UPDATE 2-US White House AIDS strategy to focus on prevention

WASHINGTON, July 12 (Reuters) – U.S. President Barack Obama released a domestic AIDS strategy on Monday that aims to cut the infection rate by 25 percent, test 90 percent of those infected and get 85 percent of patients treated right away.

The new plan, to be formally released on Tuesday, also has modest aims to get 20 percent more of the most at-risk groups such as gay and bisexual men and blacks treated with drugs to control their infections.

“Unless we take bold actions, we face a new era of rising infections, greater challenges in serving people living with HIV, and higher health care costs,” the report reads.

The United States should be able to lower the annual number of new infections by 25 percent from 56,300 to 42,225 a year by 2015, the plan said.

It also proposes to cut the HIV transmission rate by 30 percent. Currently, 5 percent of HIV patients infect someone else and the plan aims to lower this to 3.5 percent.

The U.S. Centers for Disease Control and Prevention says 79 percent of people infected with the human immunodeficiency virus that causes AIDS know they have it. The plan aims to increase this to 90 percent.

To this end, the plan calls for the U.S. Food and Drug Administration to make a top priority the review of new HIV diagnostic tests.

It also promises to get 85 percent of newly diagnosed patients into a doctor’s office or clinic within three months. Currently, 65 percent get treated that quickly.

The plan also targets behavior. “Congress and State legislatures should consider the implementation of laws that promote public health practice and underscore the existing best evidence in HIV prevention for sexual minorities,” it reads.

More than 1.1 million people in the United States are infected with the human immunodeficiency virus that causes AIDS, according to the Centers for Disease Control and Prevention.

While only about 5 percent of patients infect someone else, this is enough to keep levels of the virus stable in the United States, the CDC says. The fatal and incurable virus is spread during sex, in blood and breast milk and by contaminated needles.

The U.S. government has a program to fight AIDS globally — PEPFAR, or President’s Emergency Plan for AIDS Relief — but there has not been a similar coherent domestic strategy.

While the administration of former President George W. Bush was praised for coming up with PEPFAR, it was widely criticized for promoting abstinence-only education in place of more comprehensive programs stressing condom use.

The new Obama plan includes abstinence but also stresses other approaches.

“We must also move away from thinking that one approach to HIV prevention will work, whether it is condoms, pills, or information,” the plan reads.

“Instead, we need to develop, evaluate, and implement effective prevention strategies and combinations of approaches including efforts such as expanded HIV testing (since people who know their status are less likely to transmit HIV), education and support to encourage people to reduce risky behaviors (and) the strategic use of medications and biomedical interventions,” it adds.

Some AIDS activist groups began criticizing the policy even before it was released, saying it did not come close to doing what they had hoped.

The AIDS virus infects 33 million people globally and has killed 25 million since the pandemic began in the 1980s.

In Africa, most new AIDS patients are women infected by men during sex. In the United States HIV disproportionately affects men who have sex with men, blacks and Hispanics.

(Editing by Eric Beech)

US White House AIDS strategy to focus on prevention

WASHINGTON, July 12 (Reuters) – U.S. President Barack Obama released a domestic AIDS strategy on Monday that aims to cut the infection rate by 25 percent, test 90 percent of those infected and get 85 percent of patients treated right away.

The new plan, to be formally released on Tuesday, also has modest aims to get 20 percent more of the most at-risk groups such as gay and bisexual men and blacks treated with drugs to control their infections.

“Unless we take bold actions, we face a new era of rising infections, greater challenges in serving people living with HIV, and higher health care costs,” the report reads.

The United States should be able to lower the annual number of new infections by 25 percent from 56,300 to 42,225 a year by 2015, the plan said.

It also proposes to cut the HIV transmission rate by 30 percent. Currently, 5 percent of HIV patients infect someone else and the plan aims to lower this to 3.5 percent.

The U.S. Centers for Disease Control and Prevention says 79 percent of people infected with the human immunodeficiency virus that causes AIDS know they have it. The plan aims to increase this to 90 percent.

To this end, the plan calls for the U.S. Food and Drug Administration to make a top priority the review of new HIV diagnostic tests.

It also promises to get 85 percent of newly diagnosed patients into a doctor’s office or clinic within three months. Currently, 65 percent get treated that quickly.

The plan also targets behavior. “Congress and State legislatures should consider the implementation of laws that promote public health practice and underscore the existing best evidence in HIV prevention for sexual minorities,” it reads.

