senator McCain, and again on Saturday, October 4, in Newport News, Virginia.

"Now I know that at this moment, when we stand in the midst of a serious economic crisis, some might ask how we can afford to focus on health care. Well, let’s be clear: the rescue package we just passed in Congress isn’t the end of what we need to do to fix our economy -- it’s just the beginning. Because the fundamentals of our economy are still not strong -- contrary to what Senator McCain says. And we’ve got to address those fundamentals -- and address them right now.

In other words, the question isn’t how we can afford to focus on health care -- but how we can afford not to. Because in order to fix our economic crisis, and rebuild our middle class, we need to fix our health care system too. Let’s not forget, it’s not just small businesses and families who are struggling. Some of the largest corporations in America -- including major American auto manufacturers -- are struggling to compete in the global marketplace because of high health care costs. They’re watching their foreign competitors prosper -- unburdened by these costs -- as they struggle to create the good jobs we need to get our economy back on track.

So it’s clear that the time has come -- right now -- to solve this problem: to cut health care costs for families and businesses, and provide affordable, accessible health insurance for every American."

In other words, there can and will be no backing away from the commitments that Senator Obama has made during this campaign. The funds necessary to expand coverage to the currently uinsured constitute a downpayment on a comprehensive solution to our growing health care crisis. That crisis is intimately linked to our overall economic problems. Our competitiveness in the world economy suffers because of our uncontrolled health care spending, and we cannot, in good conscience, address the cost problem without also assuring -- at the same time -- that all Americans have access to essential health care services. We need to see beyond the confusion created by our financial turmoil to fundamental solutions. Comprehensive health reform is a necessary foundation for a revived and stable economy.

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These last few weeks have been a sobering reminder about the interdependence of various sectors of the economy. Turbulence in the financial sector has been spilling over into other sectors of the economy, with overnight borrowing rates equal or greater than 30 year mortgage rates and some short turn returns approaching zero so as not to put at risk the base amount, making borrowing for short term business needs somewhere between chaotic and impossible. The Congress has now passed a $700 billion rescue package-or bailout-depending on your point of view. This, along with a $400 billion deficit, is going to make all new spending programs a challenge for the next Congress.

Although it is hard to tell from a lot of the media coverage, health care reform includes so much more than only expanding insurance coverage, as important as that is, particularly for those who are uninsured and also for the communities where they live. Focusing on ways to make health care and insurance more affordable has always been important since increasing health care spending is one of the major predictors of increased numbers of people with health insurance coverage, moderating health care spending would make coverage expansions so much easier and because increased levels of health care spending are having such negative effects on wages and government budgets. The current economic environment makes this focus even more urgent.

Senator McCain has made improving reimbursement under Medicare and Medicaid, including realigning financial incentives to encourage a focus on outcomes, collaboration and care coordination, greater transparency in pricing and quality, increased focus on disease management, particularly for chronic diseases and improving programs for wellness and prevention by improving our public health infrastructure and investing in early intervention programs as important a part of his health care reform as changing the way people are subsidized to purchase their insurance.

Come 2009 and the newly elected President begins working with a newly elected Congress to consider ways to implement health care reform, it’s hard to believe that these economic "facts of life" won’t make themselves felt.

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