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WASHINGTON PERSPECTIVE
NEWS WASHINGTON PERSPECTIVE
Republicans’ swift health-legislation
moves
The antigovernment mood roars on in Congress, even when the government itself is the victim. Clinton’s latest recuperation in the political polls is in part attributed to Republican actions that he depicts as cruel to the elderly and poor. He says that the financial reductions that the Republicans seek are needlessly large for assuring the financial viability of federal health programmes. Their motive, he says, is a tax cut for the rich, and he promises vetoes of the health and tax bills.
Bill Clinton and his party-mates in from legislation adopted in 1988 to Congress talked about health-care improve standards of accuracy. And reform for 2 years, and in the end physicians would no longer be proaccomplished nothing. Post-mortems hibited from referring patients to outagreed that the languid pace enabled side medical facilities in which the opposition to mobilise and sow hold financial interests. : confusion. For the pharmaceutical lobby, one dissent and Lesson learned, the Republican majorities in sweetener would be repeal of a Congress are saying little, ignoring requirement for price discounts on the tradition of extensive public heardrugs for facilities serving lowings on major legislative proposals, income and AIDS patients. And, both and moving rapidly toward their the drug firms and the medicalDaniel S Greenberg health-reform goals: a massive reducdevice manufacturers would be tion in previously planned federal shielded against punitive damages in health spending over 7 years, higher law suits arising from Republicans woo AMA charges for patients, less regulation, approved by the Food and Drug After signalling that its support was waverand a lessened solicitude for care of Administration-even if, as oppothe needy. Coming out of various nents complain, approval was based ing, the American Medical Association now stands solidly behind the House House and Senate committees is a on faulty or deceptive testing. Medicare plan. AMA’s panoply of bills to produce radical Another change in the works would Republicans’ change-of-heart arose when it secured a changes in Medicare and Medicaid. raise the evidentiary standards for promise from House Speaker Newt GinBut the absence of the usual hearingestablishing financial fraud in the grich that the budget bill would not cut room marathons does not mean that Medicare programme, though the physician fees. House Republicans had the interested are going unheeded. federal government’s own investigainitially proposed a US$26 billion cut in Last week, as legislation moved tions indicate that health care for the payments to doctors-a move that AMA along under tight majority control, a elderly is riddled with rackets that and other physician groups claim would : have forced doctors to turn away public blessing was bestowed on thrive even after exposure. : health reform, Republican style, Given the raging concern for Medicare patients. The initial House plan would have significantly reduced the dolthe American Medical Association. frugality in health spending, the indiflar conversion factor that Medicare uses Purring could also be heard from two ference to these findings is puzzling. to determine how much a doctor is paid major industrial associations, the A recent report by the General for a service. The deal, struck on Oct 10 in Pharmaceutical Research and ManuAccounting Office, Congress’s own a closed-door session while two key House facturers of America and the Health investigative service, states: "Despite Medicare committees were readying the egregious cases of Medicare fraud, package for a floor vote this week, would Industry Manufacturers after both were assured that their however, corporate providers have bring the plan closer to the Senate’s. The Senate Finance Committee has been allowed to continue their pro- : heartfelt interests would receive legisvoted to cut$22-6 billion from projected lative recognition. : gram participation. In one of the : on physician services. According Though far diminished in power more significant health care fraud spending to AMA documents, Gingrich’s offer from the days when it squelched prosecutions to date, a clinical labowould cut the conversion factor to$35-42 Harry Truman’s plans for national ratory company acknowledged over from the current$36-10. But that figure health insurance, the AMA nonethe$100 million in fraud committed as "will gradually increase in each of the next less is so big, rich, and well-organised part of a nationwide scheme against seven years" as a result of less-thanthat its preferences command politiMedicare, Medicaid, and the Civilian projected volume growth. The CongresHealth and Medical Program of the sional Budget Office estimates that the cal attention. And it received a generous helping of favourable treatment Uniformed Services over a 4-year growth of physician services will grow by 2002. But from the Republican law period. The lab was allowed to nego- about 10% a year through will volume AMA physicians keep says leading an AMA spokesman to tiate a civil settlement including Ianat slightly more than half that rate, growth describe the legislative formula as guage that specifically permitted its thus enabling the conversion factor to : continued participation in all three increase "politically astute". (the higher the volume, the lower
they
products
by
Association,
writers,
Legislation
now
moving along programs".
would moderate planned reductions The seemingly inexplicable outin Medicare fees for physicians. Anticome of that episode is in large part trust laws would be modified to attributed by the GAO to lack of staff for enforcement and weak regulatory permit physicians and hospitals to establish health plans without meetpowers. The proposed legislative current for substaning requirements changes would greatly worsen the tial financial reserves to cover fraud problem, according to the unexpected demands for services. Inspector General in the Department of Health and Human Malpractice awards would be limited. Clinical laboratories in physicians’ which administers Medicare and the offices would be largely exempted federal side of Medicaid. No matter.
