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of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943
Omnia pro aegroto
Volume 50, No. 11 November 1994
Task Force Documents Give Glimpse of Inner
``What we are doing is far more significant than
Medicare/Medicaid. We'll be setting in place the health care
system for the next generations.'' stated a Task Force Working
Group member in handwritten notes from a secret meeting.
More than a year after the President's Health Care Task
Force officially disbanded, those able to go to the National
Archives II in College Park, MD, can get a glimpse into the
process that intended to bring about a ``radical restructuring of
the health care system with major shifts in power and
responsibility, under the auspices of the federal government.''
A participant who managed to win a coveted spot on the Task
Force, though but recently graduated from college, told of
``wonking till the wee hours'' in a ``finals like'' atmosphere,
under the pressure of tollgates.
Members were admonished not to talk to the press, and not
even to tell what groups they were working with.
During the process, the public and the press were given no
inkling of the serious misgivings of some Task Force members.
``A consensus is forming,'' stated Ira Magaziner.
That was a ``euphemism,'' according to James Ukockis of the
Treasury Department. Concerning the short-term cost controls,
``every option has fatal flaws,'' he said. For example, if
Medicare price limits were expanded to all, Ukockis predicted
``financial havoc.'' Premium regulation, a policy that ``looks
favorably upon the prospective forced exit of many companies from
the health insurance field,'' would destroy incentives to invest.
``With both timid and aggressive investors excusing
themselves, we are left with only crazy investors, which brings
us to the government,'' said Ukockis. He spoke also of dim
prospects for investment in drugs, equipment, and training for
physicians and other medical personnel.
AAPS researchers have uncovered no evidence that anyone
bothered to refute the naysayers. Perhaps they were simply
ignored. Perhaps they had some influence in that the Clinton
Plan did not include such Draconian proposals as the ``shock
treatment.'' For physicians, a 100% federal tax was proposed on
income exceeding prescribed limits. It was to be enforced by
withholding 15 to 20% of gross revenue, refundable only by
submitting an independent auditor's statement of full compliance.
The burden of proof was to be wholly on the provider.
Certain ideas of the Working Groups will be back next year,
even though reform was defeated in this session of Congress.
Perhaps most important is the establishment of a central
computerized data base, in the name of ``accountability,''
``administrative simplification,'' ``paperwork reduction,'' and
``In an effort to catch the cheaters, privacy is put at
risk,'' stated one Working Group member. It is not only
``providers'' who need to be caught responding to the incentives
created by federal money; ``abusers'' and ``chronics'' must also
be tracked by means of personal identifiers.
Despite the cost-containment concerns, ``administrative
streamlining is not the key to savings,'' said one Task Force
member. In fact, ``Ira's convinced that computerization in
business has added cost.''
Not just administrative data, but patient-care data, in
standardized format, are a high priority. ``Simplification should
not mean data poor-more information should result as
automation increases.'' One purpose of the information
infrastructure is to ``provide a report card to the government.''
``It seems to me,'' wrote one participant, ``that we should
use exactly the same data that the providers need/depend on-that
way, the providers cannot cheat, or they will screw themselves
Many private vendors of hardware and software were intensely
interested in the Task Force and the opportunity to profit from
``this unique window in history for developing the health
After being immersed in boxes full of the drafts, memoranda,
lists, notes, personal journals, and scrap paper of this
remarkable committee, an observer may feel overpowered by the
hubris. The elite thousand, driving themselves through dawn-to-
midnight meetings, were apparently quite serious about their
mission to destroy and resurrect a one-trillion dollar enterprise
affecting 260,000,000 human beings.
The revelations of some possibly embarrassing notes have
been made for one purpose: to have the case of AAPS v.
Clinton thrown out of court on the grounds of mootness. The
Department of Justice asserts that ``plaintiffs now have access
to far more material than they would have been entitled to had
they prevailed on their FACA [Federal Advisory Committee Act]
The White House has not admitted to violating the open-
meetings law, which requires public notice and participation,
with contemporaneous availability of documents. Nor has
it provided full disclosure of conflicts of interest, or
information regarding Task Force expenditures and sources of
funding. There is no index provided for the material, though one
document refers to its preparation.
