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Updated Goals for 2008

October 21, 2008 By: Curtis Category: progress updates

I reviewed and made some updates to our goals for the year recently. Part of the updates have to do with the way the stock market has performed this year and part has to do with the fact that I chose to not teach as much this summer as I had earlier in the year. Here are the updates and our status on them as of the end of September.

2008-sep-goal-update.jpg

  • Credit Cards - I had originally hoped to get that balance down to -$40,000. I’ve changed it some, but still hope to get $10,000 paid off on it this year. It’s still a bit of a stretch at the current pace, but we should hopefully come close to that.
  • Net Worth - Much of this has to do with the market as well. If you look at the numbers on the retirement section below, you will understand why (not that you don’t already). But I actually calculated that if we had gotten a small 3-5% return on the market so far this year, our current net worth would be $3,000-$4,000 higher than it is currently. So, we won’t make our orignal goal of zero net worth until next year, but we will still make it none the less.
  • Retirement - Yikes, this has been a disaster this year. I’m still hoping there will be a bit of a market recover here soon. October has been rough and the number looks even worse than the end of September (the current balance is shrinking down below $9,000 at present). I still have nearly $2,000 of contributions coming out my paycheck yet this year, so some small market corrections and I just might make that goal yet.
  • Cash - Last month should have been the low point since we just got back from vacation (missing a full week of work unpaid) and I hadn’t been teaching for a while. I’ll have some better paychecks the rest of the year and I start teaching another class in about 3 weeks, so this should get back up, though not as high as my original goal of 10k by the end of the year.

Anyway, probably some more realistic goals in this economy. I suppose I’ll have to start thinking about goals for next year as well.

Saving or Borrowing?

October 20, 2008 By: Curtis Category: banking, economics

Something has been bugging me for a while in all this credit crisis we’ve been having.  The government keeps doing what they can to stimulate the economy and get us out of the credit crunch.  They keep trying to get more money into the hand of the banks to free up the credit market and more money into the hands of consumers to encourage us to spend.

Isn’t it the spending that got us into trouble in the first place?  It was too much credit that lead to the defaults that worked it’s way up to banks not wanting to lend money to each other.  If Americans had been saving more of their income and spending  less, then the banks wouldn’t have reached this crisis in the first place.

Of course, if that had happened, our economy wouldn’t have had the great boom we have experienced the last decade or so.  If avoiding the bust means avoiding the boom, I think we should consider that option.  But, let me run through the scenario to make sure I’ve got this right:

  1. Economy is booming and people are spending more money than they make, borrowing the rest from the bank.
  2. The banks lend out lots more money to people than the people are putting into the bank to save.
  3. Banks run out of money to lend because the lent it all out already.
  4. Banks go under.
  5. The government gives the bank more money to try and stimulate the economy back into a boom (see #1)

Maybe it’s  just me, but I’m thinking we need to consider how to get out  of this little cycle.

Wanna See the Market REALLY Tank?

October 16, 2008 By: Curtis Category: economics, retirement

Madam X over at My Open Wallet just posted some information on The Candidates’ Economic Proposals: IRA & 401k Withdrawals.  Both McCain and Obama seem to think allowing people to withdraw their 401(k) or IRA funds early with no penalty will help stimulate the economy by getting people money to spend to cover this difficult time.

Excuse me, but aren’t those funds in the stock market?  Doesn’t the average consumer typically judge our economy by whether the stock market is up or down?  So, you think that allowing people to take MORE money out of the market without being penalized is going to HELP?  I’m flabbergasted is all I can say.

What a great way to really send the stock market into an all out tail spin.  People who are already afraid of the market would now have access to pull everything out causing an even further decline.  Their worst fears will be realized as a self fulfilling prophecy.

Does this idea scare other people as much as it scares me?

It’s Budget Time Again!

October 14, 2008 By: Curtis Category: budgeting

That’s right folks, it’s that time of year again.  If you haven’t started yet, you should be considering it before long.  I like to start early to allow myself time to make actual adjustments to our spending prior to the end of the year.  I’ve done quite a few posts this last year on the topic of budgeting and how we do our budget.  You can see them all here.

Not only am I working on my budget at home, I’m getting ready to present our next year budget to the local neighborhood association (for which I am the Treasurer).  Between those 2 budgets, my head seems to be swimming with numbers lately… and it’s kind of fun!  I know, I’m weird that way.

