Gold Standard

A gold standard in health policy is finding ways to improve care, save money, and enlist patients in better managing their chronic conditions. And we have new evidence of the success of a program that is doing just that.

The Asheville Project began several years ago, enlisting local pharmacists to monitor and help manage the health of diabetes patients and coach them about using their medicines properly. In exchange for these regular visits, patients' co-payments are waived for their diabetes medicines.

The results have been impressive: Patients' health improved dramatically, and their employer — the City of Asheville, North Carolina — saved money. Direct medical costs fell up to $1,872 per patient per year, absences from sick time decreased, and productivity increased by up to $18,000 a year. The Asheville Project was expanded to help patients manage other chronic illnesses as well.

The American Pharmacists Association Foundation, which sponsored the program with support from GlaxoSmithKline, took the show on the road and began a Diabetes Ten City Challenge, enlisting employers and community pharmacists in cities from Honolulu to Milwaukee and Tampa Bay to participate. The results are similar: The health of patients improved across all key diabetes indicators, controlling blood sugar, cholesterol and blood pressure.

Overall, patients rating their diabetes care as very good to excellent increased from 39% to 87%. "This shows that when patients are supported and empowered to make the lifestyle changes necessary to manage a chronic disease, significant improvements are possible," according to Bill Ellis, CEO of the APhA Foundation. A report on cost savings will follow.

Significant improvements in health and cost savings are possible by providing new resources and incentives to engage patients in managing their care. Something as simple as having a pharmacist talk to patients about their medicines, encouraging them to monitor their blood sugar regularly, and checking their feet for evidence of problems can keep patients out of the hospital and give them the tools they need to stay healthier longer.

And, by the way, this is a private-sector initiative. No legislation required.


I attended this week a health care symposium in Leesburg, VA, sponsored by the Mayo Clinic's Health Policy Center and organized by Mayo's visionary President and CEO Dr. Denis Cortese and exceptional Health Policy Director Bob Smoldt.

Hundreds of leading health policy thinkers from around the country and the world attended to try to advance the conversation over health reform.

Mayo is a formidable force in setting the gold standard for delivery of quality health care, treating more than half a million patients a year. And it is the only major health organization I am aware of that is working to facilitate a policy conversation through this series of conferences designed to "put the patient first" on the policy agenda.

One of the best attended sessions featured spokespeople for the three leading presidential candidates talking about their candidates' health proposals.


  • Katherine Hayes represented Sen. Hillary Clinton and said that health reform would be Mrs. Clinton's top priority in the first 100 to 120 days if she were elected president. "What people have now in terms of cost and quality isn't good, and we need urgent action," she said.


  • Doug Holtz-Eakin, policy director for Senator John McCain, said that the new president must focus on health reform on "day one, day two, day three, day four" and every day of his presidency. Sen. McCain's goal: To energize the innovative market to provide more affordable, tailored, portable care and coverage. "Any reform that doesn't focus on costs is addressing the wrong problem," he said, stressing the importance of paying for quality, better chronic care management, and preventive care.


  • Kennedy staffer Dr. Kavita Patel spoke on behalf of Sen. Barack Obama and said health reform isn't as much about insurance as about care, stressing the need for coordinated care, comparative effectiveness reviews, reducing defensive medicine, and reform of the payment system.


Health care is complex, but it sounded less complex from this discussion, obscuring most of their major differences. Sharpening these differences will be important to help voters understand more about the details of the plans and the vision of the new president.

Stay tuned.

Grace-Marie Turner

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Should Congress Mandate Health Insurance for Individuals?
National Association of Realtors' Public Policy Debate Book, Winter 2008

Grace-Marie Turner of the Galen Institute and Len Nichols of the New America Foundation debate the merits of an individual mandate for health insurance, with Nichols arguing that individual requirements to purchase health insurance are necessary to make the private health insurance market both efficient and fair. But Grace-Marie counters that an individual mandate has far-reaching consequences for individuals, businesses, and the health insurance market. When political leaders require everyone to have health insurance, they must define what qualifies as acceptable coverage. The insurance market can quickly turn into a government-regulated utility as politicians, rather than the marketplace, determine the terms of the coverage and regulate how much people must pay for the policies. Further, an individual mandate almost immediately turns into an employer mandate as political leaders determine how much employers will be required to pay for their employees' coverage.

Aetna Launches Health Info Search Site
Associated Press, 3/12/08

Aetna has launched a web-based search site that allows customers to generate information about disease risks, medical costs, and local doctors using their electronic health records, reports the Associated Press. Aetna's SmartSource crunches data such as gender, age, ZIP code, employer, health care plan and information from the customer's personal health records. The search engine generates information tailored to individuals about diseases and medical conditions, treatments, health care costs, and local health care providers. Aetna will make the search engi
ne available as a pilot program this year to between 20 and 25 employers with up to 1.5 million employees, and make the service available to more customers next year.

A Threat to Innovation
Sally C. Pipes, Pacific Research Institute
Star Tribune, 03/06/08

The Patent Reform Act pending before Congress could radically reduce innovation in the medical sciences, writes Sally Pipes. For example, the legislation would require the online publication of all patent applications 18 months after they are filed — even if no decision has been made on granting a patent. But it takes the Patent Office an average of 31 months to make a determination. That means that inventors big and small would see their precious creations exposed to the world, in all their scientific detail, with no certainty of ever gaining patent protection. And copycats around the world would have more than a year to duplicate the invention and even claim it as their own. The proposed Patent Reform Act would weaken a system that has sparked innovation for two centuries. And it would alter the future of medical science for the worse.