AAPS is asking the court to rule that the White House
violated the Federal Advisory Committee Act. In addition, a
motion is pending for sanctions against Ira Magaziner for
submitting a false affidavit.
Judge Lamberth of the US District Court for the District of
Columbia denied a government motion for an expedited ruling on
the contempt allegation against Magaziner.
Oral arguments on the mootness issue is scheduled for
October 13. The outcome is not known as this newsletter goes to
From 1949 to 1994
``President Truman's special message, asking enactment of a
national compulsory health insurance program, deserves most
careful scrutiny by Congress and by the American people, whose
health would be seriously endangered if this Old World scourge is
allowed to spread to our New World.
``There is neither hope nor promise of progress in this
system of regimented medical care. It is the discredited system
of decadent nations....It is one of the final, irrevocable steps
toward state socialism....
``The President's message, in some respects, was persuasive
and disarming. The ideals and objectives were stated in glowing
terms, but the message was completely lacking in any specific
statement of the services to which the people would be entitled,
or any estimate of the taxes which they would be compelled to
``The voluntary way is the American way'' (statement of Dr.
Elmer L. Henderson, Chairman of the AMA Board of Trustees,
JAMA 140:114, May 7, 1949).
``As the President [Clinton] has said, it will take
sacrifice and shared responsibility by all of us, including
physicians and patients....[A] true and focused partnership will
have to be formed between physicians and government....''
(``Proposal for Using Negotiations and the Medical Profession's
Infrastructure to Control Costs, Disseminate Information and
Bring About Change'' submitted to the President's Task Force on
National Health Care Reform by the AMA)
``The AMA believes the status quo must go'' (James Todd,
M.D., Executive Vice President, in a March 3, 1993 cover letter
accompanying the proposal).
Community Rating: Increasing the Uninsured
A major feature of many ``reform'' proposals is to forbid
insurers to price risk.
Promising to improve the ``quality, affordability, and
accessibility'' of health care for all New Yorkers, New York
State mandated ``community rating'' in 1992. NY Legislative Act
12350 requires open enrollment, at the same premium regardless of
age, sex, or health status, for all small group and individual
policies. The act also outlawed self insurance by trade and
After one year, 43,666 people cancelled their medical
insurance, and several major insurers (Prudential, State Farm,
and Aetna), along with many smaller firms, left the state.
Community rating overcharges young, healthy subscribers.
For 30-year-old men, premiums nearly tripled in New York, and the
price of insurance for a 30-year-old with a family increased by
more than $3,000, or by 90 percent (Citizens for a Sound Economy
Community rating also forces those who adopt traditional
family values to pay substantially more so that those who follow
a high-risk life-style can pay less (National Center for Policy
Analysis Backgrounder # 132, 8/10/94).
Updates from Canada
Administrative Overhead. In 1990, Canada's 1,101
hospitals had 143,000 administrative support personnel in a total
of 464,000 employees. Each province has a huge computer system
to track payment of every bill to every provider. In British
Columbia, physicians produce 150 million separate billings every
year, mostly for less than $40.
To reduce bureaucratic overhead and to empower patients who
are spending their own money, Bill W. Weaver, M.D., has proposed
a Medisave plan for Canada. His plan is modeled on the system in
Singapore, where medical expenditures constituted 3.2 percent of
the GNP in 1988 compared with 6 percent for Canada (For details,
write Dr. Weaver, Suite 814 - 750 W. Broadway, Vancouver, B.C.
Waiting Lists. In British Columbia, 0.9 percent of the
population is on a waiting list for surgery, according to a
survey by the Fraser Institute (626 Bute St., Vancouver, B.C. V6E
3M1). About one-fourth of the cases are classified as ``urgent.''
Before reaching the surgery waiting list, patients must also wait
about four weeks for an appointment with a specialist. In some
instances, waiting times appear shorter because patients in some
provinces are simply not referred for MRI or hip replacement.
