Friday, November 21, 2008

• Kaiser Daily Health Policy Report Highlights Recent Developments Related To Health Care Overhaul Efforts

 

Kaiser Daily Health Policy Report Highlights Recent Developments Related To Health Care Overhaul Efforts
[Nov 21, 2008]

      Summaries of several recent developments related to health care overhaul efforts appear below.

• Congressional players: Congressional Democrats who hope to pass health care reform legislation next year will have to "walk a fine line as they seek to work together on what promises to be a historic legislative endeavor," as many of the "key players in the debate" have a "storied history of attempting to elbow others out of the way," Roll Call reports. Some of the important players include former Senate Majority Leader Tom Daschle (D-S.D.), whom President-elect Barack Obama reportedly plans to nominate as HHS secretary; Senate Finance Committee Chair Max Baucus (D-Mont.); Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.); and Sens. Hillary Rodham Clinton (D-N.Y.) and Ron Wyden (D-Ore.). According to Roll Call, despite certain tendencies, "most of the power players and their aides say everyone is mindful of the need to play nice to avoid the pitfalls of the Clinton administration's failed universal health care plan, when Democratic infighting allowed Republican opponents to define the issue and sink the proposal" (Pierce, Roll Call, 11/21).
  
  
• Kennedy: Kennedy, despite his recent diagnosis of incurable brain cancer, has returned to Capitol Hill "on a mission that so far has proved impossible: enactment of comprehensive health care legislation that would provide coverage for the nation's estimated 47 million people who don't have health insurance," USA Today reports. According to USA Today, "Kennedy's reappearance" after a seizure and subsequent brain surgery "sets up a potentially dramatic race against time as he seeks to cajole the notoriously slow-moving Senate into delivering the capstone of his four-decade legislative career." Congressional Democrats "are approaching health care reform cautiously," with some "urging a go-slow approach," but increases in health care costs and the number of residents without health insurance are "creating momentum for action," according to USA Today (Kiely, USA Today, 11/21).
  
  
• Peter Orszag: Former Congressional Budget Office staffers on Thursday appeared divided over whether agency director Orszag's potential move to head the Office of Management and Budget "would move the ball forward on overhauling health care or push it back," CQ HealthBeat reports. But they "agreed that the appointment would be a strong addition" to "Obama's inner circle as it confronts the twin challenges of a faltering economy and a dysfunctional health care system" and that "Orszag could prove to be a forceful advocate for controlling Medicare spending," according to CQ HealthBeat. CQ HealthBeat reports that Orszag, whom Obama reportedly plans to name as OMB director, could have a role in health care overhaul efforts and "could be a big player" on efforts to link spending and quality of care under Medicare (Reichard, CQ HealthBeat, 11/20).
  
  
• Pay-go rules: Pay-go rules should not delay efforts by congressional Democrats to pass comprehensive health care overhaul legislation next year, House Ways and Means Committee Chair Charles Rangel (D-N.Y.) said on Thursday, CQ Today reports. According to Rangel, the passage of health care overhaul legislation is more important than concerns about the effect of such legislation on the federal budget deficit. His position "suggests that Democrats will see a major overhaul of health care laws as important enough to circumvent" pay-go rules, but some Republicans have "expressed concern" about that prospect, according to CQ Today (Wayne, CQ Today, 11/20).
  
  
• Technology companies: Expectations for health care overhaul next year and a "desire of governments worldwide to drive costs of national health systems" have prompted more tech companies to "bet on health care and what many of them see as a lucrative -- but relatively untapped -- market," an "opportunity that tech companies underestimate at their own peril," Reuters reports. According to Reuters, a number of tech companies that previously had limited or no connection to health care have begun to develop tools to reduce health care costs and improve patient care. Andrew Rocklin, an analyst at Diamond Management & Technology Consultants, said, "Health care is a $2.5 trillion market in the United States alone," adding, "Anybody who chooses not to participate could be giving up a potentially large amount of revenue" (Kahn, Reuters, 11/21).
  
