PNHP

Medicaid cuts enable tax benefits for the wealthy

Medicaid cuts enable tax benefits for the wealthy

The New York Times
January 14, 2003
Most States Cutting Back on Medicaid, Survey Finds
By Robert Pear

Two-thirds of the states say they are cutting Medicaid benefits, increasing co-payments, restricting eligibility or removing poor people from the rolls because of soaring costs and plunging revenues.

The Bush administration has opposed any increase in the federal share of Medicaid, saying that the federal government has fiscal problems of its own.

http://www.nytimes.com/2003/01/14/politics/14MEDI.html

Comment: As long as we have a separate health care program for low-income individuals with little political voice, this program will be politically managed and funded as a “welfare program.” If we were all in a single, universal health care program, most of us would not tolerate a policy position that seriously underfunds our health care system while reducing taxes for those that will never feel a quality-of-life impact of the tax benefit.

How can a just society adopt policies that further impair access and outcomes for the most vulnerable individuals in our society? Continuing to tolerate this injustice does not speak well for the American ethic.

D. Hong on health care in mainland China

Dorothy Hong is a second year medical student at the University of Southern California. She was raised in mainland China, and her mother teaches at Beijing University. Michael Kennedy, M.D., who teaches at USC, asked her to comment on our prior dialogue on health care in mainland China.

Dorothy Hong:

Hi Dr. Kennedy:

Their arguments are very interesting (U. Reinhardt, E. Christiansen, with a further comment by R. Covell). Both opinions are correct in certain aspects.

As Dr. Christiansen stated: “Hospitals are exceedingly well staffed with an abundance of well-trained physicians and registered nurses.” The best hospitals in China are excellent. However, there are very few excellent hospitals. Only a small percentage of people have access to decent health care.

In terms of the health care system, both socialism and capitalism co-exist. It all depends on whom you work for. If you are an employee of a public institution (run by the government), like my father, you and your children (not your spouse) can be covered by the company’s health plan. You can go to any hospital in your local area. The government pays the health care expenses. My father had to pay a very reasonable fee to insure my brother and me. Therefore, some lucky citizens are protected by the socialist health care system. However, if you are self-employed or work for a private company the government will not pay for your health care. China does not even have hospitals like the LA County hospitals. Human lives are not very important in the eyes of the government. There are too many people for the government to handle.

The socialist health care in China is good for those who can benefit from it. Both of my parents have to spend a day to do their annual physical exam, and this day is considered as a working day. They do basic screening tests based on your age, and a CBC. During their yearly routine examination, my father found out that he had hypertension, my mother, borderline diabetes.

For the past fifty decades, the Chinese socialist health care system has managed its expenses because only a very small percentage of people can take advantage of it. However, things are changing. My parents are concerned about for how much longer they can have this benefit.

Overall, I agree more with Dr. Covell and Dr. Reinhardt. One of my motivations to study medicine is to take care of my family’s health care needs in the future.

Dorothy

"Significant" small steps are no substitute for comprehensive reform

The Commonwealth Fund
January 2003
Small but Significant Steps to Help the Uninsured
By Jeanne M. Lambrew and Arthur Garson, Jr.

This paper suggests a number of low-cost policies that could improve health coverage in this environment by providing discrete groups of people with access to private health insurance, public coverage, or both.

Generally, the policies outlined below would cost less than $1 billion per year-a small amount relative to total spending on Medicare and Medicaid ($260 billion and $270 billion, respectively). Even if all were enacted, they would neither significantly reduce the number of uninsured nor substitute for comprehensive health system reform.

* Extending COBRA continuation coverage to all workers who need it.
* Adding health insurance assistance to unemployment insurance.
* Testing a Federal Employees Health Benefits Program buy-in through a
demonstration.
* Testing an individual insurance tax credit through a demonstration.
* Gradually phasing in public coverage of poor adults.
* Extending private plans’ dependent coverage up to age 21.
* Extending Medicaid/CHIP options up to age 21.
* Extending COBRA continuation coverage for early retirees.
* Creating a Medicare buy-in for younger spouses of Medicare beneficiaries.
* Allowing Medicaid to act as a high-risk pool.
* Gradually phasing out Medicare’s 24-month waiting period.
* Creating a national health coverage advisory commission.

