Mary Ellen Schneider

About 17% of U.S. physicians have electronic health records in their offices, but only 4% of those doctors have comprehensive systems, according to a survey of more than 2,700 physicians nationwide.

However, more physicians are planning to purchase or implement the technology soon. For example, of the 83% of physicians without an EHR, 16% reported that their practice had purchased a system that had yet to be implemented. And 26% said that their practice was planning to purchase an EHR system in the next 2 years, according to a survey (N. Engl. J. Med. 2008;359:50-60).

“If these intentions are realized, we could see a good-sized increase in the number of physicians with an EHR over the next 3-5 years,” Catherine DesRoches, Ph.D., the lead author of the study, said during a press briefing to release the survey results. Dr. DesRoches is an assistant in health policy at the Institute for Health Policy at Massachusetts General Hospital in Boston.

The nationally representative survey was conducted between September 2007 and March 2008 by researchers at the Massachusetts General Hospital, Cornell University, and the George Washington University. The study was funded by the Office of the National Coordinator for Health Information Technology, part of the Health and Human Services department, and the Robert Wood Johnson Foundation. Some of the researchers reported receiving grant support from GE Healthcare, which markets EHRs.

The Office of the National Coordinator for Health Information Technology commissioned the survey to provide a definitive national estimate of EHR adoption by physicians in the United States. Previous estimates of adoption range from 9% to 29%, but most of the estimates are based on small sample sizes or incomplete definitions of an EHR, according to the researchers.

The researchers randomly selected 4,484 eligible physicians from the American Medical Association's 2007 Physician Masterfile, of whom 2,758 completed the survey. They found that 4% of physicians have a fully functional EHR, which they defined as one that includes the ability to write and send orders electronically, the ability to view lab results and images, and the ability to provide clinical decision support and reminders. In addition, about 13% of physicians reported having a basic EHR, which has electronic prescribing but lacks clinical decision support and certain order entry capabilities.

Physicians were more likely to report having a fully functional system if it was integrated with their hospital system, the survey found. For example, 71% of physicians who reported a fully functional EHR said that their system was integrated with their affiliated hospital system, compared with 56% among those physicians with a basic EHR system.

Adoption continues to be influenced by the size and setting of a practice. For example, the survey showed that adoption was more likely among physicians who practiced in large groups (at least 50 physicians) than among those who practiced in groups of 3 physicians or fewer.

Most physicians who have adopted EHRs reported satisfaction with the system and positive effects on quality of care and communication. About 93% of physicians who have implemented fully functional EHRs reported being satisfied with their systems, along with 88% of physicians with basic systems.

Cost continues to slow adoption, the researchers found. Capital costs were cited as barriers by 66% of physicians without an EHR. Other barriers noted by physicians without an EHR include finding a system that meets their needs (54%), concerns about the return on investment (50%), and worries that the system will become obsolete (44%).

But adoption could be improved by helping physicians to purchase EHRs through loans or direct payments, and by offering additional payment for the use of a system, according to the survey. “We're not surprised by that, given their worries about the cost of the system,” Dr. DesRoches said.

“This suggests that we might be able to significantly increase the rate of adoption by easing the financial burden on office-based providers. I think this is particularly true for providers in smaller one- and two-physician practices,” Dr. DesRoches said.

About 17% of U.S. physicians have electronic health records in their offices, but only 4% of those doctors have comprehensive systems, according to a survey of more than 2,700 physicians nationwide.

However, more physicians are planning to purchase or implement the technology soon. For example, of the 83% of physicians without an EHR, 16% reported that their practice had purchased a system that had yet to be implemented. And 26% said that their practice was planning to purchase an EHR system in the next 2 years, according to a survey (N. Engl. J. Med. 2008;359:50-60).

“If these intentions are realized, we could see a good-sized increase in the number of physicians with an EHR over the next 3-5 years,” Catherine DesRoches, Ph.D., the lead author of the study, said during a press briefing to release the survey results. Dr. DesRoches is an assistant in health policy at the Institute for Health Policy at Massachusetts General Hospital in Boston.

The nationally representative survey was conducted between September 2007 and March 2008 by researchers at the Massachusetts General Hospital, Cornell University, and the George Washington University. The study was funded by the Office of the National Coordinator for Health Information Technology, part of the Health and Human Services department, and the Robert Wood Johnson Foundation. Some of the researchers reported receiving grant support from GE Healthcare, which markets EHRs.

The Office of the National Coordinator for Health Information Technology commissioned the survey to provide a definitive national estimate of EHR adoption by physicians in the United States. Previous estimates of adoption range from 9% to 29%, but most of the estimates are based on small sample sizes or incomplete definitions of an EHR, according to the researchers.

The researchers randomly selected 4,484 eligible physicians from the American Medical Association's 2007 Physician Masterfile, of whom 2,758 completed the survey. They found that 4% of physicians have a fully functional EHR, which they defined as one that includes the ability to write and send orders electronically, the ability to view lab results and images, and the ability to provide clinical decision support and reminders. In addition, about 13% of physicians reported having a basic EHR, which has electronic prescribing but lacks clinical decision support and certain order entry capabilities.

Physicians were more likely to report having a fully functional system if it was integrated with their hospital system, the survey found. For example, 71% of physicians who reported a fully functional EHR said that their system was integrated with their affiliated hospital system, compared with 56% among those physicians with a basic EHR system.

Adoption continues to be influenced by the size and setting of a practice. For example, the survey showed that adoption was more likely among physicians who practiced in large groups (at least 50 physicians) than among those who practiced in groups of 3 physicians or fewer.

Most physicians who have adopted EHRs reported satisfaction with the system and positive effects on quality of care and communication. About 93% of physicians who have implemented fully functional EHRs reported being satisfied with their systems, along with 88% of physicians with basic systems.

Cost continues to slow adoption, the researchers found. Capital costs were cited as barriers by 66% of physicians without an EHR. Other barriers noted by physicians without an EHR include finding a system that meets their needs (54%), concerns about the return on investment (50%), and worries that the system will become obsolete (44%).

But adoption could be improved by helping physicians to purchase EHRs through loans or direct payments, and by offering additional payment for the use of a system, according to the survey. “We're not surprised by that, given their worries about the cost of the system,” Dr. DesRoches said.

“This suggests that we might be able to significantly increase the rate of adoption by easing the financial burden on office-based providers. I think this is particularly true for providers in smaller one- and two-physician practices,” Dr. DesRoches said.

About 17% of U.S. physicians have electronic health records in their offices, but only 4% of those doctors have comprehensive systems, according to a survey of more than 2,700 physicians nationwide.

However, more physicians are planning to purchase or implement the technology soon. For example, of the 83% of physicians without an EHR, 16% reported that their practice had purchased a system that had yet to be implemented. And 26% said that their practice was planning to purchase an EHR system in the next 2 years, according to a survey (N. Engl. J. Med. 2008;359:50-60).

“If these intentions are realized, we could see a good-sized increase in the number of physicians with an EHR over the next 3-5 years,” Catherine DesRoches, Ph.D., the lead author of the study, said during a press briefing to release the survey results. Dr. DesRoches is an assistant in health policy at the Institute for Health Policy at Massachusetts General Hospital in Boston.

The nationally representative survey was conducted between September 2007 and March 2008 by researchers at the Massachusetts General Hospital, Cornell University, and the George Washington University. The study was funded by the Office of the National Coordinator for Health Information Technology, part of the Health and Human Services department, and the Robert Wood Johnson Foundation. Some of the researchers reported receiving grant support from GE Healthcare, which markets EHRs.

The Office of the National Coordinator for Health Information Technology commissioned the survey to provide a definitive national estimate of EHR adoption by physicians in the United States. Previous estimates of adoption range from 9% to 29%, but most of the estimates are based on small sample sizes or incomplete definitions of an EHR, according to the researchers.

The researchers randomly selected 4,484 eligible physicians from the American Medical Association's 2007 Physician Masterfile, of whom 2,758 completed the survey. They found that 4% of physicians have a fully functional EHR, which they defined as one that includes the ability to write and send orders electronically, the ability to view lab results and images, and the ability to provide clinical decision support and reminders. In addition, about 13% of physicians reported having a basic EHR, which has electronic prescribing but lacks clinical decision support and certain order entry capabilities.

Physicians were more likely to report having a fully functional system if it was integrated with their hospital system, the survey found. For example, 71% of physicians who reported a fully functional EHR said that their system was integrated with their affiliated hospital system, compared with 56% among those physicians with a basic EHR system.

Adoption continues to be influenced by the size and setting of a practice. For example, the survey showed that adoption was more likely among physicians who practiced in large groups (at least 50 physicians) than among those who practiced in groups of 3 physicians or fewer.