  
• Town hall meetings: PricewaterhouseCoopers and the National Association of Children's Hospitals and Related Institutions on Thursday hosted a series of town hall meetings in a dozen locations nationwide to discuss the top priorities for health care overhaul, the San Francisco Chronicle reports. According to meeting participants, the "central challenge" is the development of proposals to "fix a monumentally complex and costly health system amid a nose-diving economy," the Chronicle reports. The meetings coincided with the release of a survey by the groups that found U.S. residents cite efforts to reduce costs as their top health care priority, while health industry leaders prioritize expanded access to coverage, according to the Chronicle. The survey included 1,800 respondents, including 800 policymakers and health industry executives (Fernandez, San Francisco Chronicle, 11/21).

Opinion Pieces
Summaries of several recent opinion pieces related to health care overhaul appear below.

• Gerald Seib, Wall Street Journal: The "opportunities for the Obama administration to drive through its agenda" on health care and other issues "actually are getting better" as the "economic signs grow ever more grim," Journal columnist Seib writes. He writes, "The thing about a crisis ... is that it creates a sense of urgency." According to Seib, as a result of the current economic downturn, thousands of U.S. residents will lose their jobs and employer-sponsored health insurance and "swell the ranks of the nation's uninsured." He adds, "That will add a bit of rocket fuel to the Obama call for universal health coverage" (Seib, Wall Street Journal, 11/21).
  
  
• David Sirota, San Francisco Chronicle: "Based on advertisements, Obama identified no more important priority than guaranteeing health care for all citizens," Sirota, a fellow at the Campaign for America's Future and a board member of the Progressive States Network, writes in a Chronicle opinion piece. He writes, "The moral case for universal health care is obvious," adding, "In the world's richest country, ... 18,000 people die each year because they lack health insurance." According to Sirota, "We permit this annual massacre while our wasteful system exacerbates our debt and saps our economic competitiveness by forcing us to spend more money per capita on health care than any other nation." He writes, "That said, if morality alone prompted solutions, this problem would have been addressed long ago." Sirota adds, "While some claim the deficit should preclude bold health care legislation, it's the other way around," and "as with everything in Washington, a political motive is needed for action -- and even conservatives acknowledge Democrats have such a motive when it comes to health care" (Sirota, San Francisco Chronicle, 11/21).
  
  
• William Snyder, Wall Street Journal: Obama as president "will almost certainly move quickly toward some form of government-provided -- and possibly government-mandated -- health insurance," Snyder, a policy adviser to the Heartland Institute, writes in a Journal opinion piece. He adds, "A principal reason for this is the oft-cited figure of 46 million uninsured U.S. residents," but the "notion that there are 46 million Americans who can't get the health care they need for lack of money or public assistance is a myth." Snyder writes that the "other two common misperceptions are that the uninsured don't get health care and that when they do they're 'free riders,' i.e., they don't pay for the care they get." According to Snyder, "Perhaps we should look for ways to encourage the millions of people who are currently eligible for existing government programs to enroll before we expand programs to include people that may not need assistance" (Snyder, Wall Street Journal, 11/21).

Broadcast Coverage
PBS' "NewsHour with Jim Lehrer" on Thursday examined the obstacles that Obama might face in health care overhaul efforts. The segment includes comments from Uwe Reinhardt of Princeton University, Stuart Butler of the Heritage Foundation, Karen Ignagni of America' Health Insurance Plans and Chris Jennings, a former White House health care adviser (Woodruff, "NewsHour with Jim Lehrer," PBS, 11/20).