Conclusion

Small policies cannot cure the myriad problems in the health insurance system in the United States. Solutions will require both significant new funding, since affordability is a major problem, and insurance and delivery system reform, to remove the structural barriers to coverage. The ideas presented in this paper represent a sample of ideas that could be considered in addition to those that have been proposed in Congress and by state officials, researchers, providers, and consumers. They are not incompatible with larger visions for the health system, nor are they intended to substitute or delay action on major reforms. Instead, they aim to break the recent impasse on policy for the uninsured and to make some, albeit limited, progress on reducing the number of uninsured Americans. Success in passing and implementing incremental health policies may, rather than diverting attention away from systemic reform, instill confidence in public policy’s ability to take on the larger challenges in improving health insurance coverage in the United States.

http://www.cmwf.org/programs/insurance/lambrew_smallsignificant_585.pdf

Comment: The most important statement in this report: “Even if all were enacted, they would neither significantly reduce the number of uninsured nor substitute for comprehensive health system reform.”

The two major pathways to reform include (1) incremental measures, such as those listed, that improve access and equity, and (2) comprehensive reform that assures everyone full, affordable access to health care. To follow one pathway, while publicly opposing the other, constitutes health policy malpractice!

We all need to support modest but politically expedient measures which can be enacted now. But, of much greater importance, we are all ethically mandated to move forward, with all of the forces that we can muster, toward true, comprehensive reform. There can be absolutely no hesitancy nor compromise in this effort.

Those working on modest reforms must continue to do so. But, as we support their efforts, they need to publicly support, in the clearest terms possible, our efforts for comprehensive reform. By unifying our advocacy on behalf of our health care system, we can clarify the confused message that the public is receiving. The public must understand that there is absolutely no substitute for truly comprehensive reform.

The Malpractice Crisis

Published on Monday, January 6, 2003 by CommonDreams.org
by Ralph Nader

Have you been watching the tv news or the tv news magazine shows lately about the sharp increase in medical malpractice insurance premiums and agitated physicians walking off their jobs in some states? If you have, didn’t they leave you with the impression that lawsuits against bad doctors were the cause? And these poor old insurance companies being forced to raise those premiums, 30%, 40%, 70% all of a sudden!

Propaganda and slanting the news are going hand in hand these days, choreographed by the hidden persuaders hired by the American Medical Association together with the behind-the-scenes lobbyists of the gouging insurance companies.

Why in the world would some physicians be willing tools of the insurance companies who are gouging them regardless of whether they are competent, caring doctors or the negligent, incompetent few who account for most of the claims by injured patients? Part of the answer is that the insurance companies are scaring many doctors with spectres of litigation volume that simply does not exist.

Malpractice cases filed and actual payments in constant dollars have been level for many years; about nine of ten malpractice harms do not result in any law suits being filed, according to various studies. Yet the human toll is deadly. A Harvard study estimated that gross malpractice just in hospitals takes 80,000 American lives a year plus causing hundreds of thousands of serious injuries.

Good physicians should delve deeper into the way medical malpractice insurers do their accounting, their reserving, and their actual practices. If physicians would total the entire amount of premiums they paid last year and divide it evenly by all the physicians practicing in the United States, the average premium is less than $10,000 per doctor per year. Very manageable.

So why are some doctors paying $50,000 or $100,000 a year to their malpractice insurers? Because the companies have learned in the past thirty years to over-classify their risk pools, thereby reducing their number to specific specialties like obstetrics or orthopedic surgery in order to charge much more. In addition, by not surcharging the few bad physicians in these specialties (known as experience loss rating), the good specialists pay as much as incompetent ones with a large number of payouts to their wounded patients.

There is another political benefit for this kind of over-classification. When obstetricians are gouged, they scream loudly, threaten not to deliver babies or actually go on strike. This makes perfect visuals for television ‚ crying babies, physicians in their garb blaming trial lawyers, who after all still have to persuade juries and judges (the latter being mostly former business lawyers). Meanwhile, the insurance companies are laughing all the way to the bank.

