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Volume 51, No. 2 February 1995
DID THE WHITE HOUSE LIE ON
The President's Task Force on Health Care Reform was
permitted to operate in secret for one reason: a sworn affidavit
by Ira Magaziner, which declared that all participants were
federal employees (see AAPS News, Oct. 1994). Not even
the White House is prepared to defend the truth of that
But a false statement is not necessarily a lie, and a false
statement made under oath is not necessarily perjury or contempt
of court. The person making the statement has to have known that
it was false, and must have intended to mislead the court.
On December 21, 1994, Judge Royce Lamberth dismissed the
case of AAPS v. Clinton as moot on the grounds that the
White House has released all documents covered by the Federal
Advisory Committee Act (FACA). (Or promised to release them-as
of this writing, AAPS is still unable to obtain copies of 250
floppy disks. They are said to be at the National Archives II,
but a series of impediments has kept them out of our hands for
weeks.) He referred the question of Magaziner's possible
criminal contempt to the U.S. Attorney and stated that the
Attorney General was responsible for deciding whether to seek
appointment of an Independent Counsel.
Regarding Magaziner's declaration of March, 1993, the Judge
Plaintiffs allege that an examination of
the Secret Service records of entries into
the Old Executive Office Building-entries of
people who were cleared in by Mr. Magaziner
or his immediate staff-demonstrates that many
of these individuals (who were not federal
employees and who were active working group
participants) were entering the White House
complex well before Mr. Magaziner signed his
March 3 declaration. Moreover, plaintiffs
allege that members of Mr. Magaziner's own
private consulting firm and its successor
company were participants in the working
groups whom he certainly should have known
The Judge also observes that while the White House ``now
make[s] much of the `fluidity' of this process [of appointing
members to the Working Group], none of that `fluidity' is
included in Mr. Magaziner's March 3 declaration.''
Later, the White House took the position that ``membership''
on the Working Group was a meaningless term and was impossible to
define. This ``simply demonstrates how misleading, at best, Mr.
Magaziner's March 3 declaration actually was,'' stated the Judge.
In his sworn deposition, taken by AAPS on October 25, 1994,
Magaziner stated that he did direct someone to prepare a list of
participants in the Interdepartmental Working Group, probably
sometime in February of 1993. However, he said ``I never looked
at the list....I never checked all the names or screened the
How, then, did he swear on March 3 that all of the
working group participants were employed by the federal
government without exception? He and the Department of
Justice must have known that a single exception would have
destroyed the claimed exemption from FACA.
One might also ask how Magaziner planned to do a competent
job of reinventing one-seventh of the U.S. economy if he was not
even aware of the important private-sector positions held by
people he had appointed to leadership positions on his own
Another question: who was responsible for correcting the
error in the March, 1993, declaration, once it was discovered?
Was it ultimately Hillary Rodham Clinton's job? And is the
Department of Justice immune from accountability?
Magaziner certainly conferred with government attorneys, for
example, before conducting ``informal'' (certifiably non-Working
Group) meetings with the President, who wanted to be educated by
``some of the experts we had brought together and who were
working on the health care proposal.'' Magaziner wanted to be
sure the meetings were done properly ``because I knew there was a
As we go to press, Attorney General Janet Reno has stated
that it would be ``premature'' for her to comment about the case.
``The matter has been referred to the U.S. Attorney''
(Washington Times 12/23/94).
Many questions about the Task Force remain unanswered
because they are outside the Court's jurisdiction. For example:
How much money was spent on the process? Did the Administration
lie to Congress about the budget? What were the undisclosed
conflicts of interests of key members of the Task Force? Who was
responsible for enforcing disclosure requirements? What
contracts were let to private entities, circumventing the
required oversight? Why did the subsidies proposed for academic
medical centers increase by billions of dollars? Did it have
anything to do with the meetings of a ``Saturday Morning Working
Group'' of deans, who had discussions after the Task Force
officially disbanded? What behind-the-scenes influence did tax-
exempt corporations wield, and was it the functional equivalent
of illegal lobbying, in violation of IRS rules? (See AAPS
News, January 1995, for information about the involvement of
the Robert Wood Johnson Foundation in state Clinton Look-alike
A conference regarding sanctions is to be held in Judge
Lamberth's Court on January 9. After that, Phase I of this case
may be over. But the repercussions will continue in Congress.
