In an interview published Jan. 31 on the Health Affairs Web site, former Senate Democratic leader Tom Daschle (D-SD) predicts the passage of comprehensive health care reform and expresses skepticism about high-deductible, "consumer-driven" plans. Daschle tells Robert Galvin, M.D., General Electric Corp.'s director of global health, that the filibuster-proof budget reconciliation process, with its bare majority, fifty-one-vote threshold for passage, could be the vehicle that delivers fundamental health care change.

The new Medicare drug benefit is likely to result in modest to moderate declines in out-of-pocket spending for seniors who do not receive low-income subsidies, but vulnerable populations will not share equitably in those savings, a team led by Walid Gellad reports in the January/February Health Affairs. Using data from the 1996-2000 Medicare Expenditure Panel survey, the researchers estimate that many racial and ethnic minorities, near-poor people, and people with severe chronic conditions will face higher costs than others eligible for the standard Medicare benefit.

To what extent do hospitals shift costs to private insurers to compensate for reductions in Medicare and Medicaid payments? In the January/February Health Affairs, Jack Zwanziger and Anil Bamezai say California hospitals shifted $210 million to private payers from 1997 to 2001 as a result of public payment reductions. The authors found that cost shifting from Medicare and Medicaid to private payers accounted for 12.3 percent of the total increase in private payers' prices from 1997 to 2001, slightly more than $33 per day or an additional $632,000 per year in private payments to the average hospital.