Anyway, I’ve already started picking out a few areas where I think we can save money in our budget this next year.  The biggest question at this point is still where my income will be coming from.  I know I have my current contracting job and it should be quite safe through all of next year if I choose to stay, so that’s what I’m basing the income from.  I’m hoping to be able to supplement that by sometime early next year with some income on my own business (you can take a sneak peek here) and possibly start working full time for myself by the last half of next year if things go well.  So, here are the areas of our budget I plan on address over the next few months to see what can be done.  I’ll give more detail of each area as we make decisions and move forward.

  • Income - As I mentioned above, this is based on my current job only.  I don’t plan on any less than this.  Also, as a contractor, this amount includes me being away for 5-6 weeks during the year on holidays and vacation and factors in the 401(k) match.
  • Medical Insurance - Anyone who’s read much of this blog will realize I’m not a big fan of my current medical insurance.  I’m very strongly considering going to a private HSA plan this coming year and upping our deductible from $2,000/$4,000 to $10,000.  I’ve already started investigating this one as open enrollment is coming soon.  I would especially like to make this change with the anticipation of working for myself.  That way I already have it in place and won’t have to do it later.
  • Life Insurance - This is something we drastically need to get added to our budget this year.  It’s not a huge expense at our ages, so we need to get moving and protect ourselves.  We have some unique needs in our estate planning, so it should prove to be an interesting investigation.
  • Cell Phones - A line of budget that is no more, only because these are now business expenses.
  • Irregular - This area is going to get more detailed next year based on our spending this past year.  I’ll be splitting that up to include our HSA funds, vacation and home repairs.

So, there’s the basics.  Stick around to see more details and see what other areas we delve into over the next couple of months.

Saving Money… for Charity

October 13, 2008 By: Curtis Category: charity, saving

I finally did it last Friday.  For the past several months we have done nothing with the daily newspaper.  We pay $15 a month for the paper (Thursday to Sunday), and if it makes it in the house from the porch, it sits in it’s bag for a couple of weeks until I go through them and put them into recycling.  Well, Friday I called and canceled.   As luck would have it, the twice weekly local “free” paper they deliver is also going to a $20 annual subscription starting in November.  So, our lawn will shortly not be cluttered by unwanted newspapers.

I talked to my wife over the weekend after thinking about this for a bit.  That $15 a month adds up to $180 a year.  I realized that we spend a LOT of time watching the local PBS station (we don’t have cable) and listening to the local NPR radio station.  Well, we decided that we will take our saved $180 this year and divide it up between the two.  After all, we had been willingly spending money on news we didn’t want and getting what we did want for free.  We’ve talked about supporting our public broadcasters in the past, but never actually did anything about it.  So, we’ll have that money set aside and ready to give by early next year.  Just our small contribution to pay for what we actually use.

Living Within a Budget

October 09, 2008 By: Curtis Category: budgeting

As I mentioned yesterday, we are working to get back on track with living within our budget. We have been a little more lax over the summer months and leading up to vacation. Now we’re back and the bank account has dwindled. Today was payday, so the bank accounts are back up a bit.

If you’re not familiar, I have my paycheck split between 2 different checking accounts based on how we plan on spending the money. For things we woud normally pay for out of pocket (groceries, gas for the car, etc) we have an account at National City (NCC) which has several local branches. I calculated the amount we “should” need every 2 weeks between paychecks and have it directed there. The remainder goes into our online account with E*Trade (ETFC). There we pay all of the bills electronically. Because we also have a savings account there, we can transfer money temporarily over to savings when it’s not needed (such as most of the bills being due in a single pay period).

So, this last 2 week pay period ended yesterday. I checked our NC account online yesterday morning and noticed the our projected balance at the end of the day, after pending charges clear, was $-3.10. Not good. Of course, there is an Overdraft Protection account that would cover the difference and I could pay that back off this morning and likely not end up with interest charges. I was stuck on principle though, I didn’t want to use it. I let the wife know and she made a quick trip to the bank (about 1 mile) and deposited $5 cash for good measure.

Now, there have been a couple of times I knew we had a special purchase coming up and I transferred some extra from the savings account to make up the difference, but I didn’t do that this time.  Often, when it gets to a new pay period, I transfer anything left over from our “allowance” at NC back to the savings account, so an occasional transfer back doesn’t bother me that much.

So now I’m torn.  We really need to watch our spending more carefully, but I also don’t want to have to feel like a dictator about stuff.  I’ve been trying to think of a way to involve the rest of the family in just tracking how much we spend every 2 weeks to make sure we don’t have a repeat of yesterday.  I’m not concerned about WHAT we spend the money on, just that we watch more closely HOW MUCH we’ve spent.  I know some people would say we should just use cash, but I don’t feel comfortable with that were we live.  I’d much prefer to continue using our check card for most every purchase and finding an easier to keep track of our status from day to day.