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Rep. Waxman Expected To Act on Health Care, Energy, Environment as New Chair of House Energy and Commerce Committee
[Nov 21, 2008]

      The Democratic Caucus on Thursday voted 137-122 to name Rep. Henry Waxman (D-Calif.) as the new chair of the House Energy and Commerce Committee "in a coup that is expected to accelerate passage of energy, climate and health legislation backed by President-elect Barack Obama, the New York Times reports. Waxman will replace current Chair John Dingell (D-Mich.), who has held the position for 28 years (Broder, New York Times, 11/21).

According to the Wall Street Journal's "Health Blog," Waxman's takeover is a "big deal for the health care world because the committee will be one of the key power centers for any big health care reform bills" (Goldstein, "Health Blog," Wall Street Journal, 11/20). The AP/Atlanta Journal-Constitution reports that Waxman is an "avid environmentalist and booster of health care programs" (Taylor, AP/Atlanta Journal-Constitution, 11/20). According to CongressDaily, he is "set to play a leading role in crafting health care legislation" and other measures "sought by the incoming Obama administration" (Friedman/Bourge, CongressDaily, 11/20). The panel also is "a central player in Congress' relations with the drug and [medical] device industries," according to the Journal's "Health Blog" ("Health Blog," Wall Street Journal, 11/20).

After the vote, Waxman said, "The argument we made was that we needed a change for the committee to have the leadership that will work with this administration and members in both the House and the Senate in order to get important issues passed in health care, environmental protection, in energy policy" (AP/Atlanta Journal-Constitution, 11/20). House Speaker Nancy Pelosi (D-Calif.) said she expects Waxman to achieve "progress toward making America energy independent, making health care available to all Americans and addressing the greatest challenge of our time, global warming" (Ivanovich/Powell, Houston Chronicle, 11/20).

Editorial
Dingell's "fall from power ... is an important inflection point in the history of the modern Democratic party," and "it is symbolic of the party's change in culture and policy priorities in the Barack Obama era," a Journal editorial states. It continues, "It's obvious who now pulls the Democratic levers of power, and anyone in the energy or health care business had better erect the barricades" (Wall Street Journal, 11/21).

Broadcast Coverage
CNN's "Newsroom" on Thursday reported on Waxman's victory (Bash, "Newsroom," CNN, 11/20). A transcript is available online.

PBS' "NewsHour with Jim Lehrer" on Thursday also reported on the vote (Holman, "NewsHour with Jim Lehrer," PBS, 11/20).

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Bipartisan Group of Senators Opposes Proposed Rule That Would Require Tricare To Use Medicare's Reimbursement System for Outpatient Hospital Care
[Nov 21, 2008]

      A bipartisan group of 55 senators has signed a letter asking the Department of Defense to reconsider a proposed rule for the military's Tricare health insurance program that would require hospitals that treat Tricare beneficiaries to use the same reimbursement system for hospital outpatient services as Medicare, CQ HealthBeat reports. The letter will be sent to U.S. Defense Secretary Robert Gates and Office of Management and Budget Director Jim Nussle.

In the letter, proposed by Sen. Ben Nelson (D-Neb.), the senators offered their support for the basic premise of the proposed rule but voiced concern that the current proposal "lacks a broad, effective transition" that would prevent any inconvenience to program beneficiaries during the policy transition. The senators wrote, "Sudden and severe shifts in payments as have been proposed by DOD could jeopardize providers' ability to care for Tricare patients," adding, "To prevent such disruptions to quality of and access to care, it is crucial that such new payment policies be implemented with a meaningful transition period."

Sens. James Inhofe (R-Okla.), John Cornyn (R-Texas), Edward Kennedy (D-Mass.), Chuck Schumer (D-N.Y.), Lindsay Graham (R-S.C.) and Jim Webb (D-Va.) are among those who already have signed the letter (Weyl, CQ HealthBeat, 11/20).

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Democrats Postpone Work on Economic Stimulus Package Until January 2009
[Nov 21, 2008]

      Congressional Democratic leaders on Thursday said they will postpone work on an as much as $150 billion economic stimulus package until January 2009, the Wall Street Journal reports (Reddy, Wall Street Journal, 11/21).

