Every American man, women and child has the right to affordable health care, a right that has been denied Americans far too long. Every western nation provides universal healthcare. Why not us? Within 90 days of taking office Joe Biden will propose a plan of action to provide all Americans with affordable healthcare.

Everyone-adults and children-should have access to health care in this country. Yet nine million children and thirty seven million adults have been denied that goal. 70% of those people have families with one or more full time workers.

We now face an opportunity and an obligation - to turn the page on the failed policies of yesterday’s health care debates. It’s time to bring together businesses, the medical establishment, the pharmaceutical community, and members of both parties, around a comprehensive solution to this predicament.

Joe Biden has proposed a health care plan of action that will meet the following goals:

1. Insure every child;
2. Provide all adults with access to affordable health insurance;
3. Assist families and companies with burdens of catastrophic cases;
4. Modernize and simplify the system.

The path towards universal coverage starts with most vulnerable in our society. I would make sure that every child has health insurance. One way we can do this is by expanding state children’s health insurance programs. I would relieve families and companies of the burden of catastrophic cases.Beyond that, we should evaluate the best way to provide coverage for the remaining uninsured. Let me be clear- this is not a question of if we’re going to provide universal healthcare-but how we are going to provide universal health care.

I would support experimentation on the state level, as they are doing in Massachusetts and California, to determine how employer mandates and individual mandates work best. And I would support states, like my home state of Delaware, that are making the transition to ‘electronic medical record’ systems that allow doctors and patients real-time access to records and help prevent dangerous and costly mistakes and duplications.

But focusing on universal access to health care alone isn’t enough. Our national health care policy must also include a strategy to keep skyrocketing costs in check. We can do that by modernizing the system, simplifying it and improving the quality. We can modernize health care by providing the electronic records to doctors, nurses and pharmacists, giving them access to histories and information in real time. We can improve health care by taking the best medical practices and applying them to disease management. We must do a better job of promoting prevention and wellness and making sure that people who suffer from chronic diseases, like heart disease and diabetes have adequate access to care, can afford medication and are able to manage and treat their illness and avoid serious complications.

We now face an opportunity, indeed an obligation, to turn the page on the failed policies of yesterday’s health care debates. It’s time to bring together businesses, the medical community and members of both parties to a comprehensive solution to this crisis. It’s time to let the drug and insurance industries know that while they’ll have a seat at the table, they won’t get to buy every chair.

Joe Biden’s highest priority, along with ending the war in Iraq, is universal health care and health education. He will convene a national gathering of healthcare interests from labor, business, the insurance industry, the healthcare industry and government within the first 90 days of his administration to seize an historic opportunity, created by the realization by organizations ranging from the Fortune 500, the business Roundtable and the labor movement, that the time has come for Universal, affordable health care. The time has come to develop a comprehensive plan for coverage of every American. Biden proposes four essential steps to lay the foundation for a comprehensive plan:

Step one: Reducing the cost of healthcare

The reality is that the United States spends more on medical services than any other developed nation, including those countries that provide health insurance for all. We can afford to provide universal health care in this country and we can pay for it with a national agenda of sensible steps to get health care costs under control. The USA spends over a trillion dollars on medical care every year, almost $7,000 per person. Healthcare is 16% of our gross national product. Health insurance expenses are the fastest growing cost component for employers premiums which have gone up to 87% since 2000, four times the rate of wages. We still we have no national agenda to address affordable health care. Joe Biden plans to bring health care costs under control and increase the quality of care by a series of intelligent steps:

Focusing on prevention

According to the agency for healthcare research and quality, approximately 108 million people in the United States have at least one chronic disease. Including such diseases as heart disease, diabetes, asthma, hypertension or osteoarthritis. Any one of these conditions can have a severe impact on the quality of a person’s life. Obesity, which increases the risk for these conditions, has doubled among adults over the last two decades. Treating these chronic diseases accounts for 74% of private insurance spending and 83% of government spending.

