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Posted by on January 23, 2012

Preparing for the Future of Health Care in America

The Congressional Health Care Caucus will begin a new series leading up to the Supreme Court reviewing the Patient Protection and Affordable Care Act.  The purpose of this series is to discuss future policy ideas that will result as a decision is made by the Supreme Court.

Tom Miller, Resident Fellow at American Enterprise Institute

Jim Capretta, Fellow at the Ethics and Public Policy Center

Click here for Tom Miller's handout
Click here for Jim Capretta's handout 

  Tuesday, January 31

12:30-1:30pm  
2218 Rayburn House Office Building

Open to Members, Staff, Interns and the Public

Hosted by Rep. Michael C. Burgess, M.D.
Chairman, Congressional Health Care Caucus

Posted by Dr. Lori Anderson on July 05, 2011

It’s July and temperatures are high.  It can be humid or rainy.  Add an increase in outdoor activities, including picnicking and barbequing, and you have a perfect medium for “food-borne” illnesses.  Everyone from parents to child-care centers and vacationers needs to keep this in mind while dining in these hot summer months. 

What is a “food-borne” illness?  It almost always gets down to tiny organisms:  viruses, bacteria, and parasites.  Usually, they or their by-products (toxins) travel on foods, get ingested, and cause unpleasant symptoms.  Bacteria, in particular, are everywhere, every day, on every item in sight (literally, unless carefully sterilized); at least some ingestion is unavoidable, so what’s key to getting symptoms?  Generally, symptoms arise when the number of microbes or severity of toxins is too high, or someone is particularly vulnerability.  Sometimes, though, it just seems like bad luck:  remember, even the most feared, drug-resistant bacteria are routinely found in common places, yet the worst infections are rare. 

In the United States, extra-vigilant federal agencies cooperate to protect the citizenry, but individuals remain responsible, too; regulations are never fool-proof.  

So what to do?  What to know?  Let’s go over the most recent information and safety-conscious recommendations for food. 

FOODS and their Microbes

Before going over what you need to do, let’s look at the common sources of infection, and why they pose a problem:

1.       Meats:  any raw or undercooked meats can allow growth of bacteria that isn’t completely removed prior to cooking, such as the notorious Esherichia coli (e coli, especially type O157:H7 in beef), also Salmonella, Campylobacter (especially in broiler chickens), and Listeria.

2.       Mushrooms:  some are poisonous, some are not; be knowledgeable before harvesting your own

3.       Shellfish:  by the very nature of how shellfish live in marine waters, they routinely gather bacteria from the Vibrio species, so particular care must be used in preparing for consumption; cases in the United States, though rare, have increased

4.       Produce:  lettuce, cucumbers, tomatoes have all been in the news for causing rashes of infections; since they’re not cooked, these are usually carefully rinsed at harvest sites; otherwise they can easily harbor microbes, from bacteria (E coli, Salmonella, Yersinia, Shigella, Listeria) to parasites, and even viruses; take precautions, and watch news reports

5.       Sprouts:  get their own category because they’re minimally prepared in order for the delicate plant (presold as seeds in some cases) to continue growing after reaching the marketplace; they’re frequently the source of outbreaks from bacteria such as E coli (in the recent European incident, the serotype produced a particularly dangerous toxin); use cautiously

6.       Eggs:  the 2010 egg recall was due to Salmonella contamination; this bacterium can live inside or outside the shell; new egg regulations are in place to hopefully reduce such incidents

7.       Poultry:  they give us meat and eggs, so pose a double threat, but Salmonella is generally the source in both cases; despite progress in other infectious diseases, Salmonella infection rates remain the same, and are still the most common known source of food-related infections, hospitalizations, and death (most cases of food-borne illnesses are still from unknown sources). 

8.       Pork:  pork meat needs higher cooking temperatures to kill cysts of the roundworm genus Trichinella.  Ingestion causes trichinosis, resulting in stomach symptoms, but also muscle and joint pain, and fever, if the larvae invade human muscle.  It may require medications, but usually resolves in a few months.  Pork can also have bacteria, such as Staphylococcus, and those mentioned under meats (#1, above).