There are no visuals for the slowly dying and other human casualties who receive neither justice nor compassion nor compensation. Nor do people like Donald J. Zuk get any television time. Mr. Zuk, chief executive of SCPIE Holdings Inc., a leading malpractice insurer in the west, told the Wall Street Journal (June 24, 2002) in a very revealing analysis, “I don’t like to hear insurance company executives say it’s the tort injury-law system ‚ it’s self-inflicted.”

Neither organized medicine nor the insurance companies are really going after bad doctoring. The AMA’s web site does not report any data about incompetent or crooked physicians who give medicine a bad name. And loss prevention is something the insurance companies leave to professors of insurance to talk about.

Instead both lobbies are funding and pressing legislators to enact laws that politicize the courts, tie the hands of judges and juries ‚ the only ones who see, hear and evaluate the evidence before them ‚ and make it harder for innocent men, women and children to bring tragic cases to court and obtain an adequate award.

A favorite way to achieve this callous goal is to put a $250,000 lifetime cap on pain and suffering. Apart from the fact that some insurance executives make that much in one week, every week, from your premium insurance dollars, consider how such a cap wrecks the innocent in California.

Two year old Steve Olson, now twelve, became blind and brain-damaged because the hospital refused to give him a CAT scan that would have detected a growing brain mass. His mother left her job to take care of her son. A jury awarded Steven $7.1 million in non-economic compensation for his life of darkness, pain, and around-the-clock supervision. But the judge was forced by a California law, that these lobbies now want Congress to enact nationwide, to reduce the amount to $250,000.

Don’t think for a moment that restricting your court rights will reduce malpractice premiums for physicians. Not only have past restrictions not done so, but insurance industry and company spokespeople have openly said they will not do so and in some cases have raised premiums right after a state enacted restrictions.

There is an obligation for the many good doctors to speak out. Just a few weeks ago, nine of the doctors who walked out of Wheeling Hospital in West Virginia, had cost their insurers at least $6.3 million in malpractice claims. Among the damage they caused , wrote the Charleston Gazette, was operating on the wrong knee, causing the need for a liver transplant by leaving a surgical clip on an artery, and causing a massive and fatal infection by inadvertently slicing into a patient’s stomach.”

The whole malpractice insurance premium business amounts to about what this country spends on dog food and is one half of one percent of health care costs in this country. Isn’t it about time to focus on malpractice prevention first and foremost, instead of pounding on the rights of hundreds of thousands of Americans who leave their doctors far worse than when they greeted them?

If you want to find out more about “questionable doctors” in your area and how little the state medical licensing boards are doing to protect you, log on to www.citizen.org/hrg/

For more information on the malpractice crisis, go to www.centerjd.org And get ready to contact your members of Congress before it is too late.

“Significant” small steps are no substitute for comprehensive reform

The Commonwealth Fund
January 2003
Small but Significant Steps to Help the Uninsured
By Jeanne M. Lambrew and Arthur Garson, Jr.

This paper suggests a number of low-cost policies that could improve health coverage in this environment by providing discrete groups of people with access to private health insurance, public coverage, or both.

Generally, the policies outlined below would cost less than $1 billion per year-a small amount relative to total spending on Medicare and Medicaid ($260 billion and $270 billion, respectively). Even if all were enacted, they would neither significantly reduce the number of uninsured nor substitute for comprehensive health system reform.

* Extending COBRA continuation coverage to all workers who need it.
* Adding health insurance assistance to unemployment insurance.
* Testing a Federal Employees Health Benefits Program buy-in through a
demonstration.
* Testing an individual insurance tax credit through a demonstration.
* Gradually phasing in public coverage of poor adults.
* Extending private plans’ dependent coverage up to age 21.
* Extending Medicaid/CHIP options up to age 21.
* Extending COBRA continuation coverage for early retirees.
* Creating a Medicare buy-in for younger spouses of Medicare beneficiaries.
* Allowing Medicaid to act as a high-risk pool.
* Gradually phasing out Medicare’s 24-month waiting period.
* Creating a national health coverage advisory commission.

