When disease-specific support groups started leaving church basements and turning to the Internet, members found a few sympathetic ears could grow into national or international communities several thousand strong. More members meant more power. And, ultimately, more power meant more action.

Over the past decade, online patient groups have evolved from large communities of people sharing a common disease to even larger communities sharing a common goal: to help spread awareness and support for the treatment and cure of their respective conditions.

The evolution of the Assn. of Cancer Online Resources has become a typical example of this trend.

ACOR was founded in 1995 by Gilles Frydman after his wife, Monica, was diagnosed with the ductal carcinoma in situ type of breast cancer, shortly after recovering from a rare heart disorder.

Not satisfied with the answers his wife's doctor was giving them, Frydman turned to Internet groups for information. The groups he found convinced him that his wife needed a second opinion and also helped him find a new doctor. But, he found that navigating the boards was difficult and cumbersome. The idea of ACOR was to provide one-stop shopping for every type of cancer support group.

Now, due to its amplitude, ACOR has evolved from a patient resource to a source for researchers looking for clinical trial subjects; a directory of specialists, complete with firsthand critiques; and a large collection of cancer information and research. The group is now moving into fundraising.

[...]

UnitedHealthcare is going ahead with plans to release its physician rankings for the New York area, despite a threat of legal action from the state's attorney general, a United spokesman said.

However, the company is delaying implementation of the rankings system for a few months so physicians can get more familiar with it -- a move United says has nothing to do with the attorney general's threat.

United will roll out its Premium program -- a physician evaluation system based on cost and quality-of-care data -- in the New York area, including New Jersey and Connecticut, at the end of the year, said United spokesman Tyler Mason. The health plan already uses the program in 100 other markets, he said.

A July 13 letter from the attorney general's office said the ranking system would influence patients to use physicians who are cheaper but not necessarily better. The letter told United it would face legal action if it released the rankings as planned at the end of July.

Mason said United will release the rankings at the end of the year, and added that the delay is not because of the letter, but because the plan had already decided to give physicians more time for input and review.

"It's a national trend," Mason said. "All health plans are engaged in this type of activity. The need for consumers to have information as they pick up a larger share of their health care costs is here. So to the degree [the state is] contending [the rankings] could cause confusion, we obviously disagree with that."

[...]

New federal planning documents suggest that the money needed to treat ailing ground zero workers could soar to $20 million a month by the end of this year, up from about $6 million a month now.

The documents, prepared by the National Institute for Occupational Safety and Health, present one of the most comprehensive cost estimates of ground zero health issues. They project that costs will rise because the number of recovery workers getting sick is increasing, and their illnesses are becoming more severe.

The increased costs would mean that the $50 million for monitoring and treatment proposed by a House subcommittee for the federal budget for next year, which the full House is set to vote on this week, would be far from adequate.

The new estimates, which have not been published, are based on monthly records of treatment provided by the Mount Sinai Medical Center and four other metropolitan area clinics in New Jersey, Long Island, Queens and Bellevue Hospital Center, which are part of a medical consortium that has been treating ground zero workers.

Among the factors driving the cost increase are the large number of workers still registering for screening and treatment. Since the fifth anniversary of the attack last September, about 500 workers a month have been signing up with the monitoring and treatment programs, more than at any time since early 2004.

The total number of workers registered, including firefighters, now exceeds 37,000 and could go as high as 65,000 in two years, according to the documents. That would strain the programs, which are already short of doctors and so busy that newly registered workers must wait more than three months to be examined.

Records show that about half of the workers entering the program now receive treatment for ground zero-related physical health problems, like asthma and other respiratory ailments. About a quarter of them are treated for stress-related mental problems.

According to the documents, the workers coming into the programs now tend to have illnesses that appear to be more intense than in previous years, in part because many of them have waited so long to be examined that their conditions have worsened.

The planning documents were provided to The New York Times by a Congressional staff member who favors greater health care financing for people exposed to the trade center dust.

A different government official, who worked on the documents but was not authorized to speak about them and declined to be identified, said they show a deteriorating health situation and inadequate financing.

“The bottom line is that people are ill and they’re not getting better,” the official said.

