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Vital Signs

Candidates present policy proposals, not just sound bites

By Laura Stephenson Carter

Presidential candidates are always eager to campaign in New Hampshire, the state with the first-in-the-nation primary—January 8, 2008, this quadrennium. Some are even eager to appear at a place where they aren't allowed to campaign—DHMC, the state's only academic medical center.

All of the major candidates were invited to present their views on health-care policy at forums called Health Policy Grand Rounds. Two Republicans—Mitt Romney and Mike Huckabee—and two Democrats—Hillary Clinton and John Edwards—had appeared at press time.

Crowd: The first candidate to accept DHMC's invitation was former Massachusetts governor Mitt Romney. In February 2007, he told the crowd of doctors, students, and hospital administrators that he believes the country will eventually adopt a systemfor mandatory health insurance similar to the one he signed into law in the Bay State in 2006.

Romney supports a free-market system to spread out the risk for the insurance industry and give insurers an incentive to offer lower rates. He said a system that mandates insurance coverage will avoid the problem of people without insurance waiting until they have amedical crisis to get care, necessitating expensive hospital care and driving up costs for everyone else.

In August, New York Senator Hillary Rodham Clinton outlined her plan. She wants to lower costs, improve quality, and see that all Americans are insured. Her presentation at DHMC focused on quality. She proposes to raise standards for providers, educate patients, and require insurers to reward innovation (she had high praise for DHMC's Center for Shared Decision Making). She would also overhaul the reimbursement system so it doesn't punish doctors for providing patient-centered care and would promote physician certification programs to keep doctors up-to-date.

And she would address the nursing shortage by providing $300 million to expand enrollment in nursing schools, create mentoring programs for new nurses, and recruit more minorities into the profession.

Crisis: In November, Mike Huckabee and John Edwards presented their proposals. Huckabee, the former governor of Arkansas, said the health-care industry and insurance companies need to place more emphasis on prevention.He saidAmerica is not facing a health-care crisis—citing DHMC as an example of some of the best health care available anywhere—but a health crisis, in which dealing with largely preventable chronic diseases, caused by lifestyle choices and a lack of preventive screening, is consuming as much as 80% of the country's healthcare resources. He called the American health-care system "upside

At press time for this issue—only a few weeks before New Hampshire's first-in-the-nation presidential primary—four major candidates had been to DHMC to give Health Policy Grand Rounds. In November, John Edwards 1 posed for a gaggle of press photographers and 2 spoke to several hundred medical students, doctors, nurses, and other DHMC employees. The scheduling and security details of the series fall to 3 DHMC's director of government relations, Frank McDougall (far left), pictured here with Mike Huckabee (in the blue tie). Before his speech, Huckabee 4 got a chance to discuss details of his health-care proposal with a couple of medical students. 5 Mitt Romney also accepted DHMC's invitation to come speak. And 6 Hillary Clinton had a conversation before her speech with Mark Israel, the director of Dartmouth's Norris Cotton Cancer Center.

down," because it too often intervenes only after people have become catastrophically ill.

John Edwards called for a dramatic increase in health-care spending to guarantee universal coverage, provide paid family leave, and extend unpaid leave to more than 13 million Americans. His plan would require employers to either cover workers or help finance their insurance. He supports the creation of new tax credits, the expansion of Medicaid, the reform of insurance laws, and the identification of innovative ways to contain costs. He would also create regional "health-care markets" to increase choice among insurance plans and cut costs for businesses offering insurance.Once these steps have been taken, his plan would then require all Americans to get insurance.

Idea: The idea for Health Policy Grand Rounds was an outgrowth of medical grand rounds, where experts lecture on clinical issues. The policy forums last an hour, with the candidate speaking for 30 to 45 minutes and then answering questions from DHMC physicians, nurses, researchers, administrators, and students. The media may attend but cannot ask questions. The series was launched during the 2003-04 campaign.

Health Policy Grand Rounds "gives the candidates an invaluable forum for getting feedback from nationally known experts at one of the country's leading academic medical centers," says FrankMcDougall, DHMC's vice president for government relations, who oversees the forums. "It's great to be in the forefront of the health-policy discussions."

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