Most physicians who have adopted EHRs reported satisfaction with the system and positive effects on quality of care and communication. About 93% of physicians who have implemented fully functional EHRs reported being satisfied with their systems, along with 88% of physicians with basic systems.

Cost continues to slow adoption, the researchers found. Capital costs were cited as barriers by 66% of physicians without an EHR. Other barriers noted by physicians without an EHR include finding a system that meets their needs (54%), concerns about the return on investment (50%), and worries that the system will become obsolete (44%).

But adoption could be improved by helping physicians to purchase EHRs through loans or direct payments, and by offering additional payment for the use of a system, according to the survey. “We're not surprised by that, given their worries about the cost of the system,” Dr. DesRoches said.

“This suggests that we might be able to significantly increase the rate of adoption by easing the financial burden on office-based providers. I think this is particularly true for providers in smaller one- and two-physician practices,” Dr. DesRoches said.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee, experts continued to scrutinize his plans to reform health care.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program–the system available to federal employees and members of Congress. For those who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in either the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same standards for quality and efficiency.

Employers also would have a role to play under the Obama plan. Those employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers under the proposal.

The Obama proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program. Under the proposal, the government would offer subsidies to individuals who do not qualify for Medicaid or SCHIP but still needed financial assistance to purchase health insurance.

Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage. Instead, the plan mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage widespread adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies since paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that, if implemented, the reforms they propose would save the average family about $2,500 a year in medical expenses.

“I want to wake up and know that every single American has health care when they need it, that every senior has prescription drugs they can afford, and that no parents are going to bed at night worrying about how they'll afford medicine for a sick child,” Sen. Obama said in June during a health care town hall meeting in Bristol, Va.

If elected, Sen. Obama has pledged to implement his health care proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

“That is not a level playing field,” said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.), who supports changing the tax structure to pay for health care coverage (“McCain Plan Relies on Tax Changes, Cost Control,” June 2008, p. 58).

Sen. Obama's approach is really a “backdoor” to getting everyone on a government-funded health plan, she said.

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the costs of catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faced criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan “falls far, far, short” by continuing to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection and the premiums would become unaffordable, Dr. McCanne said. The only way around that would be to provide additional funding through taxes or to have some method of risk pool transfer, in which the private plans with healthier beneficiaries would shift funds to pay for higher risk individuals, he said.

But Dr. Jack Lewin, CEO of the American College of Cardiology, said that maintaining the private system is politically smart. Sen. McCain's plan has the potential to destabilize the existing employer-based coverage system, he said. It might be a good idea to move away from that system, but that should be a gradual process, he said.

Dr. Lewin also praised the Obama plan for starting with coverage for children. However, after the mandate for universal coverage of children, the plan's details are somewhat murky, he said.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute.

And Sen. Obama's plan would likely get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more “plowing of the ground,” he said. The debate over SCHIP has started the conversation about the need for universal coverage and at the same time a majority of Americans are worried about the affordability of health insurance, he said.

Naomi P. Senkeeto, a health policy analyst at the American College of Physicians, agreed that there are reasons to be optimistic about health reform passage this time around. This year, both candidates have recognized the need for health care reform and all of the stakeholders are at the table, she said.

Sen. Barack Obama's reform proposal would allow people to remain in their employer-sponsored health plans.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee, experts continued to scrutinize his plans to reform health care.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program–the system available to federal employees and members of Congress. For those who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in either the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same standards for quality and efficiency.

Employers also would have a role to play under the Obama plan. Those employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers under the proposal.

The Obama proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program. Under the proposal, the government would offer subsidies to individuals who do not qualify for Medicaid or SCHIP but still needed financial assistance to purchase health insurance.

Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage. Instead, the plan mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage widespread adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies since paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that, if implemented, the reforms they propose would save the average family about $2,500 a year in medical expenses.

“I want to wake up and know that every single American has health care when they need it, that every senior has prescription drugs they can afford, and that no parents are going to bed at night worrying about how they'll afford medicine for a sick child,” Sen. Obama said in June during a health care town hall meeting in Bristol, Va.

If elected, Sen. Obama has pledged to implement his health care proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

“That is not a level playing field,” said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.), who supports changing the tax structure to pay for health care coverage (“McCain Plan Relies on Tax Changes, Cost Control,” June 2008, p. 58).

Sen. Obama's approach is really a “backdoor” to getting everyone on a government-funded health plan, she said.

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the costs of catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faced criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan “falls far, far, short” by continuing to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection and the premiums would become unaffordable, Dr. McCanne said. The only way around that would be to provide additional funding through taxes or to have some method of risk pool transfer, in which the private plans with healthier beneficiaries would shift funds to pay for higher risk individuals, he said.

But Dr. Jack Lewin, CEO of the American College of Cardiology, said that maintaining the private system is politically smart. Sen. McCain's plan has the potential to destabilize the existing employer-based coverage system, he said. It might be a good idea to move away from that system, but that should be a gradual process, he said.

Dr. Lewin also praised the Obama plan for starting with coverage for children. However, after the mandate for universal coverage of children, the plan's details are somewhat murky, he said.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute.

And Sen. Obama's plan would likely get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more “plowing of the ground,” he said. The debate over SCHIP has started the conversation about the need for universal coverage and at the same time a majority of Americans are worried about the affordability of health insurance, he said.

Naomi P. Senkeeto, a health policy analyst at the American College of Physicians, agreed that there are reasons to be optimistic about health reform passage this time around. This year, both candidates have recognized the need for health care reform and all of the stakeholders are at the table, she said.

Sen. Barack Obama's reform proposal would allow people to remain in their employer-sponsored health plans.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee, experts continued to scrutinize his plans to reform health care.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program–the system available to federal employees and members of Congress. For those who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in either the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same standards for quality and efficiency.

Employers also would have a role to play under the Obama plan. Those employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers under the proposal.

The Obama proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program. Under the proposal, the government would offer subsidies to individuals who do not qualify for Medicaid or SCHIP but still needed financial assistance to purchase health insurance.

Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage. Instead, the plan mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage widespread adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies since paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that, if implemented, the reforms they propose would save the average family about $2,500 a year in medical expenses.

“I want to wake up and know that every single American has health care when they need it, that every senior has prescription drugs they can afford, and that no parents are going to bed at night worrying about how they'll afford medicine for a sick child,” Sen. Obama said in June during a health care town hall meeting in Bristol, Va.

If elected, Sen. Obama has pledged to implement his health care proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

“That is not a level playing field,” said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.), who supports changing the tax structure to pay for health care coverage (“McCain Plan Relies on Tax Changes, Cost Control,” June 2008, p. 58).

Sen. Obama's approach is really a “backdoor” to getting everyone on a government-funded health plan, she said.

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the costs of catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faced criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan “falls far, far, short” by continuing to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection and the premiums would become unaffordable, Dr. McCanne said. The only way around that would be to provide additional funding through taxes or to have some method of risk pool transfer, in which the private plans with healthier beneficiaries would shift funds to pay for higher risk individuals, he said.

But Dr. Jack Lewin, CEO of the American College of Cardiology, said that maintaining the private system is politically smart. Sen. McCain's plan has the potential to destabilize the existing employer-based coverage system, he said. It might be a good idea to move away from that system, but that should be a gradual process, he said.

Dr. Lewin also praised the Obama plan for starting with coverage for children. However, after the mandate for universal coverage of children, the plan's details are somewhat murky, he said.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute.

And Sen. Obama's plan would likely get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more “plowing of the ground,” he said. The debate over SCHIP has started the conversation about the need for universal coverage and at the same time a majority of Americans are worried about the affordability of health insurance, he said.

Naomi P. Senkeeto, a health policy analyst at the American College of Physicians, agreed that there are reasons to be optimistic about health reform passage this time around. This year, both candidates have recognized the need for health care reform and all of the stakeholders are at the table, she said.

Sen. Barack Obama's reform proposal would allow people to remain in their employer-sponsored health plans.

NEW YORK – More than 10% of teens in New York City public high schools who have ever had intercourse reported bisexual behavior in a 2005 survey, according to a recent analysis.

Those teens reported a higher prevalence of risky behaviors, including lower rates of condom use and a greater number of sex partners, researchers from the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention found.

The analysis is based on responses to the New York City Youth Risk Behavior Survey, a population-based survey of in-school adolescents. Of 1,881 males who reported ever having had intercourse, 94% reported opposite sex partners, 3% reported same-sex partners, and 3% reported partners of both sexes. Of 1,705 females who reported ever having had intercourse, 88% reported opposite sex partners, 3% reported same-sex partners, and 9% reported partners of both sexes.