Freedom. On June 19, 1986, the Ontario provincial
government passed Bill 94, which made it a felony, subject to
prison or a $10,000 fine, if a doctor billed a patient directly
or accepted anything more in payment for his services than the
In July, 1994, citizens of Toronto were arrested for
carrying a copy of the Buffalo News, which contained
information about a trial that the government did not wish them
to read. Television screens went blank after the station
broadcast 10 seconds of news about the trial in contravention of
a ban. A high-pitched whistle was broadcast instead of the rest
of the news. Canadians who cross the border to get a haircut or a
tune-up on their car are prosecuted for evading the 7 percent tax
on these services (Detroit Free Press).
Anti-Free Speech Bill Defeated
Congress and the press called its target the ``Lobbyist
Lunch.'' That is how it started out, but something got inserted
in the Conference Committee without being voted on by either
house. (This was one reason for opposing all ``health-care
reform'' measures. Any bill that passed could have
emerged from conference as the Clinton Plan.) The bill
introduced extensive new reporting requirements for organizations
that engage in ``grassroots lobbying'' or that simply inform
their members about issues and encourage them to contact their
Congressman. Organizations might have been required to divulge
their membership lists to a government agency reporting to the
A remarkable coalition of associations ranging from the
Christian Coalition to the Feminist Majority activated their FAX
networks, calling the bill a ``gag rule'' or ``Hillary's
revenge.'' At first assured of passage, the bill failed to
obtain the required two-thirds majority in the Senate. (If you
would like to be added to the AAPS FAX network, please send us
your FAX number-remember, your machine has to know how to answer
the phone automatically.)
All Europe adopted the Soviet attitude....Instead of
governments supported by-and limited by-the people, the people
would be supported by-and limited by-the government.
Otto Scott, Chalcedon Report, May 1994
How About Legal Reform?
As current trends in medicine, augmented by so-called
``health-care reform,'' tend to circumscribe the traditional role
of the physician, trends in the law are in the opposite
direction. The plaintiff's bar is expanding its never-ending
battle for truth and justice into a new, massive War on Crime.
The result: an epidemic of huge monetary awards against owners
of premises on which violent criminal acts are perpetrated
against patrons. Forty percent of the award goes to the lawyers.
Writing in the (Miami) Herald (4/10/94), attorney
Thomas R. Spencer, Jr., stated that it's time for a ``monster
``We now have less than five percent of the world's
population and more than 75 percent of the lawyers. By those
statistics, a distant observer could conclude that this society
is the model of law and order. In fact, the opposite is true.
Each day the explosion in crime against property and the
avalanche of mindless regulations from administrative
agencies...pile more and more expense on the product of our
The combined costs of crime, civil liability, and admini-
strative regulatory games are destroying the American dream. We
need a real legal revolution, but without throwing out the Bill
of Rights. ``It will take a massive effort akin to the Manhattan
Project,'' Spencer wrote.
``Laymen will have to direct the effort because we will need
to apply radical surgery to a judiciary that is arrogant,
defensive, and unresponsive to the urgent needs'' of a
productive, free-enterprise society.
``We will have to reverse and repeal 30 years of ridiculous
bureaucracy and begin to burn the red tape that is wrapping up
our businessmen and producers. We will need to retrain a good
percentage of our nation's lawyers (bright and talented people)
to produce something useful....''
[Thomas Spencer is representing AAPS in the case of AAPS
Beware of Surveys from the Inspector General. The IG's
office recently sent a 13-page survey to about 1,000 home-health
providers, allegedly to be used in the development of new policy.
Attorneys warn that such surveys can really be a ``fishing
expedition'' for potential violations. For example, one question
is: ``Do you believe it is appropriate for a physician who has
not personally seen the patient to sign the plan of care?'' This
practice will be the subject of a fraud alert.
Return of such surveys is often not required. They are
coded so the IG knows who sent the survey even if returned
anonymously (Medicare Compliance Alert 9/12/94).