Approximately 1.7 million hospitalizations occur annually for heart attacks and over 600,000 people die each year of heart disease. Nearly 50,000 people die each year as a result of diabetes. Health care costs for asthma patients rose dramatically from $4.5 billion in the 1980s to 10.7 billion in the 1990s. Over 50 million people suffer from high blood pressure. More than half of people over the age of 65 have evidence of osteoarthritis. Joe Biden will require insurance providers participating in federal programs to cover preventative care. Joe Biden will establish chronic disease treatment programs in Medicare and other federal programs to better manage care.

Step two: Improve the management of chronic diseases.

America spends far more per capita on health care than any other industrialized nation, but the increased spending does not result in better healthcare outcomes.One of the challenges facing our healthcare system, especially with an aging population, is controlling the amount of money we pay for treatment. While it is tempting to control Medicare costs by simply reducing payments to providers, that approach does not address the issue of the volume of services used and also creates an access problem, as many providers drop out of publicly run programs when reimbursement drops too low.

Our current system reimburses providers on the volume of ’services use’, without actually examining what services work best. We need to establish a mechanism to examine what methods work better than others.

One approach is to create a panel that will compare the effectiveness of medical treatments and technologies. Many other countries require clinical and economic assessments of medical services as a condition for reimbursement. Joe Biden intends to establish a ‘comparative effectiveness’ panel to evaluate treatment protocols, medical devices and new technology, and to establish test practices for management of chronic diseases.

Invest in information technology:
Joe Biden’s home state, Delaware, is a leader in adopting new health information technology, statewide health information and electronic data interchange for public and private use, establishing a reliable exchange of health information among the many health care providers treating patients throughout Delaware.

The potential for a significant improvement in the delivery of healthcare exists when healthcare providers and consumers have access to complete health and treatment histories. Access to this information about a patient’s medical history enables a health provider to make better clinical decisions, resulting in better health outcomes for the patient. Improved ‘patient provider communication’ results in the patient being more involved in treatment decisions, improving compliance and then, over all health outcomes.

Two of the most significant cost drivers in the healthcare industry are prescription drugs and high technology diagnostic and testing services. Compounding these costs is the potential for duplication. Electronic medical records can stop duplicate tests and procedures. The potential savings to the healthcare industry from full adoption of electronic medical records is substantial. The Rand corporation has estimated that the full adoption of electronic medical records could save $77 billion annually.

Joe Biden would invest at least $1 billion per year in moving to electronic health records, would provide grants to states to develop electronic medical records, and would assist hospitals, medical facilities and doctors in upgrading to electronic records systems.

Require uniform billing and claims:
30% of all health care expenditures in the United States are spent on administrative costs. One of the reasons for such high costs are the numerous insurance ‘claims forms’ that providers must fill out to get paid for their services. The state of Utah recently tackled this problem by giving all insurance providers a standardized, electronic form designed to eliminate claim disputes and reams of paperwork. The Utah health information network, created in 1994, is estimated to save the state one hundred to two hundred million per year by switching to a common system for medical billing. This system allows many different billing systems used by doctors, insurers and hospitals to communicate with one another and required substantial cooperation form Utah’s competing insurers. 900 codes were reduced to 90. The cost of health insurance has remained flat in Utah while elsewhere it has increased an average of 13% per year in the United States.

To support the movement to the uniform billing system, Joe Biden will:

• provide federal funding to support state initiatives to adopt Utah-like insurer agreements to create one plane.
• Two require insurers participating in federal programs to shift to paperless uniform billing and claims forms.

Negotiate ‘prescription drugs’.

The Medicare part D prescription drug program was created in the Medicare Modernization of 2003 Act. Medicare covers more that 40 million seniors and disabled Americans who are projected to consume $1.8 trillion worth of prescription drugs over the next decade. Unfortunately, this act expressly forbids the federal government from interfering in drug negotiations between pharmaceutical companies and the numerous private insurers spread out across the country. Simply put, this “non-interference” dilutes Medicare’s bargaining position.Joe Biden will remove the prohibition against the federal government negotiating prices for prescription drugs, to allow the federal government to use its bulk purchasing power to reduce costs for Medicare beneficiaries.

Meeting the needs of new healthcare professionals:

Nurses
Nurses play a critical role in this nation’s health care system. They make the difference in the quality of care patients receive. With an estimated 2.9 million licensed registered nurses, they represent the largest occupational group of healthcare workers and provide patient care in virtually all locations in which health care is delivered.