Males and females were equally likely to report same-sex only behavior, but females were three times more likely to report bisexual behavior, Preeti Pathela, Dr.P.H., a research scientist at the New York City Department of Health and Mental Hygiene said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

Males who reported both male and female sex partners reported an earlier age of sexual debut, compared with heterosexual and homosexual respondents. Males who reported partners of both sexes also were more likely than the other two groups to report a greater number of lifetime and recent sex partners. For males reporting sex in the previous 3 months, 83% of those with partners of both sexes reported sex with two or more partners, compared with 46% of those with opposite-sex partners, and 28% of those with same-sex partners.

About 28% of males with partners of both sexes reported condom use at last sex, compared with 77% of homosexual males and 79% of heterosexual males.

Among females, the patterns were somewhat different, Dr. Pathela said. Females with partners of both sexes and those with same-sex partners only were both more likely than those with opposite sex partners only to report a greater number of lifetime and recent sex partners. Females with partners of both sexes were also more likely than those with opposite sex partners only to report alcohol and drug use at last sex, she said.

The researchers also found that in many cases the sexual identity given by the respondents and the behaviors they reported did not match up. For example, they found the greatest discordance in males who had same-sex partners only but reported a heterosexual identity.

Discordant findings were even more striking in females, Dr. Pathela said. Among those reporting only female partners, 79% of girls identified as heterosexual but engaged in same-sex behaviors only and 13% whose sexual identity was bisexual engaged only in same-sex behaviors.

NEW YORK – More than 10% of teens in New York City public high schools who have ever had intercourse reported bisexual behavior in a 2005 survey, according to a recent analysis.

Those teens reported a higher prevalence of risky behaviors, including lower rates of condom use and a greater number of sex partners, researchers from the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention found.

The analysis is based on responses to the New York City Youth Risk Behavior Survey, a population-based survey of in-school adolescents. Of 1,881 males who reported ever having had intercourse, 94% reported opposite sex partners, 3% reported same-sex partners, and 3% reported partners of both sexes. Of 1,705 females who reported ever having had intercourse, 88% reported opposite sex partners, 3% reported same-sex partners, and 9% reported partners of both sexes.

Males and females were equally likely to report same-sex only behavior, but females were three times more likely to report bisexual behavior, Preeti Pathela, Dr.P.H., a research scientist at the New York City Department of Health and Mental Hygiene said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

Males who reported both male and female sex partners reported an earlier age of sexual debut, compared with heterosexual and homosexual respondents. Males who reported partners of both sexes also were more likely than the other two groups to report a greater number of lifetime and recent sex partners. For males reporting sex in the previous 3 months, 83% of those with partners of both sexes reported sex with two or more partners, compared with 46% of those with opposite-sex partners, and 28% of those with same-sex partners.

About 28% of males with partners of both sexes reported condom use at last sex, compared with 77% of homosexual males and 79% of heterosexual males.

Among females, the patterns were somewhat different, Dr. Pathela said. Females with partners of both sexes and those with same-sex partners only were both more likely than those with opposite sex partners only to report a greater number of lifetime and recent sex partners. Females with partners of both sexes were also more likely than those with opposite sex partners only to report alcohol and drug use at last sex, she said.

The researchers also found that in many cases the sexual identity given by the respondents and the behaviors they reported did not match up. For example, they found the greatest discordance in males who had same-sex partners only but reported a heterosexual identity.

Discordant findings were even more striking in females, Dr. Pathela said. Among those reporting only female partners, 79% of girls identified as heterosexual but engaged in same-sex behaviors only and 13% whose sexual identity was bisexual engaged only in same-sex behaviors.

NEW YORK – More than 10% of teens in New York City public high schools who have ever had intercourse reported bisexual behavior in a 2005 survey, according to a recent analysis.

Those teens reported a higher prevalence of risky behaviors, including lower rates of condom use and a greater number of sex partners, researchers from the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention found.

The analysis is based on responses to the New York City Youth Risk Behavior Survey, a population-based survey of in-school adolescents. Of 1,881 males who reported ever having had intercourse, 94% reported opposite sex partners, 3% reported same-sex partners, and 3% reported partners of both sexes. Of 1,705 females who reported ever having had intercourse, 88% reported opposite sex partners, 3% reported same-sex partners, and 9% reported partners of both sexes.

Males and females were equally likely to report same-sex only behavior, but females were three times more likely to report bisexual behavior, Preeti Pathela, Dr.P.H., a research scientist at the New York City Department of Health and Mental Hygiene said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

Males who reported both male and female sex partners reported an earlier age of sexual debut, compared with heterosexual and homosexual respondents. Males who reported partners of both sexes also were more likely than the other two groups to report a greater number of lifetime and recent sex partners. For males reporting sex in the previous 3 months, 83% of those with partners of both sexes reported sex with two or more partners, compared with 46% of those with opposite-sex partners, and 28% of those with same-sex partners.

About 28% of males with partners of both sexes reported condom use at last sex, compared with 77% of homosexual males and 79% of heterosexual males.

Among females, the patterns were somewhat different, Dr. Pathela said. Females with partners of both sexes and those with same-sex partners only were both more likely than those with opposite sex partners only to report a greater number of lifetime and recent sex partners. Females with partners of both sexes were also more likely than those with opposite sex partners only to report alcohol and drug use at last sex, she said.

The researchers also found that in many cases the sexual identity given by the respondents and the behaviors they reported did not match up. For example, they found the greatest discordance in males who had same-sex partners only but reported a heterosexual identity.

Discordant findings were even more striking in females, Dr. Pathela said. Among those reporting only female partners, 79% of girls identified as heterosexual but engaged in same-sex behaviors only and 13% whose sexual identity was bisexual engaged only in same-sex behaviors.

In addition to the presidential candidates, other players in the health care arena are also unveiling their own detailed plans to provide health care coverage for all or most Americans.

The Commonwealth Fund's proposal, called “Building Blocks,” seeks to cover 44 of the 48 million Americans estimated to be uninsured in 2008. At the center of the proposal is a national health insurance connector that would allow small businesses and individuals without large employer insurance to shop for a health plan.

The connector would feature private plans and a “Medicare Extra” option. The latter would offer monthly premiums of $259 for individuals and $702 for families, 30% lower than the average premium charged to employers today, said the Commonwealth Fund, a private foundation that supports research on health policy reform.

The plan also calls for expanding Medicaid and the State Children's Health Insurance Plan to cover all adults and children below 150% of the federal poverty level and would include individual and employer mandates for health coverage.

Using modeling from the Lewin Group, the Commonwealth Fund estimated the proposal would add $15 billion to current total health spending in the United States during the first year and about $218 billion over 10 years. But it could save $1.6 trillion over 10 years if it is combined with other reforms such as changing Medicare payments to hospitals and physicians, investing in better health information technology, allowing Medicare to negotiate drug prices, and improving public health.

Meanwhile, the Healthcare Leadership Council, a coalition of hospitals, health plans, and pharmaceutical and device manufacturers that aims to improve the quality and affordability of health care, has offered its own market-based proposal aimed at covering all Americans. Called “Closing the Gap,” it calls for subsidies and tax breaks to help individuals afford coverage, improved health care quality through health information technology and care coordination, and realignment of financial incentives in the health care system to pay for value.

The plan calls for the government to provide premium subsidies to help employees afford their employer-sponsored insurance premiums and for the same tax breaks to be applied to individually purchased health insurance as applied to employer-sponsored coverage. The group did not endorse individual mandates.

The plan also calls for a move away from a payment system that rewards physicians and hospitals for the volume of services provided, instead paying for evidence-based care and prevention, said Dr. Denis Cortese, chair of the Healthcare Leadership Council and president and chief executive officer of the Mayo Clinic, at a press briefing to release the plan.

In addition to the presidential candidates, other players in the health care arena are also unveiling their own detailed plans to provide health care coverage for all or most Americans.

The Commonwealth Fund's proposal, called “Building Blocks,” seeks to cover 44 of the 48 million Americans estimated to be uninsured in 2008. At the center of the proposal is a national health insurance connector that would allow small businesses and individuals without large employer insurance to shop for a health plan.

The connector would feature private plans and a “Medicare Extra” option. The latter would offer monthly premiums of $259 for individuals and $702 for families, 30% lower than the average premium charged to employers today, said the Commonwealth Fund, a private foundation that supports research on health policy reform.

The plan also calls for expanding Medicaid and the State Children's Health Insurance Plan to cover all adults and children below 150% of the federal poverty level and would include individual and employer mandates for health coverage.

Using modeling from the Lewin Group, the Commonwealth Fund estimated the proposal would add $15 billion to current total health spending in the United States during the first year and about $218 billion over 10 years. But it could save $1.6 trillion over 10 years if it is combined with other reforms such as changing Medicare payments to hospitals and physicians, investing in better health information technology, allowing Medicare to negotiate drug prices, and improving public health.