But the dire picture presented in the planning documents is not universally accepted within the federal government. While several studies have shown that many recovery workers developed respiratory and gastrointestinal problems after working at ground zero, a link between exposure to the dust and life-threatening diseases has not been conclusively proved.

Officials at the Department of Health and Human Services, which oversees the National Institute for Occupational Safety and Health, have not made a forceful case for more financing from Congress.

A spokesman for the department declined to comment, saying she was not aware of the documents. Officials at the New York City Department of Health and Mental Hygiene also declined to comment.

Starting in 2002, the federal government provided money for screenings, but not treatment (at that time, some limited financing for treatment was provided by the Red Cross). In 2004 Washington provided money for a monitoring program, through which workers could be tracked over time. Since then, there have been two supplemental or emergency appropriations to keep the programs going.

Starting in January, federal money became available for the first time for treatment for three categories of illnesses: aerodigestive (like asthma or reflux disorders), psychological and musculoskeletal (like lower back problems). The treatment programs exclude cancers and all other illnesses.

Federal officials estimate that the current average annual cost of treating recovery workers is about $8,000. For workers with physical ailments, most of that cost is for diagnostic tests and prescription drugs needed to manage diseases like asthma. Treatment for stress-related psychological problems includes some medication and weekly office visits.

The treatment cost per worker could go as high as $10,500 a year in two years, according to the documents. And if cancers are treated, costs will escalate drastically.

Currently, about 19 percent of the 37,000 workers in the combined monitoring and treatment programs have respiratory and gastrointestinal problems, but that number could rise to nearly 50 percent if trends accelerate.

The percentage of workers with psychological problems is also expected to rise. Currently, 14 percent of workers have some kind of stress-related mental condition. That is expected to increase to 20 percent, and possibly as high as 26 percent, according to the planning documents.

Only the basic musculoskeletal injuries, like slipped discs, are expected to remain steady at about 1 percent of registered workers.

The annual cost for ground zero health care, including administrative and data collection expenses, is calculated to be $195 million by the end of this year, an estimate that assumes that expenses will increase as the treatment program becomes better established. The unpublished documents predict that over the next two years total costs are likely to increase to $428 million and could soar to as much as $712 million a year if more people come in and a higher percentage of them need treatment.

This week, the House of Representatives is expected to vote on putting $50 million for the treatment program at the consortium clinics into the 2008 budget. The Senate is considering a slightly larger amount and wants to cover other groups, including residents, that were exposed to trade center dust.

Earlier this year, a report issued by Mayor Michael R. Bloomberg estimated that medical care for ground zero victims could reach $392 million a year. That figure was widely seen as being driven by Mr. Bloomberg’s recent attempts to get the federal government to assume greater responsibility for sick workers.

WASHINGTON, July 17 — In a rousing indictment of the Bush administration and the Supreme Court it created, Senator Barack Obama told a Planned Parenthood convention here on Tuesday that the next election would decide a fundamental question: “What kind of America will our daughters grow up in?”

The speech by Mr. Obama, of Illinois, came on a day when the leading candidates for the Democratic presidential nomination expressed their commitment to reversing the Bush administration’s approach to abortion rights, judicial appointments, sex education and contraception.

Senator Hillary Rodham Clinton declared that President Bush had consistently “played politics with women’s health.” She added, “He has chipped away at reproductive rights, and he has worked to turn Washington, D.C., into an evidence-free zone where facts are subordinate to ideology.”

Mrs. Clinton, of New York, argued that the Bush administration and its conservative allies had undermined and underfinanced longstanding education and family planning programs while heavily favoring abstinence education. She added, to cheers, “I want you to know that when I’m president, I will devote my very first days in office to reversing these ideological, antiscience, antiprevention policies that this administration has put into place.”

Mr. Obama, who was repeatedly interrupted by applause, said the recent Supreme Court decision upholding a federal ban on a type of abortion was the beginning of a profound retreat on women’s rights, and should be presented that way to the voters.

“We know that five men don’t know better than women and their doctors what’s best for women’s health,” Mr. Obama said, alluding to the 5-to-4 majority in the abortion case, Gonzales v. Carhart, which upheld the Partial Birth Abortion Ban Act of 2003.