Conclusion

Small policies cannot cure the myriad problems in the health insurance system in the United States. Solutions will require both significant new funding, since affordability is a major problem, and insurance and delivery system reform, to remove the structural barriers to coverage. The ideas presented in this paper represent a sample of ideas that could be considered in addition to those that have been proposed in Congress and by state officials, researchers, providers, and consumers. They are not incompatible with larger visions for the health system, nor are they intended to substitute or delay action on major reforms. Instead, they aim to break the recent impasse on policy for the uninsured and to make some, albeit limited, progress on reducing the number of uninsured Americans. Success in passing and implementing incremental health policies may, rather than diverting attention away from systemic reform, instill confidence in public policy’s ability to take on the larger challenges in improving health insurance coverage in the United States.

http://www.cmwf.org/programs/insurance/lambrew_smallsignificant_585.pdf

Comment: The most important statement in this report: “Even if all were enacted, they would neither significantly reduce the number of uninsured nor substitute for comprehensive health system reform.”

The two major pathways to reform include (1) incremental measures, such as those listed, that improve access and equity, and (2) comprehensive reform that assures everyone full, affordable access to health care. To follow one pathway, while publicly opposing the other, constitutes health policy malpractice!

We all need to support modest but politically expedient measures which can be enacted now. But, of much greater importance, we are all ethically mandated to move forward, with all of the forces that we can muster, toward true, comprehensive reform. There can be absolutely no hesitancy nor compromise in this effort.

Those working on modest reforms must continue to do so. But, as we support their efforts, they need to publicly support, in the clearest terms possible, our efforts for comprehensive reform. By unifying our advocacy on behalf of our health care system, we can clarify the confused message that the public is receiving. The public must understand that there is absolutely no substitute for truly comprehensive reform.

Aaron – Who should control health care spending?

Health Affairs
Web Exclusive
January 8, 2003
Should Public Policy Seek To Control the Growth of Health Care Spending?
By Henry J. Aaron

Who makes the decisions?

Some observers believe that people can impose such budget constraints through their decisions about the purchase of insurance. This is the way most markets work, and normally they work quite well. In the case of health care, I believe that this view is simply wrong in practice. The inefficiencies of the individual health insurance market are insoluble. More importantly, the incentives and morality of providers and the wishes of patients will defeat private regulation every time because such regulation lacks legitimacy. In one way or another, private agents charged with the task of reining in costs will come a cropper for the same reason that the American public effectively fired managed care. I may-underscore may-join with my fellow citizens to support politically determined limits on care that I or my spouse or child may receive. That is how successful cost control works in other countries. But I will not-underscore not-authorize some corporate executive to do so.

Other countries have shown that government regulation can control the level of health care spending and the pay providers receive. They may have made a Faustian bargain. Clearly, most of them do not think so. Many have wisely begun to try to mobilize market incentives to promote efficient resource allocation. However, none has relied on market incentives to establish overall health care budget constraints. Whatever this means, the United States clearly has not yet found effective ways to hold down health care spending in ways that would not entail far more central government direction than Americans seem willing to accept.

http://www.healthaffairs.org/WebExclusives/Spending_Web_Excl_010803.htm

Supporting cost containment that didn't work?

CBSNews.com
Jan. 9, 2003
When Cure Is Worse Than Disease
By Dick Meyer, Editorial Director of CBSNews.com

The Republicans know exactly what they want to do to control the growth of health care spending; they want to make Medicare and other public programs more like private, market systems. More like managed care. That’s what scares me most.

Get this: in 2001, spending by Medicare increased by 7.8 percent, less than the measures of private health care spending. Health insurance premiums went up 10.5 percent and benefits were up 10.1 percent in 2001.

So why would putting more “managed care” in Medicare help control costs when it doesn’t work in the private sector. And cost containment is the Republicans’ primary goal.