Meanwhile, the Healthcare Leadership Council, a coalition of hospitals, health plans, and pharmaceutical and device manufacturers that aims to improve the quality and affordability of health care, has offered its own market-based proposal aimed at covering all Americans. Called “Closing the Gap,” it calls for subsidies and tax breaks to help individuals afford coverage, improved health care quality through health information technology and care coordination, and realignment of financial incentives in the health care system to pay for value.

The plan calls for the government to provide premium subsidies to help employees afford their employer-sponsored insurance premiums and for the same tax breaks to be applied to individually purchased health insurance as applied to employer-sponsored coverage. The group did not endorse individual mandates.

The plan also calls for a move away from a payment system that rewards physicians and hospitals for the volume of services provided, instead paying for evidence-based care and prevention, said Dr. Denis Cortese, chair of the Healthcare Leadership Council and president and chief executive officer of the Mayo Clinic, at a press briefing to release the plan.

In addition to the presidential candidates, other players in the health care arena are also unveiling their own detailed plans to provide health care coverage for all or most Americans.

The Commonwealth Fund's proposal, called “Building Blocks,” seeks to cover 44 of the 48 million Americans estimated to be uninsured in 2008. At the center of the proposal is a national health insurance connector that would allow small businesses and individuals without large employer insurance to shop for a health plan.

The connector would feature private plans and a “Medicare Extra” option. The latter would offer monthly premiums of $259 for individuals and $702 for families, 30% lower than the average premium charged to employers today, said the Commonwealth Fund, a private foundation that supports research on health policy reform.

The plan also calls for expanding Medicaid and the State Children's Health Insurance Plan to cover all adults and children below 150% of the federal poverty level and would include individual and employer mandates for health coverage.

Using modeling from the Lewin Group, the Commonwealth Fund estimated the proposal would add $15 billion to current total health spending in the United States during the first year and about $218 billion over 10 years. But it could save $1.6 trillion over 10 years if it is combined with other reforms such as changing Medicare payments to hospitals and physicians, investing in better health information technology, allowing Medicare to negotiate drug prices, and improving public health.

Meanwhile, the Healthcare Leadership Council, a coalition of hospitals, health plans, and pharmaceutical and device manufacturers that aims to improve the quality and affordability of health care, has offered its own market-based proposal aimed at covering all Americans. Called “Closing the Gap,” it calls for subsidies and tax breaks to help individuals afford coverage, improved health care quality through health information technology and care coordination, and realignment of financial incentives in the health care system to pay for value.

The plan calls for the government to provide premium subsidies to help employees afford their employer-sponsored insurance premiums and for the same tax breaks to be applied to individually purchased health insurance as applied to employer-sponsored coverage. The group did not endorse individual mandates.

The plan also calls for a move away from a payment system that rewards physicians and hospitals for the volume of services provided, instead paying for evidence-based care and prevention, said Dr. Denis Cortese, chair of the Healthcare Leadership Council and president and chief executive officer of the Mayo Clinic, at a press briefing to release the plan.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee, experts continued to scrutinize his plans to reform health care.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program—the system available to federal employees and members of Congress. For those who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same quality and efficiency standards.

Under the Obama plan, employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers.

The proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program.

Under the proposal, the government would offer subsidies to individuals who do not qualify for Medicaid or SCHIP but still need financial assistance to purchase health insurance.

Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage, and mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage widespread adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies, because paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that the proposed reforms would save the average family about $2,500 a year in medical expenses.

If elected, Sen. Obama has pledged to implement his health care reform proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

“That is not a level playing field,” said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.).

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faces criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan “falls far, far short” by continuing to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection, and premiums would become unaffordable, Dr. McCanne said. The only way around that would be to provide additional funding through taxes or to have a method of risk pool transfer, in which the private plans with healthier beneficiaries would shift funds to pay for the higher-risk individuals, he said.

But Dr. Jack Lewin, CEO of the American College of Cardiology, said that maintaining the private system is politically smart. One of the drawbacks of Sen. McCain's plan is that it has the potential to destabilize the existing employer-based coverage system, he said. It might be a good idea to move away from that system, but that should be a gradual process, he said.

Dr. Lewin also praised the Obama plan for starting with coverage for children. However, after the mandate for universal coverage of children, the plan's details are somewhat murky, he said. For example, Sen. Obama's plan commits to improving quality and efficiency in the system, but it doesn't define how it would be done, he said.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute.

Still, Sen. Obama's plan is likely to get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more “plowing of the ground,” he said. The debate over SCHIP has started the conversation about the need for universal coverage, and at the same time, a majority of Americans are worried about the affordability of health insurance, he added.

Naomi P. Senkeeto, a health policy analyst at the American College of Physicians, agreed that there are reasons to be optimistic about health reform passage this time around. This year, both candidates have recognized the need for health care reform and all of the stakeholders are at the table, she said.

How the reform will look will also depend on how quickly the issues are taken up following the inauguration. There is a growing sense that given all the competing priorities, if health care is not addressed in the first 100 days it will be increasingly difficult to pass. “It's really important to hit the ground running,” Ms. Senkeeto said.

Sen. Barack Obama estimates that his health care plan would save the average family $2,500 per year.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee, experts continued to scrutinize his plans to reform health care.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program—the system available to federal employees and members of Congress. For those who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same quality and efficiency standards.

Under the Obama plan, employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers.

The proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program.

Under the proposal, the government would offer subsidies to individuals who do not qualify for Medicaid or SCHIP but still need financial assistance to purchase health insurance.

Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage, and mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage widespread adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies, because paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that the proposed reforms would save the average family about $2,500 a year in medical expenses.

If elected, Sen. Obama has pledged to implement his health care reform proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

“That is not a level playing field,” said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.).

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faces criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan “falls far, far short” by continuing to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection, and premiums would become unaffordable, Dr. McCanne said. The only way around that would be to provide additional funding through taxes or to have a method of risk pool transfer, in which the private plans with healthier beneficiaries would shift funds to pay for the higher-risk individuals, he said.

But Dr. Jack Lewin, CEO of the American College of Cardiology, said that maintaining the private system is politically smart. One of the drawbacks of Sen. McCain's plan is that it has the potential to destabilize the existing employer-based coverage system, he said. It might be a good idea to move away from that system, but that should be a gradual process, he said.

Dr. Lewin also praised the Obama plan for starting with coverage for children. However, after the mandate for universal coverage of children, the plan's details are somewhat murky, he said. For example, Sen. Obama's plan commits to improving quality and efficiency in the system, but it doesn't define how it would be done, he said.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute.

Still, Sen. Obama's plan is likely to get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more “plowing of the ground,” he said. The debate over SCHIP has started the conversation about the need for universal coverage, and at the same time, a majority of Americans are worried about the affordability of health insurance, he added.

Naomi P. Senkeeto, a health policy analyst at the American College of Physicians, agreed that there are reasons to be optimistic about health reform passage this time around. This year, both candidates have recognized the need for health care reform and all of the stakeholders are at the table, she said.

How the reform will look will also depend on how quickly the issues are taken up following the inauguration. There is a growing sense that given all the competing priorities, if health care is not addressed in the first 100 days it will be increasingly difficult to pass. “It's really important to hit the ground running,” Ms. Senkeeto said.

Sen. Barack Obama estimates that his health care plan would save the average family $2,500 per year.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee, experts continued to scrutinize his plans to reform health care.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program—the system available to federal employees and members of Congress. For those who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same quality and efficiency standards.

Under the Obama plan, employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers.

The proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program.

Under the proposal, the government would offer subsidies to individuals who do not qualify for Medicaid or SCHIP but still need financial assistance to purchase health insurance.

Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage, and mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage widespread adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies, because paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that the proposed reforms would save the average family about $2,500 a year in medical expenses.

If elected, Sen. Obama has pledged to implement his health care reform proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

“That is not a level playing field,” said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.).

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faces criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan “falls far, far short” by continuing to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection, and premiums would become unaffordable, Dr. McCanne said. The only way around that would be to provide additional funding through taxes or to have a method of risk pool transfer, in which the private plans with healthier beneficiaries would shift funds to pay for the higher-risk individuals, he said.

But Dr. Jack Lewin, CEO of the American College of Cardiology, said that maintaining the private system is politically smart. One of the drawbacks of Sen. McCain's plan is that it has the potential to destabilize the existing employer-based coverage system, he said. It might be a good idea to move away from that system, but that should be a gradual process, he said.

Dr. Lewin also praised the Obama plan for starting with coverage for children. However, after the mandate for universal coverage of children, the plan's details are somewhat murky, he said. For example, Sen. Obama's plan commits to improving quality and efficiency in the system, but it doesn't define how it would be done, he said.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute.

Still, Sen. Obama's plan is likely to get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more “plowing of the ground,” he said. The debate over SCHIP has started the conversation about the need for universal coverage, and at the same time, a majority of Americans are worried about the affordability of health insurance, he added.

