In post-Katrina New Orleans, there is a
crying need for the medical care of a proposed new world-class teaching
hospital. In our region, such a hospital in tandem with the nearby new
Veterans Administration facility would lay the foundation for a biochemical
corridor, the most potent economic engine this metro area has seen in
For LouisianaStateUniversity and TulaneUniversity,
the new hospital is key to the future of their
respective medical schools. LSU and Tulane, we are confident, want the venture
Last week, both
universities seemed on the verge of ratifying a memorandum of understanding
as to the governance of the new hospital. Today that's no longer true.
Despite the powerful arguments for a unified step forward, we are at an impasse.
unfortunately, seems to view the question of how the hospital will be
governed as a control issue: that's why it rejected a state-brokered deal
approved by Tulane that would have created a mostly independent board for the
nonprofit corporation that will run the hospital.
The LSU board's
rejection of that proposal Monday is disappointing. The document offers a
reasonable deal. It follows the model of independent control that's been
successful at premiere teaching hospitals affiliated with universities
elsewhere in the country. And those top-notch teaching hospitals are the real
competitors for this new venture.
The deal also
gives LSU far more control than any other entity -- four of the board's 12
seats, including the chairmanship, compared to one slot each for Tulane and
Xavier universities and a rotating slot for other New Orleans schools. The five remaining
seats would be filled by the state.
offered by LSU -- an 11-member board with five LSU slots -- is a fundamental
shift away from independent oversight. That's worrisome.
LSU's board should
reconvene and reconsider its position. Its focus should be on what's best for
the hospital and the community it will serve, not on a power struggle between
LSU and Tulane. Louisiana is still trying to
get a fair share of money from FEMA for the damage Katrina caused at CharityHospital. This kind of squabbling
within the state can't possibly help that effort or persuade the Obama
administration that we have our act together.
impasse threatens the future of the project. That should worry everyone. New Orleans needs a replacement for CharityHospital,
but we need more than just a hospital that's better than its predecessor.
This facility is key to ambitions to build a
thriving biomedical corridor that can compete with those in Birmingham
And obviously, a teaching hospital is also vital to both LSU and Tulane's
argue that they need control because the school will own and operate the
hospital and would be financially responsible for its bond debt, the $400
million that the nonprofit corporation will have to borrow to build the
But that's simply
not the case. The nonprofit will be a separate entity. LSU's own attorney
said the university system may not be legally liable. Rather, he
characterized it as a "moral and practical obligation if LSU ever
intends to issue bonds again."
The truth is, all parties involved have a huge stake in the success of
this hospital. The state, the city and all the universities who will use it
as a teaching facility want and need it to succeed. Moreover, language in the
proposed agreement commits all parties to doing what's best for the hospital.
BATON ROUGE -- The
state Legislature enters the final day of a tumultuous two-month session
Thursday with the biggest item on its agenda -- the state budget -- still
The House and
Senate were still trying to craft an agreement late Wednesday on several
must-pass spending bills that would complement the $28 billion operating
budget sent to Gov. Bobby Jindal earlier this month
for the 2009-10 fiscal year. The additional spending would add money back for
health care, education and other programs that otherwise would face deep cuts
as the state struggles to tighten its belt in response to a
$1.3 billion revenue drop.
The budget bills
are not the only unfinished business as time expires for a session that was
supposed to focus on fiscal matters but has strayed into a host of other
policy areas. Among dozens of bills awaiting final approval are measures that
would regulate school-based dentistry clinics, give public colleges more
freedom in setting tuition, study the downsizing of
government and provide tax breaks to a number of targeted industries.
The waning hours
of a session also are the traditional time for political sleight-of-hand,
when bills presumed dead suddenly find new life through a timely amendment
added on in a House-Senate conference committee.
One bill that could get resurrected is
House Bill 830 by Speaker Jim Tucker, R-Algiers, which would create an
independent governing board to run the proposed teaching hospital in lower
Mid-City. The bill has languished in the Senate for weeks while LouisianaState and Tulane universities tried to
decide the governing structure through a memorandum of understanding. After
LSU's board rejected a draft memorandum this week, Tucker said he might try
to resolve the issue through last-minute legislation.