Senate Democrats on Monday introduced a $100.3 billion stimulus package (S 3689) that included $37.8 billion in additional federal Medicaid funds for states and $1 billion in additional funds for NIH, among other provisions (Kaiser Daily Health Policy Report, 11/18). In September, the House approved a $60.8 billion stimulus package that included $14.7 billion in additional federal Medicaid funds for states and $1.2 billion in additional funds for NIH, among other provisions, but the package failed to pass in the Senate (Kaiser Daily Health Policy Report, 9/29).

Congressional Democrats "don't appear to have enough support for a major stimulus program before January," as Republicans have raised concerns that such a package would increase the federal budget deficit unnecessarily and would not help the economy in time, according to the Journal.

Rahm Emanuel, chief of staff to President-elect Barack Obama, said that the new administration would make the enactment of a stimulus package the "first order of business" next year. "Obama has indicated a willingness to set aside concerns about deficit spending in the short run to restore the economy," the Journal reports (Wall Street Journal, 11/21).

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Massachusetts Hospitals Respond to Boston Globe Investigation of Insurance Payment Discrepancies
[Nov 21, 2008]

      Citing a recent Boston Globe investigation, officials from some large academic medical centers and community hospitals in Massachusetts this week sent a letter to Gov. Deval Patrick (D) requesting an investigation into how some hospitals in the state receive higher payments from insurers, even though there are no obvious differences in the quality of care that those hospitals provide -- especially for the most common procedures, the Boston Globe reports (Krasner, Boston Globe, 11/20).

According to an ongoing investigation by a Globe Spotlight Team, a recent review of private insurance data found that some hospitals in the state receive payments from insurers that on average are about 15% to 60% more than payments for the same procedure at competing hospitals. The hospitals that receive the highest rates are those that have the bargaining clout -- often based on a powerful brand name and elite reputation or geographical location -- to demand higher insurance payments (Kaiser Daily Health Policy Report, 11/17).

In the letter, Marshall Carter, chair of the Boston Medical Center, said that the Globe article "shone a very important light on the widening inequities in our health care system." He wrote, "The disparities in payments from private insurers to certain favored providers without a clear connection to quality or greater cost efficiency should trouble us all," adding, "The Globe Spotlight article demonstrated that so-called 'supplemental' payments do, in fact, come in different forms. For large and powerful hospitals that care for patients with higher incomes and the best insurance plans, those subsidies come in the form of higher payments from private insurers."

Ellen Zane, president and CEO of Tufts Medical Center, wrote, "Clout, over anything else, has driven insurers to disproportionately and inappropriately pay some providers more than others." She continued, "There are huge imbalances in this market -- not just between teaching hospitals and community hospitals, but among the various teaching hospitals," adding, "Tufts Medical Center offers the same (advanced) services as [Children's Hospital Boston] and Partners HealthCare, but is paid at unsustainably low reimbursement rates -- well below our real costs."

Paul Levy, CEO of Beth Israel Deaconess Medical Center, wrote, "We had heard talk about these payment differentials before, but to see them in black and white is startling and discouraging for those of us who are pursuing a quality and safety agenda."

In a statement, Rich Copp -- a spokesperson for Partners, which according to the Globe has been the "greatest beneficiary" of the payment discrepancies -- said, "We agree that there is a health care cost crisis, but it is not unique to Massachusetts," adding, "While we take exception to a number of points that were made (in the Globe report), including the use of outdated data to compare the quality of patient care, we welcome a dialogue on these issues, and believe the community will benefit from an honest and open discussion of all sides."

Consumer Web Site
In related news, the state Health Care Quality and Cost Council on Wednesday approved the development of a new Web site that is scheduled to be launched next month and that will include hospital payment data from insurers and hospital rankings based on quality measures for dozens of inpatient and outpatient procedures, the Globe reports (Boston Globe, 11/20).