AEI's Roger Bate writes that the high court in India is reviewing a case that could allow Indian drug companies to use "compulsory licensing" to break the patent held by two Western countries for two cancer drugs. If successful, the lawsuit could open a Pandora's Box that would allow countries to override patents for all sorts of chronic conditions, including diabetes, hypertension and heart disease. Nothing less than the sanctity of the global patent system — and the future of drug innovation — are at stake.

The Cost's the Thing
Michael D. Tanner, Cato Institute
National Review, 03/12/08

John McCain and Barack Obama are reflecting a growing consensus that the continued growth of health spending is unsustainable and that something must be done to bring costs under control. But that doesn't mean Obama and McCain agree on how to reduce costs. Sen. Obama's plan, with its heavy reliance on government, leads to the same problems that bedevil universal healthcare systems all over the world: limited patient choices and rationed care, Tanner writes. In contrast, he says Sen. McCain's proposal is much more consumer centered and taps into the best aspects of the free market. He would attempt to promote greater competition by allowing people to buy insurance plans across state lines. And he would shift toward a system where individuals purchase and own their own insurance plans using new refundable tax credits.

Testimony in Opposition to LD 2247 – An Act to Continue Maine's Leadership in Covering the Uninsured
Tarren Bragdon, Maine Heritage Policy Center
Maine Legislature's Joint Standing Committee on Insurance and Financial Services, 03/13/08

Maine's effort to cover all of the uninsured in the state by 2009 through its Dirigo Health plan is a costly disappointment, Tarren Bragdon recently testified. "Simply put, Dirigo Health was started in 2003 with the goal of covering 128,000 uninsured Maine people in a self-supporting health insurance program which would need no further taxes or state funds after the first year. Today, the program covers only 4,466 Mainers who were previously uninsured, which is less than 4% of the 2003 goal, in a program that costs over $45 million a year," notes Bragdon. The insurance reforms proposed in this legislation, which would increase taxes for additional Dirigo Health funding, are costly, unproven and actuarially estimated to have a nominal impact on premiums. Maine's insurance laws should be reformed with proven patient-centered regulations shown to reduce costs, increase choices and expand competition.

The Impact of Medicare's Anemia Drug Coverage Decision on Cancer Patients: Comparative Effectiveness vs. Patient Centered-Care
Robert Goldberg, Ph.D.
The Center for Medicine in the Public Interest, 03/08

In this detailed paper, CMPI's Bob Goldberg analyzes the decision by the Centers for Medicare and Medicaid Services (CMS) to limit the ability of doctors to prescribe anti-anemia drugs known as Erythropoiesis-Stimulating Agents (ESAs) to patients undergoing chemotherapy. The report finds that CMS ignored the benefits of these medicines and also ignored the risks of blood transfusions (a more aggressive anemia treatment). The study also reviewed a 1997 decision by CMS to limit payment for ESAs in the End Stage Renal Dialysis program. As a result of that decision, anemia levels soared and patients died. Only after CMS removed the cap did patient well-being improve. Additionally, the report found that many new cancer drugs and treatments shown to prolong life are dependent on the use of anemia drugs that permit patients to undergo arduous therapies. CMS failed to consider the impact of reducing access to anemia drugs on cancer survival as a result of treatment. The report recommends that CMS, private insurers, companies, and researchers develop more patient-centered approaches to determining what medicines and treatments to use.

A Food and Drug Administration panel yesterday recommended that doctors continue to prescribe anemia drugs for patients with cancer, reports the Los Angeles Times. But the panel also suggested scaling back which patients should be treated based on their type of cancer and the severity of the disease.


Health Policy "Checkup" with Sen. Ron Wyden
Oregon Health Forum Event
Wednesday, March 19, 2008, 7:00 a.m. – 9:00 a.m.
Portland, OR

The Explosion of Health Scares: Everything Is Dangerous!
The Heartland Institute Event
Wednesday, March 19, 2008, 11:30 a.m. – 1:30 p.m.
Chicago, IL

Supporting Rural Family Caregivers
U.S. Department of Health and Human Services Satellite Broadcast
Wednesday, March 19, 2008, 1:00 p.m. – 3:30 p.m. Eastern

Ask the Experts: Tax Subsidies and Health Insurance
Kaiser Family Foundation Webcast
Thursday, March 20, 2008, 12:30 p.m. EDT

Healthcare Cost of Quality: The Relationship between Performance Metrics and Financial Results
American Society for Quality Webinar
Wednesday, March 26, 2008, 1:00 pm. – 2:00 p.m. CDT

Health Reform Forum: Are Individual Mandates the Answer?
National Federation of Independent Business Event
Wednesday, March 19, 2008, 3:00 p.m. – 5:00 p.m.
Washington, DC
For more information, please contact Christopher Dougherty at 202-326-1746 or

Health Policy Matters is a weekly news
letter containing summaries of timely and informative studies and articles on free-market health reform. It features research and writings by participants in the Health Policy Consensus Group, articles of interest from the health policy world, and 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

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