Resource Archive - Page 1191 of 1209

Ohio Group Tells Drug Reps: We'll Listen — If You Pay

AMNews
August 20, 2001
by Cheryl Jackson

“Leaders at the Queen City Physicians Group in Cincinnati figured that if drug company representatives wanted to lavish their doctors with gifts, why not instead have the reps give something that would help the practice and its patients? Hence, the thought process that led to the 56-physician multispecialty group’s plan to charge $65 for a 10-minute visit to listen to a pitch from a drug company sales rep.”

Frank A. Reddick, M.D., chair of the AMA’s Council on Ethical and Judicial Affairs (CEJA):

“This is setting up a commercial relationship, and it might prove a refreshing approach in that it’s a straightforward transaction. Whatever the pharmaceutical reps would have you say about their role, their role is a commercial one.” “Putting it on a flatly commercial way to access the physicians might actually lead to fewer of the sort of concerns that CEJA or the AMA has about gifts to physicians and some things that really aren’t related to the physician’s practice, like taking them to the ballgame. It may prove the wave of the future.”

http://www.ama-assn.org/sci-pubs/amnews/pick_01/bil20820.htm

Comment: From an unrelated letter in the same edition of AMNews:

Herbert Rakatansky, M.D., immediate past chair of CEJA:

“There is clear evidence that acceptance of similar gifts from industry influences prescribing habits. Such gifts are prohibited by opinion 8.061. Doctors who accept such gifts maintain they are not so influenced. The literature suggests otherwise. It is desirable for physicians to avoid even the appearance of impropriety in these circumstances.”

The new chair of AMA’s CEJA could learn from the prior chair. Or is this another unfortunate misstep in the transformation of the AMA?

Ohio Group Tells Drug Reps: We’ll Listen — If You Pay

AMNews
August 20, 2001
by Cheryl Jackson

Frank A. Reddick, M.D., chair of the AMA’s Council on Ethical and Judicial Affairs (CEJA):

http://www.ama-assn.org/sci-pubs/amnews/pick_01/bil20820.htm

Comment: From an unrelated letter in the same edition of AMNews:

Herbert Rakatansky, M.D., immediate past chair of CEJA:

The new chair of AMA’s CEJA could learn from the prior chair. Or is this another unfortunate misstep in the transformation of the AMA?

Burton's German Trip Protested

The Washington Post
August 11, 2001
by Juliet Eilperin

“Rep. Dan Burton (R-Ind.), chairman of the House Government Reform Committee, arranged for an unusual government-paid trip to Frankfurt and Bonn this week to investigate the German postal system. He is also visiting his wife, who is receiving medical care in Frankfurt, according to the congressman’s aides.”

http://www.washingtonpost.com/wp-dyn/articles/A61368-2001Aug10.html

Comment: This is a very difficult report on which to comment. Those of us that dedicate our lives to health care are always saddened to hear stories of serious medical problems that require extraordinary measures. Our first and overriding response is the deep concern that we have for Mrs. Burton and for her family that shares in the pain of her difficult challenges. Any comments that follow inevitably will be interpreted by some as being callous for having used this opportunity to posture politically, but the posturing is precisely on behalf our concerns about access to health care for everyone that faces similar difficulties.

On to the comments:

What rhetoric predominates today?

Examples:

American has the best health care in the world.

We must continue to support research by our technological and pharmaceutical firms that are providing us with the most advanced care available, no matter what the cost.

Everyone should have the same insurance that members of Congress have (FEHBP).

Medicare needs to be modernized, giving beneficiaries choice like the federal employees have with the FEHBP program.

We don’t want a government program of health care.

Etc., etc.

Most of those reading these comments recognize this rhetoric, and understand the policy issues that drive it. There are very serious problems with our health care system, especially in access and coverage in a system that is infamous for wasting our abundant resources. Our national policies continue to favor the entrepreneurial elements in the health care system while continuing to neglect the unmet needs of the people. Unfortunately, the rhetoric continues to drive the displacement of our national priorities, as if the unmet needs were merely a nebulous construct, rather than real needs of real people.