Many provisions of the plan will surface, incrementally and
without attribution, in both the national and state arena.
Interested citizens need to ask questions like the above in their
Control vs. Coverage
Imagine an overnight change in U.S. medicine:
- Medicare and Medicaid are gone.
- Office visits to GPs, including a filled prescription for
antibiotics, cost $20.
- True catastrophic health insurance is available and so
affordable that nearly everyone chooses it voluntarily.
- Malpractice insurance costs are negligible because of the
implicit understanding that physicians do the best they can for
Such a situation exists even now in Taiwan. AAPS student
member Nancey Trevanian Tsai reports on her observations on a
visit to her homeland, after an absence of 17 years. Over that
period of time, many people had gone from tending rice paddies to
wearing diamond Rolex watches, thanks to a free-enterprise
economy. A visit to a physician now costs about 1.5 times as
much as having one's hair washed and styled-a twice weekly ritual
for many middle-class women.
And yet, there is a movement to socialize medicine in
Taiwan. Some physicians are working more diligently, to save for
the time when they lose their practices.
The debate is not about cost and coverage, Ms. Tsai states.
``It is about the power of a select few to control the society
they claim to serve'' (Esteem, vol. II, #1, 600-K
Fairfax Ave., Norfolk, VA 23507).
A Transition Phase
Managed care is not the wave of the future, in the view of
Bob G. Lanier, M.D., President of the Medical Association of
Georgia. Rather, it ``is a transition phase in the current ...
reform process. Capitation and discounted fixed-fee plans will
phase in, change, and phase out.''
Nor is managed care the key to ``cost containment.'' Lanier
states, ``What we are doing now with managed care is increasing
the cost, increasing paper work, excluding care, and controlling
providers.'' In the long run, ``we can expect it to change.''
His recommendations: Protect medical freedom. Encourage
and make it possible for patients to make independent decisions-
for example, through medical savings accounts (JMAG,
83:658, Dec, 1994).
1994 Brought 1,625-Page List of Regulations
Publication of the government's annual inventory of
regulatory actions was delayed until after the November
elections. The purpose was concern that Republicans might seize
on the 1,625-page document as evidence of a pro-regulatory bias.
The official explanation: computer glitch.
According to a 1993 Executive Order (EO 12866), only
``significant'' regulations (those with an annual impact greater
than $100,000,000) need to be cleared by the White House before
they can go forward (BNA's Medicare Report 11/11/94).
The nation was launched by a 1,322-word document, The
Declaration of Independence. Present regulations on the sale of
cabbage total 26,911 words (National Review 10/24/94).
Anti-Progress Is Logarithmic
If this year the nation falls a year behind, and next year
it falls behind again, it is not just two years behind, but three
or four. The reason is failure to build on the progress of the
first year. Every subsequent year it just gets worse. It's like
compound interest in reverse.
Dr. Frank R. Di Fiore points out this principle in
Private Physicians Newsletter, Nov., 1994 (1441 Avocado
Ave. Suite 408, Newport Beach, CA 92660). By now, Canada is a
century behind, in his view. Not only are women in labor
deprived of epidural analgesia, in many places their babies are
mandated to be delivered by midwives.
Bad Report Cards Have Their Uses
The Government Accounting Office (GAO) states that 10 or 15
years will be needed to develop ``highly'' reliable and valid
performance measures for report cards on health plans.
Administrative data bases are not designed for recovering
clinical data, and the review of a single patient medical record
costs about $16. There are no evaluative studies on the validity
of report cards now used by health plans and government entities
(BNA's Medicare Report 10/7/94).
