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 Tag: ObamaOur newsletter features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. It is emailed in an HTML format from the galen@galen.org email address, via Constant Contact, and you may have to adjust your email settings and junk mailbox to ensure that you don’t miss an issue.NewslettersMay, 9 2008
Making ProgressI spent the early part of this week in Las Vegas at the Consumer Health World conference at the Venetian Resort and continue to be awed by the innovative ideas and investment in solutions, technologies, and advances in health care and coverage. HighlightsCONSUMER HEALTH WORLD: I spent the early part of this week in Las Vegas at the Consumer Health World conference at the Venetian Resort and continue to be awed by the innovative ideas and investment in solutions, technologies, and advances in health care and coverage. Sally Pipes of the Pacific Research Institute and I did a keynote address with thoughts about how the policies of a new Republican or Democratic president would impact consumers and health care. But the real news was from business and medical leaders who are leading market changes, including: Digital medical care, the globalization of medicine, medical tourism, the unstoppable demand for more personalized information from consumers, technologies to extend a medical home, sophisticated employee wellness programs, and ways to dramatically reduce health costs through efficiencies in the delivery of care. My take away from the conference: More and more companies from other industry sectors are focusing their skills, technologies, and experience on the health care space, with the potential to produce dynamic, bottom-up change. The political climate matters a lot in being receptive to these changes, but these companies have the potential to be transformative in reducing costs and increasing quality if we will let the market work. The next conference will be in Washington, Dec. 8-10, just after the presidential election, and it will be even more important then to see what these leaders see for the future. Congratulations to Skip Brickley and his team at Transmarx for another great conference. It's hard work, but hugely valuable.  The conference happened to coincide with the opening night of the new Cher concert in Las Vegas, and my dear husband figured out how to get us tickets. Cher is a world-class performer with spectacular sets and at least a dozen even more spectacular costumes. At age 61, she is the quintessential performer.  She will be rotating with other performers (Elton John, Bette Midler) for the next three years at Caesars Palace. See the show if you can. It's not to be missed. WYDEN-BENNETT BILL: The Wyden-Bennett health reform bill received a coveted "budget neutral" cost estimate from the Congressional Budget Office and the Joint Tax Committee last week, and the bi-partisan legislation is attracting even more attention as a result. But let's look at the fine print:
Budget scorings are important. Former HHS Secretary Donna Shalala said during a Senate Finance Committee hearing this week that a CBO estimate of the cost of the Clintons' proposed Health Security Act in 1994 was "devastating. It changed the momentum of the discussion." Alluding to CBO's estimate that Sen. Wyden's Healthy Americans Act would be budget neutral, Shalala said that if one starts the debate with a score of budget neutrality, "you take a giant step." But the numbers also reflect the reality of the bill. And it would be a major, major change from the current system. The details matter. AN OPEN LETTER FROM DOCTORS: Physicians are mad as hell and they're not going to take it anymore. That's the conclusion we draw from a new grassroots campaign by a group of physicians to get signatures on an open letter to Americans from physicians. Their unifying theme: "We all desire to provide the best medical care possible to patients in our respective communities. This is at the heart of everything we do." But they are "alarmed by the current trends in our healthcare system…and the challenges we face in providing quality care to our patients." The idea was proposed by Sean Khozin, MD, MPH, and gained 1,000 signatures just in the first day it was posted on the Sermo website (a very interesting, innovative, and important secure web-based discussion platform that allows doctors to consult with each other about medical cases). The doctors say that "For decades the United States has led the world in healthcare. We have enjoyed the finest hospitals, medical schools, research, technology, and resources." But they say that as a result of high costs and third-party intrusion, "patients have lost their freedom of choice…As a result, it has become difficult for physicians to deliver the best possible care," and the