More than 1.1 million people in the United States are infected with the human immunodeficiency virus that causes AIDS, according to the Centers for Disease Control and Prevention.

While only about 5 percent of patients infect someone else, this is enough to keep levels of the virus stable in the United States, the CDC says. The fatal and incurable virus is spread during sex, in blood and breast milk and by contaminated needles.

The U.S. government has a program to fight AIDS globally — PEPFAR, or President’s Emergency Plan for AIDS Relief — but there has not been a similar coherent domestic strategy.

While the administration of former President George W. Bush was praised for coming up with PEPFAR, it was widely criticized for promoting abstinence-only education in place of more comprehensive programs stressing condom use.

The new Obama plan includes abstinence but also stresses other approaches.

“We must also move away from thinking that one approach to HIV prevention will work, whether it is condoms, pills, or information,” the plan reads.

“Instead, we need to develop, evaluate, and implement effective prevention strategies and combinations of approaches including efforts such as expanded HIV testing (since people who know their status are less likely to transmit HIV), education and support to encourage people to reduce risky behaviors (and) the strategic use of medications and biomedical interventions,” it adds.

Some AIDS activist groups began criticizing the policy even before it was released, saying it did not come close to doing what they had hoped.

The AIDS virus infects 33 million people globally and has killed 25 million since the pandemic began in the 1980s.

In Africa, most new AIDS patients are women infected by men during sex. In the United States HIV disproportionately affects men who have sex with men, blacks and Hispanics.

(Editing by Eric Beech)

Consumer Directed Health Plan Enrollment Grows by 27 Percent in 2009

WASHINGTON–(Business Wire)–
Enrollment in Consumer-Directed Health Plans (CDHPs), providing consumers more
control over the cost of their health care, grew to an estimated 23 million
people in 2009, up from 18 million people in 2008 – a 27 percent increase. This
key finding was reported in an analysis of Mercer`s National Survey of Employer
Sponsored health Plans by the American Association of Preferred Provider
Organizations (AAPPO). Released today by AAPPO, this analysis also reveals that
small employers lead CDHP adoption in 2009, accounting for most of the growth
among all employers.

“At a time when employers are faced with the difficult choice of limiting
benefits or raising health care costs to their employees, they are turning to
CDHPs given the cost savings inherent in these plans,” said Karen Greenrose,
president and CEO of AAPPO. “We also saw small employers turn to CDHPs at a much
greater rate, largely due to this cost savings. CDHPs, which are predominately
built on PPO networks, offer the affordability, choice and access that employers
and consumers alike are looking for.”

Another interesting finding of the analysis showed that while employers prefer
to offer CDHPs with health savings accounts (HSAs), employees are enrolling in
CDHPs with health reimbursement accounts (HRAs) at a greater rate. As consumers
look to get the biggest bang for their buck, HRAs are more appealing given that
they provide an employer contribution to the employee`s HRA, whereas HSAs do not
always do so.

“Health Savings Accounts are a valuable tool to help make health coverage more
affordable and accessible for millions of Americans. This important study
further demonstrates the success of consumer directed health plans,” said
Congressman Paul Ryan (R-WI).

To view the entire study, please visit www.aappo.org.

About the American Association of Preferred Provider Organizations (AAPPO)

Founded in 1983, AAPPO (www.aappo.org) is the leading national association of
preferred provider organizations (PPOs). PPOs put control for medical decisions
in the hands of the physician and patient, resulting in easy access to the right
care, provided by the right doctor, at the right time. AAPPO creates a forum for
discussion and dissemination of PPO best practices.

for the American Association of Preferred Provider Organizations (AAPPO)
Teresa Schofield, 202-347-7516
tschofield@theheraldgroup.com

Copyright Business Wire 2010

Power of plants harnessed to fight hemophilia

Washington, Mar 31 (ANI): Researchers at the University of Florida and the University of Central Florida have modified plants to fight hemophilia, a disease linked with legends of European monarchs.

The standard treatment for the disease is infusion with an expensively produced protein that helps the blood to clot. But in some patients the immune system fights the therapy, and in a subset of those, it sets off an allergic reaction that can result in death.

Now boffins at the universities have come up with a way that potentially could help patients develop tolerance to the therapeutic protein before they are in need of treatment.

They genetically modified plants to encapsulate the tolerance-inducing protein within cell walls so that when ingested, it can travel unscathed through the stomach and be released into the small intestines where the immune system can act on it.

The low-cost plant-based system, now being tested in mice, eventually could help improve the lives of many people who have hemophilia and dramatically reduce related health-care costs. The approach also has the potential for use with other conditions such as food allergies and autoimmune diseases.