Mandatory Medicare and Medicaid Exclusions Upheld. A
review of decisions by Administrative Law Judges in appeals of
mandatory exclusions shows the following: (1) The ALJ has no
power to modify or reduce an exclusion imposed by the Inspector
General. The state court system is the only proper forum for
collaterally attacking a conviction. (2) The fact of conviction
triggers the exclusion, and a guilty or no-contest plea
constitutes a conviction, even if the charge is misdemeanor and
the record is expunged. There is no need to prove criminal
intent. (3) For purposes of mandatory exclusion, the Act
makes no distinctions relating to the number of convictions. One
(probably inadvertent) unlawful act in 20 years triggered a five-
year exclusion for a supplier of medical equipment. (4)
Cooperation with authorities is not a mitigating factor unless
the party provides actual evidence that leads to the conviction
of other parties (Civil Money Penalties
Software May Be a Medical Device. The FDA now requires
registration and approval of software products used by blood
establishments to prevent the release of unsuitable blood
components, unless the device was distributed before May 28,
1976, and has undergone no significant change since then
(BNA's Health Care Policy Report 9/12/94).
Deselected Physicians Ordered to Pay Aetna's Costs.
The US District dismissed a case that sought to prevent Aetna
from dropping five physicians from its PPO network (Texas
Medical Assoc. v Aetna Life Insurance Co., DC STexas, No.
94-0288, 8/24/94). Plaintiffs claimed they were denied due
process rights granted by the Texas Administrative Code. The TMA
argued that Aetna's action put pressure on physicians to make
decisions based on economic factors rather than the best
interests of their patients. The court ruled that only the Texas
Dept. of Insurance could enforce its rules, and ordered the TMA,
the Harris County Medical Society, and the five physicians to pay
all of Aetna's costs (BNA HCPR 9/19/94).
The Patient : Bureaucrat Ratio
``My calculations show that, if present trends continue, by
the year 2026 there will be 2.5 million administrators in U.S.
hospitals and no patients at all'' (Victoria Sweet, M.D., N
Engl J Med 329:1655, 1993, reprinted with permission).
Implications of ERISA Waivers
Several states, including Washington, are asking for waivers
of the Employee Retirement Income Security Act of 1974. ERISA
provides that individual states may not intervene in compensation
and benefit agreements between employers and employees. This
means that large multistate employers, who are typically self-
insured, are not subject to state mandatory benefits laws. If
Washington State fails to get a waiver, the impact of the Health
Services Act will fall disproportionately on small business,
``getting their attention in a very substantial way,'' stated
AAPS Director Michael Schlitt, M.D., who opposes the waiver. It
would also move the state closer to a single-payer system, which
is not popular in Washington, and could lead to repeal of the
Act. (The Act provides for single or limited-sponsor plans if
the ERISA waiver fails.)
Medical Students' Futures: The signs and symptoms of
the future equal servitude to the state....Current legislation
will decide tomorrow's life-and-death situations, and we the
medical students will be the ones whose souls must live with the
consequences. Our freedom to choose the best treatment for our
patients will be replaced by protocols that may or may not be
suitable. We must remember that lab rats are used for a reason.
Americans must not be used for a price. The freedom of choice
must continue to define us as Americans and as America's future
I hope that the student sector of AAPS will become a vibrant
voice for our future. Beginning a student chapter is easy; call
AAPS for guidelines. I started a chapter in Houston and was able
to find sponsors (private practice physicians and small business
owners). You might be able to obtain school financing, but be
aware of the stipulations that government money may place on your
freedom to assemble.
Liza Leal Barton, MS III National Chairman, Student
Chapters of AAPS
``Paperwork Reduction'' May Mean Privacy Reduction: As
tempting as the perceived ease of electronic transfer of medical
billing and information seems, such procedure, if compelled,
holds inherent dangers for both patients and physicians.
Problems will occur in obtaining and maintaining proof of
accurate receipt and submission of data; errors in billing and in
payment will be much more difficult to detect and correct. The
legal ramifications of electronic evidence and its admissibility
in court must be explored: a new body of law may be required.
Computers currently print forms for billing or insurance
submission with a touch of a button-an effort no more labor-
intensive than an electronic transfer. Such printed forms
provide the safety of a paper trail to provide an accurate record
of billings and services.
Government-provided software may well command the computer
to transfer information specifically not intended for government
scrutiny. Thus privacy is threatened. Access to patient records
will be demanded for audit of accuracy of electronic billing, a
demand already incorporated into the Medicare program's
electronic transmission program.