Another pitfall, according to the GAO, is that some plans
might intentionally decide to ``represent themselves
unfavorably...to discourage enrollment of very sick and costly
patients.'' For example, a plan might make no effort to improve
a poor five-year survival rate for breast cancer patients. Or,
if the plan wanted to look good, one strategy would be to focus
resources on areas that are being measured (Health Care
Reform Week 10/10/94).
With cuts in entitlements on the agenda of the new Congress,
the AARP designated January 10 as ``Social Security and Medicare
Defense Day.'' They asked their members to jam the Congressional
switchboards, demanding opposition to proposed cuts. AAPS
responded with Senior Citizens Freedom Day on January 9.
Senior citizens have good cause to be concerned. However,
the threat comes not from Congress, but from demographics.
Social Security and Medicare will soon be bankrupt, unless action
is taken. Already, senior citizens, who relied on the
government's false promises, are suffering. It is becoming
increasingly difficult for them to receive the medical care they
need. Physicians want to help them, but are less and less able
to do so under increasingly oppressive Medicare constraints.
AAPS does not ask for government subsidies. Rather, we need
a long-term solution. We suggested that seniors consider the
following changes: 1. Cut fraud, abuse, and overcharging by
outlawing the assignment of benefits. All payments should be
made directly to the patient. 2. Cut overhead
costs by repealing useless or counterproductive laws and
regulations (CLIA, OSHA, the ADA, coding and claims submission
requirements). 3. Repeal all price controls. Pay
patients a standard indemnity, and allow patients and physicians
to negotiate a mutually acceptable fee. Physicians then need not
fear that they will be accused of fraud if they give a needy
patient a reduced rate. They will be better able to help the
needy if not forced to work at below-market rates for all
patients. 4. Permit and encourage private alternatives to
If you'd like to be informed of developments by FAX and are
not already on our network, please send us your FAX numbers.
Ours is: (602)326-3529.
Another FACA Case-on Practice Guidelines. The US
District Court for the District of Columbia rejected a request by
a manufacturer of a device used in spinal surgery to prevent the
issuance of guidelines for the treatment of low back pain
(Sofamor Danek Group Inc. v. Clinton). These guidelines
recommend exercise and over-the-counter medications for most
episodes of pain. A 23-member panel, which included private-
sector members, was convened by the Agency for Health Care Policy
and Research. Plaintiffs contended that the Federal Advisory
Committee Act (FACA) required open panel meetings and public
availability of documents. AHCPR argued that FACA did not apply
because the panel was not created by statute to give advice to
the president or federal agencies. Rather, AHCPR set up the
panel itself, exercising the discretion given to it by statute,
which also allows the function to be contracted out to private
AHCPR guidelines are meant to advise ``health care
providers,'' not the government, ruled the court. Therefore,
they may be formulated in secret by panels constructed in
whatever manner AHCPR chooses, without regard to requirements
such as openness or balance. (See BNA's Health Care Policy
AMA Releases ``Final E&M Guidelines.'' On November 9,
the AMA released documentation guidelines for ``evaluation and
management'' services, which are published in BNA's Medicare
Report 11/18/94. In the past, there were no guidelines on
such questions as how many body systems must be examined to
justify reimbursement for specific procedure codes. In fact,
there were ``no guidelines to speak of'' at all, according to
Bill Cox of the American College of Emergency Physicians
(BNA's Health Care Policy Report 11/21/94).
Doug Henley, President-elect of the American Academy of
Family Physicians, stated that physicians are ``encouraged'' to
start using the guidelines as of June, 1995, for protection in
the event of a chart audit. Also, he believes family physicians
might be receiving less reimbursement for their work because they
use less complex codes than they legally could.