doctor-patient relationship is being compromised. The doctors don't make any policy recommendations in the letter, but it is a way for them to give a voice to their central concern about wanting and needing to put their patients first. That's the right place to start with any policy discussion. Grace-Marie Turner Recent News Articles and Studies How Risky is Individual Health Insurance? How Risky is Individual Health Insurance? Mark V. Pauly and Robert D. Lieberthal, Wharton School at the University of Pennsylvania People in fair or poor health who have health insurance are less likely to drop or lose coverage if they have individual insurance than if they have small-group coverage, according to a study from Mark Pauly and Robert Lieberthal of Wharton. In particular, the study found that among workers in relatively worse health, those with small-group coverage who became unemployed were substantially more likely to also become uninsured than their counterparts with individual coverage. Among those with small-group coverage, 67% of workers in fair or poor health who became unemployed also became uninsured, while among those with individual coverage, only 9% of workers in fair or poor health who became unemployed also became uninsured, according to the study. The authors say this result stems largely from a unique policy feature generally included in individual health insurance policies: guaranteed renewability at class-average rates. Drug Companies Win Alzheimer's Appeal Against Watchdog Nigel Hawkes Tens of thousands of Alzheimer's sufferers and their families had their hopes raised last week as two drug companies won a landmark victory in the U.K.'s Court of Appeal, reports The Times. The National Institute for Health and Clinical Excellence (NICE), the powerful body that controls access to new drugs, was judged to have acted unfairly in making an appraisal of the Alzheimer drug Aricept. NICE had ruled that Aricept should not be prescribed on the NHS to patients with mild Alzheimer's disease because the economic model failed to show that it provided good value. But it refused to allow Eisai and Pfizer, who market the drug, full access to the model. The court ruled that NICE must give up its most precious secrets — how it measures the benefits that novel treatments bring. The ruling is the first case that NICE has lost in court and means that, in the future, it will have to be transparent in the way it reaches its decisions, revealing the inner workings of the models it uses to measure value for money, reports the Times. UnitedHealth: HSA Enrollment Exceeds Traditional Accounts Carissa Wyant UnitedHealth Group said last week that for the first time, enrollment by its members in health savings accounts (HSAs) have surpassed enrollment in more traditional health reimbursement arrangements (HRAs), reports the Minneapolis/St. Paul Business Journal. UnitedHealth said it had 2.7 million individuals enrolled in its consumer-driven health plans; 1.38 million were enrolled in HSA-qualifying insurance as of March 31, compared to 1.34 million members who were enrolled in HRAs. The figures include plans which are employer-sponsored as well as plans purchased by individuals and families. More than 22,000 employers now offer such plans through UnitedHealthcare, and it recorded an increase of 325,000 participants from December 2007 to March 2008, reports the Business Journal. A new podcast from Deloitte on "Embracing Disruption: How Consumers Are Transforming the U.S. Health Care System" describes consumer activists who are searching for quality care and are willing to go outside the traditional health care system to get it. Sally Satel, M.D., American Enterprise Institute Do various financial relationships between doctors and the pharmaceutical industry — promotional marketing, paid speaking and consulting, and research funding — compromise patient care, bias medical research, and diminish the integrity of the profession, asks AEI's Sally Satel. Unfortunately, on many medical-center campuses, the verdict is already in: physicians who engage in any financial relationship with industry are not to be trusted. Such blanket condemnation of all associations with the companies that invent and produce countless life-saving healthcare products will surely have real costs to society, writes Satel. We can live without free pens and mouse pads. The real threat to medicine and the public interest is suppression of freedom of university-based researchers to interact with their scientific colleagues in the pharmaceutical industry, writes Satel. That might make anti-industry purists feel better — at least until they look for the next breakthrough drug only to find that it doesn't exist. Scott Gottlieb, American Enterprise Institute As a presidential candidate, Sen. Barack Obama says people lack