9.       Canned salted/smoked fish, other canned goods:  any can that appears damaged, rusted, buckled, or (especially) bulging could be a reservoir of the bacterium Clostridium botulinum, which grows without oxygen and produces the botulism neurotoxin; severe symptoms require medical attention


PREVENTIVE MEASURES

What can we do to best avoid “bad luck” experiences?  Don’t let summer fun relax your vigilance:  here are the three food handling rules --cold, heat, and washing-- with some added considerations for summer preparations:

1.       Do not partially cook meats or poultry (ie, at home) hoping to complete the cooking later (at the campsite):  this allows bacteria to grow to more than can be destroyed by the “final” second cooking.  Instead, completely cook the foods just before eating, wherever that may be.

2.       Grilling or barbequing can sear meats without cooking their insides, where bacteria or parasites can survive, so cook fully, and use a food thermometer to check internal temperatures.

3.       If you’re on the road without a refrigerator, keep a cooler or thermos with ice inside to maintain foods normally kept in the refrigerator.  This includes:  potato/egg/macaroni salads; cooked, cold-eaten foods, like pizza/chicken/sliced turkey/cooked eggs/lunch meats; and condiments such as mayonnaise.  Take care that the ice isn’t melted and the cooler really is cool (in the shade).

4.       Cutting surfaces require care:  whether at home or on the road, surfaces that contact raw meat or poultry or their drippings should not touch foods that are ready to eat.  For instance, don’t put raw hamburger on a board that will later hold lettuce or cooked ham; either use a different board, or thoroughly wash the first.  Wooden boards should be dedicated to either cooked or uncooked foods, since they can hold bacteria even after washing. 

5.       Fast food is a good idea (it’s been carefully prepared), but be sure to eat within 2 hours of purchase, or else put the food on ice (see #3) or in the refrigerator.      

6.       Refrigerate leftovers or prepared foods by 2 hours; reduce that to 1 hour if the ambient temperature is 90 degrees F or over

7.       Leftover stuffing should be removed from the meat and refrigerated separately

8.       Buy only refrigerated eggs, with no cracks in the shell (cracks can harbor the Salmonella bacterium); use pasteurized eggs, egg substitute, or properly heated soft eggs (see below) in recipes asking for “soft” or raw eggs; don’t wash the shells of eggs, as they have a protective coating

9.       Routinely rinse vegetables with cold water when you get them home; take special care with sprouts; some sources recommend scrubbing of melon skins

10.   Wash your hands for at least 20 seconds after handling raw anything; use soap and warm water.  Yes, wash your hands, even if baking

11.   The temperature danger zones:  always maintain refrigerator temperatures at or below 40 degrees F, and cook all foods at or above 140 degrees F  


PREPARATION

Here are specific measures for food preparation.  New recommendations give some leeway, but the following list gives the safest guidelines without requiring additional precautions.  All temperatures were checked internally, by food thermometer; you should do the same:

1.       Whole poultry:  raw poultry should be cooked to an internal temperature of 180 degrees F

2.       Ground raw poultry:  cook to an internal temperature of 165 degrees F

3.       Beef, lamb, veal, roasts:  all raw meats of this sort need internal temperatures of 145 degrees F

4.       Pork:  a special category because of the parasites that can grow within the muscle, so cook to an internal 160 degrees F

5.       Ground meats:  ground meats are mixtures from several sources, so cook raw grounds to 160 degrees F, internally

6.       Raw ham:  internal temperature of 160 degrees F; precooked ham should reach 140 degrees F 

7.       Casseroles:  need an internal temperature of 165 degrees F

8.       Reheating:  all already cooked foods should be reheated to 140 degrees F internally

9.       Marinate and defrost foods in the refrigerator, not at room temperature

10.   Eggs:  cook until both yolk and whites are solid; poached eggs:  5 minutes over boiling water; soft-boiled eggs:  7 minutes in shell; use pasteurized eggs, egg substitute, or properly cooked soft eggs in recipes asking for raw or soft eggs.  Cook egg mixtures to 160 degrees F internally (eggnog, custards, homemade mayonnaise, ice cream). 