They could also go to jail if they are using more complex
codes than HCFA believes are warranted. Mr. Edgardo P‚rez-
DeL‚on, former office manager for internist and AAPS member Wanda
Velez-Ruiz, M.D., was just released after spending a year in the
Ingham County Jail (see AAPS News, July 1994). In
response to his Freedom of Information Act request for
information on the definition of ``office exam,'' Esther Reagan,
Assistant to the Director of the Michigan Medical Services
Administration, stated that ``the answers to these questions are
generally available/discernable from a review of the Medicaid
Manual, MUPC Manual, and/or CPT Coding Books.'' She also told
him that future FOIA requests would receive no response until he
was released from prison. She advised him to have his attorney
submit requests following ``appropriate rules for discovery.''
What Mr. P‚rez-DeL‚on is trying to discover is the policy
under which he was jailed; his interpretation of ``office visit''
seems consistent with that in the recommended manuals.
Search Warrant Checklist. In today's threatening
practice environment, you may want to brief all employees on what
to do if confronted by a government agent with a search warrant.
The November 24, 1994, issue of Medicare Compliance
Alert (11300 Rockville Pike, Suite 1100, Rockville, MD
20852) offers a checklist. Some pointers include: (1) Ask to
see the agent's identification. (2) Obtain a copy of the warrant
and the affidavit supporting it. (3) Remember that everything
you say can be used against you. (4) Check the expiration date
on the warrant. (5) Contact your lawyer before leaving the
office. (Agents' favorite time to appear is quitting time.) (6)
Don't allow agents to use your copying machine as this makes it
difficult to determine what has been taken. (7) Get a complete
and very specific inventory of what is taken.
HHS Policy: No Justice, No Mercy. In pursuant to a
plea agreement, Doina M. Buzea, M.D., entered a guilty plea to
the misdemeanor offense of making a false statement on a Medicare
claim. She said she was ``manipulated'' by her superiors into
signing a statement that she had personally supervised a
treatment done before she was employed by the facility. She
argued that a five year exclusion from Medicare amounted to
depriving her of her profession, and such a severe and
disproportionate sanction violated the ``spirit'' of the plea
agreement. However, the statute requires a minimum five-year
exclusion, and ``petitioner's equitable arguments cannot prevail
against the plain words of the statute.''
Jacqueline A. Cordle-Boggs was the president of a
corporation that supplied medical equipment to nursing homes.
The company received $12,000 in Medicare payment for catheter
irrigation kits, which are not reimbursable when used to
administer fluids to patients unable to drink normally. She was
sentenced to 24 months in prison (all but three months being
suspended), five years of probation, restitution of $104,000, and
five years exclusion. She argued that the billing practices were
approved in advance by an official of the Medicare carrier.
Further, she entered a guilty plea only because she did not wish
to risk a trial, not because she had knowingly violated the law.
Lack of criminal intent, unfairness of trial, and mitigating
circumstances are ``all arguments that cannot be address in the
HHS forum.'' Neither the Inspector General nor the Administrative
Law Judge is authorized to reduce the mandatory minimum exclusion
(Civil Monetary Penalties Reporter, Nov. 1994).
No Moratorium on Stark II. HHS rejected a request from
the AHA, the AMA, and ten other physician and hospital groups to
delay enforcement of the Stark II self-referral ban scheduled to
go into effect January 1, 1995. The law expands the Stark I ban
on Medicare referrals to clinical laboratories in which
physicians have a financial interest to many other services,
including physical and occupational therapy, durable medical
equipment, and inpatient and outpatient hospital services. Any
misunderstanding of the law could lead to significant penalties.
There are no proposed regulations for Stark II and no final
regulations for Stark I. After thousands of hours of scrutiny of
the law and the legislative history, many physicians have been
unable to determine how or whether the law applies to them
(BNA's Health Care Policy Report, 1/2/95). If you have
a question, ask your Congressman. He probably doesn't know the
answer (HCFA is trying to clarify unclear portions of the law),
but he at least needs to learn the questions.
A Word of Advice from Wanda Velez-Ruiz, M.D. ``Don't
take government money.''