Back and forth
But it is the
budget that has produced the most serious philosophical divide between the
chambers, with senators pushing for far more spending than the House and the
Late Wednesday, Jindal used his line-item veto authority to cut more than
550 spending items from the main budget bill, House Bill 1 by Rep. Jim Fannin, D-Jonesboro, because they were tied to the
passage of other legislation that failed.
The vetoes were
not unexpected -- Jindal announced most of them
last week -- but they underscored the urgency of passing the supplemental
spending bills that would add back some of the money.
Leaders in both
bodies expressed confidence that by the 6 p.m. adjournment deadline a budget
deal would emerge, which would determine how much spending will be added for
health care, higher education and "member amendments" that steer
money to legislators' pet projects.
"We are very
optimistic that we will have something we can present at some point tomorrow, " Senate Finance Committee Chairman Mike Michot, R-Lafayette, said Wednesday.
Tucker said the
biggest remaining difference is how much money to take from the rainy-day
fund, and how much money will be used to defray cuts to higher education. The
House -- backed by Jindal -- wants to use $86
million from the account, while the Senate is proposing to spend $204
The House is
reluctant to spend more out of the rainy-day account because it could
budget woes in future years, when federal stimulus money disappears and the
state's share of Medicaid costs is expected to increase.
But senators have
argued that the fund was designed for exactly the type of financial pinch the
education, Jindal has proposed restoring at least
$70 million of the $219 million in proposed cuts, which would bring the total
reduction in state support to less than 10 percent. But Michot
said the Senate would like to restore at least $100 million.
bills still being resolved include:
-- House Bill 881
by Rep. Jim Fannin, D-Jonesboro, a supplemental
appropriations bill that passed the Senate earlier this week with $274
million in additional spending, which is far more than the House
is willing to accept.
-- House Bill 802,
also by Fannin, a companion bill to the
supplemental spending bill that takes money from several state funds.
Concurrent Resolution 236, by Fannin, which
authorizes the tapping of the rainy-day account, formally known as the Budget
-- House Bill 720
by Rep. Jane Smith, R-Bossier City, which could generate as much as $175
million by setting up an amnesty program for tax scofflaws. Some of the money
would be used to replenish the rainy-day fund.
--House Bill 2 by
Rep. Hunter Greene, R-Baton Rouge, the $5.3 billion capital construction
budget that includes almost $800 million in state surplus dollars, of which
$85 million would go to renovate the Superdome -- the final piece of a deal
to keep the Saints in New Orleans.
House and Senate
leaders enter the final day of the legislative session today without a
resolution on the state budget.
chambers said they are close to an agreement on the remaining issues: how to
distribute money from the state’s “rainy day” fund and other sources for
higher education, health care and lawmakers’ projects.
The dispute over
the state budget slowed Senate President Joel ChaissonII’s progress through the Senate chamber Wednesday.
lawmakers stopped him every few feet to get a status report on the
negotiations between the House and the Senate.
progress,” Chaisson, D-Destrehan, said repeatedly.
On the other side
of the State Capitol, House Speaker Jim Tucker said an agreement is likely to
come down to the wire.
must wrap up its work by 6 p.m. today.
“I’m not worried
about getting out of here without a budget,” said Tucker, R-Terrytown.
Gov. Bobby Jindal got House Bill 1, the main budget legislation,
earlier in the session and acted upon it Wednesday.
As expected, Jindal vetoed spending that the Senate tied to delaying
an income tax break, tapping the state’s “rainy day” fund — formally known as
the budget stabilization fund — and draining a dormant insurance fund.
“We informed House
leaders that we would veto everything in the bill contingent upon funding
from the Insure Louisiana Incentive Program Fund, from the Budget
Stabilization fund, and from delaying planned tax relief,” the governor wrote
in his veto letter.
The vetoes chop
spending on higher education, health care, the arts, agriculture and
trying to use other legislation to minimize budget cuts and carve out
spending for projects in their districts.
Jindal also stripped funding for endowed
professorships, university library acquisitions, and high school students.
“I have vetoed
these items to give the Legislature the opportunity to work with the higher
education community,” he wrote in his veto message.