11.   Shellfish (clams, oysters, mussels):  cook until shell opens during cooking

12.   Fish (with fins):  requires an internal temperature of 145 degrees F, or flesh is opaque and flakey with a fork

13.   Other seafoods (shrimp, lobster, crabs, scallops):  cook until flesh is opaque and pearly or firm

 
IMPORTANT SYMPTOMS

The “stomach flu” or “24-hour bug” is recognized now as almost always a case of “food poisoning”, ie, the food-borne illnesses we’ve been discussing.  Symptoms are usually brief and mild, but can be a legitimate cause of concern.  Here’s what to watch for:

1.       Most cases of food-borne illness involve nausea, stomach ache or cramps, diarrhea, and sometimes vomiting and generalized weakess.  Symptoms usually start within hours and can last up to 3 days.  Be sure to keep up with fluid loss by slow regular intakes of water.  Consider an “electrolyte” beverage like Pedialyte; sports drinks may not suffice.  Use general over-the-counter medications for minor muscle aches, and rest.

2.       Avoid anti-diarrheal medications, as they keep the offending microbe in your system longer.

3.       Be careful with very thin, elderly, immune-compromised, pregnant, or very young people.  In this population, fluid intake is key, and maintain vigilance for worsening symptoms.

The following symptoms require immediate assessment by a physician:

4.       Bloody diarrhea

5.       A high fever, over 101.5 orally, in the presence of the symptoms listed above.

6.       Vomiting that prevents fluid intake, lasting over 3  hours for the young and other people at high risk (see above)

7.       Diarrhea for over 3 days, particularly watery

8.       Dehydration or shock, as noted by low blood pressure, “thready” or weak and quick pulse, increased breathing rate or shallow breathing, dry/sticky saliva, dizziness and fatigue, decrease in urination

9.       Confusion, difficulty reasoning

10.   Double vision, difficulty speaking or swallowing, or breathing (indicating possible botulism)

 

With that final note, you may have decided to forgo the outdoor picnic.  However, remember that food-related illnesses, when they do arise, are often mild.  Most food is safe.  With the above precautions, you further increase your chances of a great summer, even in the summer heat.  So be careful and enjoy that Texas barbeque!

 

Information for this article was obtained from the US Dept of Agriculture’s Food Safety and Inspection Service (FSIS); Dept of Health and Human Services’ Centers for Disease Control and Prevention (CDC), including Morbidity and Mortality Weekly Reports; National Digestive Diseases Information Clearinghouse; FoodSafety.gov, a federal website; the Mayo Clinic and its websites; and uihealthcare.com, from the University of Iowa Hospital and Clinics

Posted by Rebekah West on July 20, 2010

The implementation of the Patient Protection and Affordable Care Act is now underway and one of the most anticipated inclusions, the high-risk pool, just had its coming out party.  This program, known as the Pre-Existing Condition Insurance Plan (PCIP), was designed to aid individuals unable to find health insurance due to a pre-existing condition.  One qualification states an individual must have been without insurance for six months due to a pre-existing condition.  In many states a rejection letter from an insurance company stating they have denied coverage due to a specific condition or a note from a doctor is also required.   PCIP is intended to serve as a temporary measure until the Health Insurance Exchanges – a marketplace where individuals and small businesses can buy qualified health care - begin operating in 2014. 

This program is expected enroll between 200,000 and 350,000 participates throughout its lifetime, roughly 10 percent of Americans uninsured due to costly medical conditions.  Lower income individuals may refrain from enrolling due to the premiums participants will incur which could vary from $140-$900. 