Naomi P. Senkeeto, a health policy analyst at the American College of Physicians, agreed that there are reasons to be optimistic about health reform passage this time around. This year, both candidates have recognized the need for health care reform and all of the stakeholders are at the table, she said.

How the reform will look will also depend on how quickly the issues are taken up following the inauguration. There is a growing sense that given all the competing priorities, if health care is not addressed in the first 100 days it will be increasingly difficult to pass. “It's really important to hit the ground running,” Ms. Senkeeto said.

Sen. Barack Obama estimates that his health care plan would save the average family $2,500 per year.

Under an agreement among physicians, consumers, employers, and large insurers, some health plans have agreed to have their physician rating systems audited by independent experts.

The announcement comes after physicians around the country have questioned the methods used by health plans to produce the physician performance ratings for consumers.

Under the voluntary agreement, health plans would disclose their rating methods. In addition, physicians would have a chance to review their performance data and challenge it prior to publication.

“Having that transparency is a huge change,” said Dr. Douglas Henley, executive vice president of the American Academy of Family Physicians, which is supporting the agreement, known as the Patient Charter for Physician Performance Measurement, Reporting, and Tiering Programs.

Giving physicians a chance to ensure that the data are accurate makes the process fair, he said.

It's also beneficial for consumers who will be able to better rely on the information provided by their health plan, Dr. Henley said.

The project was led by the Consumer-Purchaser Disclosure Project, a coalition of consumer, labor, and employer organizations that support publicly reported health performance information.

Other principles of the Patient Charter state that the measures should aim to assess whether care is safe, timely, effective, equitable, and patient centered. The measures used should also be based on national standards, preferably those endorsed by the National Quality Forum. The principles of the Patient Charter do not apply to pure cost-comparison or shopping tools.

This agreement provides a foundation for physicians to build on, said Dr. David C. Dale, president of the American College of Physicians, another supporter.

Now when any health plan establishes a physician rating system, physicians can ask whether it is standardized and how it stacks up against the requirements of the Patient Charter, he said.

The Patient Charter also has the support of the American Medical Association, the American College of Cardiology, and the American College of Surgeons.

And some heavy hitters in the insurance industry have agreed to abide by the principles of the charter, including trade group America's Health Insurance Plans (AHIP), as well as Aetna, Cigna, UnitedHealthcare, and WellPoint.

Other health plans are likely to follow suit, said Susan Pisano, AHIP spokeswoman. Third-party review of rating systems and allowing physicians to review and challenge data before they become public will likely become the industry standard, she said.

“We believe strongly that consumers both want and need good information on health care quality,” Ms. Pisano commented.

Now that the Patient Charter has laid down the ground rules for how clinical performance measures should be used, the next step is to ensure that physician ratings accurately reflect all the care given, because patients are generally scattered across multiple health plans. Ms. Pisano said the AHIP Foundation is studying how to aggregate data from across different plans to provide a full picture of physician quality.

Under an agreement among physicians, consumers, employers, and large insurers, some health plans have agreed to have their physician rating systems audited by independent experts.

The announcement comes after physicians around the country have questioned the methods used by health plans to produce the physician performance ratings for consumers.

Under the voluntary agreement, health plans would disclose their rating methods. In addition, physicians would have a chance to review their performance data and challenge it prior to publication.

“Having that transparency is a huge change,” said Dr. Douglas Henley, executive vice president of the American Academy of Family Physicians, which is supporting the agreement, known as the Patient Charter for Physician Performance Measurement, Reporting, and Tiering Programs.

Giving physicians a chance to ensure that the data are accurate makes the process fair, he said.

It's also beneficial for consumers who will be able to better rely on the information provided by their health plan, Dr. Henley said.

The project was led by the Consumer-Purchaser Disclosure Project, a coalition of consumer, labor, and employer organizations that support publicly reported health performance information.

Other principles of the Patient Charter state that the measures should aim to assess whether care is safe, timely, effective, equitable, and patient centered. The measures used should also be based on national standards, preferably those endorsed by the National Quality Forum. The principles of the Patient Charter do not apply to pure cost-comparison or shopping tools.

This agreement provides a foundation for physicians to build on, said Dr. David C. Dale, president of the American College of Physicians, another supporter.

Now when any health plan establishes a physician rating system, physicians can ask whether it is standardized and how it stacks up against the requirements of the Patient Charter, he said.

The Patient Charter also has the support of the American Medical Association, the American College of Cardiology, and the American College of Surgeons.

And some heavy hitters in the insurance industry have agreed to abide by the principles of the charter, including trade group America's Health Insurance Plans (AHIP), as well as Aetna, Cigna, UnitedHealthcare, and WellPoint.

Other health plans are likely to follow suit, said Susan Pisano, AHIP spokeswoman. Third-party review of rating systems and allowing physicians to review and challenge data before they become public will likely become the industry standard, she said.

“We believe strongly that consumers both want and need good information on health care quality,” Ms. Pisano commented.

Now that the Patient Charter has laid down the ground rules for how clinical performance measures should be used, the next step is to ensure that physician ratings accurately reflect all the care given, because patients are generally scattered across multiple health plans. Ms. Pisano said the AHIP Foundation is studying how to aggregate data from across different plans to provide a full picture of physician quality.

Under an agreement among physicians, consumers, employers, and large insurers, some health plans have agreed to have their physician rating systems audited by independent experts.

The announcement comes after physicians around the country have questioned the methods used by health plans to produce the physician performance ratings for consumers.

Under the voluntary agreement, health plans would disclose their rating methods. In addition, physicians would have a chance to review their performance data and challenge it prior to publication.

“Having that transparency is a huge change,” said Dr. Douglas Henley, executive vice president of the American Academy of Family Physicians, which is supporting the agreement, known as the Patient Charter for Physician Performance Measurement, Reporting, and Tiering Programs.

Giving physicians a chance to ensure that the data are accurate makes the process fair, he said.

It's also beneficial for consumers who will be able to better rely on the information provided by their health plan, Dr. Henley said.

The project was led by the Consumer-Purchaser Disclosure Project, a coalition of consumer, labor, and employer organizations that support publicly reported health performance information.

Other principles of the Patient Charter state that the measures should aim to assess whether care is safe, timely, effective, equitable, and patient centered. The measures used should also be based on national standards, preferably those endorsed by the National Quality Forum. The principles of the Patient Charter do not apply to pure cost-comparison or shopping tools.

This agreement provides a foundation for physicians to build on, said Dr. David C. Dale, president of the American College of Physicians, another supporter.

Now when any health plan establishes a physician rating system, physicians can ask whether it is standardized and how it stacks up against the requirements of the Patient Charter, he said.

The Patient Charter also has the support of the American Medical Association, the American College of Cardiology, and the American College of Surgeons.

And some heavy hitters in the insurance industry have agreed to abide by the principles of the charter, including trade group America's Health Insurance Plans (AHIP), as well as Aetna, Cigna, UnitedHealthcare, and WellPoint.

Other health plans are likely to follow suit, said Susan Pisano, AHIP spokeswoman. Third-party review of rating systems and allowing physicians to review and challenge data before they become public will likely become the industry standard, she said.

“We believe strongly that consumers both want and need good information on health care quality,” Ms. Pisano commented.

Now that the Patient Charter has laid down the ground rules for how clinical performance measures should be used, the next step is to ensure that physician ratings accurately reflect all the care given, because patients are generally scattered across multiple health plans. Ms. Pisano said the AHIP Foundation is studying how to aggregate data from across different plans to provide a full picture of physician quality.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee this month, health care experts are once again scrutinizing his plans to reform the health care system.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program—the system available to federal employees and members of Congress.

For individuals and families who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in either the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same standards for quality and efficiency.

Employers also would have a role to play under the Obama plan. Those employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers under the proposal.

The Obama proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program.

Under the proposal, the government would offer subsidies to individuals who do not qualify for Medicaid or SCHIP but still needed financial assistance to purchase health insurance. Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage. Instead, the plan mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies since paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that, if implemented, the reforms they are proposing would save the average family about $2,500 a year in medical expenses.

"I want to wake up and know that every single American has health care when they need it, that every senior has prescription drugs they can afford, and that no parents are going to bed at night worrying about how they'll afford medicine for a sick child," Sen. Obama said in June during a health care town hall meeting in Bristol, Va.

If elected, Sen. Obama has pledged to implement his health care proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

"That is not a level playing field," said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.).

Sen. Obama's approach is really a "backdoor" to getting everyone on a government-funded health plan, she said.

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the costs of catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faced criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan "falls far, far, short."

Dr. McCanne said he objects to the plan because it continues to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program for health care.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection and the premiums would become unaffordable, Dr. McCanne said.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute. However, that murkiness may be appropriate since members of Congress will be the ones to refine the details of any health care reforms, he said.