Back to the difficult part of this message. We need to look at the actions of Rep. Burton, a man who is now deeply and intimately involved with the real needs of a real person. This overriding issue makes it impossible to fault his actions. He is making the best decisions he can in a very difficult, trying situation. He has walked away from “the best health care system in the world” and gone to another country that offers some of the best care available. He has walked away from “the most advanced research and technology” to another nation that likewise has advanced research and technology. With FEHBP coverage, he has his choice of any care within the limitations of his plan, but he elects to go to a country that happens to assure that care is covered and accessible for essentially everyone, with virtually no restrictions on providers. At home, he continues to work with elements in our society that want to keep government out of our health care. Yet he accepts a government funded health plan, and even is not above accepting government transportation for a combined personal and quasi-government-business trip. Apparently Rep. Burton does want the government involved in health care when it is providing him and his loved ones with access and coverage.

Real people have real needs. None of our needs are met by rhetoric. In health care, they are met partly by our own personal efforts. But clearly most of us by ourselves can never assure that we can meet the financial demands of catastrophic illness, nor the public health protections that can be provided only on a population basis, nor the assurance that the health care infrastructure will be there when we need it, nor the assurance that our resources will not be frittered by Wall Street and by the technological and pharmaceutical firms that have their own priorities which they have placed higher than the public good. Real people with real needs can expect those needs to be met only with a combination of personal effort balanced with a public effort that places reality above rhetoric.

Uwe Reinhardt comments on Bob LeBow’s response:

“It is hard to argue with Bob. He is totally right.”

Repeating the concluding remarks of Bob LeBow’s response:

Our system seems to embrace the ideals of “personal responsibility” for the poor but “personal opportunity” for the rich. Community benefit? That would be socialism. So “personal opportunity,” with its double-digit inflation result, has set the tone for American health care. We can see that with the direction our system is taking, the poor and near-poor will be increasingly left out, priced out of the market, by the “opportunists” who will then continue to lecture the less well-off about “personal responsibility.”

Yes, we have created a monster, but some folks are more to blame than others.

Burton’s German Trip Protested

The Washington Post
August 11, 2001
by Juliet Eilperin

http://www.washingtonpost.com/wp-dyn/articles/A61368-2001Aug10.html

On to the comments:

What rhetoric predominates today?

Examples:

American has the best health care in the world.

We must continue to support research by our technological and pharmaceutical firms that are providing us with the most advanced care available, no matter what the cost.

Everyone should have the same insurance that members of Congress have (FEHBP).

Medicare needs to be modernized, giving beneficiaries choice like the federal employees have with the FEHBP program.

We don’t want a government program of health care.

Etc., etc.

Uwe Reinhardt comments on Bob LeBow’s response:

“It is hard to argue with Bob. He is totally right.”

Repeating the concluding remarks of Bob LeBow’s response:

Yes, we have created a monster, but some folks are more to blame than others.

Management of Acne

U.S. Department of Health and Human Services Agency for Healthcare Research and Quality
Evidence Report/Technology Assessment, Number 17 March, 2001

“It is estimated that over 45 million people in the United States have acne vulgaris…” “Coupled with loss of productivity and unemployment, the direct cost of acne may exceed $1 billion per year in the United States.”

Findings: * “The literature is extremely heterogeneous, severely limiting the number of meaningful conclusions…” * “Evidence for subpopulations is either not available or reported in such varied manner as to prevent meaningful integration.” * “Evidence for quality-of-life outcomes and cost is not available.” * “Of 250 comparisons, only 14 had evidence of level A.” (Level A = moderate to strong evidence of a clinically meaningful endpoint) * “The literature is not organized to differentiate responses to (different levels of) therapy.”

http://www.ahrq.gov/clinic/acnesum.htm

Comment: If we cannot evaluate the management of the most common medical disorders, how can we ever make decisions about the proper allocation of our resources? An integrated, information technology system that links together our entire health care system would move us much closer to a model that would more readily provide answers to these fundamental questions about health care and our health care resources. Yes, there is much more work to be done to refine the information technology tools that would enable this, but we are moving much closer to that reality. Some of the challenges are discussed in the publication, “Networking Health” published by the National Academy Press (http://www.nap.edu).