Anyone out there have any suggestions?

Progress Update - September 2008 (Official)

October 08, 2008 By: Curtis Category: progress updates

Well, it’s October, we made it through September.  As I mentioned yesterday, September was not a strong month asset wise, but we continued to pay down our debts.  So, here’s the dirty details via my NetworthIQ Profile.  I’ll go over the details of the whys below the picture.

 2008-sep-net-worth-update.jpg

  •  Cash - One big word here, Vacation.  Such is life when you are a contract employee.  The vacation itself wasn’t quite as expensive as 6 days away from work.  Being away from work made up for almost three quarters of the decline in cash for the month.  The rest was a new bed for my son (he’d well outgrown the old and had been sleeping on a couch in his room) and the rest of the vacation expenses (gas, food, etc.)
  • Retirement - I promise, I really did put money in my retirement account last month!  No, Really!  Of course, when the stock market does what it did last month, this is to be expected.  At least I’ll be buying a lot more shares with each paycheck contribution the next few months.
  • Cars - Updated the value based upon the current Kelly Blue Book value listed online.
  • Total Assets - Not a pretty picture here, all those circumstances above leads to a bad month on our asset balance.
  • Total Debts - Regular old month here, not much to tell.  We continue to make progress on that number.  We haven’t been able to do much extra lately as I haven’t been teaching and we were saving for vacation.  There were 2 car payments that cleared the bank this month, so that did help to offset the asset slide a bit more than usual.  Otherwise, it’s slow and steady at this point.  I start teaching again next month, so hopefully we’ll be making more progress soon.

So, what’s up next?  Well, being a little worried, I checked out our budget for the year.  We are actually less than 1% over budget on spending so far this year.  Add to that being 5% over budget on income and we end up being pretty well off.  Of course, some of that extra income was my 401(k) matching that I didn’t account for as income in my budget and has since disappeared in the stock market.

Over this weekend I’m thinking about sitting down as a family and looking over our budget for next year and where we can find some more savings without giving up having fun too.  I’m sure there are still some more places to save, we just need to to coax them out of hiding.

Brief Update for September

October 07, 2008 By: Curtis Category: progress updates

I haven’t actually recorded all the numbers from September yet, but I can tell you that things don’t look good.  Between vacation (which means missing an entire week of pay), the stock market plunge at the end of the month and another write down of the value of our car (which I do quarterly) our net worth has dropped 2k-3k last month.

Despite that, I do know that our debt went down.  Most of the bad changes were in our assets category and not in our liabilities, so that’s one bright side.  I’ve looked briefly, but haven’t had the time to physically record the numbers as of yet.  Hopefully that will be coming this evening.

Also, as we’ve been tightening our belt again lately, I’ve noticed us going through a cycle of spending money right away when I get paid, and then not having anything left to spend in our “allowance” for the last week before the next pay day.  On one hand, it’s good that we are keeping to our allowance type budget, but on the other, I’d like to have more even spending rather than the binge and then nothing.  So, we’ll be sitting down soon as a family and talking about the upcoming holidays and what we can expect budget wise.

We’ll also need to start sitting down and pouring through our budget for the coming year to see where we can save more.  It might be a bit tricky as I will hopefully make the transition to self-employed next year as my business is beginning to take off.  So, lots of planning to take place in the weeks to come.  That means lots more posts from me about how we decide what to keep and what to get rid of for next year.

By the way… can you believe it’s October already!

My Take on the Candidates Health Care Proposals

October 02, 2008 By: Curtis Category: insurance

Yesterday I posted about the stance on Health Care by the Presidential Candidates. I thought it was enough information that I’d leave it there and give you my take on them today. Once again, I’ll go alphabetically by party.

Democrat - Barack Obama

My biggest issue with Obama’s stance is that he instantly jumps to fixing health care by making insurance affordable. Health insurance is used to buy health care. The cost of that insurance is often not considered when a person makes decisions about their health. If you have a choice to pay a co-pay $10 or $30 for prescriptions that have actual costs of $25 or $100, you might be inclined to pick the slightly more expensive drug as the difference in cost is not much to you. However, if you were faced with the larger difference, you would almost certainly choose the lower cost drug unless there were major differences in their effectiveness. By having more responsibility for the actual cost of my care, I can control my TOTAL health care cost, not just the cost of my insurance.