“We”re hoping that our research will, in the future, result in better and more cost-effective therapies,” said Roland Herzog, Ph.D., an associate professor of pediatrics, molecular genetics and microbiology in the UF College of Medicine and a member of the UF Genetics Institute, who was one of the study”s leaders.

The findings have been published in the Proceedings of the National Academy of Sciences.

Hemophilia is characterized by defects in the gene that produces a protein required for blood to clot. People with hemophilia can suffer from spontaneous internal bleeding or severe bleeding resulting from minor injuries. Males get the disease, which is linked to the X chromosome, while females are “carriers” who rarely exhibit symptoms. The two forms of the disease — hemophilia A and B — are associated with the absence of proteins called factor VIII and factor IX, respectively. (ANI)

US Congress approves ‘historic’ health care overhaul bill

Washington, Mar 22(ANI): US Congress has approved a legislation over the nation’s health care system along the lines proposed by US President Barack Obama that would provide medical coverage to millions of uninsured Americans.

The bill cleared the House on a 219-212 vote, with Republicans unanimous in opposition.

Congressional officials said that they expected Obama, whose crusade for such legislation has been a hallmark of his presidency, to sign the bill as early as Tuesday.

Obama had earlier spoken with 92 lawmakers, either in person or by telephone, for passing the bill, the White House said.

The House also passed a package of changes to the bill and sent it to the Senate, which has promised to take it up in the coming week.

The Democrats hailed the votes as historic and a long overdue step forward in social justice, comparable to the establishment of Medicare and Social Security.

“This is the civil rights act of the 21st century,” The New York Times quoted James E. Clyburn, Representative of South Carolina, as saying.

Democrats said that in expanding access to health coverage for uninsured Americans, the government was creating a new program as important as Social Security and Medicare, while also putting downward pressure on rising health care costs and reining in federal budget deficits.

According to the Congressional Budget Office, the health care bill would require most Americans to have health insurance, would add 16 million people to the Medicaid rolls and would subsidize private coverage for low- and middle-income people, at a cost to the government of 938 billion dollars over 10 years.

It would also require many employers to offer coverage to employees or pay a penalty.

The budget office estimates that the bill would provide coverage to 32 million uninsured people, but still leave 23 million uninsured in 2019.

Meanwhile, Republicans said the plan would saddle the nation with unaffordable levels of debt, leave states with expensive new obligations, weaken Medicare and give the government a huge new role in the health care system. (ANI)

Genetic discovery could pave way for obesity, diabetes treatments

Washington, Aug 27 (ANI): Researchers at University of Central Florida have identified a new genetic mechanism that controls the body’s fat-building process, paving way for treatments for obesity and type 2 diabetes.

The discovery has the potential to help hundreds of millions of people and dramatically cut health care costs.

Led by Pappachan Kolattukudy, director of UCF’s Burnett School of Biomedical Sciences in the College of Medicine, found that a gene called MCPIP (Monocyte Chemotactic Protein-1 Induced Protein) controls the development of fat cells.

Until now, a different protein, known as peroxisome proliferator-activated receptor gamma (PPAR gamma), has been universally accepted as the master controller of fat cell formation, known as adipogenesis.

But the new findings has opened new doors for scientists looking forward to develop drugs that could benefit the more than 300 million people worldwide who are clinically obese, and who have much higher risks of suffering from chronic disease and disability.

Besides, it is projected that more than 300 million people will be diabetic by the year 2025.

Kolattukudy said MCPIP is potentially an ideal target for drugs that would prevent the body from becoming resistant to insulin and prone to type 2 diabetes.

“Our research has shown that MCPIP is a regulator of fat cell formation and blood vessel formation that feeds the growing fat tissue. Therefore, a drug that can shut down its function can prevent obesity and the major inflammatory diseases resulting from obesity, including diabetes and cardiovascular diseases,” the expert said.

For the study, the researchers introduced MCPIP to living cells from mice that had been stripped of the PPAR gamma gene and found that the cells still completed the developmental process necessary to build fat.

Now, the researchers are planning to explore chemical combinations to discover drugs that are effective at shutting down the novel gene.

The development of new drugs that can block or slow down the formation of MCPIP likely would take several years.

The findings will be published in the October issue of the Journal of Biological Chemistry. (ANI)

Prostate cancer screening not very beneficial, say scientists

Washington, June 29 (ANI): Two recently conducted large randomised trials suggest that prostate cancer screening has yet to prove its worth.

