President Bush plugged a gaping hole in Medicare—the lack of coverage for outpatient prescriptions—by passing the Medicare Part D plan. Now, after more than 75 years of intermittent efforts and incremental advances, universal health insurance coverage has become a hot topic in Washington. It appears that the laudable goal of affordable, high quality healthcare and services for all has somewhat better prospects now than it has for decades. Despite the achievements of NIH and the larger health sciences and life sciences community in this country and elsewhere, the US is underinvested in some areas that are important to our social compact with the American people. Patients and healthcare professionals expect scientists to generate effective and safe clinical and public health advances from all the spectacular basic biomedical work. However, translating basic advances into clinical applications remains difficult. Eliciting support from healthcare insurers and managed care organizations for access to patients and funding for the costs of clinical studies and clinical trials has been difficult. Healthcare providers need research-based evidence of what works and what does not, and what is safe when used as directed and what's not, in medical care and in public health. The knowledge base underlying healthcare spending is generally inadequate, too short-term, and not generalizable to all the diverse populations of our country, let alone the world. And prevention still gets short shrift compared with diagnosis and treatment. Ideally, the biomedical, behavioral, and health services research agenda should be related to the healthcare cost equation. As noted, the social compact that yields generous support for research is based on an expectation of the benefit of improved health for the American people and people elsewhere. To honor that compact, I have five suggestions for action:
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