Sen Clinton’s Plan to Fight Cancer

Hillary Clinton released her plan to fight cancer today as she appeared at Lance Armstrong’s LIVESTRONG Presidential Cancer Forum in Cedar Rapids, IA.

Cancer is the leading cause of death in this country for people under age 85. One in two men and one in three women will get cancer in their lifetime. About 1.4 million new cancer cases are expected in the United States in 2007, and more than 1,500 people per day will die of cancer. NIH estimates the overall cost of cancer in the U.S. in 2006 was about $206 billion for direct medical costs and lost productivity due to illness and early death. As President, Hillary Clinton will invest the necessary resources so that our nation is on a path to achieve the National Cancer Institute’s goal of ending death and suffering from cancer by 2015 through:

Ending Insurance Discrimination. Today, insurance companies spend millions of dollars working to discriminate against those with expensive, pre-existing conditions by denying them coverage or treatment. Cancer patients are those most victimized by insurance company practices of trying not to cover care when it’s needed most. In order to end insurance discrimination, Hillary Clinton will:

· Create a guarantee issue system. A “guarantee issue" system, built on the concept of shared responsibility, allows anyone to join a health insurance plan. This system will end the days of relegating high-cost individuals to separate, more costly, plans or public programs. In addition, insurance companies will no longer be allowed to carve out benefits or charge higher rates to people with health problems or at risk of them.

· Reducing marketing costs and improving value for the premium dollar. Under a universal coverage plan with real insurance regulations, i nsurers would compete on low costs and high quality, not on successful underwriting and deceptive marketing practices. Hillary Clinton will create a structure of accountability for public and private insurance plans that provides transparency for consumers and allows us to wring out administrative costs that do nothing but add to the bottom line.

Ending Genetic Discrimination. Today, many Americans, especially those with a history of cancer in their family, are fearful of getting genetic tests, because they are worried they will be denied health insurance even though these tests could enable them to make changes in their lifestyle or obtain more regular screenings that could save their lives. Senator Clinton believes in the power and the promise of genetic testing to do good, but does not want to see these tests exploited to harm the very people who are at greatest risk for getting cancer. Hillary will prohibit health insurance companies from discriminating against individuals or their families on the basis of a genetic test. Insurance companies would not be allowed to require genetic tests or consider the results of any test when determining eligibility for or cost of health insurance.

Increased federal funding for cancer. Cancer research has made remarkable progress in prevention, detection, and treatment. According to the American Cancer Society, the absolute number of cancer deaths declined for the second consecutive year last year. Despite these advances, research funding is not keeping pace. During the Clinton Administration, the NIH budget more than doubled – from $8.9 billion in 1992 to $20.5 billion in 2001. It then grew to $27 billion by 2003. But adjusting for inflation, the NIH has not been increased over the past four years. Since 2003, funding has fallen behind medical inflation and in 2006, the NIH budget was cut for the first time in 35 years. Today, the National Cancer Institute has 12% less purchasing power than it had four years ago. The American Association for the Advancement of Science predicts that the percentage of NIH proposals receiving funds will be cut nearly in half by the end of 2007, compared with 2001 levels. As a result, cancer programs have stalled at major centers across the country; clinical trial accrual has slowed, and in some cases, clinical trials have been abandoned for lack of resources. Young researchers are turning to other career opportunities because of the uncertainty of future funding, and many of the best and brightest no longer see the promise of a career in science. In 1970, the average age of a first research grant was 34.2 years; today it is 41.7. If the current situation continues, there will be lasting damage, even if funding is increased in future years. As President, Hillary Clinton will:

· Double the NIH and NCI budgets. She has proposed to increase the NIH budget by 50% over five years and double the budget in ten. She will call for comparable increases to the National Cancer Institute’s budget.

· Expand the Cancer Centers program so that every American lives within the service area of an NCI Cancer Center. Today, there are 18 states with no Cancer Center, including large swaths of the country. As President, Hillary will expand this vital program so that it is in reach for every American living with cancer.

· Increase by fivefold the number of patients participating in cancer clinical trials. This will require expanding access to experimental cancer therapies at NCI Cancer Centers; increasing the Community Clinical Oncology Group, which places underserved populations in rural and urban areas in community-based clinical trails; increasing funding for the cancer clinical cooperative group; and increasing the Specialized Programs of Research Excellence (SPORES) program, which conduct research on different types of cancer.