And Sen. Obama's plan is likely to get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more "plowing of the ground," he said. The debate over SCHIP has started the conversation about the need for universal coverage.

Naomi P. Senkeeto, a health policy analyst at the American College of Physicians, agreed that there are reasons to be optimistic about health reform passage this time around.

While much depends on the new president and the makeup of Congress, it is increasingly clear that how the reform will look will also depend on how quickly the issues are taken up following the inauguration. There is a growing sense that given all the competing priorities, if health care is not addressed in the first 100 days it will be increasingly difficult to pass. "It's really important to hit the ground running," Ms. Senkeeto said.

Sen. Barack Obama estimates his plan would save the average family $2,500 per year.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee this month, health care experts are once again scrutinizing his plans to reform the health care system.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program—the system available to federal employees and members of Congress.

For individuals and families who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in either the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same standards for quality and efficiency.

Employers also would have a role to play under the Obama plan. Those employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers under the proposal.

The Obama proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program.

Under the proposal, the government would offer subsidies to individuals who do not qualify for Medicaid or SCHIP but still needed financial assistance to purchase health insurance. Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage. Instead, the plan mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies since paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that, if implemented, the reforms they are proposing would save the average family about $2,500 a year in medical expenses.

"I want to wake up and know that every single American has health care when they need it, that every senior has prescription drugs they can afford, and that no parents are going to bed at night worrying about how they'll afford medicine for a sick child," Sen. Obama said in June during a health care town hall meeting in Bristol, Va.

If elected, Sen. Obama has pledged to implement his health care proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

"That is not a level playing field," said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.).

Sen. Obama's approach is really a "backdoor" to getting everyone on a government-funded health plan, she said.

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the costs of catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faced criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan "falls far, far, short."

Dr. McCanne said he objects to the plan because it continues to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program for health care.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection and the premiums would become unaffordable, Dr. McCanne said.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute. However, that murkiness may be appropriate since members of Congress will be the ones to refine the details of any health care reforms, he said.

And Sen. Obama's plan is likely to get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more "plowing of the ground," he said. The debate over SCHIP has started the conversation about the need for universal coverage.

Naomi P. Senkeeto, a health policy analyst at the American College of Physicians, agreed that there are reasons to be optimistic about health reform passage this time around.

While much depends on the new president and the makeup of Congress, it is increasingly clear that how the reform will look will also depend on how quickly the issues are taken up following the inauguration. There is a growing sense that given all the competing priorities, if health care is not addressed in the first 100 days it will be increasingly difficult to pass. "It's really important to hit the ground running," Ms. Senkeeto said.

Sen. Barack Obama estimates his plan would save the average family $2,500 per year.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee this month, health care experts are once again scrutinizing his plans to reform the health care system.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program—the system available to federal employees and members of Congress.

For individuals and families who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in either the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same standards for quality and efficiency.

Employers also would have a role to play under the Obama plan. Those employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers under the proposal.

The Obama proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program.

Under the proposal, the government would offer subsidies to individuals who do not qualify for Medicaid or SCHIP but still needed financial assistance to purchase health insurance. Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage. Instead, the plan mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies since paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that, if implemented, the reforms they are proposing would save the average family about $2,500 a year in medical expenses.

"I want to wake up and know that every single American has health care when they need it, that every senior has prescription drugs they can afford, and that no parents are going to bed at night worrying about how they'll afford medicine for a sick child," Sen. Obama said in June during a health care town hall meeting in Bristol, Va.

If elected, Sen. Obama has pledged to implement his health care proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

"That is not a level playing field," said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.).

Sen. Obama's approach is really a "backdoor" to getting everyone on a government-funded health plan, she said.

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the costs of catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faced criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan "falls far, far, short."

Dr. McCanne said he objects to the plan because it continues to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program for health care.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection and the premiums would become unaffordable, Dr. McCanne said.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute. However, that murkiness may be appropriate since members of Congress will be the ones to refine the details of any health care reforms, he said.

And Sen. Obama's plan is likely to get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more "plowing of the ground," he said. The debate over SCHIP has started the conversation about the need for universal coverage.

Naomi P. Senkeeto, a health policy analyst at the American College of Physicians, agreed that there are reasons to be optimistic about health reform passage this time around.

While much depends on the new president and the makeup of Congress, it is increasingly clear that how the reform will look will also depend on how quickly the issues are taken up following the inauguration. There is a growing sense that given all the competing priorities, if health care is not addressed in the first 100 days it will be increasingly difficult to pass. "It's really important to hit the ground running," Ms. Senkeeto said.

Sen. Barack Obama estimates his plan would save the average family $2,500 per year.

The presidential candidates aren't the only ones with proposals to reform the American health care system.

While the designs are different, more and more players in the health care arena are unveiling their own detailed plans to provide health care coverage for all or most Americans.

For instance, the Commonwealth Fund recently outlined a proposal called "Building Blocks" that seeks to cover 44 million of the 48 million Americans estimated to be uninsured in 2008. At the center of the proposal is a national health insurance connector that would allow small businesses and individuals without large employer insurance to shop for a health plan.

The connector would feature both private plans and a "Medicare Extra" option. The Medicare Extra plan would offer premiums of $259 a month for individuals and $702 a month for families, 30% lower than the average premium charged to employers today, according to the Commonwealth Fund, a private foundation that supports research on health policy reform.

The plan also calls for expanding Medicaid and the State Children's Health Insurance Plan (SCHIP) to cover all adults and children below 150% of the federal poverty level. And the plan would include both individual and employer mandates for health coverage.

Using modeling from the Lewin Group, officials at the Commonwealth Fund estimate that the proposal would add $15 billion to current total health spending in the United States during the first year and about $218 billion over 10 years. But the plan could actually save $1.6 trillion over 10 years if it is combined with other reforms such as changing Medicare payments to hospitals and physicians, investing in better health information technology, allowing Medicare to negotiate drug prices, and improving public health, according to the Commonwealth Fund.

"This approach builds on group insurance coverage and the national reach of Medicare and at the same time addresses the high administrative and premium costs for individuals and small groups," Karen Davis, Commonwealth Fund president, said in a statement.

In the meantime, the Healthcare Leadership Council, a coalition of hospitals, health plans, and pharmaceutical and device manufacturers that aims to improve the quality and affordability of health care, has brought forward its own market-based proposal aimed at covering all Americans. Called "Closing the Gap," the proposal calls for subsidies and tax breaks to help individuals afford coverage, improving health care quality through health information technology and care coordination, and realigning the financial incentives in the health care system to pay for value.

For example, the plan calls on the government to provide premium subsidies to help employees afford their employer-sponsored insurance premiums. The plan also calls for applying the same tax breaks to individually purchased health insurance as apply to employer-sponsored coverage. However, the group did not endorse the idea of individual mandates for health insurance.

The plan also calls for moving away from a payment system that rewards physicians and hospitals for the volume of services they provide and instead paying for evidence-based care and prevention. The current model rewards inefficiency and pays better when patients are sicker, Dr. Denis Cortese, chair of the Healthcare Leadership Council and president and chief executive officer of the Mayo Clinic, said during a press briefing to release the plan.

"We really are suggesting we turn that upside down," he said.

The presidential candidates aren't the only ones with proposals to reform the American health care system.

While the designs are different, more and more players in the health care arena are unveiling their own detailed plans to provide health care coverage for all or most Americans.

For instance, the Commonwealth Fund recently outlined a proposal called "Building Blocks" that seeks to cover 44 million of the 48 million Americans estimated to be uninsured in 2008. At the center of the proposal is a national health insurance connector that would allow small businesses and individuals without large employer insurance to shop for a health plan.

The connector would feature both private plans and a "Medicare Extra" option. The Medicare Extra plan would offer premiums of $259 a month for individuals and $702 a month for families, 30% lower than the average premium charged to employers today, according to the Commonwealth Fund, a private foundation that supports research on health policy reform.

The plan also calls for expanding Medicaid and the State Children's Health Insurance Plan (SCHIP) to cover all adults and children below 150% of the federal poverty level. And the plan would include both individual and employer mandates for health coverage.

Using modeling from the Lewin Group, officials at the Commonwealth Fund estimate that the proposal would add $15 billion to current total health spending in the United States during the first year and about $218 billion over 10 years. But the plan could actually save $1.6 trillion over 10 years if it is combined with other reforms such as changing Medicare payments to hospitals and physicians, investing in better health information technology, allowing Medicare to negotiate drug prices, and improving public health, according to the Commonwealth Fund.

"This approach builds on group insurance coverage and the national reach of Medicare and at the same time addresses the high administrative and premium costs for individuals and small groups," Karen Davis, Commonwealth Fund president, said in a statement.