What managed care did bring us medical consumers in the real world was less choice, less personal attention, more bureaucracy and more confusion.

http://www.cbsnews.com/stories/2003/01/09/opinion/meyer/main535869.shtml

The Bad Doctor: Bill Frist’s long record of corporate vices

by Doug Ireland
LA Weekly
While TV gushed last week over the Republicans’ new Senate majority leader, Bill Frist, intervening in a traffic accident, portraying the former heart surgeon as a “Good Samaritan,” in truth the GOP has simply replaced a racist with a corporate crook.

Frist was born rich, and got richer — thanks to massive criminal fraud by the family business. The basis of the Frist family fortune is HCA Inc. (Hospital Corporation of America), the largest for-profit hospital chain in the country, which was founded by Frist’s father and brother. And, just as Karl Rove was engineering the scuttling of Trent Lott and the elevation of Frist, the Bush Justice Department suddenly ended a near-decadelong federal investigation into how HCA for years had defrauded Medicaid, Medicare and Tricare (the federal program that covers the military and their families), giving the greedy health-care behemoth’s executives a sweetheart settlement that kept them out of the can.

The government’s case was that HCA kept two sets of books and fraudulently overbilled the government. The deal meant that HCA agreed to pay the government $631 million for its lucrative scams — which, on top of previous fines, brought the total government penalties against the health-care conglomerate to a whopping $1.7 billion, the largest fraud settlement in history, breaking the old record set by Drexel Burnham.

The deal also meant that HCA can continue to participate in Medicare. And, as part of the Bushies’ deal shutting down what Deputy Assistant FBI Director Thomas Kubic called “one of the FBI’s highest-priority white-collar crime investigations,” no criminal charges were brought against the top HCA execs who presided over the illegal bilking of federal programs designed to aid the poor — and that includes Senator Frist’s brother, Thomas, HCA’s former CEO (and current director), who’s been described by Forbes magazine as “one of the richest men in America,” with a personal fortune estimated at close to $2 billion.

What did HCA do? It inflated its expenses and billed the government for the overrun; it billed the government for services ineligible for reimbursement (like advertising and marketing costs). HCA violated both law and medical ethics when, as Forbes put it, “the company increased Medicare billings by exaggerating the seriousness of the illnesses they were treating. It also granted doctors partnerships in company hospitals as a kickback for the doctors’ referring patients to HCA. In addition, it gave doctors ‘loans’ that were never expected to be paid back, free rent, free office furniture — and free drugs from hospital pharmacies.”

This is the ethical climate that reigned in the Frist family’s money machine. In an unguarded moment, Senator Frist told the Boston Globe that conversations with his doctor father about the family calling were like “benign versions of the Godfather and Michael Corleone.” Apparently the senator considers defrauding the government “benign.” So too does the Bush White House, which dictated the Justice Department deal with HCA that let the crooks escape jail just as Frist was being anointed the Senate’s majority leader. A pure coincidence in timing, of course.

The senator has always claimed no current connection to HCA because the $26 million he and his wife hold in the company’s stock is in a so-called “blind trust.” But it was the family’s dirty money that bought Frist a place in the Senate. In 1994, Frist — who’d never bothered to vote before first running for the Senate that year — spent some $3.4 million of his personal fortune to buy the seat from Tennessee (HCA’s headquarters) that he now occupies. Moreover, “In the Senate, Frist has used his influence to further HCA’s cause by stopping a strong patients’ bill of rights, gridlocking a mandatory Medicare prescription-drug benefit, and promoting caps on damages for victims who sue negligent hospitals like HCA’s,” points out Jamie Court, executive director of the Santa Monica–based Foundation for Taxpayer and Consumer Rights, who adds, “The Senate should not replace a racist with a principal backer of one of the largest corporate swindles ever perpetrated against the American public. If Frist was a patriot first, he would have sold his HCA stock long ago.”

But Frist’s pandering to the lobbyists of the voracious health-care industry knows no bounds. “Frist isn’t the senator from Tennessee — he’s the senator from the state of Health Care Industry Influence — he’s gotten more than $2 million from the health-care sector, giving him the dubious distinction of raising more cash from health-care interests than 98 percent of his colleagues,” says Nick Nyhart, executive director of Public Campaign.

