In response to Martin Bauer's letter, "Too Many People Not Paid Enough" (July 30), I agree with much of what he wrote.

President Bush's tax cuts did provide too much of their benefit to the wealthiest among us. Those making more than $1 million received an average tax cut of $118,477 in 2006, compared with an average tax cut of $398 for those making less than $50,000. That's unfair. It's also bad economics - since these tax cuts were financed by adding to the debt, which ultimately hurts economic growth.

But Bauer wrongly characterized my views on Social Security, Medicare and Medicaid. Throughout my career, I have defended our nation's health and retirement programs and worked to make them solvent for future generations.

The fact is that while Social Security gets the most attention, due to rising health care costs, our health programs are the larger challenge to our nation's long-term fiscal security. That is why I have made a number of proposals to address rising health care costs.

For example, I have long said one way to control the rising cost of health care is to focus on the chronically ill - people with several serious medical conditions. According to estimates, the chronically ill represent about 5 percent of Medicare beneficiaries but account for about half of Medicare costs. Studies have shown that this patient population's care is not well-coordinated.

As a result, they're often taking too many prescription drugs, many times actually making them sicker, rather than healthier. Studies show that coordinating the care of the chronically ill better can save money and improve health care outcomes.

I have also called for broadening the use of information technology to improve the quality and efficiency of health care. Investing in high-tech health information systems could save thousands of lives and save tens of billions of dollars. The RAND Corp. has found that health IT measures already in the works could eventually save $80 billion each year.

In addition, I've called for the creation of a comparative effectiveness center to examine which health care practices and technologies now being used across the country are the most efficient. The results would be developed into best practices and shared within the medical community.

With the coming retirement of the baby boom generation, we are facing a real demographic tsunami. We must find savings in our entitlement programs. But we can reform these vital programs without harming beneficiaries. Given the coming retirement of the baby boom generation, doing nothing is not an option.

(Conrad is a U.S. senator from North Dakota. - Editor)