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Pennsylvania Gov. Rendell Extends Health Care Cost Containment Council Set To Expire Nov. 30
[Nov 21, 2008]

      Pennsylvania Gov. Ed Rendell (D) on Wednesday announced that he has extended through June 30, 2009, an executive order that allows the Pennsylvania Health Care Cost Containment Council to continue operating, the Philadelphia Inquirer reports. Without the extension, PHC4 -- which collects records on millions of hospital visits and outpatient procedures to help rein in health care spending -- would have been shut down at the end of this month. The state Legislature will have the opportunity to renew PHC4 when it convenes in January.

Rendell said, "PHC4 has been responsible for a lot of very, very important advances in the health care delivery system," adding, "I have the power to extend their life span, and I did just that." Pennsylvania Chamber of Business Director of Government Affairs Sam Denisco said, "We are pleased that the governor has essentially given new life to the council" (Goldstein/Worden, Philadelphia Inquirer, 11/20). Rendell noted that the agency should reduce its $5.3 million budget by 4.25% -- the same amount other agencies must cut because of a state budget shortfall (Pittsburgh Post-Gazette, 11/20).

In related news, Rendell reiterated his pledge not to approve an extension of a program that provides medical malpractice insurance assistance for doctors until his health insurance proposal is approved. The state House on Wednesday, the last day of its 2008 session, rejected a measure to extend the abatement program (Philadelphia Inquirer, 11/20).

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Kaiser Daily Health Policy Report Highlights News About State Budgets
[Nov 21, 2008]

      Summaries of recent news about state budgets in Nevada, New York, Virginia and Washington state appear below.

• Nevada: The state budget office on Friday warned state agencies to prepare for an additional 20% budget reduction in the upcoming two-year budget cycle, the Nevada Appeal reports. According to the memo from state Director of Administration Andrew Clinger, the plans are to give the administration an idea of the impact of budget reductions. The warning follows the Thursday announcement by the office that state agencies should prepare plans to reduce their budgets for the current fiscal year by up to 11% for a total of $358 million. The agency budgets already have been reduced by 14%, and if the additional cuts are ordered, the budget will be two-thirds the amount originally approved by the state Legislature and governor for the current fiscal year. In all, the reductions, if ordered, would reduce the state Health and Human Services Department budget by $705.8 million (Dornan, Nevada Appeal, 11/16).
  
  
• New York: Gov. David Paterson (D) and state lawmakers on Tuesday were unable to reach an agreement to cut $2 billion in spending during an emergency session of the state Legislature, the Rochester Democrat and Chronicle reports. They agreed to wait until Paterson releases his FY 2010 budget on Dec. 16 before considering any cuts during the current fiscal year. Lawmakers still have the option of coming back after that time and before 2009 to make cuts; however, Paterson suggested cuts might not occur until the new session begins, when Democrats are expected to take control of the state Senate. According to Paterson, at the beginning of 2009, the state will be faced with an estimated $15 billion budget gap and a $47 billion budget gap over the next four years. Paterson has proposed cutting $527 million from health care programs (Spector, Rochester Democrat and Chronicle, 11/18).
  
  
• Washington state: State lawmakers on Wednesday said that the newly projected $5 billion budget gap in the next two-year budget will have to force cuts and possible measures to increase revenue, the Seattle Times reports. The governor's budget office informed state agencies that they should prepare for deep budget cuts. State Department of Social and Health Services spokesperson Thomas Shapley said that the agency has been anticipating such a possibility, adding that there are three areas where the agency could make cuts: in provider payments, by reducing benefits and by limiting eligibility. The agency also is considering laying off employees (Garber, Seattle Times, 11/20).