The United States is in the midst of a nursing shortage that is expected to intensify as baby boomers age. The Veterans Administration, the largest sole employer of nurses in the United States a nursing vacancy rate of 10% is estimated to increase to 340,000 by the year 2020.

There are several reasons for this nursing shortage. First, the nursing workforce is rapidly aging. Second, the population of new nurses is growing at a slower rate. Third, many nurses feel burdened by heavy patient loads, stressful working conditions and long hours. Many are leave the nursing profession. Fourth, our nursing schools are unable to educate more nurses at the rate they are needed. Nursing schools turn away an estimated 43,000 qualified applicants each year due to an insufficient number of faculty, clinical sites, classroom space, and budget constraints.

Joe Biden will help train and put 100,000 new nurses in the workforce in the next five years, increase funding for the nurse student loan program, double funding for the nursing faculty loan program, and provide funds for academic institutions to establish a doctoral nursing degree program. States that currently lack such programs, will be encouraged to establish pilot projects between health facilities and academic institutions, to allow nurses to stay in their jobs, while attending school to earn a graduate degree.

Public Health Workers
Joe Biden will help train the next generation of public health workers by establishing the public health workforce scholarship program to provide eligible students with scholarships to study public health; establish a public health workforce loan repayment program; create a catalog to publish federal health employment opportunities.

Physicians.
Joe Biden will continue support for graduate medical education and support initiatives to prepare physicians to practice in specialties that address impending needs of Americans, especially geriatrics, family medicine and emergency care.

Step two: Cover all children

The path to universal health care starts with making sure that the most vulnerable of our population and our children have health insurance.

Joe Biden will cover all kids by:

• Expanding the State children’s health insurance programs by at least 300%.
• Allowing all families to buy into SCHIP, with sliding scale premiums and copayments, based on family income.
• Extend coverage to at least age 21.
• Emphasize wellness and prevention by eliminating key copayments for physicians, vaccinations, vision and hearing screenings, and preventative dental checkups for children of any income level.
• Automatically enroll eligible uninsured children at birth, at school registration and through other programs such as Head Start.
• Expand Medicaid to cover low income parents or childless couples.

Step three: Lower health care costs for employers.

Most Americans, some 60%, receive health insurance through their employers. But employers are scaling back benefits as the cost of health care insurance and healthcare itself rises. Millions of workers no longer receive insurance from employers. 70% of the uninsured are employed. The 5% of people with the greatest health care costs account for half of health care spending in the country. Just one employee with high medical expenses can push premiums for all and make insurance unaffordable.

In addition to helping families and businesses avoid financial disasters,a catastrophic coverage plan could help lower administrative costs and reduce the variation in health care costs. It has been estimated that a ’stop loss plan’ that pays 75% of claim costs for catastrophic illnesses, and reduces the risk factor for health plans, would most likely translate into lower health insurance premiums.

A federal ’stop loss’ pool in the health insurance market is not a new role for the federal government in the private insurance market. The federal government currently assumes the risk for high-cost cases in several other private markets, including the Federal Emergency Management Agency which plays a key role in providing financial assistance for the private sector, facing catastrophic losses.

Joe Biden would establish a federal reinsurance pool to reimburse employers, insurers or associations for 75% of catastrophic health care costs (those exceeding $50,000 per individual). To participate in the rebate program, insurance providers would have to cover all employees and apply best practices to chronic disease management. This health care plan would allow small business pools to utilize this reinsurance pool if they comply with existing state laws.

Step four: Encourage reform in the insurance industry

Insurance companies often discriminate against people who need insurance the most, those with pre-existing conditions and those with high risk factors for certain diseases. For individuals who do not have access to employer sponsored insurance, the high cost of individual insurance policies simply forces them to go without health insurance. To help these people, Joe Biden would allow insurers that offer individual policies to access the reinsurance pool if they agree to use community rating to underwrite their policies and not turn away people because of pre-existing conditions. This program would also protect against genetic discrimination by prohibiting employers and insurance companies from collecting and using genetic information when making decisions about hiring, providing health coverage, or discriminating in the pricing of an insurance policy.