I do like the idea of a tax credit for health insurance premiums. Currently, you can enroll in a group plan with your employer and pay pre-tax from your paycheck. However, for people who don’t require such extensive coverage (such as myself and my family) we pay higher rates than we could pay out of pocket on our own. If we did that though, we would not be able to pay for those premiums pre-tax unless we spend a large amount on health care that year. This means the real cost has a much smaller difference and I end up paying more money to the insurance company that I would normally. This helps to pad their pockets and cover for those use more health care. By giving me a credit for paying my own premiums, I can make an affordable decision for myself.

Green - Cynthia McKinney (I found no direct references to a stance on health care on either McKinney’s campaign site nor the green party site).

Libertarian - Bob Barr

Barr gets in line with me on this particular issue. The government mandates of insurance, while they seem to be good for consumers, they end up allowing insurers to raise rates because people have to buy them. Allowing more choice gives people the chance to buy just as much insurance or health care as they require. This allows people with few medical issues to purchase just major coverage and pay the rest out of pocket as needed, and those with more consistent problems to buy more extensive coverage as needed. I say this coming from someone with a family history of Diabetes and High Blood Pressure. I do try to watch my own health and take care of myself so I don’t end up like my father and grandmother. But, with group medical plans, I have no incentive to do that. I pay the same as someone with my same pre-disposition who choose not to take care of themselves.

Now, onto his statement about countries with socialized medicine. I wouldn’t agree that those countries control cost by denying needed care. Most often, they deny wanted care and limit the provide care to just the necessities. Is it truly a need to get a prescription for every little thing that might be wrong? Do you have to have that small operation to feel a little bit better when others are much worse? The downside of that is that consumers don’t have the choice but don’t have to pay. I would prefer to have the choice and have to pay.

Republican - John McCain

And now we come to the very thorough (or long-winded) McCain.  Again, I do like the ides and proposals to allow more choice for me as a consumer.  I also like the idea of expanding benefits of the HSA program.  As an HSA participant, I like that I can have catastrophic coverage should something happen, but that I can still pay for my medical expenses out of pocket, pre-tax.  Being able to save my money in a tax free account and use that for health expenses I deem necessary is a great find.  Add to that tax deductions for private insurance premiums and I’d be set.  I’d quickly drop my employer sponsored plan and switch to a plan that is $400 a month cheaper than the one I have now ($10,000 deductible versus $2,000) and save that extra $400 a month for when I actually have expenses I need to cover.

I’m not sure what to think about his Guaranteed Access Plan though.  Again, we are talking about providing government sponsored insurance to those who do not have insurance.  With the way the government runs Medicare, I would have an issue with this.  Can they guarantee that my tax money will not be squandered on unnecessary expenses? They haven’t proven very good stewards of my tax dollars for Medicare, so it’s likely to be the same here (or most likely, I’d guess rolled into Medicare somehow).

In General 

Obama and McCain both mentioned controlling drug costs by re-importing drugs to the US and/or bringing generics to the market sooner.

  1. First, the drug companies have large outlays of funds to develop these drugs.  They charge high prices  in the US because we will pay them with out lovely insurance programs as I mentioned above.  They make their money back from us and can then offer them at lower prices elsewhere.  If we re-import those lower cost drugs, the drug company won’t be making their money and will either slow down development of new drugs, or raise foreign prices of drugs to match their total inflows.  So we won’t see the entire savings, but there should be some.  Our savings of course, would end up coming from the pockets of consumers in other countries.
  2. Second, the same thing will happen if you bring generics to market sooner.  This requires shortening patents on drugs and shortening the time the drug company has to repay their expenses for research.  Earlier generics would likely increase drug costs even more and possibly kill research into drugs that would be borderline profitable.

It’s a tough choice to make between the candidates as there are good and bad with all of them.  What’s more, an elected President actually pushing something through exactly the way they want it to be has about a snowball’s chance in hell.  Hopefully though, my discussions have helped you as well.

2008 Presidential Candidates Stance on Health Care

October 01, 2008 By: Curtis Category: Uncategorized

I’ve commented a while back extensively on the issue of health care in the US. I continue to get a number of hits every day from searchers finding those articles. So, I decided to compile a single list here of our Presidential Candidates and their stance on health care. Despite the current financial crisis, health care is a major issue for many (and a large part of my family’s budget every month).

If I’m missing anyone, let me know.  Candidates and their positions are listed alphabetically by party.  It’s a lot to digest (McCain is either very thorough or long-winded, I’ll let you decide), so I’ll let you read up and I’ll have another post in the next couple of days with my comments.