There is a serious concern surrounding the $5 billion allotted to cover those enrolled in PCIP and its sustainability until 2014.  The CMS Actuary released a report that found these funds would be depleted before 2014 and enrollees could then be faced by higher premiums and access to care could be limited.  Officials at Health and Human Services (HHS) have not indicated what will happen if funds are depleted, and whether a capping or enrollment could occur. 

 

Posted by on June 29, 2010

 Is there a way to receive free insurance under the law?

No – However, there are expanded options - most not beginning until 2014 - for those who qualify, through Medicaid and tax credits available Insurance Exchanges that can help the uninsured purchase coverage 

January 1, 2014 – States must expand Medicaid eligibility to all individuals under 65 with family incomes below 133% of the Federal Poverty Level - 14,404 for individuals and $29,326 for a family of four, according to current poverty guidelines

January 1, 2014- States must have created at least one insurance “American Health Benefits Exchange,” which would sell health insurance to individuals and small employers regardless of preexisting conditions

·         Policy prices only may vary due to family structure, geographic location and tobacco use



I am uninsured, what are the ramifications for remaining uninsured?

January 1, 2014 – Individuals must maintain qualified insurance coverage for themselves and their dependants or pay a new penalty.   Those who fail to comply will pay a fine each month they are in non-compliance

·         Penalty can be up to $695 or 2.5% of income, whichever is greater



I am uninsured due to a preexisting condition.

June 21, 2010 – Deadline for the Secretary of Health and Human Services (HHS) to establish a $5 billion high risk pool that will work in conjunction or alongside current state high risk pools to provide coverage to people who had been without coverage due to a preexisting condition.  To qualify a person must:

·         Have been without coverage for more than 6 months AND

·         Have a preexisting condition as defined by HHS

July 1, 2010 – Deadline for the Secretary of Health and Human Services (HHS)  establish a web site through which you can search health coverage options including private insurance, Medicaid and State high-risk pools

September 23, 2010 - Insurers may not deny coverage to a dependent child under age 19 because of preexisting condition

January 1, 2014 – Insurers cannot deny coverage due to a preexisting condition

 

I have been kicked off my parent’s insurance plan due to graduation from college, age, ineligibility, etc.

September 23, 2010 – All insurance companies must allow “children” to stay on their parent’s health plan until age 26.  Be aware your premiums may increase as well as:

·         A child cannot be eligible if they are offered an employer sponsored health plan (until 2014)

·         A company must have previously offered coverage to dependants

·         Not eligible if married and insurance is offered through the spouse’s place of employment

 

My employer does not offer insurance due to the cost.

January 1, 2010 - A tax credit may be available for some employers from 2010-2013; however, they must qualify under specific guidelines.  It is estimated that only 12% of businesses will qualify

·         To get the maximum 35% credit, the employer must:

o   Have 10 or fewer employees

o   Pay 50% of the premium of the insurance

o   Average annual income of $25,000 or less

·         Smaller tax incentives are for companies who:

o   Have less than 25 employees

o   Pay 50% of the premium of the insurance

o   Average annual income of $50,000 or less

 January 1, 2014 – Employers with more than 200 full-time employees who offer health benefits must automatically enroll new employees into an offered plan.  The employee must opt themselves out

·         Companies may find they will pay less by paying the penalty than by providing coverage



Does this law apply to illegal immigrants?

Section 1312 of the Patient Protection and Affordable Care Act limits enrollment to those who are lawful residents.  Those who are not qualified individuals cannot qualify to purchase insurance from the State Exchanges or receive tax credits.  Those who are here without documentation (unqualified aliens) already do not qualify for Medicare or Medicaid*.        