Rights and Duties. Regarding the statement in last
month's Legislative Alert that physicians have the right to
follow their best judgment regardless of practice ``guidelines'':
It is patients who have the right to the
benefit of their physician's best judgment; physicians have the
duty to use it.
Robert Carlen, M.D., Sayville, NY
British Priorities. My wife and I just returned from
Britain. The failure of the National Health Service is evidenced
by two articles from the London Daily Telegraph. While
bloated with bureaucrats, the British system has a serious
shortage of cardiologists; 30 health districts were without a
single one. Most Western nations have six times as many
cardiologists per capita, and the U.S. has eight times as many.
Willard J. Ambrose, D.V.M., Phoenix, AZ
Why I Will Not Participate in Medicare. To Mr. Preston
Lowen, HCFA Representative, Syracuse, NY: As you know, I usually
write to you every year to tell you why I will not voluntarily
participate in Medicare. I have read that an increasing number
of physicians have given up hope trying to fight the constant
harassment and punishments applied to nonparticipating
physicians....For Medicare to point to this increasing
participation as evidence of its growing popularity is not much
different from Hitler pointing to the growth of the Nazi party as
proof if its popularity....
I am aware that participating physicians are paid more....I
know that you are aware of my many adverse experiences, including
the time the bureaucracy cheated me out of $13,000 in one year
alone, through a mistake that a Medicare carrier admitted to
making. Sovereign immunity, however, allows the rights of the
government and its bungling Medicare program to supersede the
rights and well-being of the individual. To sacrifice the
individual for the good of the State is one of the main tenets of
Socialism. I will not ever agree voluntarily to participate in
Socialism...[I]t is evil and immoral....
Lawrence R. Huntoon, M.D., Ph.D.
Government Intrusion Spreads. I will not forget the
support we received from AAPS and Dr. Camardese in 1992 when
federal and state agencies tried to ruin our organization [see
``Nursing Home Invaded,'' AAPS News, Sept. 1992]....
When I heard on the news yesterday that Clinton is going to
``assess fines'' on all nursing facilities who fail to ``pass''
their totally subjective surveys, I just shuddered, and thought
to myself, ``Is there no end to their arrogance?''
In the mid 1960s, when I tried to get support from local
individuals and organizations to fight against Medicare, I was
laughed out of town. I could see at that time the stranglehold
that was being forced on unwilling participants....Anyone who
spoke out was a ``crook'' opposed to ``quality health care.''
Now that those tentacles are penetrating all aspects of
our lives, people are much more willing to listen....We always
hear that ``you can't beat the system,'' but organizations like
AAPS are proving this statement wrong.
William C. Dotson, Administrator-Owner Gaymont Nursing
Center, Norwalk, OH
Priority or Disease? [Dr. Michael Johns, Dean of Johns
Hopkins medical school stated in a JAMA editorial that]
``health care reform is now a national priority''....It is easy
to conjure up a res publica with metaphoric legs and genitals
beleagured by elephantiasis-the inevitable endpoint of burgeoning
infestation by parasitic government and its prot‚g‚s. Our heavy-
legged nation already drags, staggers, and stumbles....
William F. Sheeley, M.D., Phoenix, AZ
excerpted from letter to JAMA 270:2807
Statements of Fact. The following is excerpted from a
letter that was mailed by the Idaho Medical Association to all
its members: (a) The cost of medical care in Idaho is one of
the lowest of any state in the nation, and the quality of care is
as good or better here. (b) The Draconian cuts imposed by the
fiat of managed care nationwide have had disastrous consequences
for patients and physicians alike. (c) It has been estimated that
if fewer than 20 to 30% of physicians capitulate and submit to
managed-care contracts, managed care will probably be unable to
take over a community. (d) Five or six attempts at managed care
intrusion into the Boise medical community in the past 15 years
have all failed. (e) Denying medical care for profit, which is a
basic principle of managed care, is not in the best interest of
patients or physicians. (f) Putting the patient in control of
medical costs will solve price distortions. Medical savings
accounts are currently the best way to achieve this goal. (g)
The choice is ultimately OURS.