Attempts at integrating our fragmented health care system, as exemplified by the Healtheon model, have failed miserably, largely because of conflicting interests in the marketplace. The framework that would enable integration would be a universal system of publicly-administered health insurance. Through an integrated information technology system for health care, we could help to provide a basis for making rational decisions on where our health care dollars would be wisely spent, and avoid wasting them on ineffective services. We will never achieve high quality until we develop a health care structure that drives quality.

Aetna Posts Wider Losses, Citing High Costs

The New York Times
August 9, 2001
by Milt Freudenheim

“The nation’s biggest health insurer, Aetna, said yesterday that its losses deepened in the second quarter as medical costs jumped 17 to 18 percent in its core managed care business.”

Aetna wants to “…. sharply reduce Aetna-insured H.M.O. membership while raising the number of self-insured employers that it serves. Self-insured companies take the risk of paying for any illnesses of workers; they hire administrative services companies like Aetna to line up discounts from hospitals and doctors and handle the bills.”

http://www.nytimes.com/2001/08/09/business/09CARE.html

Comment: So Aetna, the nation’s largest health insurer, wants to exit the market of health care risk pooling. They are content with the role of paper shuffling, while passing their traditional role of risk assumption on to employers. This is an implicit admission that they have been unable to fulfill the promise of cost containment in health care. But breaking large risk pools up into smaller ones increases the exposure to financial risk, now being passed on to employers. We have already seen that the employers no longer want to accept risks, and they are now, in turn, passing risk on to their employees, in the form of flexible (i.e., reduced) benefits and cost-sharing options (i.e., higher out-of-pocket expenses). Innumerable studies have demonstrated that these measures are reducing access to care because of lack of affordability, and impaired access results in impaired medical outcomes. As Aetna and other insurers flee their responsibilities to pool risk, the health of the nation deteriorates.

The solution to the problem of pooling risk is simple. Place all risk into one pool in the form of equitably-funded universal health insurance, diluting the risk such that financial barriers to care are eliminated. The other problem, containing costs, has defied all attempts of the defining authorities of the marketplace to invoke controls. The solution to cost containment is also simple. Establish a global budget for health care. We have more than enough resources to provide quality care for everyone. The budget process will allow us to allocate those resources more equitably. Those that reject a budget for our health care system are denying the fundamental reality that all of us use budgets all of the time. Revenues, expenditures, and judicious use of debt service, whether explicit or implicit, are characteristic of our management of our businesses, our household budgets, and even our government. Why should our health care system be allowed to escape budgetary control?

Is there a future for Aetna in a publicly administered program of universal health insurance? Aetna now wants to push paper, albeit in a modernized, information technology world. Aetna and other “insurers” can be a vendors of information management services. They can be adequately compensated by negotiating fair rates with the public administrators. This is the role they seem to want, and it is the role that would serve the rest of us well. Let’s quit bashing each other and join together in the cause of health care justice for all.

Uwe Reinhardt, Ph.D., James Madison Professor of Political Economy, Princeton University, commenting on today’s quote from the New York Times article, “Aetna Posts Wider Losses, Citing High Costs”:

“Aetna’s problem is not really unique. Never mind profits. They are a tiny leftover after expenses. Medical expenses are rising at other companies at pretty much the same rate.

“The real explanation is that the American people prefer a health system whose costs rise in the high double digits. They fought for it at the job and in the political forum. Now they have it. Mazel tov!”

Alan Sager, Ph.D., Professor of Health Services and Co-Director, Health Reform Program, Boston University School of Public Health, responds to the comments of Uwe Reinhardt, Ph.D.:

Do you know anyone who fought for things that contributed to double-digit increases? Anyone who wants a health system with rapidly rising costs? I don’t. I do know people who were worried by HMOs that made money when their patients got less care, and by HMOs that passed this incentive along to doctors and hospitals.