Democrat - Barack Obama

On health care reform, the American people are too often offered two extremes - government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.

The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors and plans to implement the plan. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.

Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year.

If you don’t like your health insurance, or you don’t have health insurance, you will have a choice of new, affordable health insurance options.

Make Health Insurance Work for People and Businesses - Not Just Insurance and Drug Companies.

  • Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
  • Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.
  • Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.
  • Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.
  • Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees health care.
  • Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
  • Ensure everyone who needs it will receive a tax credit for their premiums.

Reduce costs and save a typical American family up to $2,500 as reforms phase in: Lower drug costs by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs and taking on drug companies that block cheaper generic medicines from the market

  • Require hospitals to collect and report health care cost and quality data
  • Reduce the costs of catastrophic illnesses for employers and their employees.
  • Reform the insurance market to increase competition by taking on anticompetitive activity that drives up prices without improving quality of care.

The Obama-Biden plan will promote public health. It will require coverage of preventive services, including cancer screenings, and increase state and local preparedness for terrorist attacks and natural disasters.

A Commitment to Fiscal Responsibility: Barack Obama will pay for his $50 - $65 billion health care reform effort by rolling back the Bush tax cuts for Americans earning more than $250,000 per year and retaining the estate tax at its 2009 level.

Green - Cynthia McKinney (I found no direct references to a stance on health care on either McKinney’s campaign site nor the green party site).

Liberterian - Bob Barr

Access to affordable, quality health care is an important objective. For this reason, some politicians have pushed for government programs to extend health care benefits to those who cannot afford or who otherwise do not maintain private medical insurance. These efforts come on top of taxpayer-subsidized benefits in the form of Medicare and Medicaid.

There are many causes of today’s high healthcare cost “crisis”. Medical care costs more than it should; access to insurance is more limited by government than it should be; the practice of medicine is more regulated than it should be. The American health care system desperately needs to be treated for ill health.

Our health care policy should be reformed based on the principle of consumer-oriented health care. Regulations which mandate insurance coverage and inflate premiums should be eliminated. Controls which unduly restrict competition within the health care industry, and that limit access to insurance across state lines, should be ended. Moreover, current tax policy, which is biased towards employer-provided, comprehensive health insurance, should be reformed, encouraging individual purchase of less costly catastrophic policies.

Federal health care programs, most notably Medicare and Medicaid, have become financially unsustainable. These programs need to be transformed to emphasize patient choice, focus on the truly needy, and add cost-saving incentives. Here, too, market principles should be applied to bring better quality health care at less cost.

Today’s health care problems are complex, but the solution is not socialized medicine in any form. Countries that have nationalized their medical systems inevitably ration care through the political system; costs are driven down only by denying needed care.

Republican - John McCain

John McCain believes we can and must provide access to health care for every American. He has proposed a comprehensive vision for achieving that. For too long, our nation’s leaders have talked about reforming health care. Now is the time to act.

Americans Are Worried About Health Care Costs. The problems with health care are well known: it is too expensive and 47 million people living in the United States lack health insurance.

John McCain’s Vision for Health Care Reform

John McCain Believes The Key To Health Care Reform Is To Restore Control To The Patients Themselves. We want a system of health care in which everyone can afford and acquire the treatment and preventative care they need. Health care should be available to all and not limited by where you work or how much you make. Families should be in charge of their health care dollars and have more control over care.

Making Health Insurance Innovative, Portable and Affordable

John McCain Will Reform Health Care Making It Easier For Individuals And Families To Obtain Insurance. An important part of his plan is to use competition to improve the quality of health insurance with greater variety to match people’s needs, lower prices, and portability. Families should be able to purchase health insurance nationwide, across state lines.

John McCain Will Reform The Tax Code To Offer More Choices Beyond Employer-Based Health Insurance Coverage. While still having the option of employer-based coverage, every family will receive a direct refundable tax credit - effectively cash - of $2,500 for individuals and $5,000 for families to offset the cost of insurance. Families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider. Those obtaining innovative insurance that costs less than the credit can deposit the remainder in expanded Health Savings Accounts.

John McCain Proposes Making Insurance More Portable. Americans need insurance that follows them from job to job. They want insurance that is still there if they retire early and does not change if they take a few years off to raise the kids.

John McCain Will Encourage And Expand The Benefits Of Health Savings Accounts (HSAs) For Families. When families are informed about medical choices, they are more capable of making their own decisions and often decide against unnecessary options. Health Savings Accounts take an important step in the direction of putting families in charge of what they pay for.