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Newspapers Look at Potential Physician Shortages in Several States
[Nov 21, 2008]

      Summaries of articles about physician shortages in several states appear below:

• Florida: Florida will need 63% more primary physicians within the next 10 years to avoid a shortage, according to the American Academy of Family Physicians, the South Florida Sun-Sentinel reports. The state faces the third-largest physician shortage in the nation. According to the Sun-Sentinel, surveys show that more students are choosing "specialties with regular hours and fewer late-night calls," as well as those with higher pay. In 2006, 8.7% of medical school graduates in Florida entered family medicine, compared with the national average of 9.5%, according to AAFP. The group reports that nationally, the percentage of students entering family medicine has declined by about half over the past decade. AAFP President Ted Epperly said, "America won't be cared for properly by having a million radiologists and dermatologists." He added, "We're producing the wrong doctor work force for America" (LaMendola, South Florida Sun-Sentinel, 11/17).
  
  
• Maine: The Bangor Daily News on Wednesday examined the shortage of rheumatologists in Maine. According to Sidney Block -- one of about a dozen rheumatologists in the state -- specialized care for osteoarthritis, rheumatoid arthritis, lupus, gout, chronic fatigue syndrome and Sjogren's syndrome will be difficult to find unless the problem is addressed. According to Block, several factors are contributing to the shortage. He said that the specialty does not pay as well as some others and that rural states such as Maine have more difficulty recruiting new physicians (Haskell, Bangor Daily News, 11/19).
  
  
• Texas: Texas will need an additional 40,000 doctors by 2025 to keep up with a growing population, particularly among Hispanics, the San Antonio Express-News reports. About 20,000 of the 37,000 doctors currently practicing in Texas will have retired or left their practices over the next 17 years, Karl Eschbach, state demographer and director of the Institute of Demographic and Socioeconomic Research, said Thursday at the San Antonio Hispanic Chamber of Commerce Third Annual Health Care Summit. Access to care is a particularly "dire" issue for Hispanics, who often work for small businesses and are disproportionately uninsured, the Express-News reports. Hispanics make up the largest group of uninsured people in Texas border cities. About 66% of Hispanic workers are employed by companies that provide employer-sponsored health insurance, Roland Angel, professor of sociology at the University of Texas-Austin, said. In comparison, more than 80% of blacks and whites have employer-sponsored health insurance (Poling, San Antonio Express-News, 11/14).

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Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries
[Nov 21, 2008]

      While mainstream news coverage is still a primary source of information for the latest in policy debates and the health care marketplace, online blogs have become a significant part of the media landscape, often presenting new perspectives on policy issues and drawing attention to under-reported topics. To provide complete coverage of health policy issues, the Kaiser Daily Health Policy Report offers readers a window into the world of blogs in a roundup of health policy-related blog posts. "Blog Watch," published on Tuesdays and Fridays, tracks a wide range of blogs, providing a brief description and relevant links for highlighted posts.

The American Prospect's Ezra Klein suggests how the insurance industry could be treated in the reform of the health care system. He asserts that the "fundamental problem" with U.S. health care is the cost of care itself, not coverage.

Dean Baker on The Guardian's Comment Is Free argues that the U.S. government should "spend large amounts right now" to get the "health care system in order," which he says also would help boost the economy.

Health Populi's Jane Sarasohn-Kahn looks at a new report from the International Foundation of Employee Benefit Plans that found 64% of employers surveyed think employer-sponsored insurance should continue to be the primary source of the benefit for employees.

Brian Klepper on The Health Care Blog says that businesses should unite in a "common interest" for health care reform that could "overwhelm" any health care industry opposition.

Merton Bernstein on the National Academy for Social Insurance's Policies to Promote Economic Security for Families blog looks at the difference in administrative costs between Medicare and private insurers, saying the differences "argue for locating insurance where it costs least."

Joanne Kenen on the New America Foundation's New Health Dialogue looks at a study in the International Journal of Health Services that found the uninsured are about 20 times more likely to donate a liver or kidney than to receive one.

Anna Wilde Mathews of the Wall Street Journal's Health Blog looks at COBRA and reports many employees have difficulty affording their employer-based policy after losing their jobs.