Aren’t all payers’ costs rising rapidly, HMO and others? If so, this would suggest that managed care’s loosening of control is not the cause.

We should consider a few other possible causes of today’s spending increases:

1) Hospitals and doctors demanding catch-up after years of slow payment increases, with hospitals able to enforce this demand, in many parts of the nation, through their increased market power–owing to mergers, closings, and the like.

2) Prescription drug spending doubling every five years or so.

3) Aging baby boomers getting more care.

4) Managed care, having squeezed out indemnity, is finally obliged to pay for care for more of the sicker people, many of whom had clung to their indemnity coverage as long as possible.

5) Managed care wrung out some one-time savings– took a step back on the up-escalator of health costs, but that escalator has continued its rise.

Where’s the evidence that actual HMO practices saved money in durably affordable ways? Where’s the evidence that they have suddenly vanished? I still know many groups of doctors that face the same tight withholds and expenditure targets today that they did in past years. And I know many doctors and others who insist that any HMO savings were more than offset by new paperwork and friction costs inside HMOs and imposed on caregivers’ practices.

Managed care advocates should not be allowed to blame rising costs on abandonment of some aspects of their pet techniques. Not, at least, without a reasonable assessment of all the reasons for the slow-down in cost increases in the mid-90s, and their acceleration today.

Kip Sullivan responds to Uwe Reinhardt:

Uwe,

Your statement that “the American people . . . fought for” this system is, at best, a gross exaggeration as applied to the work place, and so dreadfully wrong as applied to politics that your remark caused my toes to curl in my shoes.

I recognize that many economists, especially those less astute than you, espouse the notion that “the American people” shouldn’t be whining about the current health care system because it was “the American people” who, by “choosing” to enroll in managed care organizations (MCOs), got us into this mess. But this view, so typical of economists, ignores that dirty word “power” and that unpleasant phrase “economic duress.” Millions of Americans were given no choice by their employer — they had to enroll in an MCO. Millions more were given a “choice” between an MCO and a FFS plan, but the MCO, benefiting from cherry-picking, rationing, and cost-shifting, could charge lower premiums, and because most of “the American people” are not wealthy, the 5-10% savings on premiums amounted to significant financial pressure to enroll in the MCO. Our political leaders didn’t ask us whether we wanted to play consumer in a system rigged in favor of MCOs. We sure as hell didn’t “fight for it.”

Similarly, Medicaid recipients were never asked if they wanted to be placed at the tender mercies of HMOs. And America’s elderly have never been asked whether they want to be forced into HMOs via the Breaux-Frist-Bush “premium support” voucher plan, but by God, they’re going to get “premium support” if the right wing and the insurance industry has anything to say about it.

Polling data from the late 1980s to today indicate that when Americans are asked about managed care methods, they indicate disapproval of them. What little survey work has been done among seniors indicates they strongly oppose being pushed into MCOs, especially if the current bribe (called drug coverage) is taken away.

The error of your comments about what “we fought for” is even more obvious as applied to “the political forum.” Your remark suggests you think that what Congress does or doesn’t do is an accurate reflection of what “the American people fight for.” Where to begin? Dear Uwe: In this money-drenched democracy of ours, you run a grave risk of looking very foolish if you make statements based on the assumption that Congressional action or inaction reflects the will of “the American people.” Cf any newspaper. Cf anything that pops up on a Net search engine if you type in the words “campaign finance reform.” Trust me, you made yourself look foolish.

What little evidence we have about what “the American people” would vote for if we ever had anything resembling a fair debate indicates Americans would vote for a single-payer system. We have some polls indicating that, but we all know polls can offer different results depending on the wording. But at least two “citizen jury” experiments, which are a lot more trustworthy, indicate single-payer would win big in a fair debate. In a debate between an advocate of MSAs, of managed care, and of a single-payer system here in Minnesota in 1996, the single-payer advocate won. I was the single-payer advocate. Michael Scandrett, the director of what was called the Minnesota HMO Council, spoke for HMOs. The debate took place before 14 Minnesotans selected by the Minneapolis Star Tribune and KTCA TV, the local public TV station. It was moderated by the League of Women Voters. After three-and-a-half hours of debate, single-payer won 8 votes, 3 voted for managed competition, MSAs got no votes, and three abstained.