V.L. Goltry, M.D., AAPS Director, Boise, ID
Unity...How about Some Definitions First? In any
conflict between two men (or two groups) who hold the
same basic principles, it is the more consistent one who
wins. In any collaboration between two men (or two
groups) who hold different principles, it is the more
evil or irrational one who wins. When opposite basic principles
are clearly and openly defined, it works to the advantage of the
rational side; when they are not clearly defined but are hidden
or evaded, it works to the advantage of the irrational side.
V.L. Goltry, M.D., quoting Ayn Rand
Legislative AlertSerious As a Heart Attack
If there is any doubt about the seriousness of the new
Congressional leadership-Gingrich, Armey, and DeLay-put it to
rest. These guys are about as serious as a heart attack. Look
for major reforms of Congress, including cutbacks in committee
staff and the elimination of proxy voting (the practice of having
committee chairmen vote on behalf of absent Members of their
Committee). There is talk of reductions in personal staff and
limitations on the franking privilege. The legislative support
agencies and the caucuses of the House, including the Black
Caucus, the Republican Study Group, and the Democratic Study
Group, are going to get the axe.
Look for fast action on unfunded federal mandates and a line
item veto for the President, and expect House action on the
Balanced Budget Amendment to the federal Constitution. Capitol
Hill observers expect the Balanced Budget piece will also be
accompanied by a supermajority (a two-thirds requirement) for
raising taxes to comply with its provisions; in other words, this
balanced budget amendment is going to fix a bias in favor of
federal spending cuts.
Regardless of what happens on the Federal Budget, Gingrich
appears ready to go after federal spending through the
appropriations process of the House, cutting and literally
killing or zeroing out unwanted federal programs. It is hard for
a President to veto an Appropriations bill because it doesn't
have enough spending in it; Gingrich appears to be ready
to make Clinton face that politically unpleasant option.
Gingrich is taking nothing for granted. He met with Black
Democrats Kweisi Mfume of Maryland and Charles Rangel of New York
and told them that the welfare state has been an extravagant
failure, especially so for black Americans, and that black
political leaders should rethink their entire approach to liberal
interest-group politics. Fat chance. But Gingrich is playing for
big stakes, and he can't be called pessimistic.
Health Policy Slots
Congresswoman Nancy Johnson (R-CT) wants to take over the
Chairmanship of the House Ways and Means Subcommittee on
Oversight. A skillful debater, Johnson knows a lot about health
policy and would use this position for more than Oversight over
HCFA. Look for the subcommittee to become a major policy center.
Incidentally, Johnson's role highlights another fact; women are
showing a high profile in Congress. Their political coloration is
very different, however. Eight Democratic women lost in November,
seven of them very liberal members of the famous 1992 class
heralded as the ``Year of the Woman'' in politically correct
circles. Seven Republican women won in November, six of them very
The previously powerful Ways and Means Subcommittee on
Health is expected to come under the chairmanship of Congressman
Bill Thomas of California. Pete Stark (D-CA), who has ruled the
Subcommittee for so many years, is expected to remain on the
panel as ranking minority member.
The rumor is that Senator Bob Bennett of Utah is going to
become the Chairman of the Senate Republican Task Force on Health
Care Reform, the panel chaired previously by Senator John Chafee
of Rhode Island. Bennett is a genuine free-marketeer who
believes that tax reform is the key to health policy reform, and
he has been influenced by the intellectual labors of the so-
called ``Consensus Group,'' a coalition of Washington-based think
tanks (the American Enterprise Institute, the Cato Institute, and
the Heritage Foundation), chaired by Washington health policy
guru Grace Marie Arnett.