The House and the
Senate are at odds on how to reduce cuts to higher education, health care and
other state services in the $28 billion state budget for the fiscal year that
starts July 1.
The Senate wants
to take $204 million from the state’s “rainy day” fund and generate $118
million by delaying an income tax break.
The House soundly
spurned the tax cut delay proposal but agreed to take $86 million from the
“rainy day” fund.
With the tax cut
delay all but certainly dead, the focus is on the $775 million “rainy day”
fund, which was set up to tide the state over during a budget deficit.
The state is
facing a $1.3 billion drop in revenue in the upcoming fiscal year. The
economic downturn is expected to continue for several years.
Tucker said the
House is being more fiscally prudent than the Senate by holding to the $86
leadership wants state government to tighten its belt. The argument is that
higher education and other state services are bloated.
Tucker said the
House does want to set aside $30 million for projects in legislators’
districts. The projects — often derided as slush funds — include roads,
community organizations and museums.
Chaisson said he wants to chop in half the $219
million in cuts that Jindal proposed for public
colleges and universities.
He said he will
agree to legislators’ projects if the cuts to higher education and health
care are significantly reduced.
“We still have a
number of issues to resolve,” Chaisson said.
Those issues are
largely being discussed behind closed doors except when one chamber nixes the
other chamber’s budget solution.
For example, the
House Wednesday rejected the Senate’s attempt to withdraw $204 million from
the state’s “rainy day” fund.
The Senate amended
House Concurrent Resolution 236 to withdraw $204 million instead of the $86
million that the House favors.
State Rep. Jim Fannin, D-Jonesboro and chairman of the House
Appropriations Committee, urged the House to reject
the Senate’s amendment.
He said lawmakers
need to be careful about how much money they withdraw from the “rainy day”
fund because the fund will be needed again in two years when the federal
stimulus dollars are gone.
stimulus package accounts for about $1 billion in the proposed budget for the
State Rep. Sam
Jones, D-Franklin, urged the House to embrace the Senate’s changes.
“This is your best
chance to fund the universities … You will not get this opportunity again,”
The House refused
the Senate’s changes with 57 voting to reject them and 43 voting to accept
tosses the resolution to a conference committee in which a handful of
lawmakers from each chamber will work out a compromise.
State Sen. Mike Michot, R-Lafayette and chairman of the Senate Finance
Committee, assured lawmakers that a compromise will be struck.
“We are optimistic
that we will have something that we can present,” he said.
BATON ROUGE, LA
(AP) - A final decision by Louisiana lawmakers on how deeply to cut public
colleges, health services and other state programs next year was expected to
come Thursday, in the waning hours of the legislative session.
"I feel like
we'll have an agreement. We don't have it worked out yet, but we're close,
close," said House Appropriations Committee Chairman Jim Fannin, D-Jonesboro.
The divide between
House and Senate leaders over how to craft the final touches of the $28
billion budget for the fiscal year that begins next week has grown smaller.
But the chambers remained split Wednesday on how much to add back into the
spending plan and where to add it.
session must end Thursday by 6 p.m.
Many of the session's other major issues have been wrapped up. The
largest outstanding matters all were financial: the 2009-10 budget, surplus
spending plans, the state's deal with to keep the New Orleans Saints in Louisiana and the
package of tax breaks lawmakers will pass, which will have to be reconciled
with the budget plans.
The budget bills
were all tied up in legislative compromise committees, and the negotiations
Wednesday were all behind closed doors.
working diligently. Everybody has the goal of doing it on time and getting to
a fair and reasonable compromise, and that's what we're working
towards," said Senate President Joel Chaisson,
What both the
House and Senate agree on is using $86 million from the state's "rainy
day" fund for the upcoming budget year and $74 million from an expired
insurance grant fund to restore dollars to next year's budget and stave off
proposed delaying a tax break to generate more dollars for higher education,
but the House rejected that idea. The House initially refused any use of the
rainy day fund but reversed course and backed a limited use of the fund amid
pressure from the Senate.
and health care, the outcome of the negotiations will determine the extent of
cuts to state parks, tourism and arts programs and agriculture services next
year. Also being negotiated is the fate of the pet projects lawmakers want
funded in their local districts.