Several bloggers commented on President-elect Barack Obama's reported choice of former Senate Majority Leader Tom Daschle (D-S.D.) for secretary of HHS:

• Igor Volsky on the Center for American Progress Action Fund's Wonk Room points to Daschle's support of a "federal health board," along with his proposals to strengthen Medicaid, provide more federal subsidies for purchasing health insurance, increase the value of care and improve the health care infrastructure.
  
  
• Merrill Goozner of Gooz News says, "President-elect Barack Obama sent a clear signal that he is serious about pursuing health care reform legislation in the new year. Whether it will be comprehensive reform or piecemeal improvements remains to be seen."
  
  
• Bob Laszewski on Health Care Policy and Marketplace Review says, "A Daschle appointment would make clear that President-elect Obama does not intend to cede this process entirely to the Congress. It would also indicate that it will be HHS that will take the health care policy lead on behalf of the administration -- not White House staff."
  
  
• Jonathan Cohn of the New Republic's The Plank calls HHS secretary the "perfect role" for Daschle, noting that Daschle's book on health reform "urges precisely the sorts of reforms President-elect Obama and his congressional allies are promoting right now."

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Roll Call Opinion Pieces Address Health Care Reform, Other Issues Obama Administration, Congress Should Address in 2009
[Nov 21, 2008]

      Roll Call on Tuesday published several opinion pieces about health care reform and other issues that the new Obama administration and Congress should address next year. Summaries appear below.

• Former Sens. Howard Baker (R-Tenn.)/George Mitchell (D-Maine): U.S. residents next year seek action from the federal government on health care and other issues, not "bickering and backstabbing," Baker and Mitchell, co-founders of the Bipartisan Policy Center write. They write that the center has begun several policy products, one of which focuses on health care, and plans to release recommendations in January 2009 to address the "Four Pillars of Health Care Reform." According to Baker and Mitchell, the pillars include the need to protect and improve the quality and value of health care; affordable health insurance choices in an improved market; ensure and promote a strong individual role in coverage and costs; and secure a mechanism to finance the system (Baker/Mitchell, Roll Call, 11/20).
  
  
• Former Rep. Tom Delay (R-Texas): "Surely Obama would love to be the president who finally delivers" health insurance to all U.S. residents funded by the federal government as part of his agenda for next year, but whether U.S. residents would "really stomach the tax hikes necessary to afford such a move" remains questionable, Delay, who served as House majority leader from 2003 to 2005, writes. Delay cites the need to address economic issues before health care and other concerns. He adds that, "if socialized health care, tax hikes or taxpayer-funded partial-birth abortions arrive before the economy does get better, well, honeymoon over" (DeLay, Roll Call, 11/20).
  
  
• Former Sen. Bill Frist (R-Tenn.): Comprehensive "health care reform is likely to be shoved to the back burner" next year, Frist writes, adding, "Don't let it." He says conventional "reasoning is that no money exists" for such a proposal, but "that fact actually opens the door, doesn't close it, to the type of structural reform that is so badly needed, Frist, a practicing heart and lung transplant surgeon, writes. In an effort to "effectively and quickly get the ball rolling, Frist recommends expanded use of health care information technology, the elimination of the variation of spending for medical services in different regions, increased enrollment of those uninsured already eligible for Medicaid and SCHIP, capping the tax preference for employer-sponsored insurance that promotes overuse of health care services, the passage of health care reform legislation, the early appointment of a new surgeon general and an increase in funds for medical research (Frist, Roll Call, 11/20).
  
  
• Ret. Gen. Colin Powell: Eight million U.S. children today lack health insurance, and 13 million live in poverty, Powell, a former Secretary of State and a former chair of the Joint Chiefs of Staff, writes. According to Powell, Congress next year must "put our children first" and seek to ensure that "all children have quality health care," among other proposals (Powell, Roll Call, 11/20).
  

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