HEALTH CARE EMERGES AS PRIME CONCERN IN PRESIDENTIAL CAMPAIGN.

Voters in New Hampshire's Jan. 27 Democratic presidential primary gave Sen. John F. Kerry (D-MA) his second primary win, with exit polls showing soaring health care and Medicare costs were a prime reason they voted for him.

Immediately after the results were made public, President Bush traveled to New Hampshire to give one of three major addresses he delivered last week on health care, an indication he had taken the exit polls seriously.

Bush has called for the federal government to limit medical malpractice awards, offer refundable tax credits to help low-income Americans buy health insurance, allow small businesses to form association health plans to help them buy coverage and negotiate for lower insurance rates and create a tax deduction for the cost of premiums for catastrophic health care coverage.

His proposal would provide health insurance to 10 million of the 43.3 million who lack coverage and is estimated to cost $35 billion a year.

Kerry, who won his fourth term to the Senate with 81 percent of the vote, generally has left health issues to his fellow Massachusetts Democratic senator, Edward M. Kennedy, who is the ranking member of the Senate Health, Education, Labor and Pensions Committee.

Before the Iowa primary, however, Kerry came out with a five-point plan that focuses on "controlling the spiraling costs of health care."

First, he would create "a premium rebate pool that will make health care more affordable for all employers and employees by helping out with certain high cost health cases."

To be eligible, employers and their insurers would have to: provide affordable health coverage to all their workers; demonstrate that workers will receive the savings; and encourage disease management to improve care quality and decrease the costs of care.

Second, Kerry would make prescription drugs more affordable by requiring transparency rules for pharmacy benefit managers doing business with the federal government to clearly show what savings they are receiving from the industry and from bulk purchasing, by ending loopholes that keep more affordable prescription drugs from the market and by giving states authority to negotiate real discounts on prescription drugs.

Third, he says he would make malpractice insurance more affordable by substantially reducing meritless claims and defenses, enhancing opportunities to resolve claims fairly without protracted litigation and making the system fairer for doctors and patients alike.

He "strongly opposes capping damages in medical malpractice lawsuits" but opposes the award of punitive damages except upon proof of intentional misconduct, gross negligence or reckless indifference to life.

Fourth, Kerry says he would reduce the number of medical errors by providing financial incentives to help providers and purchasers improve quality, reward health care organizations and physicians that invest in modern information systems, provide economic incentives to computerize prescribing systems and make medical "errors and patient injuries immediately known and reported, not to punish people but to find ways to prevent their reoccurrence."

Fifth, he would cut administrative or paper work costs in half by applying modern information technology to cut costs associated with the preparation, submission, calculation and payment of bills.

Kerry says his plan would provide coverage to about 27 million previously uninsured and would cost an average of $72 billion annually for the next five years.

Gov. Howard Dean, a physician who served as governor of Vermont for 11 years and came in second to Kerry in the New Hampshire primary, has proposed adopting the plan similar to the one he launched in Vermont, which he says has resulted in 92 percent of the state's residents being insured and 96 percent of its children being insured.

Under his proposal, the Children's Health Insurance Plan to the states would extend coverage to every uninsured child and young adult up to age 25. He also would expand Medicaid coverage to an additional 11.8 million, provide tax credits to help low-income families purchase health insurance and assist small businesses in buying into larger insurance pools.

He would create a new Health Care Institute within the National Institutes of Health that would serve as a clearinghouse for vital information, assess the cost/benefit of new technologies and products, explore new ways of organizing and paying for care, and increase emphasis on implementation, not just research.

He says he would cut down on paperwork and administrative costs by mandating standardized electronic medical records, which could be integrated with a uniform billing system, so prescriptions could be written electronically to reduce errors, possible dangerous drug reactions could be spotted and whether filling and refilling of prescriptions could be tracked.

Dean says he would curb the rapidly rising cost of prescription drugs by preventing the pharmaceutical companies from avoiding competition from generic drug companies; by allowing states to experiment with controlling drug costs, as Vermont and Maine have done; by removing restrictions from importation of drugs from countries with drug protections similar to those this nation has; and by requiring pharmaceutical manufacturers to disclose any gift, fee, subsidy or other economic benefit provided to a physician, hospital, nursing home, pharmacist or health benefit plan administrator.