What do you do about an unpleasant past? Simple. You do
away with it. Recall that President Clinton on November 13th, in
a rambling press conference on the 1994 election Meaning of It
All, insisted that his health-care plan was ``mischaracterized''
as a ``government-run plan,'' and that this was not what he
``wanted to do.'' Make no mistake. This was not the blubberings
of pummelled politician, too punch drunk to think of a credible
alternative explanation (Such as: It was a government-
run health-care system, and the American people didn't like
it). No; this is the Official White House Line. It is in
the same category as other precious gems of Little Rock rhetoric,
e.g. ``There are no price controls in our health-care bill.'' Or,
``premium caps are not-repeat-not, price controls.'' One knows
it's really super-official when the establishment's literary
cognoscenti feel compelled to embellish and give some
respectability to the Official Line in high-toned mags. So, James
Fallows writes an apologia in the December Atlantic
Monthly that says that we all got the whole Clinton health
plan, the whole thing, all wrong.
Regardless of how often the President and his shrinking
number of allies in the establishment press repeat the Official
Line on health-care reform, it is not likely to change the
public's original, and correct, perception of the Clinton Health
Plan. In fact, by harping on it in this fashion, the President
only risks even further damage to his already battered
credibility. All folks have to do, if they are interested, is go
back and check.
In speaking of the 1994 health-care debate and what it means
for the future, Will Marshall of the ``moderate,'' Democratic-
oriented Progressive Policy Institute remarked, in the November
5th edition of Congressional Quarterly, ``The health
care debate did much more damage to this president than many
realize. It defined the administration in conventional liberal
Perhaps even more interesting is the commentary of Jonathan
Yardley, a genuine liberal, who is cultural critic at The
Washington Post. In a January 2, 1995, article, Yardley
suggests that the problems for Clinton and Co. go so deep as to
be quite beyond conventional political fixes. The problem has to
do with the evolution of liberalism itself: ``Liberalism isn't
liberalism anymore; it's statism. However one may feel about the
origins of contemporary American liberalism in the early New
Deal, there can be no doubt that as it matured through the New
Frontier and the Great Society into whatever it is that Bill
Clinton calls the farce over which he presides, it's abandoned
its commitment to the individual and placed all faith in
government.'' The chief effect of modern liberalism, the thing
that devolved into the monstrous thing it is today, is the
grasping, groping attempt by liberals ``to exercise control over
all areas of economic life.'' According to Yardley, ``This
includes tax policy designed not merely to raise federal revenues
for all those programs that don't work but to engage in
deliberate social engineering, with the consequence that under
present federal tax laws we are encouraged to purchase houses but
not to get married. Go figure.''
As we have noted, it is also a tax policy designed to
promote restriction on consumer choice in medical care, while
nicely promoting uninsurance among those who can least afford it:
employees in small firms.
And why all of this concentration of power: to crush
individuality. Says Yardley, ``This it is doing-eagerly abetted
by its handmaidens, the radical feminists and English department
Marxists and multiculturalists-through a variety of efforts aimed
at limiting individual free speech and action so as to avoid
giving offense to persons whom it honors not as individuals but
as members of victimized groups. Small wonder that `liberal'
might as well now be a synonym for `fascist'.''
Remember, ladies in gentlemen, this comes straight from a
premier columnist for The Washington Post!
The Next Stage of the Debate on American Medicine
Health-care reform remains high on the list of priorities
for the general public, being listed as the voters' number one
concern in a network exit poll. The new Congressional leadership
cannot ignore this fact. However, Gingrich and his colleagues
are not going to tackle this issue in the first hundred days of
the new Congress, and it is not part of the Contract with
One of the most striking features of the debate, cited by
Daniel Yankelovich, chairman of DYG Inc., is the persistent
support for ``universal coverage.'' But the support is
superficial. What people really mean when they say they support
``universal coverage'' can be paraphrased this way: ``We don't
believe anybody should be deprived of care because of money. We
support the President's goal of insurance for all that can never
be taken away. But only if the nation can afford it and it
doesn't limit choice of doctors or raise taxes significantly or
cause employers to cut jobs.''