Published in CA: A Cancer Journal for Clinicians, a study report says that if there is a benefit of screening, it is, at best, small.

Given that prostate cancer is virtually ubiquitous in men as they age, the report points out that it is clear that a goal of “finding more cancers” is not acceptable.

The authors instead say that public health principles demand that screening must reduce the risk of death from prostate cancer, reduce the suffering from prostate cancer, or reduce health care costs when compared with a non-screening scenario.

According to them, prostate cancer screening has yet to reach one of these standards to date.

The research team-including Dr. Otis W. Brawley of the American Cancer Society and Dr. Donna Ankerst and Dr. Ian M. Thompson of the University of Texas Health Science Center at San Antonio-agree that a decrease in prostate cancer death rates has been observed as compared to the mid-1980s, since when screening with the prostate-specific antigen (PSA) blood test has more than doubled the risk of a prostate cancer diagnosis.

They, however, say that the relative contribution of PSA testing as opposed to other factors, such as improved treatment, has been uncertain.

The experts say that a computer modeling study using National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) registries estimated that more than one in four cancers detected in whites (29 percent) and nearly half of cancers detected in blacks (44 percent) were overdiagnosed cancers.

A similar model using data from Europe estimated a 50 percent overdiagnosis rate, they add.

The team even say that patients who are diagnosed with clinically insignificant tumours are subject to unnecessary diagnostic tests and unneeded treatment and suffer psychosocial harms. Such patients are also labelled “a cancer patient”, which can have negative economic consequences.

The authors further say that over-diagnosis significantly affects 5-year survival statistics, making them uninformative in demonstrating progress in cancer control.

Their report says that the future of prostate cancer will include better screening tests, better methods to assess a man’s risk of prostate cancer, and prevention strategies, including the use of finasteride, a drug currently used for the treatment of urinary symptoms related to prostate enlargement.

In another editorial, Dr. Peter Boyle of the International Prevention Research Institute, Lyon, France and report co-author Dr. Brawley say: “The real impact and tragedy of prostate cancer screening is the doubling of the lifetime risk of a diagnosis of prostate cancer with little if any decrease in the risk of dying from this disease.”

The authors pointed out that in 1985, before PSA screening was available, an American man had an 8.7 percent lifetime risk of being diagnosed with prostate cancer and a 2.5 percent lifetime risk of dying from the disease.

Twenty years later, in 2005, an American man had a 17 percent lifetime risk of being diagnosed with prostate cancer and a 3 percent risk of dying from the disease.

According to the report, even in the best case scenario, applying the findings of a European trial that found PSA led to a 20 percent reduction in the risk of death, the average man who chooses screening decreases his risk of prostate cancer death from a lifetime risk of 3 percent to a lifetime risk of 2.4 percent.

In exchange, he doubles the chances of becoming a prostate cancer patient, his risk of diagnosis rising from about nine percent to at least 17 percent.

“Men should discuss the now quantifiable risks and benefits of having a PSA test with their physician, and then share in making an informed decision, and the weight of the decision should not be thrown into the patient’s lap,” the authors concluded. (ANI)

Indian American aides to help Obama cut unnecessary spending

Lalit K Jha Washington, Apr 18 (PTI) US President Barack Obama today revealed his blue print to fulfill his election promise of providing transparent, efficient and effective governance, a task in which two young Indian Americans will play a key role. Aneesh Paul Chopra Shah, whose appointment as the Chief Performance Officer, was announced today and Vivek Kundra, the Chief Technology Officer of the President are among the top three key Obama aides who will assist him in revamping the administration.

The appointment of Chopra along with Jeffrey Zients, as his Chief Performance Officer, was announced today by Obama. “Together with Chief Information Officer Vivek Kundra, they (Chopra and Zients) will help give all Americans a government that is effective, efficient, and transparent,” Obama said in his weekly radio address today.

While Zients will work to streamline processes, cut costs and find the best practices throughout the government, Chopra will promote technological innovation to help US meet its goals from job creation, reducing health care costs and protecting the homeland, Obama said. The US President also announced the nomination of Indian American Raj Shah as the Under Secretary for Research, Education and Economics in the Department of Agriculture.

In the coming weeks, Obama said he will be announcing the elimination of dozens of government programmes shown to be wasteful or ineffective. PTI.

Two Indian-Americans get key posts in Obama team

United States President Barack Obama on Saturday announced the appointment of two more Indian-Americans – Raj Shah and Aneesh Paul Chopra – to his key administration posts.