Consider the special servicing he gave to pharmaceutical giant Eli Lilly. In another example of his “patriotism,” Frist engineered the insertion into the Homeland Security bill of a provision that would protect Eli Lilly from lawsuits over Thimerosal, a mercury-based preservative used in its vaccines. Thousands of lawsuits have been filed against Lilly by parents who believe Thimerosal caused autism and other neurological maladies in their kids. The Frist-authored rider shields Lilly by forcing those lawsuits into a special “vaccine court,” where they can be easily scuttled, potentially saving Lilly hundreds of millions. The pharmaceutical industry was the largest single contributor to the National Republican Senatorial Campaign Committee that Frist chaired, ladling out some $4 million — and Lilly was the single biggest contributor to the GOP from that industry, having given $1.6 million in the last election cycle, 79 percent of it to Republicans.

The good Dr. Frist voted against patients’ rights to sue their HMOs for failure to provide adequate treatment, and voted to give tax subsidies to HMOs and insurance companies to offer prescription drugs to seniors, rather than providing them through Medicare. Frist has, of course, personally raked it in from the interested industries, gobbling up $123,750 in campaign cash from the HMOs and $265,023 from the pharmaceutical industry. Frist also took $130,204 from the food-processing industry — and then helped kill a bill putting teeth into the USDA’s authority to crack down on processing plants that violate federal standards for bacterial and viral infection of meat and poultry.

There’s a lot more, like this — so much that it leads to an inescapable conclusion: In the Senate, “Good Samaritan” Frist has almost daily violated the injunction of the physicians’ Hippocratic oath: “First, do no harm.”

http://www.laweekly.com/ink/03/08/news-ireland.php

Frist's loyalty is to health care industry, not patients

January 4, 2003

By Jamie Court and Frank Smith

Capitol Hill’s well-heeled lobbyists and political cognoscenti have proclaimed that with a doctor in charge of the U.S. Senate, health care reform is imminent. Unfortunately for the public, the doctor running the house, Sen. Bill Frist (R-Tenn.), typifies the GOP government’s new health care strategy: Care most about the health of corporations that elect you.

If the public does not stop Frist and K Street’s hired guns, the gains of the patients’ rights movement will be erased and the freedoms of drug companies, HMOs and hospital chains will be expanded at the expense of patients.

Frist sponsored legislation this year limiting legal liability for drug maker Eli Lilly and other manufacturers of a mercury-based additive to vaccines that is linked to autism in children. The provision drew outrage from parents of autistic children as special-interest pandering when it passed as part of the homeland security legislation just after the election. The corporate pork was the first payback for pharmaceutical companies’ heavy last-minute financing for key Republican Senate candidates that changed the balance of power in the Senate. The Washington Post also reported that Eli Lilly bought 5,000 copies of Frist’s recent book.

As head of the National Republican Senatorial Committee, Frist raised more than $100 million for GOP senators’ election campaigns. It is in this fund-raising role that observers say Frist won his new post. In 2003, the debts to these donors, many from the medical-insurance complex, will come due. As Senate majority leader, Frist will have the power to schedule or not schedule votes on legislation, determine committee assignments and control all debate, absent a supermajority against him. Given these powers, it’s little wonder there were few words of criticism about this election, even from Senate Democrats.

Frist’s ownership and entanglement with one of America’s biggest corporate criminals, hospital chain Columbia/HCA, shows his loyalty and should have prevented him from leading the U.S. Senate. In total, the company now called HCA will pay more than $1.7 billion in civil and criminal penalties–the largest amount ever in a health care fraud case.

Frist’s family founded the company, which the government prosecuted for massive billing fraud. USA Today reported the U.S. Senate disclosure statements show he owned as much as $25 million in company stock. His wife has more than $1 million in stock.

Frist claims the money is in a blind trust, but when a trust is invested heavily in a company, rather than an industry, it is all too visible.

Last month, Rep. Pete Stark, the senior Democrat on the Ways and Means health subcommittee, stated that the government’s HCA settlement may have understated the fraud and could benefit the Frist family greatly.