However the final
deal is crafted, next year's budget will be smaller than this year's because
of a $1.3 billion drop in state general fund revenue next year.
behind-the-scenes negotiations continued, Gov. Bobby Jindal
issued his line-item vetoes Wednesday to the budget bill already sent to his
office by lawmakers.
As promised, Jindal stripped out any money tied to the tax break delay
that won't pass and other items connected to the ongoing debate about the
rainy day fund and insurance dollars. He also removed a few projects added by
lawmakers. The bulk of the bill was left in tact.
BATON ROUGE --
Rep. Herbert Dixon is trying to head off a move that could lead to
downgrading the amount of services at Huey P. Long Medical Center in
Dixon, D-Alexandria, got unanimous House
approval Wednesday of a resolution calling for help in his effort. He said
the hospital provides crucial services in Central
Louisiana, and many people depend on it as a full-service
facility, not a clinic.
"the Louisiana State University Board of Supervisors, the governor, the
Louisiana Legislature and the Police Jury Association of Louisiana to take
the appropriate steps necessary to keep the Huey P. Long Medical Center in
Pineville open and viable in the state of Louisiana."
Re: "Jindal agrees to $80 million more in spending," Page
1, June 23.
antiquated, ineffective and costly service systems for citizens with
developmental disabilities are the program of choice -- and therefore funding
-- instead of best-practice, effective and cost-efficient programs.
It is beyond any
reasonable person's comprehension why "Health officials' . . . top
priorities are to provide more money for private group homes" that are
mini-institutions, as opposed to investing our tax dollars (both state and
federal) into restoring cuts to home and community-based services for the
elderly and those with developmental disabilities.
there is a surplus in the Medicaid program, which I find ironic if Gov. Bobby
Jindal is cutting home and community-based service
provider rates, those funds should be used to restore cuts to these programs
and fund additional waiver slots. In this way, our citizens with
developmental disabilities can truly exercise their rights to life, liberty
and the pursuit of happiness in their community of choice instead of being
sent to state institutions.
I urge all
advocates for people with disabilities to contact the governor and their
legislators and demand the constitutional rights of people with disabilities
be reflected in the budget by restoring cuts and funding more slots for home
and community-based services.
Will Louisiana's most
vulnerable citizens be forgotten once again?
development of Medicaid programs and services, citizens with disabilities
received home- and community-based services. Louisiana moved forward. At least, so it
appeared. The support and services allow people to live in their communities
and spend their days in meaningful and safe ways.
What has taken
years to establish may abruptly be set back with the governor's feared veto
of the restoration of the funding reductions included in the state budget.
my services" is the plea of the 150 people with developmental
disabilities and special needs served by the Arc of St. Charles, Inc. in Boutte. What would their alternatives be if the
reimbursement rates were drastically reduced to the providers of services?
Don't we all want to live, work and learn in our communities?
I urge our
legislators to approach Gov. Jindal and provide a
voice for these citizens -- children and adults with intellectual and related
disabilities and their families.
I invite all
readers of The Times-Picayune as their fellow citizens to join in our effort.
Please provide a voice for someone -- a neighbor, friend, relative or even a
stranger you have seen on the street -- who needs and benefits from these
Over the last 40
years I have seen the delivery of medical care decrease as costs have
I began working in
public hospitals — I worked in a private hospital for a short time — and the
difference between the two was a window into what was to become of our
In the public
hospital, the focus was on the care of the patient. In the private hospital,
the focus was on the bottom line.
We were required
to account for every item used on each patient — even something as
insignificant as a Band-Aid.
Imagine the time
involved in accounting for each individual item used on each patient. Where
does that time come from? You guessed it. The patient suffers because the
company insists there be an accounting and charge for all patient usage.
Not only is
patient care by nurses and doctors affected, but also costs increase because
of the need for increased support staff to provide and file paperwork.