The right answer for simplification and real paperwork
reduction is to return responsibility for most routine care to
the patients in a direct contractual relationship with their
physicians. This answer is incorporated in medical savings
accounts combined with high-deductible (and therefore
infrequently used) catastrophic insurance policies. Interaction
with third parties is therefore minimized.
Returning responsibility to the patient is necessary to
Lois Copeland, M.D., AAPS President-Elect
The Anti-Trust Side Show: The Georgia ballot will have
an antitrust initiative sponsored by physicians, who have been
stripped of their traditional role as decision makers by managed
care. It would allow physicians to band together to form
essential insurance companies. A better solution is to equalize
the tax deductibility of all medical care. This would allow
workers to exclude employers from the medical care loop without a
tax penalty. If employers did not provide our medical care,
there would be no managed care.
Bert A. Loftman, M.D., Atlanta, GA
Legislative AlertHow the End Came - for This
When Senate Majority Leader George Mitchell announced that
he was not going to pursue health-care reform in the 103rd
Congress, many Americans and many Members of Congress breathed a
deep sigh of relief.
Perhaps more important was the previous speech by Senator
Daniel Patrick Moynihan (D-NY), Chairman of the powerful Senate
Finance Committee, delivered almost two weeks before Mitchell
formally threw in the towel. Moynihan's speech stunned Mitchell,
Chafee, and his Senate colleagues with a simple message on health
care reform: Just Stop It. Forget even ``incremental reform.''
Senator Moynihan proved to be the most important contributor to
the continuing Senate seminar on the topic: Do We Know What We
Are Doing? Newsweek's economist, Robert J. Samuelson,
called for a halt last August: basically on the grounds that
Members of Congress clearly do not know what they are
As reported in the Washington Post (9/16/94),
Moynihan said a close examination of the ``Mainstream Coalition
Proposal'' revealed that it would be a step backward for many
states. Like the Clinton clones, it contained a government-
standardized benefits package, a powerful new federal health
commission, insurance underwriting that amounts to community
rating, new taxes and cuts in Medicare and Medicaid. Moynihan
argued that there is an ``unbridgeable gap'' between what
Congress wants and the means to pay for it.
The Mainstream Proposal was not published in legislative
language, and Congressional staff had to go into a room and sign
in, in order to look at the legislative language available. How
about that for keeping the cards close to the vest? What the
Congressional staff carrying water for government-managed
medicine now realize is that any detailed piece of legislation
incurs the danger of opposition based precisely on the details.
The latest problem to surface in the ``health-care reform''
debate: the kind of subsidies that would be available to low-
income people. The Congressional Budget Office found the
mechanics of the Mitchell Plan to be simply unworkable. Robert
Reischauer, Director of the CBO, served as the most effective
naysayer in Washington. ``This is an era in which Reischauer's
cold-turkey reviews fit neatly into Congress's latter-day
obsession with budget deficits, promoted by Bill Clinton, who
(with some prodding from Ross Perot) made budget reduction his
top legislative priority in 1993,'' wrote Hobart Rowen in the
Washington Post (8/25/94).
Perhaps the most prestigious intervention into the
Congressional mess was that of Joseph A. Califano Jr., President
Carter's Secretary of HHS. Califano's prescriptions for reform
are hardly conservative, but his analysis of the current process
could have been ghosted by Senator Phil Gramm (R-TX). Writing in
the Washington Post (8/18/94), Califano warned:
``Opportunities for mischief abound in the feeding frenzy of
special interests as they circle several thousand pages of fine
print in bills no Member of Congress has read or fully
Never has the best of American medicine been in such peril.
