We don’t recall Michael Leavitt saying anything like this during the 4 years he served as Secretary of HHS under George W. Bush, but now he’s quite forthright in calling Medicare a fiscal disaster, and declaring that health reform proposals built around it would end up just the same.

With surely not a whit of political intent, the former Secretary told the Washington Post today that Medicare provides uncoordinated, expensive, poor quality care because “every incentive in the system is to provide more care, not better care.”

Referring to the Big O’s fading aspiration to create a public option that would compete against Big Insurance, Leavitt scoffed that such an idea would lead to “essentially a bankrupt system.”

Building on Medicare “is the equivalent of trying to solve obesity by prescribing a perpetual regimen of double calories,” Leavitt told the Post.

Then, in a remarkably transparent sleight of hand designed to distance himself from what he just said was the abject failure of a program for which he was responsible, Leavitt pointed a finger at Congress.

It’s too soft, too beholden to the special interests, he deadpanned. 

Planned cuts in Medicare payments to physicians were continually blocked by a Congress that was, he said, in the back pockets of providers. And Congress had OK’d competitive bidding on medical equipment, but backed away from that too, amid pressure from the device industry.

“[I]n a system that’s run by the government, lobbyists and various commercial interests, including doctors, hospitals, nurses, medical equipment dealers and every other part of the system, use the political process to restrict the capacity for change,” Leavitt said, his hands thoroughly washed of the matter.

Let’s hear it for GAVI Alliance partners, the World Bank, the WHO, UNICEF, 5 national governments and the Bill & Melinda Gates Foundation, who announced last week that they have kicked-off the first-ever Advance Market Commitment (AMC) program.

The purpose of the program is to accelerate access to vaccines against pneumococcal disease, which kills 1.6 million people each year, including a million children less than the age of 5.

90% of these deaths occur in developing countries.

Pneumonia, the most common form of serious pneumococcal disease, accounts for one in 4 childhood deaths around the world. The AMC pneumococcal program may prevent up to 7 million childhood deaths by 2030.

Pneumococcal vaccine has been part of regular immunization programs in developed countries since 2000, but there is no affordable vaccine for developing countries.

The vaccine costs $70 per dose in industrialized countries but thanks to the AMC, its price in developing countries will be secured for the long-term at $3.50.

Through an AMC, donors commit money to guarantee the price of vaccines once they have been developed, thus creating the potential for a viable future market.

These commitments provide vaccine makers with proper incentives to conduct R&D and build manufacturing capacity.

“The AMC is an important step towards reducing the health inequities between rich and poor, and a way to protect the lives of the world’s poorest children,” said Julian Lob-Levyt, GAVI’s CEO. “We look forward to pharmaceutical firms applying to the AMC quickly.”

For the pneumococcal AMC program, the governments of Italy, the UK, Canada, Russia, and Norway and the Bill & Melinda Gates Foundation combined to raise $1.5 billion, and GAVI threw in another $1.3 billion. The World Bank provides fiduciary support and the WHO has established technical criteria for a suitable vaccine. UNICEF will procure and distribute it.

Companies that participate in the AMC must commit to supply the vaccines at the low price even after donor funds are gone.

Plans are to introduce the new vaccine to 60 of the world’s poorest countries by 2015.