This is what has
happened to all health care over the last 40 years. Requirements of
for-profit insurance companies have resulted in hospitals and doctors'
offices altering their primary goal of patient care to one of making ends
meet. They have been forced to increase employees to deal with insurance
companies that deny claims whenever they believe they can get away with
Some claim the
present talk of universal health care is about socializing medicine. No one
has suggested that the government take over the health-care industry. This is
subterfuge of the insurance industry.
contrary, reformers want to get the insurance industry out of health care and
allow citizens to obtain the care they deserve without the waste built into
the for-profit insurance industry.
Health care is a
necessity, not a for-profit industry.
WASHINGTON — With lawmakers trying to crunch the
numbers on a $1 trillion health care overhaul, President Barack Obama is
leaving the door open to a new tax on employer-provided health care benefits.
said Wednesday the benefits tax could be essential for the complex plan to be
"I don't want
to prejudge what they're doing," Obama said, referring to proposals in
the Senate to tax workers who get expensive insurance policies. Obama, who
campaigned against the tax when he ran for president, drew a quick rebuff
from organized labor.
For Obama, the
health care debate got personal during an ABC News town hall at the White
House on Wednesday. The prime-time program was the latest in a string of
events designed to build public support for his plan to slow the rise in
health care costs and expand coverage to the nearly 50 million uninsured.
Dr. Orrin Devinsky, a neurologist at the New YorkUniversityLangoneMedicalCenter,
challenged Obama: What if the president's wife and daughters got sick? Would
Obama promise that they would get only the services allowed under a new
government insurance plan he's proposing?
If "it's my
family member, if it's my wife, if it's my children, if it's my grandmother,
I always want them to get the very best care," Obama said.
Earlier in the
day, the administration and its allies pushed for a prominent display of
progress in the Senate before Congress begins a weeklong vacation Friday.
Committee Chairman Max Baucus, D-Mont., labored in a series of meetings to
produce at least an outline of legislation that could command bipartisan
support. Of the five House and Senate committees working on a health care
overhaul, Finance is the only one that appears to have a chance at such an
especially eager to show progress before the exodus from the Capitol begins.
said he was negotiating with representatives of the nation's hospitals,
hoping to conclude an agreement that would build on an $80 billion weekend
deal with the pharmaceutical industry.
being asked to accept a reduction of roughly $155 billion over the next decade
in fees they are promised under government programs such as Medicare and
Medicaid, according to numerous officials.
Officials at the
American Hospital Association and the Federation of American Hospitals said
they could not comment on any discussions.
Baucus is seeking
similar concessions from nursing homes, insurance companies, medical device
makers and possibly others, noting that any legislation would create a huge
new pool of customers for industry providers.
At its heart, any
legislation is expected to require insurance companies to offer coverage to
any applicant, without exclusions or higher premiums for pre-existing medical
has said he hopes to hold the size of any legislation to $1 trillion or less,
and in private negotiations there were discussions about further scaling back
eligibility for insurance subsidies from the government.
Baucus was still searching for ways to cover the cost of his emerging
legislation, and numerous officials said he appeared roughly $200 billion shy
of achieving that goal. They added that a proposal to make it harder for
taxpayers to itemize their medical expenses was drawing renewed interest
among key senators as one way to raise revenue.
Current law allows
those expenses to be itemized when they exceed 7.5 percent of adjusted gross
income. The proposal under review would raise that
to 10 percent, officials said.
At the White
House, Obama sidestepped when asked if he was open to taxing health care
benefits, a proposal he opposed vigorously in the campaign for the White
identified the ways that I think we should finance this. I think Congress
should adopt them. I'm going to wait and see what ideas ultimately they come
up with," he said on ABC's "Good Morning America."
weighed in quickly.
Gerald W. McEntee, president of the 1.6 million-member American
Federation of State, County and Municipal Employees, said in an interview
that union leaders believe Obama is "a person of his word." He was
referring to Obama's opposition to taxing those benefits during last year's
going to tolerate that," McEntee said of
workers' views of that proposal.
Washington — For any medical schools that haven’t
finished their ethics homework, a Republican senator is handing out an extra
Medical Student Association and the Pew Prescription Project last week announced
the results of their annual survey on conflict-of-interest rules, giving 45
of 149 medical schools a grade of A or B for their policies governing
pharmaceutical-industry interactions with their faculty members and students.