Yankelovich goes on to say that the policy alternatives have
been framed by professional policy analysts and experts, whose
ideas may be quite different from those of the public. When
people are confronted with the tradeoff in a clear and consistent
fashion, they go beyond ``raw opinion'' to ``responsible public
judgment.'' One issue on which there doesn't seem to be much
debate is the portability of insurance.
A poll released in December by the Health Care Leadership
Council found that 90 percent of Americans were satisfied with
the quality of their care, 89 percent were satisfied with the
choices they had, and 74 percent were satisfied with the cost of
their coverage. The survey also found that 56 percent of the
respondents support inclusion of medical savings accounts in a
reform package, and 57 percent they would use them if they became
While not inclined to favor another stab at ``com-
prehensive'' reform, the American public is likely to support
incremental steps, if those steps are clear and do not threaten
their choices, especially of doctors and specialists. One reform
that is likely to garner broad support in the House and the
Senate is the application of 100 percent tax deductibility to the
self-employed, giving tax relief to individuals who purchase
their insurance through pools other than those organized by their
Interestingly, among the many new faces on Capitol Hill are
a small group of doctors, most notably Bill Frist of Tennessee, a
heart surgeon-a good professional balance to Congressman Jim
McDermott of Washington State, a psychiatrist, who is the leading
Congressional champion of the single-payer, Canadian-style
system. McDermott, by the way, will offer the single-payer bill
again this year.
Who's In, Who's Out
The ``health care policy community,'' many of who have
been rocked out of their trees by the November elections, are
trying to figure out a way to position themselves. It is pretty
easy to figure out who will have the ear of the new Congressional
leadership. Those with easy entry include the Health Insurance
Association of America, led by Bill Gradison, former Congressman
from Ohio and a former member of the Ways and Means Committee;
Gail Wilensky, former HCFA administrator, now of Project Hope;
John Moteley and the National Federation of Independent
Businesses (NFIB), whose small business message was well received
by conservatives when they were in the minority. Big insurance
companies, who were pushing the Cooper bill and various managed
competition schemes, are not the favorite of the conservative
Who's out? Besides the obvious (e.g. Families USA), count
the lawyers out. The Trial Lawyers Association has been a leading
opponent of tort reform; and the American Bar Association (ABA)
has gone on record against market-oriented insurance reform. Last
August 9th, even as the Clinton Plan and its various incarnations
on Capitol Hill were going down to defeat, the American Bar
Association's House of Delegates defeated a resolution that would
have favored consumer choice and market competition. In defeating
the pro-free market resolution, lawyer John Pickering from
Washington D.C. called it an ``Adam Smith approach to health care
reform which has not worked in the past and will not work in the
future to control spiraling health care costs.'' Pickering and
Company have perfect timing, right? Mr. Pickering meet Mr.
Gingrich, Mr. Armey and, uh, Mr. Smith.
A War on Regulations?
Congressman Tom DeLay of Texas has asked the Administration
to put a moratorium on federal regulations. The White House has
refused. But oversight on government regulation has only just
begun. Look for a tough review of DRG's and the RBRVS and the
CLIA and OSHA regs in this session of Congress. The HCFA is
entering a brave new world of Congressional hostility to
regulation. Nobody in living memory has ever been there before.
Regulation breeds corruption, falsification, and black
markets, especially price regulation. According to the Bureau of
National Affairs report on Medicare (12/22/94), close to 4600
hospitals face civil prosecution for violations of the False
Claims Act for wrongful billing for non-physician outpatient
services in hospitals.
The Future of Medicare
There will probably be no major reorganization of HCFA this
session of Congress. But because of the massive budget problems
of Medicare and Medicaid, look for a serious discussion on how to
bring these monsters under control. One idea that is making the
rounds is free choice. What if new retirees could opt out of
Medicare, keeping their private sector plan, perhaps receiving a
Medicare voucher to offset the cost? What a radical idea.