health insurance because "they can't afford it." But he is also partly responsible for why health insurance is too expensive, writes Gottlieb. During Mr. Obama's tenure in the Illinois state Senate, 18 different laws came up for a vote and passed that imposed new mandates on private health insurance. Mr. Obama voted for all of them. A long list of studies shows that mandates like the ones Mr. Obama has championed drive up the cost of insurance for the very people priced out of coverage, writes Gottlieb. One way to make insurance more affordable is to allow people to purchase health plans across state lines. People could choose which state regulations to buy into, creating a market for the insurance mandates. This would give states more incentives to fix local problems that have helped make health insurance expensive in the first place. Wal-Mart Expands Low-Price Drug Program Peggy Harris Wal-Mart Stores Inc., the world's largest retailer, announced Monday it would expand its discounted prescription drug program to offer 90-day supplies for $10 and add several women's medications at a discount, reports the Associated Press. The move marks the third phase of a company program that began in 2006 to provide a 30-day supply of generic prescription drugs for $4. With the expansion, the company began filling prescriptions Monday for up to 350 generic medications at $10 for a 90-day supply at Wal-Mart, Neighborhood Market and Sam's Club pharmacies in the U.S, reports the AP. Almost all the prescription generics in the company's $4 program were included in the expanded $10 offer. In addition, the company will add several women's medications to its list of prescriptions available for $9, including drugs to treat breast cancer and hormone deficiency. Wal-Mart also said it would lower the prices of more than 1,000 over-the-counter drugs to $4 or less in its pharmacies. New Georgia Law Gives Best Health Insurance Options Center for Health Transformation, 05/08/08 A new Georgia law will result in Georgia families having the best health insurance options available in any state, according to the Center for Health Transformation (CHT). The law makes premiums for health savings account-eligible plans 100% deductible against state income tax for individuals. It also allows a $250 tax credit per employee for small employers who offer HSAs to their employees. By creating opportunities for Georgia insurance companies to offer new, innovative products not only will the state benefit from a robust and competitive marketplace, but also a half million uninsured Georgians will soon have access to health coverage, writes the CHT. Department for Innovation, Universities & Skills in collaboration with the Department for Business, Enterprise & Regulatory Reform, 11/07 This report, published by the UK government, summarizes the 2006 data on investment in R&D and financial performance of the 850 most active UK companies and the 1,250 most active R&D companies globally. Key highlights include:
Saving on Surgery by Going Abroad Avery Comarow Medical tourism can produce significant discounts on care, writes U.S. News & World Report as part of its "Consumer's Guide to Medical Travel." Thousands of Americans — estimates range from 5,000 to 500,000 annually, if minor procedures are counted — leave the U.S. for surgery, especially if they are paying for the procedure themselves. For example, Brad Barnum, a 53-year old building contractor, had knee and hip replacement surgery in India for $23,000. Even after adding about $5,000 for airfare, passport, visa, and incidentals, the total was nearly 80% less than the $125,000 or more he expected it to cost in a U.S. hospital, reports the magazine. Medical travel has captured the world’s attention and imagination, but a new McKinsey study suggests that the market isn’t as large as reported and that most medical travelers seek high quality and faster service instead of lower costs. Upcoming Events Grace-Marie Turner speaking on the Kirby Wilbur Show Racial and Ethnic Disparities: States and Feds to the Rescue? The Seniors' Entitlement Crunch: The Politics of Social Security and Medicare Reform 6th Annual Health Care Conference Health Reform and the 2008 Election: Opportunities and Pitfalls National Medicare Education Program (NMEP) Coordinating Committee Meeting Whatever Happened to Medicare Reform? Presidential Forum on Health Care Reform Social Determinants of Health & Consequences of Disparities Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at http://rs6.net/tn.jsp?t=epyitmcab.0.0.xkzt75bab.0&ts=S0339&p=http%3A%2F%2Fwww.galen.org. If you wish to subscribe to this free weekly newsletter, update your address, or be removed from our list, please send an e-mail message to galen@galen.org. The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors.