But 23 schools
contacted for the survey didn’t reply, and Sen. Charles E. Grassley of Iowa, the top
Republican on the Senate Finance Committee, is now going after them. Mr.
Grassley wrote today to the 23 schools, saying he wants them to provide his
office, by July 15, with the same information on their ethics policies that
they did not provide to the American Medical Student Association.
those ties would help to build confidence that there’s nothing to hide,” the
senator said in a written statement.
Officials at some
of the schools listed by the student association as not cooperating have
already said, however, that it was apparently just a misunderstanding.
“It was like a
homework assignment we never got,” Michael L. Good, interim dean of the
College of Medicine at the University of Florida, told The Gainesville Sun.
“But it’s not like we’ve been ignoring the subject,” Dr. Good said, noting
that the medical school has a longstanding policy on potential conflicts of
interest that just went through an update.
In addition to the
University of Florida, the schools cited by Mr. Grassley are the Arizona
College of Osteopathic Medicine, Edward Via Virginia College of Osteopathic
Medicine, Medical College of Georgia School of Medicine, Northeastern Ohio
University College of Medicine, Philadelphia College of Osteopathic Medicine,
Rocky Vista University College of Osteopathic Medicine, Tulane University
School of Medicine, University of Nevada School of Medicine, Albany Medical
College, Chicago College of Osteopathic Medicine, Dartmouth Medical School,
Howard University College of Medicine, Lake Erie College of Osteopathic
Medicine, Louisiana State University School of Medicine-New Orleans, Meharry Medical College, Morehouse School of Medicine,
New York College of Osteopathic Medicine of the New York Institute of
Technology, Ponce School of Medicine, San Juan Bautista School Of Medicine,
State University of New York at Buffalo School of Medicine, University of
Medicine and Dentistry of New Jersey-New Jersey Medical School, and
University of South Carolina School of Medicine.
A large trial of
implantable devices, called cardiac resynchronization therapy, that regulates
heart rhythms in patients who have had heart attacks, showed a substantial
decrease in deaths and reoccurring heart attacks compared to traditional
implantable pacemakers.A large trial of implantable
devices, called cardiac resynchronization therapy, that regulates heart
rhythms in patients who have had heart attacks, showed a substantial decrease
in deaths and reoccurring heart attacks compared to traditional implantable
The findings of
the study showed a 29% decrease in heart failure and mortality risk in
patients who received an implanted cardiac resynchronization therapy device
with defibrillator (CRT-D) compared to patients who received only an implanted
The study, which
was led by Arthur Moss, MD, of the University of Rochester Medical Center in
Rochester, N.Y., Listed 1,800 patients with class I/II heart failure, an
ejection fraction less than 30% and prolonged intraventricular
conduction (QRS duration of 130 ms or longer).
The company stated
approximately 70 percent of all U.S. heart failure patients have
the class I or class II type. It approximated that 5.5 million people in the U.S.
have heart failure, in which the heart can’t adequately pump blood to the
rest of the body.
happens when the muscles of the heart weaken and the ventricles are unable to
coordinate properly, or synchronize, lowering the ability of the organ to
move blood through the body. In the most serious cases, patients can get so
weak that they are bedridden, or endure a assortment of symptoms, for example
shortness of breath, buildup of fluids in the lungs and other organs,
confusion and fatigue. Patients with mild heart failure typically have few or
no symptoms, but both groups have an equally high risk of atrial
fibrillation (erratic heartbeats) or death.
Senators struggled Wednesday with the possibility that in offering subsidized
health insurance to millions of individuals and families, they could
inadvertently speed the erosion of employer-provided coverage, which they
want to preserve.
Senator Max Baucus,
Democrat of Montana, who is leading efforts to write health legislation, said
“much of the discussion” focused on this issue at meetings of senators on
And, in the
evening, in an indication of how the administration is going all out to sell
the need for a new health care system, President Obama participated in a town
meeting-style gathering televised by ABC News from the White House.