 

 * Under the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), unqualified aliens may qualify for limited emergency Medicaid benefits, such as in the case of childbirth and only if they would otherwise qualify for the program if not for their citizenship status. The Deficit Reduction Act of 2005 established guidelines which required Medicaid applicants to show proof of citizenship and identity with the intent to enforce standing law; unfortunately, the Democratic controlled Congress has consistently modified  this provision allowing a social security number to suffice as burden of proof

Posted by on June 25, 2010
In 1997 Congress began using the sustainable growth rate (SGR) to determine a payment formula for physicians under Medicare Part B.  Ideally, the physician services would be adjusted annually under this formula to keep spending in line with the state of the economy.  However, the cost of health care began to outpace the economy in 2001, and to balance the two factors, cuts needed to be made to doctor payments.  To avoid cutting reimbursements, Congress has passed a series of extensions that temporarily postpone the problem.  However, with each postponement the subsequent cuts get larger and more expensive to adjust.  Congress passed another temporary extension on June 24, once again, deferring any cut until November 30.  Unfortunately, the health care law did not repeal this formula and unless a permanent solution is found, many doctors many not be able to keep their doors open and seniors may find it harder to find a care. 
Posted by on March 24, 2010
Americans have spoken - when it comes to health care reform, they do not want more government, more taxes, higher premiums and less choices. They want common-sense, patient-focused reforms that will make health care more affordable and more accessible for all.

In my "Prescription For Real Health Care Reform," I list nine principles that I believe encompass real and effective health care reform for all Americans that produces results without more government.

1. Insurance Reform
2. Tax Fairness
3. Medical Liability Reform
4. Portability
5. Medicare Payment Reform
6. Doctors to Care for America’s Patients
7. Price Transparency
8. Preventative Care and Wellness Programs
9. Create Products People Want

Click here for Dr. Burgess' Prescription for Real Health Care Reform
Posted by Eric Wilson on April 21, 2009

By Jane Norman, CQ HealthBeat Associate Editor

CQ HEALTHBEAT NEWS

April 21, 2009 – 4:58 p.m.

Republicans and conservatives spotlighted their ideas for "less government" in a proposed overhaul of the U.S. health care system at a forum Tuesday at the Capitol, stressing a need for greater personal responsibility on the part of patients and better tax breaks for individual health insurance plans.

The discussion came as the GOP looks for a way to express its priorities as lawmakers move ahead on health policy on both sides of the Capitol. "Republicans need to talk more about their ideas in regards to health care reform," said Rep. Michael C. Burgess, a Texas Republican and a physician. "In fact there are some ideas out there, there are some ways of looking at this process, of bringing some affordability and some sanity into the system, without turning it all over to the government."

Burgess said he started the Congressional Health Care Caucus, which sponsored the forum, and wrote a primer to help educate his colleagues. "This should be a Republican issue, it’s fundamentally a freedom issue," he said, and to the extent the Republican message may be perceived as missing in action, "I want to be certain to register I’m doing my part to get our message out there."

Republicans need to be united behind a plan that would work, and then take it to the American people, said Burgess. President Obama said at a meeting on health policy with lawmakers at the White House he’s open to all input on the plan and Burgess said he is taking the president and committee chairmen at their word when they say that Republicans will be involved. "This appears to be a different product that’s coming through as opposed to the stimulus bill, where we were shut out from start to finish," he said.

Also at the forum was Rick Scott, chairman of Conservatives for Patients Rights, who left the giant hospital company Columbia/HCA in 1997 when he was ousted by the board of directors. He has gone on to found a chain of 24 urgent-care clinics in Florida where three levels of prices are posted on a board, Starbucks-style, and to launch a campaign against any overhaul plan that would involve "government-run health care."

The pillars of a GOP alternative plan should be to preserve patients’ rights to choose their own doctors, competition, the right to shop for health care options, accountability and personal responsibility, said Scott. He said he helped finance and soon will release a documentary featuring Gene Randall, a former anchor and correspondent at CNN, that examines national health systems in the United Kingdom and Canada and their impact on patients. "The wait lists are ridiculous," said Scott.

Democrats have expressed interest in a public plan component for the health care overhaul, without specifics, but there does not appear to be much momentum behind a single-payer system identical to those overseas. Both supporters and opponents of the public plan, though, see the public plan as possibly opening the door to an expanded public presence in health care.