“We know that a woman’s right to make a decision about how many children to have and when, without government interference, is one of the most fundamental freedoms we have in this country,” he said.

Mr. Obama’s speech — and the reception it received from the Planned Parenthood Action Fund — underscored the power of the Supreme Court as a galvanizing issue for Democratic primary voters, after a session marked by conservative shifts on abortion, school integration and other issues. But Mr. Obama also argued that supporters of abortion rights should not shy from making their case to the broader public.

“If the argument is narrow, oftentimes we lose,” he said. “But if you ask everybody, you ask the most conservative person, do they want their daughters to have the same chances as men? Most of them will answer in the affirmative.”

Elizabeth Edwards, speaking on behalf of her husband, former Senator John Edwards of North Carolina, said his commitment to abortion rights ran deep.

“He hasn’t changed, he hasn’t wavered,” she said. “John is pro-choice not because he made some political calculation. He simply is pro-choice.”

Mrs. Edwards argued that the nation was now “one justice away from overturning Roe v. Wade,” the 1973 Supreme Court decision recognizing a right to abortion. She added that it was no time for the abortion-rights side to flinch.

“There are times when compromise simply means capitulation, and this is one of those times,” she said. “Just as you can’t be a little bit pregnant, you can’t be a little bit deprived of the right to control your body.”

All of the candidates emphasized their commitment to a “prevention agenda” that intends to reduce the number of abortions by reducing unintended pregnancies.

WASHINGTON, July 17 — The White House political affairs office directed the nation’s chief antidrug official and his deputies to appear at about 20 political events with vulnerable Republican members of Congress before the 2006 elections, a leading House Democrat charged Tuesday.

The lawmaker, Representative Henry A. Waxman of California, said the episode was further evidence of what Democrats have described as White House efforts at improperly politicizing federal agencies. Mr. Waxman said the pre-election appearances, by officials of the Office of National Drug Control Policy, which is obliged by law to be nonpolitical, were often accompanied by announcements of federal grants.

The congressman, chairman of the House Oversight and Government Reform Committee, said administration documents obtained by the committee suggested that Sara M. Taylor, then the White House political affairs director, and Karl Rove, President Bush’s chief political adviser, had helped direct the campaign-season travel plans of officials from the drug office, including its director, John P. Walters.

Mr. Waxman has asked Ms. Taylor to testify about the issue before his committee on July 30.

“Documents recently provided to the oversight committee,” he said in a letter to her, “suggest that White House efforts to politicize the activities of federal agencies may be more widespread than previously known.”

W. Neil Eggleston, a lawyer for Ms. Taylor, said no decision had been reached on how to respond to Mr. Waxman. But he added that she “believes she managed the office of political affairs in a manner consistent with prior administrations, both Republican and Democrat.”

Tom Riley, a spokesman at the drug office, said its officials regularly attended events around the country to “raise awareness of the problems of illegal drugs.” While such events in 2006 were attended by officeholders of both parties, Mr. Riley said, “it’s not terribly surprising that during campaign season, candidates from the opposing party aren’t as interested in doing events touting administration programs.”

Scott M. Stanzel, a White House spokesman, said that the political affairs office had a legitimate role in advancing the president’s policy agenda and so occasionally helped set travel schedules for all White House agencies, including the drug office. He noted that several 2006 events included Democrats like Mayor John F. Street of Philadelphia and Gov. Tom Vilsack of Iowa.

Mr. Stanzel noted that in this case, as frequently in the past, Mr. Waxman had asked the administration for a variety of documents related to his accusations. “Another day, another letter from Representative Waxman,” Mr. Stanzel said.

Mr. Waxman cited a Nov. 20, 2006, memorandum from Ms. Taylor to the drug office that he said “details 31 specific events that you recommended Director Walters or deputies attend in 2006.” He said the officeholders on the list were “like a roster of the most vulnerable Republican members of Congress seeking re-election in 2006.”

He cited a second, post-election memorandum in which Douglas Simon, the drug office’s White House liaison, described a meeting where Mr. Rove thanked Mr. Walters and his deputies for giving their time to go to “the god awful places we sent them” during the campaign.