As part of an
ambitious plan to overhaul the health care system, Democrats in both houses
of Congress want to require people to carry insurance. They would offer
subsidies to low- and moderate-income people who buy coverage through a new
regulated market known as a health insurance exchange. Employers who do not
provide coverage might have to pay penalties or contribute to a government
are more effective in preventing the erosion of employer-sponsored coverage,
the bedrock of insurance for more than 150 million Americans, the
Congressional Budget Office told lawmakers.
are less likely to provide health insurance than larger businesses. So any
penalty for not providing insurance could affect them more than other
Lincoln, Democrat of Arkansas, said preserving employer-sponsored insurance
“needs to be a huge objective.”
Conrad, Democrat of North Dakota, said Congress faced “a very complicated
calculus” in devising the new requirements.
“Even with an
individual mandate,” Mr. Conrad said, “if there is not some requirement for
employers, you will see a drifting of people to the insurance exchange and to
government subsidies. That will increase the cost.”
Mr. Baucus, the
chairman of the Finance Committee, said senators were investigating “the
ramifications and implications” of requiring employers to provide or pay for
coverage, the so-called play-or-pay requirement. Mr. Baucus said he and other
senators wanted to minimize the chance that employees “may be enticed to
leave their firms in order to get health insurance in the exchange.”
The budget office
said: “The availability of subsidized coverage in the new insurance exchange
would be an attractive option for many lower-income workers. As a result,
some employers would decide not to offer their employees health insurance
coverage, opting instead to provide other forms of compensation.”
In a letter to
Congress three weeks ago, President Obama said small businesses “should be
exempted” from any employer mandate. Whether Congress will go along is
“We will give
assistance to small business through tax credits,” Mr. Baucus said Wednesday.
When asked about
an exemption for small businesses, Mr. Baucus said: “We talked about it. But
how much sense does that really make?”
A bill drafted by
House Democratic leaders says, “There will be an exemption for certain small
businesses,” but gives no details.
generally oppose the play-or-pay requirement. They object, in particular, to
the House Democrats’ bill, under which most employers would have to provide
coverage or pay a fee equivalent to 8 percent of their payroll.
The United States
Chamber of Commerce and the National Federation of Independent Business,
which represents small employers, said the proposed requirement amounted to a
new tax and would frustrate the creation of jobs.
At the televised
session on Wednesday evening, Mr. Obama took questions from a panel of
doctors and patients, saying the varying plans in Congress were coming
“We have to have
the courage and the willingness to cooperate and compromise in order to make
this happen,” Mr. Obama said. “And if we do, it’s not going to be a
completely smooth ride. There’s going to be times over the next several months
where we think health care is dead, it’s not going to happen. But if we keep
our eye on the prize, then I’m absolutely convinced that we can get it done
Mr. Obama also
left the door open to a new tax on health care benefits. He said he did not
want to “prejudge” what efforts were being made to reach a compromise,
including proposals in the Senate to tax workers who get expensive insurance
policies. He opposed the tax as a presidential candidate.
As a society, we
trust doctors to be more concerned with the pulse of their patients than the
pulse of commerce. Yet the American Medical Association is using that trust
to try to block a robust public insurance option as part of health reform.
In fact the A.M.A.
now represents only 19 percent of practicing physicians (that’s my
calculation, which the A.M.A. neither confirms nor contests). Its membership
has declined in part because of its embarrassing historical record: the
A.M.A. supported segregation, opposed President Harry Truman’s plans for
national health insurance, backed tobacco, denounced Medicare and opposed
President Bill Clinton’s health reform plan.
So I hope
President Obama tunes out the A.M.A. and reaches out instead to somebody to
whom he’s turned often for medical advice. That’s Dr. David Scheiner, a Chicago
internist who was Mr. Obama’s doctor for more than two decades, until he
moved into the White House this year.
been on the wrong side of things,” Dr. Scheiner
told me, speaking of the A.M.A. “They may be protecting their interests, but
they’re not protecting the interests of the American public.
“In the past,
physicians have risked their lives to take care of patients. The patient’s
health was the bottom line, not the checkbook. Today, it’s just immoral
what’s going on. It’s abominable, all these people without health care.”
Dr. Scheiner, 70, favors the public insurance option and
would love to go further and see Medicare for all. He greatly admires Mr.
Obama but worries that his health reforms won’t go far enough.
Dr. J. James Rohack, the president of the A.M.A., insisted to me that
his group is committed to making health insurance accessible for all
Americans, and that its paramount concern is patient health.