In the meantime, the Healthcare Leadership Council, a coalition of hospitals, health plans, and pharmaceutical and device manufacturers that aims to improve the quality and affordability of health care, has brought forward its own market-based proposal aimed at covering all Americans. Called "Closing the Gap," the proposal calls for subsidies and tax breaks to help individuals afford coverage, improving health care quality through health information technology and care coordination, and realigning the financial incentives in the health care system to pay for value.

For example, the plan calls on the government to provide premium subsidies to help employees afford their employer-sponsored insurance premiums. The plan also calls for applying the same tax breaks to individually purchased health insurance as apply to employer-sponsored coverage. However, the group did not endorse the idea of individual mandates for health insurance.

The plan also calls for moving away from a payment system that rewards physicians and hospitals for the volume of services they provide and instead paying for evidence-based care and prevention. The current model rewards inefficiency and pays better when patients are sicker, Dr. Denis Cortese, chair of the Healthcare Leadership Council and president and chief executive officer of the Mayo Clinic, said during a press briefing to release the plan.

"We really are suggesting we turn that upside down," he said.

The presidential candidates aren't the only ones with proposals to reform the American health care system.

While the designs are different, more and more players in the health care arena are unveiling their own detailed plans to provide health care coverage for all or most Americans.

For instance, the Commonwealth Fund recently outlined a proposal called "Building Blocks" that seeks to cover 44 million of the 48 million Americans estimated to be uninsured in 2008. At the center of the proposal is a national health insurance connector that would allow small businesses and individuals without large employer insurance to shop for a health plan.

The connector would feature both private plans and a "Medicare Extra" option. The Medicare Extra plan would offer premiums of $259 a month for individuals and $702 a month for families, 30% lower than the average premium charged to employers today, according to the Commonwealth Fund, a private foundation that supports research on health policy reform.

The plan also calls for expanding Medicaid and the State Children's Health Insurance Plan (SCHIP) to cover all adults and children below 150% of the federal poverty level. And the plan would include both individual and employer mandates for health coverage.

Using modeling from the Lewin Group, officials at the Commonwealth Fund estimate that the proposal would add $15 billion to current total health spending in the United States during the first year and about $218 billion over 10 years. But the plan could actually save $1.6 trillion over 10 years if it is combined with other reforms such as changing Medicare payments to hospitals and physicians, investing in better health information technology, allowing Medicare to negotiate drug prices, and improving public health, according to the Commonwealth Fund.

"This approach builds on group insurance coverage and the national reach of Medicare and at the same time addresses the high administrative and premium costs for individuals and small groups," Karen Davis, Commonwealth Fund president, said in a statement.

In the meantime, the Healthcare Leadership Council, a coalition of hospitals, health plans, and pharmaceutical and device manufacturers that aims to improve the quality and affordability of health care, has brought forward its own market-based proposal aimed at covering all Americans. Called "Closing the Gap," the proposal calls for subsidies and tax breaks to help individuals afford coverage, improving health care quality through health information technology and care coordination, and realigning the financial incentives in the health care system to pay for value.

For example, the plan calls on the government to provide premium subsidies to help employees afford their employer-sponsored insurance premiums. The plan also calls for applying the same tax breaks to individually purchased health insurance as apply to employer-sponsored coverage. However, the group did not endorse the idea of individual mandates for health insurance.

The plan also calls for moving away from a payment system that rewards physicians and hospitals for the volume of services they provide and instead paying for evidence-based care and prevention. The current model rewards inefficiency and pays better when patients are sicker, Dr. Denis Cortese, chair of the Healthcare Leadership Council and president and chief executive officer of the Mayo Clinic, said during a press briefing to release the plan.

"We really are suggesting we turn that upside down," he said.

In 2006, more than seven working-age people in the state of Texas died each day because of a lack of health insurance coverage, according to estimates from the consumer group Families USA.

Families USA released state-by-state estimates of deaths attributed to a lack of health insurance for individuals aged 25-64 years.

The report builds on the work of the Institute of Medicine, which in 2002 released a report that found that approximately 18,000 individuals aged 25-64 years died in 2000 because they were uninsured.

A more recent study from the Urban Institute found that approximately 22,000 people in that age bracket died in 2006 because they didn't have health insurance.

"Our report highlights how our inadequate system of health coverage condemns a great number of people to an early death simply because they don't have the same access to health care as their insured neighbors," Ron Pollack, executive director of Families USA, said during a teleconference to release the report.

In general, the uninsured are less likely to have a usual source of care outside the emergency department, they often go without screenings and preventive care, and they frequently forgo needed medical treatment, Mr. Pollack said. While this often results in poor health, in the extreme it also leads to death, he said.

For example, in Utah, where 19% of the 1.2 million working-age people in the state were uninsured in 2006, on average three people died each week because of a lack of health insurance coverage. Between 2000 and 2006, more than 800 people died because of a lack of health insurance, the group estimated.

In Massachusetts, about 12% of the 3.4 million people between the ages of 25 and 64 years were uninsured in 2006. Families USA estimates that more than six working-age individuals in the state died each week in 2006 because of a lack of insurance coverage. Between 2000 and 2006, more than 2,000 working-age adults died because they didn't have insurance coverage, the group estimated.

However, these numbers are likely to improve in the next couple of years as more people gain insurance coverage as a result of health reform legislation passed in that state, Mr. Pollack said.

The Families USA estimates are based on 2000-2005 state mortality and population data from the National Center for Health Statistics and the U.S. Census Bureau Current Population Survey data from 2000 to 2006. The group released 50 state-specific reports but did not make state-to-state comparisons. The differing population sizes, mortality rates, and uninsured rates make it difficult to compare states, according to Families USA.

The state-by-state figures are available online at www.familiesusa.org

In 2006, more than seven working-age people in the state of Texas died each day because of a lack of health insurance coverage, according to estimates from the consumer group Families USA.

Families USA released state-by-state estimates of deaths attributed to a lack of health insurance for individuals aged 25-64 years.

The report builds on the work of the Institute of Medicine, which in 2002 released a report that found that approximately 18,000 individuals aged 25-64 years died in 2000 because they were uninsured.

A more recent study from the Urban Institute found that approximately 22,000 people in that age bracket died in 2006 because they didn't have health insurance.

"Our report highlights how our inadequate system of health coverage condemns a great number of people to an early death simply because they don't have the same access to health care as their insured neighbors," Ron Pollack, executive director of Families USA, said during a teleconference to release the report.

In general, the uninsured are less likely to have a usual source of care outside the emergency department, they often go without screenings and preventive care, and they frequently forgo needed medical treatment, Mr. Pollack said. While this often results in poor health, in the extreme it also leads to death, he said.

For example, in Utah, where 19% of the 1.2 million working-age people in the state were uninsured in 2006, on average three people died each week because of a lack of health insurance coverage. Between 2000 and 2006, more than 800 people died because of a lack of health insurance, the group estimated.

In Massachusetts, about 12% of the 3.4 million people between the ages of 25 and 64 years were uninsured in 2006. Families USA estimates that more than six working-age individuals in the state died each week in 2006 because of a lack of insurance coverage. Between 2000 and 2006, more than 2,000 working-age adults died because they didn't have insurance coverage, the group estimated.

However, these numbers are likely to improve in the next couple of years as more people gain insurance coverage as a result of health reform legislation passed in that state, Mr. Pollack said.

The Families USA estimates are based on 2000-2005 state mortality and population data from the National Center for Health Statistics and the U.S. Census Bureau Current Population Survey data from 2000 to 2006. The group released 50 state-specific reports but did not make state-to-state comparisons. The differing population sizes, mortality rates, and uninsured rates make it difficult to compare states, according to Families USA.

The state-by-state figures are available online at www.familiesusa.org

In 2006, more than seven working-age people in the state of Texas died each day because of a lack of health insurance coverage, according to estimates from the consumer group Families USA.

Families USA released state-by-state estimates of deaths attributed to a lack of health insurance for individuals aged 25-64 years.

The report builds on the work of the Institute of Medicine, which in 2002 released a report that found that approximately 18,000 individuals aged 25-64 years died in 2000 because they were uninsured.

A more recent study from the Urban Institute found that approximately 22,000 people in that age bracket died in 2006 because they didn't have health insurance.

"Our report highlights how our inadequate system of health coverage condemns a great number of people to an early death simply because they don't have the same access to health care as their insured neighbors," Ron Pollack, executive director of Families USA, said during a teleconference to release the report.

In general, the uninsured are less likely to have a usual source of care outside the emergency department, they often go without screenings and preventive care, and they frequently forgo needed medical treatment, Mr. Pollack said. While this often results in poor health, in the extreme it also leads to death, he said.

For example, in Utah, where 19% of the 1.2 million working-age people in the state were uninsured in 2006, on average three people died each week because of a lack of health insurance coverage. Between 2000 and 2006, more than 800 people died because of a lack of health insurance, the group estimated.