Writing on ``cost-containment'' efforts pushed by liberals in
Congress, Califano is downright contemptuous: ``The chutzpah
cost-containment award goes to those Members of Congress who seek
to cap physician pay, even though it saves almost no money. The
average general practitioner makes about $155,000 per year; a
quarter earn less than $75,000. The pay of the House or Senate
easily tops $200,000-nearly double the income of the average
family doctor. The base pay of a senator or representative is
$133,600; the value of a typical pension is $60,000 a year, and
family health coverage is worth $10,000 annually. Benefits such
as airport parking, tax deductions for maintaining home state and
D.C. residences, and subsidized gyms and haircuts easily add
another $5000. How do members of Congress think voters would
answer the question, `Who is worth more to you, your family
physician or your senator or representative?' '' The outlook:
``Congress will be legislating reforms for at least the next
decade, as it ...adjusts for the unintended consequences of prior
reforms and fights the continuing battle with costs.''
Senate Minority Leader Dole had been holding out the idea of
yet another Congressional leadership bill, something crafted by
the four party leaders of the House and Senate, with each given
veto power over whether the package should go to the floor. But
the idea also quickly died. Neither Mitchell nor Foley showed
much interest. Meanwhile, the shift in the power of Congressional
staff had gone from Sheila Burke, Dole's top health care advisor,
to Christie Ferguson, Chafee's top health care specialist.
Because Mitchell had entered into negotiations with Chafee, all
Congressional staff eyes were also focused on the role of
Christine Williams, Mitchell's health care chief. The shift in
staff power and influence in the process is decidedly to the
Time for Recrimination
In the closing days of the Senate debate, before Mitchell
mercifully pulled the plug, First Lady Hillary Rodham Clinton
seemed to take a low profile. Recently, she told the New
York Times (10/3/94) that she would be willing to take
``some'' of the blame for the death of ``health-care reform''
this year because she failed to gauge the intensity of opposition
to the White House Plan, the barrage of advertisements against
it, and the misunderstanding on the part of opponents that the
plan was to be the basis for negotiations. Could have fooled us!
In the Clinton White House, one has to be Politically
Correct. And the Politically Correct reason for the failure of
health care reform will be...? Prediction: Ira Magaziner will be
tagged as the Fall Guy. He was responsible for the Plan's
complexity; its gargantuan scope; its Rube Goldberg-like style.
Meantime, continuing the slide in approval ratings, News-
week's survey of September 29-30 finds that only 36 percent
of Americans favor the way President Clinton is doing his job,
while 48 percent disapprove.
Because Political Correctness includes a ``holistic
approach'' to blame, look for the Politically Correct to assign a
major portion of The Blame to greed, Harry and Louise, narrow
special interests, etc. If only the American people really
understood the Clinton Plan, they would have flocked to its
support, backing every title and subtitle, every section and
subsection, but they were blocked from forming an independent
judgment on the matter by the opponents of Reform.
There are other candidates for blame. John Motley, chief
lobbyist for the National Federation of Independent Business,
credits the Congressional Left; they torqued every variant of
legislation in a bureaucratic direction, making sure that the end
result would have been a government-run health-care system. Bill
Kristol, Chairman of the Project for a Republican Future, also
attributes the defeat of the Clinton Plan and its variants to a
classic case of Liberalism overreaching. The Clinton Plan was
the political equivalent of Liberalism's invasion of Russia; it
was bound to fail.
House Majority Leader Richard Gephardt has an even simpler
explanation: The Republicans did it. Ditto Ted Kennedy.
Ira Magaziner blames The Special Interests (not to be
confused with groups representing ``The Public Interest'' (AARP,
Families USA, the AFL-CIO, etc.), who frightened the public with
scare stories about bureaucracies and denial of choice of a
doctor. Ditto: Congressman Jim McDermott and Senator Paul
Dr. P. John Seward of the AMA thinks that ``complexity''
killed ``reform.'' Ditto Bob Dole.
Perhaps the most interesting view is that of Paul Ellwood
M.D., one of the champions of ``managed competition'' and the
leader of the Jackson Hole Group: ``Genuine health-care reform''
was killed in the White House, when the forces of ``pure managed
competition'' were overwhelmed by the Central Planners. Earlier
in the debate, Ellwood denounced the Task Force for issuing a
product that looked more like a reincarnation of Soviet central
Consider a better explanation of it all. The impressive
Clinton rhetoric about ``choice,'' ``competition,'' ``free
markets'' and ``simplicity'' into the system had nothing to do
with the actual language of the Clinton Proposal. Bizarre
attempts to paper over the unpleasantness of the regulatory
aspects of the Clinton Plan simply fueled public cynicism. As
David Broder of The Washington Post has noted, cynicism
in the electorate is ``epidemic'' these days. Notes Broder, ``If
the assumption is that nothing is on the level, nothing is what
it seems, then citizenship becomes a game for fools and there is
no point in trying to stay informed.''