· Preserve Medicare coverage of clinical trials. President Clinton issued an Executive Memorandum in 2000 requiring Medicare to cover the routine costs associated with participation in clinical trials. This policy has made it possible for many more Medicare cancer patients to participate in clinical trials – the number participating has grown from 25% to 38% of enrollees since the Clinton policy was adopted. This policy has been praised by researchers, as well as advocates for cancer patients and the elderly, and there is no evidence it has caused harm, raised costs or negatively impacted the quality of care patients receive. Nevertheless, the Bush Administration has proposed abandoning this simple system in favor of one that is much more complex and likely to deter researchers from using Medicare patients as part of their trials. Senator Clinton will maintain the successful Clinton-era set of rules for enrolling Medicare participants in clinical trials.

A Smart Approach to Prevention and Early Detection. According to the National Cancer Legislation Advisory Committee, we could prevent up to two-thirds of all deaths from cancer if Americans consumed a healthy diet, got their cancer screenings, used sunscreen and minimized sun exposure, exercised, and refrained from smoking. Timely and regular mammograms can prevent 30 percent of all deaths from breast cancer in women over 40. If all adults over 50 were screened for colon cancer, we would cut the death rate in half and save 30,000 lives each year. Almost a third of all cancer deaths are the result of tobacco use. Early detection and treatment not only saves lives; it saves money. Treating a precancerous lesion found in Pap smear costs $1,000 to $2,000. Treating a cancerous lesion costs 30 times that. Hillary will promote a five-tiered approach to preventing and detecting cancer early:

· Require all insurers participating in federal programs to cover prevention priorities: Hillary will make it a condition of doing business with the Federal government that health plans cover high-priority preventive services. Covered services would be based on recommendations from the U.S. Prevention Services Task Force. Insurers would provide both individuals and providers with the financial incentives, such as eliminating copays for high-priority prevention services.

· Target prevention by coordinating and pooling public funding: She will also ensure the government coordinates public spending on prevention across federal programs in the Department of Health and Human Services to maximize high-priority prevention. This public-private collaboration would ensure that prevention is pushed outside of the boundaries of the health care system and into schools, workplace, supermarkets and communities through free provision of preventive benefits. It would enlist a new prevention workforce including pharmacists, church leaders and others who can best use funds to ensure 100 percent use of cost-effective prevention.

· Increase access to screening tools that have been shown to work. In 2006, the biggest decrease in cancer deaths was instances of colorectal cancer in men and women. This decrease occurred because of increased screening and early treatment. Hillary will:

o promote a national education campaign to increase awareness about effective screening, such as mammograms, colorectal screening, and the HPV vaccine;

o require group and individual health plans to cover colorectal cancer screenings;

o authorize a colorectal cancer early detection and treatment demonstration program to serve at least 2 million low-income, uninsured individuals ages 50-64;

o remove Medicare co-pays for colorectal and breast cancer screenings and extend the Welcome to Medicare visit time limit from six months to one year;

o fully fund the National Breast and Cervical Cancer Early Detection Program; and

o invest in research aimed at identifying the molecular and genetic combinations that make people more or less susceptible to different types of cancer. Knowing more about the risks will enable people to alter their lifestyles in ways that could lower their risk of attaining cancer or increase their chances of catching it early.

· Help smokers quit and decrease the chances of young people starting to smoke. Most smokers want to quit, but quitting is hard and they need more support. Yet states aren’t dedicating the necessary funds to anti-smoking programs – even though they received substantial funding from the tobacco settlements – and the federal government is still hamstrung in regulatory efforts. Senator Clinton will:

o Enable the FDA to restrict advertising of tobacco products to children and stop illegal sales of tobacco products to children by finally enacting the Family Smoking Prevention and Tobacco Control Act . Most smokers try their first cigarette at age 13 and by 15, are smoking daily even though it is illegal for them to be purchasing cigarettes. By empowering the FDA to regulate tobacco advertising and sales, we can reduce the number of children becoming addicted to this deadly substance.

o Promote smoking cessation programs and fund them by increasing the federal excise tax on cigarettes. When the federal tax was implemented in 1960, it accounted for one third of a pack of cigarettes. Today, it makes up only 10 percent. Evidence strongly demonstrates that a higher cigarette tax discourages children and adults from smoking.

o Provide coverage for comprehensive smoking cessation in Medicaid.