Services,
the conversion factor to meet expenditure goals). AMA is keeping quiet about how much of a financial win it got from Gingrich. Estimates have ranged from$300 million to$3 billion by 2002. Irrespective of the figure, AMA’s bold lobbying tactics are drawing condemnation from congressional Democrats, who staunchly oppose the House Republicans’ plan. House Democrats last week accused AMA of "selling out their patients". Janet Firshein
1089
Republicans’ swift health-legislation
moves
The antigovernment mood roars on in Congress, even when the government itself is the victim. Clinton’s latest recuperation in the political polls is in part attributed to Republican actions that he depicts as cruel to the elderly and poor. He says that the financial reductions that the Republicans seek are needlessly large for assuring the financial viability of federal health programmes. Their motive, he says, is a tax cut for the rich, and he promises vetoes of the health and tax bills.
Bill Clinton and his party-mates in from legislation adopted in 1988 to Congress talked about health-care improve standards of accuracy. And reform for 2 years, and in the end physicians would no longer be proaccomplished nothing. Post-mortems hibited from referring patients to outagreed that the languid pace enabled side medical facilities in which the opposition to mobilise and sow hold financial interests. : confusion. For the pharmaceutical lobby, one dissent and Lesson learned, the Republican majorities in sweetener would be repeal of a Congress are saying little, ignoring requirement for price discounts on the tradition of extensive public heardrugs for facilities serving lowings on major legislative proposals, income and AIDS patients. And, both and moving rapidly toward their the drug firms and the medicalDaniel S Greenberg health-reform goals: a massive reducdevice manufacturers would be tion in previously planned federal shielded against punitive damages in health spending over 7 years, higher law suits arising from Republicans woo AMA charges for patients, less regulation, approved by the Food and Drug After signalling that its support was waverand a lessened solicitude for care of Administration-even if, as oppothe needy. Coming out of various nents complain, approval was based ing, the American Medical Association now stands solidly behind the House House and Senate committees is a on faulty or deceptive testing. Medicare plan. AMA’s panoply of bills to produce radical Another change in the works would Republicans’ change-of-heart arose when it secured a changes in Medicare and Medicaid. raise the evidentiary standards for promise from House Speaker Newt GinBut the absence of the usual hearingestablishing financial fraud in the grich that the budget bill would not cut room marathons does not mean that Medicare programme, though the physician fees. House Republicans had the interested are going unheeded. federal government’s own investigainitially proposed a US$26 billion cut in Last week, as legislation moved tions indicate that health care for the payments to doctors-a move that AMA along under tight majority control, a elderly is riddled with rackets that and other physician groups claim would : have forced doctors to turn away public blessing was bestowed on thrive even after exposure. : health reform, Republican style, Given the raging concern for Medicare patients. The initial House plan would have significantly reduced the dolthe American Medical Association. frugality in health spending, the indiflar conversion factor that Medicare uses Purring could also be heard from two ference to these findings is puzzling. to determine how much a doctor is paid major industrial associations, the A recent report by the General for a service. The deal, struck on Oct 10 in Pharmaceutical Research and ManuAccounting Office, Congress’s own a closed-door session while two key House facturers of America and the Health investigative service, states: "Despite Medicare committees were readying the egregious cases of Medicare fraud, package for a floor vote this week, would Industry Manufacturers after both were assured that their however, corporate providers have bring the plan closer to the Senate’s. The Senate Finance Committee has been allowed to continue their pro- : heartfelt interests would receive legisvoted to cut$22-6 billion from projected lative recognition. : gram participation. In one of the : on physician services. According Though far diminished in power more significant health care fraud spending to AMA documents, Gingrich’s offer from the days when it squelched prosecutions to date, a clinical labowould cut the conversion factor to$35-42 Harry Truman’s plans for national ratory company acknowledged over from the current$36-10. But that figure health insurance, the AMA nonethe$100 million in fraud committed as "will gradually increase in each of the next less is so big, rich, and well-organised part of a nationwide scheme against seven years" as a result of less-thanthat its preferences command politiMedicare, Medicaid, and the Civilian projected volume growth. The CongresHealth and Medical Program of the sional Budget Office estimates that the cal attention. And it received a generous helping of favourable treatment Uniformed Services over a 4-year growth of physician services will grow by 2002. But from the Republican law period. The lab was allowed to nego- about 10% a year through will volume AMA physicians keep says leading an AMA spokesman to tiate a civil settlement including Ianat slightly more than half that rate, growth describe the legislative formula as guage that specifically permitted its thus enabling the conversion factor to : continued participation in all three increase "politically astute". (the higher the volume, the lower
they
products
by
Association,
writers,
Legislation
now
moving along programs".
would moderate planned reductions The seemingly inexplicable outin Medicare fees for physicians. Anticome of that episode is in large part trust laws would be modified to attributed by the GAO to lack of staff for enforcement and weak regulatory permit physicians and hospitals to establish health plans without meetpowers. The proposed legislative current for substaning requirements changes would greatly worsen the tial financial reserves to cover fraud problem, according to the unexpected demands for services. Inspector General in the Department of Health and Human Malpractice awards would be limited. Clinical laboratories in physicians’ which administers Medicare and the offices would be largely exempted federal side of Medicaid. No matter.
Services,
the conversion factor to meet expenditure goals). AMA is keeping quiet about how much of a financial win it got from Gingrich. Estimates have ranged from$300 million to$3 billion by 2002. Irrespective of the figure, AMA’s bold lobbying tactics are drawing condemnation from congressional Democrats, who staunchly oppose the House Republicans’ plan. House Democrats last week accused AMA of "selling out their patients". Janet Firshein
1089