While Shah has been nominated as Under Secretary for Research, Education and Economics in the Department of Agriculture, Chopra will be the Chief Performance Officer, Obama announced on Saturday morning in his weekly radio address.

“As Chief Technology Officer, Chopra will promote technological innovation to help the country meet its goals from job creation, to reducing health care costs, to protecting the homeland,” the president said.

In his current position as Virginia’s Secretary of Technology, Chopra leads the strategy to effectively leverage technology in government reform, to promote Virginia’s innovation agenda and to foster technology-related economic development.

He has earlier worked as Managing Director with the Advisory Board Company, leading the firm’s Financial Leadership Council and the Working Council for Health Plan Executives.

On the other hand, another Indian-American Shah is currently the Director of Agricultural Development in the Global Development Programme for Bill and Melinda Gates Foundation. Said to be Gates Foundation’s sharpest executives, Shah, 36, lives in Seattle.

In this capacity, he manages the Foundation’s Agricultural Development programme — including grant-making portfolios in science and technology, farmer productivity, market access, and policy and statistics — with the goal of helping the world’s poor lead healthy and productive lives.

Having joined the Foundation in 2001, he has served as the Foundation’s Director of Strategic Opportunities and Deputy Director of Policy and Finance for Global Health.

In these roles, he helped develop and launch the Foundation’s Global Development Programme and International Finance Facility for Immunisation — an effort that raised more than USD 5 billion for child immunisation and hopes to save more than five million lives around the world.

Prior to joining the Foundation, Shah was the health care policy advisor on the Gore 2000 presidential campaign and a member of Governor Ed Rendell’s transition committee on
health.

Co-founder of Health Systems Analytics and Project IMPACT for South Asian Americans, he has served as a policy aide in British Parliament and worked at World Health Organisation.

Currently, Shah serves on the boards of the Alliance for a Green Revolution in Africa, the Seattle Public Library, and the Seattle Community College District. Shah earned his MD from the University of Pennsylvania Medical School and Master of Science in health economics at Wharton School of Business.

He is a graduate of the University of Michigan and London School of Economics and has published articles on health policy and global development. In 2007, he was named a Young Global Leader by the World Economic Forum.

China has long way to go on health reforms

Beijing – Chinese authorities released a long-awaited health reform action plan last week, but it is only the first step in a long march towards curing endemic problems marring the country’s medical system, analysts say. Over the next three years, 850 billion yuan (124 billion dollars) will be spent on lowering the costs of medicines, building and renovating hospitals and clinics, training medical staff, and improving and expanding the current medical insurance scheme.

Acknowledging the size of the task ahead, the government has appointed vice-premier Li Keqiang to head a taskforce comprising 16 government departments to coordinate the implementation of the proposed reforms.

This shows not only the government’s commitment, but also an understanding that only a top leader can motivate and unite all departments.

Health care topped the list of Chinese citizens’ concerns in a recent survey by the National Bureau of Statistics.

Until the 1980′s, health care costs in China were largely covered by the state. When this system was dismantled, medical fees sky-rocketed as under-funded hospitals struggled to keep up with demand.

Between 1985 and 2005, the annual disposable income of Chinese residents increased 20 times, but the amount they spent on health care increased by 133 times, according to Ministry of Health figures.

But reactions to the government’s new action plan have seen hope mixed with concern, as analysts question just how certain goals will be met.

“The release of the policy is only the first step in the march towards reform,” Peking University economics professor Liu Guo’an told the German Press Agency (dpa)

Physically abused women spend 40pc more on health care than non-abused

Washington, Mar 24 (ANI): Women who are victims of physical abuse from intimate partners have increased health care costs, even after the abuse has ended, a new study has found.

“Along with all the physical and emotional pain it causes, domestic violence also comes with a substantial financial price,” said Amy Bonomi, co-author of the study and associate professor of human development and family science at Ohio State University.

She claimed that the study is the largest to date to examine health care costs and utilization based on the timing and type of domestic violence that women suffer.

Co-authored with researchers from the Group Health Cooperative and the University of Washington in Seattle, the study examined data from 3,333 randomly selected women who belonged to Group Health, a health care system in the Pacific Northwest.

In the survey, the researchers asked the women about whether they experienced any physical or emotional abuse from intimate partners and if so, when it occurred.

Then, they studied patterns of health care use and costs by the women over an 11-year period, from 1992 through 2002.