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Wal-Mart, Obama, Alzheimers, CDHC, HSA, HRA, Wyden, Bennett, doctors, physicians, open letter, Sermo, Pipes, CBO, Pauly, individual health insurance, NICE, UK, Pfizer, Aricept, UnitedHealth, enrollment, Deloitte, Satel, Gottlieb, mandates, generics, Georgia, medical tourism, R&D
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CDHC April, 25 2008
Single Payer Utopia?The American Prospect, a magazine of liberal thought, carries an article in its current issue by Marcia Angell, M.D., of Harvard and former editor-in-chief of The New England Journal of Medicine that does indeed offer fuel for thought. HighlightsThe American Prospect, a magazine of liberal thought, carries an article in its current issue by Marcia Angell, M.D., of Harvard and former editor-in-chief of The New England Journal of Medicine that does indeed offer fuel for thought. Her article, "Health Reform You Shouldn't Believe In," examines the universal health coverage law in Massachusetts, criticizing "incremental efforts to increase coverage by expanding private insurance." She concludes that a single-payer system is the only viable option. Dr. Angell's earlier diatribes against the pharmaceutical industry are evidence of her animosity toward any private involvement in the health sector. And this latest article shows her clear hostility toward private insurance. While I agree with some of her assessment of the flaws in the Massachusetts health reform experiment, I could not disagree more about her conclusions. In a section of her article subtitled "Massachusetts miracle or mirage?," she acknowledges a truth that Massachusetts politicians are reluctant to admit: "While those beneath the poverty level signed up for free insurance in even greater numbers than anticipated, very few people who were required to pay for their own insurance signed up. Even those eligible for partial subsidies were slow to enroll," Angell says. "The deadline to purchase insurance had to be extended, and 60,000 uninsured people were exempted from the mandate because — yes, that's right — they couldn't afford it (so much for universality)," according to Angell. "Don't get me wrong," she says. "Massachusetts is to be congratulated for seeking to extend health care to everyone in the state. Every decent society should ensure health care, just as it does education, clean water, and police and fire protection. Massachusetts' plan is an ambitious and well-intentioned effort. But unfortunately, it's extremely unlikely to work for three main reasons," she says. To summarize her points:
All incremental efforts at reform are doomed because they leave "our current dysfunctional system essentially intact," Angell concludes. Her verdict: "The only workable solution is a single-payer system (there, I said it), in which everyone is provided with whatever care he or she needs regardless of age and medical condition. There would no longer be a private insurance industry, which adds little of value yet skims a substantial fraction of the health-care dollar right off the top. Employers, too, would no longer be involved in health care. Care would be provided in nonprofit facilities. The most progressive way to fund such a system would be through an earmarked income tax, which would be more than offset by eliminating premiums and out-of-pocket expenses." Angell says the reason this has not happened is because "the private insurance industry has managed to convince many political leaders, including progressives, that a single-payer system is unrealistic. But what is truly unrealistic is anything else," she says. "My greatest concern about the Massachusetts plan is that when it unravels, people will draw the wrong lesson. They will assume that universal care at a cost we can afford is impossible, and give up on it. It's not impossible; it's just unlikely to be achievable while leaving our dysfunctional system in place." So she envisions a utopia where "everyone is provided with whatever care he or she needs regardless of age and medical condition," with care "provided in nonprofit facilities" and funded by "an earmarked income tax." The lack of understanding of economic and political forces is alarming. And there also is no indication that she recognizes the positive forces in our health sector today that are advancing medical progress, such as:
And the list could go on and on. Are we really so polarized? We agree on the problem, but we have such vastly different views on the solution that you wonder if we ever will make progress. An article in the section below links to a story from The Hill as evidence of the difficulty of sweeping reform. Starting with a good diagnosis is important. But, my goodness, we will need to reach some agreement on a treatment plan.
The Congress is in a showdown over legislation that would block seven Medicaid rules designed to reduce some of the most obvious fraud and abuse of the program. The White House said that President Bush will veto the legislation if it comes to his desk. The House this week passed the legislation by a veto-proof 349-62. And Senate Majority Leader Harry Reid is planning to fast-track the legislation to the floor, bypassing the Senate Finance Committee, where the bill could face resistance. Here is the short version of my testimony before the House Energy and Commerce Committee about this issue. If nothing else, this shows how difficult it is to curb even documented abuse once a government health spending program is established. We must avoid expanding these expensive programs that take on a life and constituency of their own.