Sen. Paul Wellstone won a similar debate (stacked in favor of managed competition) before a “citizens jury” sponsored by the Jefferson Foundation in 1993.

Americans are most definitely not “fighting for” the current system. Let conservative politicians and Chicago-school economists engage in the pretense that gridlock in Congress and the persistence of the current health care system is the “will of the American people.” Let the rest of us who care about universal coverage state the truth: We suffer the current system and Congressional inaction because Big Money, not “the American people,” “is fighting” to preserve its status.

Kip Sullivan

Naomi Shaiken, President of Connecticut Call to Action, responds to A. Sager and K. Sullivan on Uwe Reinhardt, with another two cents added on health care reform activism:

My two cents:

Read between the lines! Uwe has been a proponent of national health care for THIS country for years!

He is angry, disgusted, fed up–with all the pontificating from DC and all the pundits – all words and no action.

Go back, my dear friends, and read what he wrote in ’90 -to the present and probably even before 1990!

He is NOT on the side of the insurance companies [none of us are!] He’s on our side – writes with sarcasm- mainly to agitate and he is most successful at that, given Sager, Sullivan et al responses.

Aetna’s demise in the health care insurance field could be a blessing in disguise, since our government runs health care better than any private insurance company! There is and always will be a need for the insurance industry – as the actuaries and as disbursement agents for the government.

We, in Connecticut, the Insurance State, have the most difficult task in selling any idea to reform the system. And, to even deepen that task, we’ve been rebuffed by our very own Medical Society! How’s them apples!

We need to mobilize in the streets, as we did in the ’60’s to get civil rights and in the ’70’s to stop an immoral war, since medical care is a human and moral right.

Forget the providers, forget the pundits – look towards the advocates who are out there daily – breaking our hearts. Any takers???

You have my permission to send my two cents out to all.

Naomi E. Shaiken President CT Call To Action – Saving Our Health Care System

Gerald Gollin, M.D., comments on pediatric underfunding

Gerald Gollin, M.D., Assistant Professor of Pediatric Surgery at Loma Linda University School of Medicine, comments on the underfunding of pediatric care in El Paso, and the implications for access to care for all of us:

I am one of the pediatric surgeons mentioned in the NY Times article who left El Paso because a children’s hospital was not built. The article is exactly right that the situation in El Paso is what much of the rest of the country can expect with the current system. Just making more people eligible to share the same limited pot of funds is not going to work, even though it makes us feel good to say that more people are being “covered”. The only way that my partners and I can make it in Southern California is that we have a mechanism to share in the disproportionate share that our hospital receives from the state. If not for that, it would be impossible to care for our population that is well over 50% MediCal. The shortage of pediatric subspecialists in California is critical and it effects all children–even those with full insurance. It is the same situation in El Paso. There are no pediatric surgeons–no matter how much money a patient’s family has–so a child with a surgical emergency is up the creek.

Gerald Gollin, MD

Comment: Dr. Gollin clearly confirms the premise in yesterday’s quote and comment. In spite of our great resources, we do not have an effective structural system for allocation that would assure efficiency in the use of those resources. Dr. Gollin has demonstrated that our current fragmented system of allocation has resulted in the total deprivation of pediatric surgical services for everyone living in El Paso, and also has resulted in the need to resort to the defective and unreliable policies of gamesmanship and cost shifting to fund pediatric surgical services in a mecca of health care.

Maldistribution of resources is not just a problem for the poor. It is now affecting all of us, even the most affluent. The Los Angeles Times published an article that provides yet another example. Inadequate resources are being directed to our emergency rooms, threatening their solvency. This is partly because of the burden of caring for uninsured individuals that, by default, are forced to use emergency rooms as their primary source of care. In a follow-up editorial, the Los Angeles Times stated what this means to all of us. “We can be rich. We can have health insurance. We can have our federal tax rebate check in our back pocket. None of this will do us any good if we’re in the back of an ambulance and the nearest hospital emergency room is full.”