· Put physical education and sports programs back in schools and take the junk food out. Fighting cancer starts with instilling healthy habits in our children. We want the next Lance Armstrong to have access to a bike, a pool, a track, and the time and encouragement to discover his potential. Unfortunately, schools are cutting physical education and recess, cutting back on team sports, and relying increasingly on junk food vending machines to supplement their budgets as a result of inadequate education funding and an intense focus on raising reading and math scores. As President, Hillary will:

o increase funding for the Carol White Physical Education program, the only federal program aimed at improving physical education programs in schools, by 50% - $36 million – and ensure that this funding gets to underserved communities with the highest rates of childhood obesity;

o implement a healthy schools program that will provide funding for schools that commit to replacing all unhealthy food in schools with healthy food by the year 2012

Improved Quality of Care for Americans Living with Cancer. One of the greatest challenges facing cancer survivors and their loved ones is the complexity of the system they must navigate in order to obtain the care they need. Survivors often interface with a variety of specialists, face challenging decisions with limited information, and feel enormous stress throughout the treatment process. In order to improve the quality of care for cancer patients, Hillary will:

o Provide funding for demonstration programs for comprehensive care and communication models. She will propose $50 million to support the development of comprehensive care and communication plans (plans that let patients know what to expect with respect to their treatment) for patients in underserved areas and those enrolled in Medicare. The plan should outline the care the patient will receive in clear, concise language, and should be revisited at each major transition point in treatment, and when transitioning from active treatment to survivorship. She will fight for Medicare to reimburse health care providers who adopt this type of plan.

o Develop patient-friendly decision aids to promote informed patient choice. She will p rovide $25 million in federal funding to encourage the development of new programs that ensure that patients have access to up-to-date information and tools to help them understand their treatment options and make decisions that reflect their values. Cancer is complex and cancer patients often lack access to basic information about their disease.

o Reduce racial and ethnic disparities in care. She will provide $50 million in federal funding for the development of culturally and linguistically competent clinical care programs, to ensure that our healthcare providers can communicate with their patients and have training and skills to fully understand and respect cultural differences in the patients they serve.

· New "Paperless" Health Information Technology System. Standardized electronic medical records will make possible significant advances in research, detection, treatment, and care over the long-term while empowering doctors and other healthcare providers to communicate electronically, reducing waste and redundancy, and improving safety and quality by reducing medical errors.

· Environmental Health Tracking. Hillary will expand the Centers for Disease Control biomonitoring work, establish a nationwide tracking network to help identify connections between disease and environment and develop a response system for addressing public health threats. This plan will enable us to identify the linkage between cancer and other chronic diseases and environmental factors.

· Enhanced Support for Survivors. Cancer treatments save lives, but they often have serious side effects and long-term impacts that we don’t yet fully understand. In addition, adolescent and young adult survivors face unique physical and emotional challenges, and there is a paucity of research on how to best treat and support them. As President, Hillary will undertake a federal survivorship initiative to:

o Increase our Understanding of Survivor Health. By developing a survivorship study – an epidemiologic tracking of cancer survivors – with a particular focus on adolescents and young adults, we will be able to better understand the long-term health impacts of cancer treatments. We can then factor this information into approach to treating cancers so that we not only save lives, but also improve the quality of life during and after treatment.

o Improving Access to Support Groups. The CDC will provide $25 million to community-based groups, in conjunction with the health care institutions providing cancer treatment, to run survivorship support groups that allow cancer survivors to meet with other survivors in their communities and gain the support and information that would not necessarily be provided by health care professionals.

o Special focus on young people. Adolescent and young adults diagnosed with cancer face different challenges than older individuals: they may feel more isolated; wrestle with body image and fertility issues; they are more likely to lack health insurance; and they have not yet lived out their dreams. In addition, these are the only age categories that are not experiencing an increase in five year survivor rates. Hillary will dedicate 10% of the funding within the survivorship study to analyzing the long term impact of cancer on adolescents and young adults.

Guaranteed, high quality health care coverage for all. Nearly 45 million Americans lack health insurance and about 16 million more are underinsured. Studies consistently show that those who lack insurance or who are underinsured have higher cancer mortality rates than those with high quality coverage, yet for cancer patients, or those at high risk of obtaining cancer, securing and maintaining high quality insurance can be an uphill battle. One out of every four cancer patients with insurance use up all or most of their life savings while treating their cancer because of the extraordinary costs of cancer drugs. Universal health care with a high quality meaningful prescription drug benefit will help those without insurance and those with underinsurance obtain the treatment they need.