“We were able to track health care costs for quite a long time, giving us a good picture of how much domestic violence is actually costing our health care system,” said Bonomi.

It was found that women experiencing ongoing physical abuse had the highest health care costs-42 percent higher than non-abused women.

“It’s likely that these women need more health care because they are seeking care for immediate injuries and associated health problems,” said Bonomi.

And women, who had been physically abused within the last five years, but not currently, had 24 percent higher yearly health costs.

Abuse that occurred more than five years ago resulted in 19 percent higher costs.

Bonomi said that one striking finding was that all abused women, whether they experienced physical or psychological abuse, used significantly more mental health services than non-abused women.

Physically abused women used significantly more primary care, pharmacy, specialty care, laboratory and radiology services.

The study was published online this week in the journal Health Services Research. (ANI)

Insomnia can be long lasting

Washington, Mar 10 (ANI): Insomnia can be a chronic problem lasting more than a year, a new study has found.

Insomnia is a symptom of a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity.

Several factors such as being female, increasing age, having anxiety or depression and experiencing pain from medical conditions have been associated with insomnia.

The condition has been linked to higher health care costs, work absenteeism, disability and higher risk of hypertension and depression.

For the study, Charles M. Morin, Ph.D., of Université Laval and Centre de recherche Université Laval-Robert Giffard, Québec, Canada, and colleagues evaluated insomnia persistence, remission and relapse in 388 adults (average age 44.8) over a course of three years.

Individuals with an insomnia syndrome (insomnia symptoms at least three nights per week for at least one month causing substantial distress or daytime impairment) at the beginning of the study were compared to those with insomnia symptoms to examine the course of initial severe sleep difficulties.

“Of the study sample, 74 percent reported insomnia for at least one year and 46 percent reported insomnia persisting over the entire three-year study,” the authors write.

The group with initial insomnia syndrome had a higher persistence rate than the group with symptoms of insomnia (66.1 percent vs. 37.2 percent), respectively.

About fifty-four percent of participants went into insomnia remission; however, 26.7 percent of them eventually experienced relapse.

“Individuals with subsyndromal insomnia [insomnia symptoms] at baseline were three times more likely to remit than worsen to syndrome status, although persistence was the most frequent course in that group as well,” the authors said.

Of the 269 individuals with baseline symptoms of insomnia, after one year 38.4 percent were classified as good sleepers, 48.7 percent still had insomnia symptoms and 12.9 percent had insomnia syndrome.

Results were similar after the second and third year of follow-up. Of the 119 participants with insomnia syndrome at the beginning of the study, 17 percent were good sleepers after one year, while 37 percent had symptoms of insomnia and 46 percent remained in the insomnia syndrome group.

The study has been published in the March 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals (ANI)

Washington summit tackles age-old issue of health care reform

Washington  – President Barack Obama convened a summit of US politicians, economists and industry groups to discuss health care reform on Thursday, vowing to tackle a critical issue that has confounded many past administrations.

Spiralling health care costs in the United States have threatened “the very foundation of our economy,” Obama warned as he kicked off the gathering at the White House. He repeated a goal to have a comprehensive plan in place by the end of the year.

More than 45 million people in the United States do not have health insurance, and the crushing costs have forced many into bankruptcy. Health spending accounted for more than 16 per cent of US economic output in 2008 and counts among the most expensive in the world.

But past efforts at dramatic reforms have failed amid sharp ideological differences over the best way to reduce costs.

Hillary Clinton, now Obama’s secretary of state, famously took the lead in crafting a plan during her husband Bill Clinton’s administration that eventually died in Congress.

Noting that even former president Teddy Roosevelt sought reforms nearly a century ago, Obama said “skyrocketing” costs had become unsustainable for an economy already in the midst of a deep recession.

“The same soaring costs that are straining our families’ budgets are sinking our businesses and eating up our government’s budget too,” Obama said.

Though Obama has set an ambitious timetable for agreeing upon a deal, his efforts got off to a rocky start. Thomas Daschle, a close friend and former Senate majority leader, was forced to withdraw last month as Obama’s choice for health secretary over a tax scandal.

Obama on Monday nominated Kansas Governor Kathleen Sebelius to lead the Department of Health and Human Services instead.

Sebelius is known as a centrist and pragmatic Democrat. But she is less established in Washington circles – lawmakers and interest groups – that will be central to the process.

Much of the discussion in the coming months will revolve over the creation of a government-run programme to compete with private insurance plans, which Obama supported in the 2008 election campaign but is resisted by most conservatives. dpa