In the Senate, Frist has used this influence to further HCA’s interests by successfully blocking a strong patients’ bill of rights, gridlocking a mandatory Medicare prescription drug benefit and promoting arbitrary caps on legal recovery by victims who sue negligent hospitals like HCA.

With the heart and lung transplant surgeon in charge, a whole new set of ”health care” issues are likely to make the U.S. Senate tick:

* Patients’ rights. Instead of expanding patients’ new rights to hold HMOs legally accountable for delaying or denying care, the Senate debate will now be about limiting the rights of victims of medical delays and negligence to hold accountable doctors, hospitals and the HMOs they work for.

* Medicare prescription benefit. Rather than force price controls on the pharmaceutical industry that turned the tide for the GOP, the Senate will create a ”voluntary” prescription drug program with insurers selling a new product to seniors, with new profits.

* Universal coverage. Forget a national Medicare plan for everyone who needs affordable health coverage. The Senate will focus on Medical Savings Accounts, which force the public, instead of insurers, to pay for their health care; bare-bones insurance policies that do not pay for drugs, hospitalization or maternity costs, and mandatory insurance laws that force people to buy an unaffordable, low-quality product.

Beware, America. If the public doesn’t lash out, health care reform will mean new burdens on patients and new freedoms for industries.

Jamie Court is executive director of the Santa Monica-based Foundation for Taxpayer and Consumer Rights. Frank Smith is senior fellow at Massachusetts-based Civil Society Institute. They are co-authors of Making A Killing: HMOs and the Threat to Your Health (Common Courage Press).

http://www.suntimes.com/output/otherviews/cst-edt-ref04.html

Supporting cost containment that didn’t work?

CBSNews.com
Jan. 9, 2003
When Cure Is Worse Than Disease
By Dick Meyer, Editorial Director of CBSNews.com

The Republicans know exactly what they want to do to control the growth of health care spending; they want to make Medicare and other public programs more like private, market systems. More like managed care. That’s what scares me most.

Get this: in 2001, spending by Medicare increased by 7.8 percent, less than the measures of private health care spending. Health insurance premiums went up 10.5 percent and benefits were up 10.1 percent in 2001.

So why would putting more “managed care” in Medicare help control costs when it doesn’t work in the private sector. And cost containment is the Republicans’ primary goal.

What managed care did bring us medical consumers in the real world was less choice, less personal attention, more bureaucracy and more confusion.

http://www.cbsnews.com/stories/2003/01/09/opinion/meyer/main535869.shtml

Frist’s loyalty is to health care industry, not patients

January 4, 2003

By Jamie Court and Frank Smith

Capitol Hill’s well-heeled lobbyists and political cognoscenti have proclaimed that with a doctor in charge of the U.S. Senate, health care reform is imminent. Unfortunately for the public, the doctor running the house, Sen. Bill Frist (R-Tenn.), typifies the GOP government’s new health care strategy: Care most about the health of corporations that elect you.

If the public does not stop Frist and K Street’s hired guns, the gains of the patients’ rights movement will be erased and the freedoms of drug companies, HMOs and hospital chains will be expanded at the expense of patients.

Frist sponsored legislation this year limiting legal liability for drug maker Eli Lilly and other manufacturers of a mercury-based additive to vaccines that is linked to autism in children. The provision drew outrage from parents of autistic children as special-interest pandering when it passed as part of the homeland security legislation just after the election. The corporate pork was the first payback for pharmaceutical companies’ heavy last-minute financing for key Republican Senate candidates that changed the balance of power in the Senate. The Washington Post also reported that Eli Lilly bought 5,000 copies of Frist’s recent book.

As head of the National Republican Senatorial Committee, Frist raised more than $100 million for GOP senators’ election campaigns. It is in this fund-raising role that observers say Frist won his new post. In 2003, the debts to these donors, many from the medical-insurance complex, will come due. As Senate majority leader, Frist will have the power to schedule or not schedule votes on legislation, determine committee assignments and control all debate, absent a supermajority against him. Given these powers, it’s little wonder there were few words of criticism about this election, even from Senate Democrats.