Another panelist was Gene Scandlen from a group called Consumers for Health Care Choices at the Heartland Institute, a Chicago think tank that advocates free-market solutions to public policy issues. Scandlen said that lawmakers can adopt a top-down approach that empowers a "health-care czar" or a bottom-up approach that emphasizes preventive medicine and rewards people for reducing costs of their own care by choosing generic drugs or avoiding visits to emergency rooms. Scandlen said some 18 to 20 percent of workers, depending on the survey, are now enrolled in high-deductible health plans.

Surveys by the Kaiser Family Foundation have confirmed the growing popularity of high-deductible plans but also warn of shifting a large burden of health-care costs to working people.

The discussion came at the same time the Senate Finance Committee launched a roundtable discussion in preparation for writing legislation that would be marked up by early June. On the House side, Majority Leader Steny H. Hoyer, D-Md., plans to meet this week with three committee chairmen to plot strategy on health care.

The forum was the second organized by the Congressional Health Care Caucus, with Web casts and a live audience invited to participate through Twitter, the social networking Web site.

Posted by on April 20, 2009

 

Politico: GOP Stumbling in health care fight
By Carrie Budoff Brown - April 20, 2009

Republicans look across the health reform battlefield and see the Democrats organized, energized and flush with cash — with several groups lined up to promote the president’s plan, and a message honed by years of preparation.

Then they look into their own camp — and get nervous.

There’s no Republican plan yet. No Republicans leading the charge who have coalesced the party behind them. Their message is still vague and unformed. Their natural allies among insurers, drug makers and doctors remain at the negotiating table with the Democrats.

So Republicans now worry the party has waited so long to figure out where it stands that it will make it harder to block what President Barack Obama is trying to do.

“I thought we would have been much farther along than we are,” said Rep. Michael Burgess (R-Texas), a physician who started the Health Care Caucus this year and wrote a 29-page “primer” for his colleagues. “Senator [John] McCain, for all his faults, had a program a year ago. People became pretty comfortable with McCain carrying the load on that and when he wasn’t successful in November, it left a big void.”

Nobody on the GOP side is waving a white flag. They think some of Obama’s ideas, including a government-run health insurance plan, will be such non-starters with the American people that they can recover in time to stop them.

But they also know the clock is ticking, as key Republican senators engage in bipartisan talks and House rank-and-file meet privately to develop alternative proposals. The House Republican Health Care Task Force will release a “solid” platform within the next month, said a spokesman for its leader, Rep. Roy Blunt (R-Mo.).

The void on the right has been so vast that a millionaire health care entrepreneur named Rick Scott stepped into it as the unlikely face of Republican opposition. His record isn’t spotless, having lost control of Columbia/HCA, then the country's largest hospital company, in 1997 amid a Medicare investigation. (Scott was not charged with any wrongdoing.) But he is the only one so far to put up money.

Now running a chain of urgent care clinics in Florida, Scott plans to spend at least $5 million to push a limited-government, free-market approach to medicine. He has assembled a staff of 12, hired the Virginia public relations firm that assisted Swift Boat Veterans for Truth, bought six weeks of radio and TV ads, and commissioned a poll by Republican strategist Tony Fabrizio.

He shared the data with members of Congress last week, and visited Grover Norquist’s Wednesday meeting of conservatives the week before to screen segments of a forthcoming documentary on the Canadian and British health care systems.

Even Scott is anxious for other groups with funding to step out front with him.

“A lot of people are waiting to see a bill and there is no bill yet,” Scott said in an interview. “So that will supposedly be the first part of June. My personal concern is that might be too late because it appears this is all going pretty fast. If you wait to get started until there is a bill you don’t like, you are going to have a tough time.”

The organizational strength behind Obama’s plan is enormous. The House speaker, the Senate majority leader and the committee chairmen have agreed to work together, minimizing the turf wars that doomed former President Bill Clinton’s effort in the 1990s. The major labor unions have teamed up with business groups. An umbrella group for liberal organizations, Health Care for America Now, is spending $40 million on the fight.