And you won't want to miss our major Spring conference, the big Medicare Forum we are co-hosting on Tuesday at the Newseum in Washington, D.C. This is a significant program, featuring a major address by HHS Secretary Michael Leavitt and a very distinguished panel of Medicare experts. You should have received an invitation earlier this week, but if not, you can still register. It's going to be a major event which will be webcast by the Kaiser Family Foundation. If you can join us, please do! Secretary Leavitt previews his remarks in today's Washington Times. See you there! Grace-Marie Turner Recent News Articles and Studies Clinton and Obama Agree — And They're Both Wrong Clinton and Obama Agree — And They're Both Wrong
Sens. Hillary Clinton and Barack Obama are exchanging blows almost daily over whether the government should require everyone to have health insurance or not, writes Grace-Marie Turner. But their debate over an individual mandate has obscured the fact that — in almost every other area — the candidates have nearly identical visions and plans for health reform. Both want to require insurers to accept all applicants. Both candidates want a national "pay or play" mandate, forcing employers to cover a preset percentage of their workers' health insurance or pay a fine. And both would massively expand Medicaid and the State Children's Health Insurance Program. The list goes on, but the overriding principle for Sens. Obama and Clinton is clear — toward a much bigger role for the government over health care decisions. But that thinking is what caused many of the problems in our health sector today. What the insurance market actually needs is more competition — not more regulation. The Hill reports that Congressional Democrats are backing away from healthcare reform promises made by Clinton and Obama, saying that even if their party controls the White House and Congress, sweeping changes will be difficult. Markets Without Magic: How Competition Might Save Medicare Mark V. Pauly, Wharton School of the University of Pennsylvania Wharton economist Mark Pauly's new book argues that unavoidable limits on Medicare financing can best be imposed through market-based choices rather than through government direction. In the short run, bringing competition to Medicare will save money for beneficiaries and improve the quality of health care; in the long run, it may save Medicare. Pauly suggests we build upon the success of the Medicare Advantage program, which gives beneficiaries private insurance alternatives to the traditional government-managed Medicare program. Pauly proposes converting the traditional Medicare program to an explicit voucher, operating under the same rules as the private plans. This would create a neutral Medicare market and provide a mechanism for setting realistic limits on the growth in spending. Competition would promote efficiency and give seniors the freedom to decide how to economize on spending growth. The Wall Street Journal, 04/19/08 Legislation passed recently by the House of Representatives would require every health savings account transaction to be reviewed and verified as a legitimate medical expense, adding a layer of bureaucracy that could sharply reduce the appeal and cost savings of HSAs, The Wall Street Journal writes in an editorial. Having lost the policy argument when HSAs were created, Democrats now are trying to kill them with regulatory subterfuge, the editorial says. The new scheme purports to ensure that money saved tax-free in an HSA is actually used for health expenses. But this is a nonproblem: Any withdrawal from an HSA is already subject to a federal tax audit, just as individual tax returns are. In any case, if people cheat on their HSAs, they are only cheating themselves. When a medical expense arises below the insurance deductible, they will be the ones paying for it, whether from their HSA or another bank account. The Senate should stop this one dead in its tracks. Today's Wall Street Journal features several letters in response to the editorial. The Wisdom of Patients: Health Care Meets Online Social Media Jane Sarasohn-Kahn, M.A., M.H.S.A., THINK-Health Online technologies and practices that people use to share opinions, insights, and experiences with each other are empowering, engaging, and educating consumers and providers in health care, writes Jane Sarasohn-Kahn, a health care economist and management consultant. Consumers are quickly adopting such social networks: One in three Americans used some form of social media online for health in 2007. People with chronic health conditions are sharing their stories with each other, not just for emotional support, but also for the clinical knowledge they gain from participating with "patients like me" in an online community. Doctors are meeting up online to discuss challenging cases with colleagues. Researchers are coming together with patients to learn about side effects in real-time to improve therapeutic regimens. In the next few years, Sarasohn-Kahn says we will see countless social media projects focusing on specific diseases and sub-specialty areas, built by and for patients, caregivers, and providers. The ongoing demands of a consumer-driven health marketplace will inspire innovation in applications that integrate clinical and financial information and ratings sites will grow in number and type. Only a consumer-centered health care system offers the incentives needed to maximize value and produce more for less systemically and consistently over the long term, writes Ed Haislmaier of The Heritage Foundation. State Health Care Reform: Key Questions and Answers Linda Gorman, Independence Institute, and R. Allen Jensen, Independent