In Massachusetts, about 12% of the 3.4 million people between the ages of 25 and 64 years were uninsured in 2006. Families USA estimates that more than six working-age individuals in the state died each week in 2006 because of a lack of insurance coverage. Between 2000 and 2006, more than 2,000 working-age adults died because they didn't have insurance coverage, the group estimated.

However, these numbers are likely to improve in the next couple of years as more people gain insurance coverage as a result of health reform legislation passed in that state, Mr. Pollack said.

The Families USA estimates are based on 2000-2005 state mortality and population data from the National Center for Health Statistics and the U.S. Census Bureau Current Population Survey data from 2000 to 2006. The group released 50 state-specific reports but did not make state-to-state comparisons. The differing population sizes, mortality rates, and uninsured rates make it difficult to compare states, according to Families USA.

The state-by-state figures are available online at www.familiesusa.org

NEW YORK — More than 10% of teens in New York City public high schools who have ever had intercourse reported bisexual behavior in a 2005 survey, according to a recent analysis.

Those teenagers reported a higher prevalence of risky sexual behaviors, including lower rates of condom use and a greater number of sex partners, researchers from the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention found.

The analysis is based on responses to the New York City Youth Risk Behavior Survey, a population-based survey of in-school adolescents.

Of 1,881 males who reported ever having had intercourse, 94% reported opposite sex partners, 3% reported same-sex partners, and 3% reported partners of both sexes. Of 1,705 females who reported ever having had intercourse, 88% reported opposite sex partners, 3% reported same-sex partners, and 9% reported partners of both sexes.

Males and females were equally likely to report same-sex only behavior, but females were more than three times as likely to report bisexual behavior, Preeti Pathela, Dr. P.H., a research scientist at the New York City Department of Health and Mental Hygiene, said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

Of males who reported both male and female sex partners, they reported an earlier age of sexual debut, compared with the heterosexual and homosexual respondents.

Males who reported partners of both sexes also were more likely than the other two groups to report a greater number of lifetime and recent sex partners.

For the males who reported sex in the previous 3 months, 83% of those with partners of both sexes reported sex with two or more partners, compared with 46% of those who had opposite-sex partners and 28% of those with same-sex partners.

About 28% of the males with partners of both sexes reported condom use at last sex, compared with 77% of homosexual males and 79% of heterosexual males.

Among females, the patterns were somewhat different, Dr. Pathela said.

Females with partners of both sexes and those with same-sex partners only were both more likely than those with opposite sex partners only to report a greater number of lifetime and recent sex partners. Females who had partners of both sexes were also more likely than those with opposite sex partners only to report alcohol and drug use at last sex, she said.

The researchers also found that in many cases the sexual identity given by the respondents and the behaviors they reported did not match up. For example, they found the greatest discordance in males who had same-sex partners only but reported a heterosexual identity.

Discordant findings were even more striking in females, Dr. Pathela said. Among those who reported having only female partners, 79% of girls identified as heterosexual but engaged in same-sex behaviors only and 13% whose sexual identity was bisexual engaged only in same-sex behaviors. And in females with partners of both sexes, 26% considered themselves heterosexual.

Given the discordance between teens' sexual behavior and sexual identity, physicians need to inquire about sexual behaviors, not just identity, to assess risk, Dr. Pathela said.

The findings also have implications for prevention campaigns, she said. These messages must be appropriate for a broad audience of teens with same and opposite sex partners, she said.

Sexual health education should also include advising youth to inquire about the sex of their partners' partners, Dr. Pathela advised.

NEW YORK — More than 10% of teens in New York City public high schools who have ever had intercourse reported bisexual behavior in a 2005 survey, according to a recent analysis.

Those teenagers reported a higher prevalence of risky sexual behaviors, including lower rates of condom use and a greater number of sex partners, researchers from the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention found.

The analysis is based on responses to the New York City Youth Risk Behavior Survey, a population-based survey of in-school adolescents.

Of 1,881 males who reported ever having had intercourse, 94% reported opposite sex partners, 3% reported same-sex partners, and 3% reported partners of both sexes. Of 1,705 females who reported ever having had intercourse, 88% reported opposite sex partners, 3% reported same-sex partners, and 9% reported partners of both sexes.

Males and females were equally likely to report same-sex only behavior, but females were more than three times as likely to report bisexual behavior, Preeti Pathela, Dr. P.H., a research scientist at the New York City Department of Health and Mental Hygiene, said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

Of males who reported both male and female sex partners, they reported an earlier age of sexual debut, compared with the heterosexual and homosexual respondents.

Males who reported partners of both sexes also were more likely than the other two groups to report a greater number of lifetime and recent sex partners.

For the males who reported sex in the previous 3 months, 83% of those with partners of both sexes reported sex with two or more partners, compared with 46% of those who had opposite-sex partners and 28% of those with same-sex partners.

About 28% of the males with partners of both sexes reported condom use at last sex, compared with 77% of homosexual males and 79% of heterosexual males.

Among females, the patterns were somewhat different, Dr. Pathela said.

Females with partners of both sexes and those with same-sex partners only were both more likely than those with opposite sex partners only to report a greater number of lifetime and recent sex partners. Females who had partners of both sexes were also more likely than those with opposite sex partners only to report alcohol and drug use at last sex, she said.

The researchers also found that in many cases the sexual identity given by the respondents and the behaviors they reported did not match up. For example, they found the greatest discordance in males who had same-sex partners only but reported a heterosexual identity.

Discordant findings were even more striking in females, Dr. Pathela said. Among those who reported having only female partners, 79% of girls identified as heterosexual but engaged in same-sex behaviors only and 13% whose sexual identity was bisexual engaged only in same-sex behaviors. And in females with partners of both sexes, 26% considered themselves heterosexual.

Given the discordance between teens' sexual behavior and sexual identity, physicians need to inquire about sexual behaviors, not just identity, to assess risk, Dr. Pathela said.

The findings also have implications for prevention campaigns, she said. These messages must be appropriate for a broad audience of teens with same and opposite sex partners, she said.

Sexual health education should also include advising youth to inquire about the sex of their partners' partners, Dr. Pathela advised.

NEW YORK — More than 10% of teens in New York City public high schools who have ever had intercourse reported bisexual behavior in a 2005 survey, according to a recent analysis.

Those teenagers reported a higher prevalence of risky sexual behaviors, including lower rates of condom use and a greater number of sex partners, researchers from the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention found.

The analysis is based on responses to the New York City Youth Risk Behavior Survey, a population-based survey of in-school adolescents.

Of 1,881 males who reported ever having had intercourse, 94% reported opposite sex partners, 3% reported same-sex partners, and 3% reported partners of both sexes. Of 1,705 females who reported ever having had intercourse, 88% reported opposite sex partners, 3% reported same-sex partners, and 9% reported partners of both sexes.

Males and females were equally likely to report same-sex only behavior, but females were more than three times as likely to report bisexual behavior, Preeti Pathela, Dr. P.H., a research scientist at the New York City Department of Health and Mental Hygiene, said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

Of males who reported both male and female sex partners, they reported an earlier age of sexual debut, compared with the heterosexual and homosexual respondents.

Males who reported partners of both sexes also were more likely than the other two groups to report a greater number of lifetime and recent sex partners.

For the males who reported sex in the previous 3 months, 83% of those with partners of both sexes reported sex with two or more partners, compared with 46% of those who had opposite-sex partners and 28% of those with same-sex partners.

About 28% of the males with partners of both sexes reported condom use at last sex, compared with 77% of homosexual males and 79% of heterosexual males.

Among females, the patterns were somewhat different, Dr. Pathela said.

Females with partners of both sexes and those with same-sex partners only were both more likely than those with opposite sex partners only to report a greater number of lifetime and recent sex partners. Females who had partners of both sexes were also more likely than those with opposite sex partners only to report alcohol and drug use at last sex, she said.

The researchers also found that in many cases the sexual identity given by the respondents and the behaviors they reported did not match up. For example, they found the greatest discordance in males who had same-sex partners only but reported a heterosexual identity.

Discordant findings were even more striking in females, Dr. Pathela said. Among those who reported having only female partners, 79% of girls identified as heterosexual but engaged in same-sex behaviors only and 13% whose sexual identity was bisexual engaged only in same-sex behaviors. And in females with partners of both sexes, 26% considered themselves heterosexual.

Given the discordance between teens' sexual behavior and sexual identity, physicians need to inquire about sexual behaviors, not just identity, to assess risk, Dr. Pathela said.

The findings also have implications for prevention campaigns, she said. These messages must be appropriate for a broad audience of teens with same and opposite sex partners, she said.

Sexual health education should also include advising youth to inquire about the sex of their partners' partners, Dr. Pathela advised.