None of this guarantees success, and the ultimate bill could provide plenty for critics to challenge. Former House Speaker Newt Gingrich said in an interview that, following Obama’s intervention in the auto and financial industries, he sees voters recoiling from a government-heavy health care plan.

But anxiety is setting in among some Republicans that they aren’t ready.

“That is a definite concern,” said an aide to a senior congressional Republican, who spoke on the condition of anonymity to talk candidly about his party. “There is catch-up in terms of us talking about it in public. There is a good core of ideas, but we haven’t talked about the issue as much as Democrats. We are playing catch up. We are running against the wind. They have a lot of momentum.”

To be sure, there has been no shortage of discussion in recent months.

At least three different GOP groups are studying the issue in the House – Blunt’s leadership-appointed task force, the conservative Republican Study Committee, and the moderate Tuesday Group.

There is also a group of 13 Republican physicians, including Burgess, Rep. Tom Price (R-Ga.) and Rep. John Shadegg (R-Ariz.), who share ideas among themselves while participating in other groups. Rep. Dave Camp (R-Mich.), the ranking member on Ways and Means, and Rep. Paul Ryan (R-Wis.), the ranking member on Budget, are also expected to take a lead.

Republicans are fielding strategic and policy advice from a familiar lineup, including Gingrich, Scott, pollster Bill McInturff, Galen Institute president Grace-Marie Turner, and Heritage Foundation health policy expert Robert Moffitt. All were involved in the health care debate in the early 1990s.

The advice so far? Republicans cannot just oppose a bill, and they cannot simply recycle the old ideas like health savings accounts and tax breaks.

“We could have come out with the same health care principles that we have always talked about,” Blunt’s spokesman Nick Simpson said Friday. “This group wants to come up with fresh solutions and not just party rhetoric – and that takes some time.”

But a Republican consultant said the party needs to present its vision quickly -- while Democrats are still debating.

"I am shocked they haven’t to this point. This has been out there for so many years," the consultant said. "There is a genuine mixture of fear and reluctance and indifference on the part of many Republicans towards the issue of health care, and they better get over it fast."

Historically, Democrats hold the advantage. Voters have consistently viewed them as better able to handle health care since the early 1990s, according to the Pew Center for the People and the Press. The margin has rarely been close, with Democrats often beating Republicans on the issue by more than 20 points.

The chasm grew last year, as Obama bombarded McCain with health care advertising. The Democrat spent $113 million, or eight times that of his rival, POLITICO reported in October. Running almost 200,000 commercials to McCain’s 11,300, Obama painted the Republican’s plan as the “largest middle class tax hike ever” for lifting the tax deduction on employer-based health insurance – an idea Democrats are now considering.

David Merritt, project director at Gingrich’s Center for Health Transformation, said the lopsided debate last fall highlighted the need for Republicans to develop a comprehensive health care strategy.

“Just look at when things really turned: in August and September, when health care was the hammer that then-candidate Obama used over the McCain campaign,” Merritt said. “The response from the McCain campaign was to talk about tax credits and financing. They didn’t talk about families.”

By February, 58 percent of Americans had little or no confidence in congressional Republican to do the “right thing” for health care, ranking just ahead of insurers and corporations, according to the Kaiser Health Care Tracking Poll. Thirty-eight percent expressed confidence in the GOP, compared to 72 percent in Obama and 57 percent in congressional Democrats, the poll found.

Burgess wrote his “Health Care Primer for Members” to nudge his Republican colleagues to embrace the issue, saying it was time to "step out of the shadow" of Democrats.

“Too often Republicans are criticized for their lack of enthusiasm or knowledge when it comes to talking about health care," Burgess wrote. "Whether that critique is fiction or contains a kernel of truth, the fact remains that we must overcome this perception.”

© 2009 Capitol News Company, LLC