Providers will always compete with each other for the resources that we do have. But if this competition occurs within a system designed to optimize allocation, we will all have access to better care. Only a unified, single payer system offers this promise. Health policy analysts understand this. But if we are to convert this principle into action, we must make every effort to be sure that the voters understand as well.

Los Angeles Times:

“Amid Nationwide Prosperity, ERs See a Growing Emergency” http://www.latimes.com/news/printedition/la-000063865aug06.story

Editorial, “Closed Door at the ER” http://www.latimes.com/news/local/la-000064011aug07.story

The New York Times:

“A City Struggles to Provide Care Ensured by U.S.” http://www.nytimes.com/2001/08/07/national/07CARE.html

A City Struggles to Provide Care Ensured by U.S.

The New York Times
August 7, 2001
by Jim Yardley

“El Paso – For the last year, an ambitious campaign by this border city focused on a critical if not particularly glamorous role: enrolling poor children for federal health benefits.”

Dr. John Guggedahl, an El Paso pediatrician: “The good news is that these children do have some access to the delivery system. The bad news is that we don’t have an adequate pediatric delivery system, because of chronic underfunding for so many years.”

Dr, Gordon McGee, chairman of the Border Health Institute: “A physician who takes nothing but CHIP and Medicaid can’t make money.”

Sara Rosenbaum, a professor of health law at George Washington University: “What El Paso is experiencing is a look into the future for all of us if we don’t come up with a national health policy.”

http://www.nytimes.com/2001/08/07/national/07CARE.html

Comment: With the $1.1 trillion that we spend on health care each year, we have more than enough funds to provide high quality, comprehensive health care for everyone, while providing very comfortable incomes for the providers of care. What we do not have is an effective method of distributing those resources such that we can assure that the delivery system is funded fairly and waste of our resources is minimized.

Our current system is designed on a business ethic that mandates pulling resources out of the system, away from patient care. We clearly need to adopt a national health policy that rewards providers for maximizing the utilization of resources for patient care. There is absolutely no question that a publicly administered, universal insurance program would provide the requisite framework. Representatives of the various components of our health care system certainly would continue to advocate for larger allocations of the available funds. But at least this form of “allocation shifting” would be shifting resources between various patient care needs based on priorities, rather than our current fragmented system that shifts allocations unfairly, resulting in excess funding of some sectors, a clear waste of resources, and grossly deficient funding of others, especially those sectors attempting to meet the needs of the most vulnerable members of our society.

We have the resources. Let’s now adopt a rational national health policy to properly manage those resources.

Newly Adopted Principles of Medical Ethics

The American Medical Association
June, 2001

Principle IX: “A physician shall support access to medical care for all people.”

Adopted by the AMA House of Delegates June 17, 2001

http://www.ama-assn.org/ama/pub/category/4256.html

Comment: Access and coverage are different issues, but the greatest impediment to access is the lack of adequate health insurance. Although access problems related to our health care infrastructure must be addressed, truly universal access is impossible without comprehensive, universal insurance. Creating a universal health insurance program is the greatest and most urgent priority if we are to realize this goal of universal access. Let’s start the process now. After all, the House of Delegates of the American Medical Association has declared it to be unethical not to do so!

The Conflict Over Drug Benefits

The New York Times
August 5, 2001
by Robin Toner

“Robert J. Blendon, a professor of health policy at the Harvard School of Public Health, said the public is closely divided on whether the government is doing too much or too little. But on Medicare, it’s not a close call, particularly among the elderly.”

http://www.nytimes.com/2001/08/05/weekinreview/05TONE.html

Comment: Dr. Blendon and others have demonstrated that Americans have accepted the rhetoric that we do not want the government involved in our affairs. In fact, Dr. Blendon’s polls, produced jointly with The Washington Post and Kaiser Family Foundation, have been used in Washington to dismiss discussion of universal, publicly administered insurance. But now, Dr. Blendon separates rhetoric from reality. The public emphatically supports publicly administered insurance in the form of Medicare, albeit for a segment of our population. We Americans may be protective of our rhetoric, but, we’ll always dismiss rhetoric in favor of the reality of health care security once we have it.