Frist’s ownership and entanglement with one of America’s biggest corporate criminals, hospital chain Columbia/HCA, shows his loyalty and should have prevented him from leading the U.S. Senate. In total, the company now called HCA will pay more than $1.7 billion in civil and criminal penalties–the largest amount ever in a health care fraud case.

Frist’s family founded the company, which the government prosecuted for massive billing fraud. USA Today reported the U.S. Senate disclosure statements show he owned as much as $25 million in company stock. His wife has more than $1 million in stock.

Frist claims the money is in a blind trust, but when a trust is invested heavily in a company, rather than an industry, it is all too visible.

Last month, Rep. Pete Stark, the senior Democrat on the Ways and Means health subcommittee, stated that the government’s HCA settlement may have understated the fraud and could benefit the Frist family greatly.

In the Senate, Frist has used this influence to further HCA’s interests by successfully blocking a strong patients’ bill of rights, gridlocking a mandatory Medicare prescription drug benefit and promoting arbitrary caps on legal recovery by victims who sue negligent hospitals like HCA.

With the heart and lung transplant surgeon in charge, a whole new set of ”health care” issues are likely to make the U.S. Senate tick:

* Patients’ rights. Instead of expanding patients’ new rights to hold HMOs legally accountable for delaying or denying care, the Senate debate will now be about limiting the rights of victims of medical delays and negligence to hold accountable doctors, hospitals and the HMOs they work for.

* Medicare prescription benefit. Rather than force price controls on the pharmaceutical industry that turned the tide for the GOP, the Senate will create a ”voluntary” prescription drug program with insurers selling a new product to seniors, with new profits.

* Universal coverage. Forget a national Medicare plan for everyone who needs affordable health coverage. The Senate will focus on Medical Savings Accounts, which force the public, instead of insurers, to pay for their health care; bare-bones insurance policies that do not pay for drugs, hospitalization or maternity costs, and mandatory insurance laws that force people to buy an unaffordable, low-quality product.

Beware, America. If the public doesn’t lash out, health care reform will mean new burdens on patients and new freedoms for industries.

Jamie Court is executive director of the Santa Monica-based Foundation for Taxpayer and Consumer Rights. Frank Smith is senior fellow at Massachusetts-based Civil Society Institute. They are co-authors of Making A Killing: HMOs and the Threat to Your Health (Common Courage Press).

http://www.suntimes.com/output/otherviews/cst-edt-ref04.html

Children Yes; Parents No

United States Department of Health & Human Services
News Release
Dec. 31, 2002
HHS Issues New Report Showing More American Children Received Health
Insurance in Early 2002

HHS Secretary Tommy G. Thompson today released a new report showing that the percent of American children with health insurance continued to increase in the first half of 2002, meaning that a half million more children are now covered by insurance than in the previous year.

“More and more children are getting the health care they need, thanks in large measure to our success in working with states to expand health coverage through the SCHIP program,” Secretary Thompson said. “We are giving governors the flexibility they need to continue to expand coverage to more children, and our strategy is paying off for children and parents alike.”

Overall, 14.2 percent of the population — 39.4 million Americans of all ages — was without health insurance coverage in the first half of 2002, about the same as in 2001…

http://www.hhs.gov/news/press/2002pres/20021231.html

Comment: Last week we were saturated with stories about the good news that the SCHIP program increased enrollment in the first half of 2002… and it is good news. But the reporters did not seem to venture beyond the press release supplied by HHS. A few more clicks on the website will show why we can have an increase in insurance coverage for children with little net change in the total numbers of uninsured.

The table on which this press release was based shows that the numbers of uninsured under age 18 decreased by 0.6 million, but the numbers of uninsured between 18 and 64 increased by 0.9 million… and that is bad news.

And now that most states are facing draconian cuts in their budgets, public programs such as SCHIP are threatened. With our current national policy proposals, HHS can now begin preparing next year’s hedaline for its “good news” press release: Upper-Income Sector Able to Maintain Insurance Coverage Because of Elimination of Taxes on Dividends.

Table on the number and percent of persons without health insurance coverage, by age group: United States, 1997-2002 http://www.cdc.gov/nchs/about/major/nhis/released200212/table01_1.htm