The Blame Game will continue through the Congressional
elections and right on up into the next Congress. For the Sixties
Kids at the White House, searching for the Meaning of It All, the
source of difficulty rests with those who have insufficient
virtue: the Forces of Darkness. These include small business
and the Health Insurance Association of America, but also
grassroots organizations that have come out swinging against the
Clinton Plan. Indeed, Congressman Tom DeLay of Texas thinks that
the modifications to the Lobbying Disclosure Act, which would
have imposed all kinds of new registration and reporting
requirements on the leadership of grassroots organizations, were
a reaction to the effectiveness of their opposition to ``health-
Phase two of the Hundred Years War is now underway. The
Clinton Administration is trying to regroup after a tough defeat,
trying to figure out how to get the infrastructure of the Clinton
style plan in place under the even more difficult scenario of an
even less friendly Congress. Reviewing the documents released by
the Task Force under pressure from AAPS, Congressman Istook (R-
OK) noted that the Clinton White House had imagined one such
reform option in the form of ``KidCare,'' the basis for the
desperate effort by Senator Tom Harkin and others, to try to get
the foot in the door for the Clinton regulatory infrastructure.
The congressional Left is going back to the barricades.
Congressman Jim McDermott (D-WA) will push hard for a Canadian-
style single-payer plan (government monopsony) next session.
Meanwhile, the Left is trying to make it big in California with a
single-payer ballot initiative. A success in California will
have a tremendous impact on the fortunes of the Congressional
Left in Congress, even if the Democratic majority diminishes. A
failure in California, however, is going to be a serious setback.
Note that the Washington health care groupies, all of the gnomes
and wonks, are pouring bucks and resources into California in a
desperate attempt to resurrect socialized medicine.
Still No Consensus
While there is widespread agreement on the need to control
costs, reform medical liability, and do something about uninsured
people, there is no consensus either among the public or the
The Committee for a Responsible Federal Budget conducted a
series of citizen exercises, supported with a grant from the
Robert Wood Johnson Foundation, using a group of 500 citizens.
After all-day exercises in ``hard choices,'' the conclusion was
that 27 percent support a ``single payer''; 24 percent favor the
provisions of the ``Mainstream Coalition''; 22 percent favor
working to fix the current system; and 14 percent prefer to do
nothing. As the Committee points out, there isn't even basic
agreement on the issues, let alone solutions or financing
In the What do They Know and When Will They Ever Learn
Department, most Americans still do not have a clue about how
much their employer spends on medical benefits at the place of
work. And too many still think that somebody else is really
paying for their ``benefits.'' Another stunning survey of the
extent of public ignorance on the topic was produced by the
Employee Benefits Research Institute in August, 1994. Among the
EBRI findings: 28 percent of all people who get health insurance
through their employer think that they pay nothing (0 percent)
for their health benefits. When asked to identify how much the
employer contributes to their health benefits package, 50 percent
of all respondents said they didn't know. While many Americans
still do not understand that the employer's contribution to their
health benefits package is their money, not the employer's money,
economists-left, right and center-know that American households,
not employers, pay 100 percent of the cost of insurance and other
It's hard to sell a market-based, consumer-choice health
care alternative when huge numbers of Americans still do not even
get the basic economics right.
Ever Expanding Government Regulation
The Society of Professional Benefit Administrators reports
that 300 different government entities issue 1500 new
requirements every year for private insurance and private
employers health and pension plans. Only one third are
``adequately announced'' and of those, 1 percent have final
compliance guidance. Of course, if you are not in compliance, you
could be in trouble. What probably saves you is that the
bureaucrats probably can't-and simply don't-keep up with their
own rules and regulations.
Perhaps the first order of business in the next Congress, to
paraphrase Senator Moynihan, is to just stop this mess.