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Where Hillary Is Heading on Health Care

FEBRUARY 15, 2006 -- Sen. Hillary Rodham Clinton, D-N.Y., is talking up health care again. She used a luncheon address Tuesday to urge AARP to join her in efforts to fix the new Medicare drug benefit and to prod the House to clear a Senate-passed bill promoting health information technology.

Her larger goal, however, is to make the health care system more efficient using information technology, preventive care, and research pinpointing the most effective forms of treatment. She would then use the resulting savings to fund coverage of the uninsured.

The Veterans Health Administration's efforts at using IT to make care more efficient and safe point the way for the nation, she added.

"I'm absolutely convinced the issue is back on the national agenda," she told a Washington meeting of AARP's board of directors. Clinton said that at the current rate of spending, one-third of the nation's income will go for health care by 2040. "It's an issue that in many ways encompasses everything," she said.

It's impossible to deal effectively with the budget deficit, retirement security, economic competitiveness, and even military preparedness without addressing health care and its rising costs, she said, pointing out that deployments to Iraq by uninsured reservists were delayed because of their medical status. "We are approaching a real turning point for the nation when it comes to this issue," she said.

But Clinton outlined a more piecemeal approach to overhauling health care than the giant plan Congress rejected in her husband's first term as president.

House passage of legislation she developed with Senate Majority Leader Bill Frist, R-Tenn., would be one step toward a more efficient system, she said. And she noted her support of comparative effectiveness research studies in the Medicare overhaul law (PL 108-173), saying a broader research effort in this area coupled with adoption by providers of best treatment practices would yield large savings.

Clinton also said smarter payment, including more coverage of preventive care, would also save money, asserting that, for example, the American health care system will pay tens of thousands of dollars for diabetes-related amputations, but not for lower-cost podiatry visits that could prevent those amputations.

Clinton noted that VA hospitals historically haven't enjoyed the best reputation but that the VA system now receives the highest ratings for quality of care and patient satisfaction. A significant part of the system's quality gains stem from the use of health information technology that provides "quality care in an electronic paperless environment."

Those systems allow the right medication in the right dose to be delivered to the right patient at the right time, she said. And unlike Medicare, the VA can negotiate drug prices with pharmaceutical manufacturers, she said.

Although she voted against the overhaul law and its creation of the new Medicare Part D benefit, Clinton said, "AARP and I share the goal of making the program work."

Clinton also said she is developing legislation with fellow Democratic Sens. Ron Wyden of Oregon and Max Baucus of Montana to "rationalize" the Medicare drug coverage program. "These plans, many of us believe, will be here today and gone tomorrow," she said.

The senator also said the proposal aims to create a regulatory framework "to weed out those plans that are not living up to their responsibilities," and that she doesn't see how plans can make a profit delivering the drug benefit to the poorest Medicare beneficiaries eligible for both Medicaid and Medicare, suggesting that consideration should be given to "nonprofit alternatives" for delivering the drug benefit to the dually eligible.

Clinton also said the asset test for the low-income drug benefit should be ended and the government should have authority to negotiate for lower drug prices in Medicare. In addition, pharmacists should be reimbursed for their out-of-pocket costs of filling prescriptions for Medicare beneficiaries when government computers did not show they were eligible, she said.

Clinton also said Medicare's Feb. 15 deadline for reimbursing states for resuming Medicaid coverage to cope with drug snafus, should be extended.

Despite all the problems in health care, Clinton expressed optimism that they could be solved. "It will require people checking their ideological baggage at the door," she said.

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