A Specific Plan of Action: Ensuring Care for Higher Risk Patients

John McCain’s Plan Cares For The Traditionally Uninsurable. John McCain understands that those without prior group coverage and those with pre-existing conditions have the most difficulty on the individual market, and we need to make sure they get the high-quality coverage they need.

John McCain Will Work With States To Establish A Guaranteed Access Plan. As President, John McCain will work with governors to develop a best practice model that states can follow - a Guaranteed Access Plan or GAP - that would reflect the best experience of the states to ensure these patients have access to health coverage. One approach would establish a nonprofit corporation that would contract with insurers to cover patients who have been denied insurance and could join with other state plans to enlarge pools and lower overhead costs. There would be reasonable limits on premiums, and assistance would be available for Americans below a certain income level.

John McCain Will Promote Proper Incentives. John McCain will work with Congress, the governors, and industry to make sure this approach is funded adequately and has the right incentives to reduce costs such as disease management, individual case management, and health and wellness programs.

A Specific Plan of Action: Lowering Health Care Costs

John McCain Proposes A Number Of Initiatives That Can Lower Health Care Costs. If we act today, we can lower health care costs for families through common-sense initiatives. Within a decade, health spending will comprise twenty percent of our economy. This is taking an increasing toll on America’s families and small businesses. Even Senators Clinton and Obama recognize the pressure skyrocketing health costs place on small business when they exempt small businesses from their employer mandate plans.

CHEAPER DRUGS: Lowering Drug Prices. John McCain will look to bring greater competition to our drug markets through safe re-importation of drugs and faster introduction of generic drugs.

CHRONIC DISEASE: Providing Quality, Cheaper Care For Chronic Disease. Chronic conditions account for three-quarters of the nation’s annual health care bill. By emphasizing prevention, early intervention, healthy habits, new treatment models, new public health infrastructure and the use of information technology, we can reduce health care costs. We should dedicate more federal research to caring and curing chronic disease.

COORDINATED CARE: Promoting Coordinated Care. Coordinated care - with providers collaborating to produce the best health care - offers better outcomes at lower cost. We should pay a single bill for high-quality disease care which will make every single provider accountable and responsive to the patients’ needs.

GREATER ACCESS AND CONVENIENCE: Expanding Access To Health Care. Families place a high value on quickly getting simple care. Government should promote greater access through walk-in clinics in retail outlets.

INFORMATION TECHNOLOGY: Greater Use Of Information Technology To Reduce Costs. We should promote the rapid deployment of 21st century information systems and technology that allows doctors to practice across state lines.

MEDICAID AND MEDICARE: Reforming The Payment System To Cut Costs. We must reform the payment systems in Medicaid and Medicare to compensate providers for diagnosis, prevention and care coordination. Medicaid and Medicare should not pay for preventable medical errors or mismanagement.

SMOKING: Promoting The Availability Of Smoking Cessation Programs. Most smokers would love to quit but find it hard to do so. Working with business and insurance companies to promote availability, we can improve lives and reduce chronic disease through smoking cessation programs.

STATE FLEXIBILITY: Encouraging States To Lower Costs. States should have the flexibility to experiment with alternative forms of access, coordinated payments per episode covered under Medicaid, use of private insurance in Medicaid, alternative insurance policies and different licensing schemes for providers.

TORT REFORM: Passing Medical Liability Reform. We must pass medical liability reform that eliminates lawsuits directed at doctors who follow clinical guidelines and adhere to safety protocols. Every patient should have access to legal remedies in cases of bad medical practice but that should not be an invitation to endless, frivolous lawsuits.

TRANSPARENCY: Bringing Transparency To Health Care Costs. We must make public more information on treatment options and doctor records, and require transparency regarding medical outcomes, quality of care, costs and prices. We must also facilitate the development of national standards for measuring and recording treatments and outcomes.

Confronting the Long-Term Challenge

John McCain Will Develop A Strategy For Meeting The Challenge Of A Population Needing Greater Long-Term Care. There have been a variety of state-based experiments such as Cash and Counseling or The Program of All-Inclusive Care for the Elderly (PACE) that are pioneering approaches for delivering care to people in a home setting. Seniors are given a monthly stipend which they can use to hire workers and purchase care-related services and goods. They can get help managing their care by designating representatives, such as relatives or friends, to help make decisions. It also offers counseling and bookkeeping services to assist consumers in handling their programmatic responsibilities.