Life and Health Insurance Broker Gorman and Jensen examine key issues that many state initiatives have failed to adequately address, including universal coverage, consumer-directed health reforms, electronic medical records, guaranteed issue and community rating, and health insurance mandates. From an individual's point of view, a mandate is tax, write the authors. By forcing people to buy a product they may not want at a price they cannot control, the individual mandate functions as a potentially unlimited tax for health insurance. It also ignores the fact that having health insurance does not guarantee medical care — which is a particular problem in government programs with reimbursement rates so low that physicians and hospitals choose not to participate. Excessive government regulation cripples markets for individual health insurance, increases health insurance costs for large numbers of people, expands dependence on government programs, and slows innovation in health care delivery and coverage, conclude Gorman and Jensen. Sound health reform should include the key elements of competition, consumer control, and deregulation. The Heritage Foundation's Bob Moffit describes six key tests for state health reform and writes that there is one overarching policy goal that should unite legislators seeking to develop and implement conservative or free-market reform: The legislative changes would shift the locus of decision-making to individuals and families, and they — not insurers or the government or employers — should control the flow of health care dollars. A Bush Success (not that he gets credit) James C. Capretta and Peter Wehner, Ethics and Public Policy Center The success of the Medicare prescription drug benefit will rank as one of George W. Bush's best domestic legacies, write Capretta and Wehner. Now in its third year, the drug benefit is working better than predicted. More than 1,800 private plans are competing for enrollment and independent surveys show 85% of beneficiaries are satisfied with their coverage. The program's competitive design is holding down costs for the government as well. There are important lessons to draw from this experience, write Capretta and Wehner. For liberals it is that the greatest threat to public support for their ideology is reality. It's been said that you can prove the possible by the actual — and in this case, the "actual" is that sensible public policy can liberate markets to work in health care just as they work in every other area. For conservatives, they say there is a need to accept the reality of measured steps in health and entitlement reform. The best approach is to gradually introduce markets and individual choice and ownership without threatening the security of the known. To his credit, President Bush recognized early on that adding a new drug benefit to Medicare presented a rare opportunity to introduce competition into the program, and he seized it. The Risky Business of Regulating Risk Henry I. Miller, Hoover Institution Congress has been in a regulating mood for the past few years, spurring federal agencies directly or indirectly to pile new regulatory requirements (and inflated costs) onto myriad consumer products and activities, writes Henry Miller. But regulation has costs — both monetary and through the inhibition of innovation — which must be weighed against benefits. Some of the worst regulatory excesses occur when the government is exercising its "gatekeeper" role, in which it must grant permission before a product can be marketed, as is the case for pharmaceuticals and pesticides. Regulators of these products are highly risk-averse, often discounting or ignoring the costs of life-saving products that are delayed or abandoned. As a result of pharmaceutical regulators constantly raising the bar for approval, bringing a new drug to market now requires 12 to 15 years and costs more than $1 billion. Instead of overreacting to acknowledged failures of oversight, Congress and federal regulatory agencies should consider carefully how we can come closer to the ideal of finding the amount of regulation that is necessary and sufficient for a given product, process or activity, and of imposing costs that are commensurate with the societal benefits. Upcoming Events Medicare Forum Featuring HHS Secretary Michael Leavitt Grace-Marie speaking on The Dave Elswick Show The LBJ Centennial Conference: Medicare — Past, Present and Future Does Intellectual Property Benefit Public Health in Developing Countries? Bridging the Gap: Affordable Health Care for New York's Uninsured Concho Valley Community Media Relations Training on the Uninsured Engineering a Learning Healthcare System: A Look at the Future Grace-Marie Turner speaking on the Talkback Show Grace-Marie Turner speaking on the Unraveling The New World Order Show National Walk@Lunch Day Ask the Experts: A Public Plan Option Under Health Reform Consumer Health World Conference Is the Grass Really Greener? A Look at International Health Care Systems Public Forum on Medicare & Medi-Cal Building Blocks for Universal Health Care in New York: Bridging Coverage Gaps with Information Technology Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at www.galen.org. If you wish to subscribe to this free weekly newsletter, update your address, or be removed from our list, please send an e-mail message to galen@galen.org. The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors.
Tags:
single payer, Medicaid, Medicare, Angell, HSA, Clinton, Obama, Grace-Marie Turner, Mark Pauly, social media, state reform, President Bush, Part D, prescription drug program, regulation, Leavitt
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