“When you don’t
have health insurance, you live sicker and you die younger,” he said. “And
that’s not something we’re proud of as Americans.”
He added that the
A.M.A. is not necessarily opposed to a public option, and I have the
impression that it might accept a pallid one built on co-ops. Dr. Rohack wouldn’t repudiate his association’s letter to the
Senate Finance Committee warning against a new public plan. That letter
declared: “The introduction of a new public plan threatens to restrict
patient choice by driving out private insurers.”
I don’t mind the
A.M.A. lobbying on behalf of doctors in the many areas where physicians and
patients have common interests. The association is dead right, for example,
in calling for curbs on lawsuits, which raise medical costs for everyone.
An excellent study
published in 2006 in The New England Journal of Medicine found that for every
dollar paid in compensation as a result of lawsuits against doctors, 54 cents
goes to legal and administrative costs.
That’s an absurd
waste of money. Moreover, aggressive law leads to defensive medicine, in the
form of extra medical tests that waste everybody’s money. Tort reform should
be a part of health reform.
Yet when the
A.M.A. uses its lobbying muscle to oppose major health reform — yet again! — that feels like a betrayal. Doctors work hard to keep us
healthy when we’re in their offices, and that’s why they win our trust and
admiration — yet the A.M.A.’s lobbying has
sometimes undermined the health of the very patients whom the doctors have
sworn to uphold.
I might expect the
American Association of Used Car Dealers to focus exclusively on
wallet-fattening, but we expect better of physicians.
In fairness, most
physicians expect better as well, which is why the A.M.A. is on the decline.
“It’s what has led
to the decline of the A.M.A. over the last half century,” said Dr. David Himmelstein, a Massachusetts
physician who also teaches at HarvardMedicalSchool.
“At this point only one in five practicing doctors are in the A.M.A., and
even among its members about half disagree with its policies.” To back that
last point, Dr. Himmelstein pointed to surveys
showing a surprising number of A.M.A. members who support a single-payer
For his part, Dr. Himmelstein co-founded Physicians for a National Health
Program, which now has more than 16,000 members. The far larger AmericanCollege of Physicians, which is
composed of internists and is the second-largest organization of doctors, is
also open to a single-payer system and a public insurance option. It also
quite rightly calls for emphasizing primary care.
Medical Student Association has issued a sharp statement disagreeing with the
association declared that it "not only supports but insists upon a
public health insurance option."
Look, a public
option is no panacea, and it won’t automatically set right the many
shortcomings in our health system. But if that option is killed in gestation, then we’re back to Square 1 and there’s
little hope of progress in solving the vast challenges confronting us.
Obama, don’t listen to the A.M.A. on this issue. Instead, for starters, call
WASHINGTON (AP) —
Congressional investigators said Wednesday that two-thirds of the nation’s
health insurance industry used a faulty database that overcharged patients
for seeing doctors outside their insurance network, costing them billions of
dollars in inflated bills.
database was operated by Ingenix, a subsidiary of
the health insurer UnitedHealth Group, which agreed in January to pay $350
million to settle allegations that it deliberately kept rates low to underpay
doctors, driving up expenses for patients.
admitted no wrongdoing in its handling of Ingenix,
though it agreed to close the database and help pay for a new one operated by
a nonprofit group.
by Senator John D. Rockefeller IV, Democrat of West Virginia, shows that
nearly 20 regional and national insurers also used Ingenix
investigation by the New York attorney
general, Andrew M. Cuomo, previously focused on the use of Ingenix data by only a handful of top insurers, including
and Cigna. About a dozen insurers, including UnitedHealth, have reached
settlements with Mr. Cuomo.
More than 100
million Americans have plans that allow them to see doctors who are not part
of their insurance network. For more than a decade, insurers submitted data
to Ingenix to determine the typical cost for care
received in such visits.
investigators say companies would deliberately skew data to underestimate the
costs of medical services, leaving patients to pay more in out-of-pocket
“The result of
this practice is that American consumers have paid billions of dollars for
health care services that their insurance companies should have paid,”
according to the report of the Senate Commerce Committee’s investigative