Radio Address of the President to the Nation

The White House
August 4, 2001

President George W. Bush:

“Medicaid is designed to provide low-income Americans with medical insurance. It has a noble purpose and some serious challenges.”

“Clearly, this important program needs reform.”

“My administration will adopt new rules that empower states to propose reforms tailored to the needs of their citizens.”

“In our new system, we will inform states in advance of the criteria for responsible Medicaid reform. If they meet those conditions, the federal government stands ready to help expand health insurance coverage to those who need it the most — no uncertainty, and no run-around.”

http://www.whitehouse.gov/news/releases/2001/08/20010804.html

Comment: The formula is simple: (no change in Medicaid contribution to funding) plus (increased numbers of low-income individuals covered) equals (reduced benefits for those currently covered).

President Bush has just announced that Medicaid is being converted from a defined benefit program to a defined contribution program — no uncertainty, and no run-around! This shift in policy controls the government’s costs while placing a greater burden on the Medicaid beneficiary by removing essential benefits from the program which now will either have to be paid for out-of-pocket, or, more likely, will be no longer be accessible simply because of lack of affordability. We have the resources to provide comprehensive care for everyone. It is inexcusable that the President of the United States is deliberately decreasing access to essential medical care for the most vulnerable members of our society merely so that he can assure that his tax cuts for the wealthy will be protected. For shame, Mr. President, for shame!

Special report: Norwood-Bush Compromise Comes Up with Win in House

kaisernetwork.org
August 3, 2001
by Samuel Goldreich, CQ Daily Monitor

“The House also adopted, 236-194, an amendment (to HR 2563, the patients’ rights bill) by Ways and Means Chairman Bill Thomas, R-Calif., that would remove limits on the number of people who could set up tax-sheltered medical saving accounts (MSAs) and allow small businesses to join “association health plans” (AHPs) that could purchase insurance under federal, not state regulation.”

http://www.kaisernetwork.org/health_cast/uploaded_files/ACFBBA.pdf

Health Affairs Volume 20, Number 1 “HealthMarts, HIPCs, MEWAs, and AHPs: A Guide for the Perplexed” By Mark A. Hall, Elliot K. Wicks, and Janice S. Lawlor

“… these proposals could erode previous market reforms whose goal is increased risk pooling.”

“A case can be made that HealthMarts and AHPs violate the principle ‘first, do no harm.’ They are unlikely to generate true efficiencies, and they partially undermine existing regulatory and market structures.”

Comment: The debate over the patients’ bill of rights has been widely attacked for merely attempting to tweak managed care, when our legislators should be addressing the real problems with our health care system. We need comprehensive reform, which should include elimination of the egregiously wasteful managed care middlemen. But until we can create the political will needed for reform, we do need to establish accountability for this industry through an effective patients’ bill of rights. The Norwood amendment significantly weakened the provisions of this legislation and will need to be reversed in the joint conference committee.

Those of us that have attacked this process as grossly deficient, considering the great needs for comprehensive reform, are particularly concerned not so much about the Norwood amendment, but rather the Thomas MSA-AHP amendment. Congress needs to act to provide comprehensive coverage for everyone. The Thomas amendment proceeds in the opposite direction! MSAs allow the healthy and wealthy to opt out of existing programs. This removes from the risk pool necessary funds to meet the medical needs of the sick, but, more importantly, it removes from the risk pool the political drive to assure that it will always be adequately funded. The poor do not have the same intense political influence of the affluent. Thus the under-funded care available to not only low-income but also average-income individuals will culminate in mediocrity. AHPs also risk removing healthy individuals with established incomes from the risk pool. Further, AHPs are intended to relax state control over insurance coverage, allowing abusive practices of insurers and association managers to proliferate, which would impair coverage for and remove choice of the intended beneficiaries. It is absolutely imperative that the Thomas amendment be amputated in the joint conference committee. And then let’s get on with the task of establishing a program of publicly administered, universal health insurance.

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