Insuring the Health Insurers

...In a CBS Reports documentary and in a 1970 book, I said: "The newest rage of the government health establishment is something represented by the mysterious initials HMO...

...History teaches that reform generally happens only when it becomes politically irresistible—that is, when voters are aroused enough to reward or punish legislators at the polls...

...The Clinton New Markets initiative, mainly the brainchild of Secretary of Housing and Urban Development Andrew Cuomo, would use government guaranteed loans and tax credits to lure private enterprise into blighted areas...

...That is to say, why don't we, on a specified day, count up how much frontloaded cash each candidate has collected and simply award the nomination to the top fond-raiser...

...The Constitution forbids expenditures except by law, but that apparently does not apply to tax expenditures...

...The notable exception to this sad litany was the Medicare and Medicaid legislation President Johnson succeeded in getting passed after a titanic struggle...

...While campaign funding reform bangs its head against the padded walls of soft money, something else has been happening...

...They stand for Health Maintenance Organization, a system of paying a fixed annual sum to a group of doctors to keep you well when they can and cure you when they can't...

...I am open to suggestions about what to do with Steve Forbes, who collects little but has much...

...A spokesman for Elizabeth Dole mourns, "If money is what it takes to win the nomination, I don't see anyone passing Bush...

...The idea of public-privatepartnership to promote investment in poverty-stricken areas is not new...

...As he prepared to submit the authorizing legislation, President Clinton said the Republicans should love the plan because it uses tax incentives to leverage private investment...

...Alexander, whistling a happy tune, says just wait for the Iowa straw polls in August, and then the money will flow...

...On the Democratic side, Bill Bradley has been raising more money than projected...

...It was promoted by former Vice Presidential candidate Jack Kemp, and was even considered by President Richard M. Nixon...

...Clintons Poverty Plan President Clinton's coast-to-coast tour of pockets of poverty in early July was reminiscent, in some respects, of a Senate committee poverty survey I covered in 1967 that included Robert F. Kennedy...

...Still not addressed are the 43 million Americans who have no coverage at all, and the Medicare patients who can no longer afford needed medicine...

...For example, on the Republican side when former Secretary of Education Lamar Alexander lays off four of his campaign staff, this is taken to mean he is short of money, and the shortage is interpreted as indicating that his candidacy is in trouble...

...That has worked in Congress with universal health care and it has worked with tobacco regulation...

...The insurance industry's media campaign is directed toward keeping public opinion from crystallizing against it...

...That stamps Bradley as "viable...

...The idea spread fast, and would have spread faster were it not for the bitter hostility of organized medicine, wedded to solo practice and fee for service...

...In a historic shift, the American Medical Association has voted to form a labor union to bargain collectively with managed care organizations on behalf of doctors...

...Helping to engineer the defeat was the health insurance industry...

...Senator John McCain of Arizona, on the other hand, because of his powerful committee positions, has been showered with money from political action committees...

...Money that doesn't come in may not look like money going out, but a tax expenditure is an expenditure...

...Governor George W Bush of Texas is way ahead in the Republican field, with S3 7.2 million as of June 30 according to Federal Election Commission records...

...Democrats say that now voter consciousness is increasing and health care may well be a hot-button issue in the year 2000 presidential election...

...A generation later, neither the doctor nor the consumer but the insurer is the ultimate decision maker...

...Since money, and especially early money, can buy the nomination, why don't we accept reality...

...On July 15, the day of the Senate vote, a group of HMOs abandoned another 327,000 Medicare beneficiaries...

...An early pioneer of prepaid group practice was industrialist Henry J. Kaiser...

...Unlike the current urban Empowerment Zones, whose number is limited, the New Markets Plan would be open-ended, and the projected revenue loss in 25 per cent tax credits has not been disclosed...

...This is simply unacceptable...

...The furious but sterile Senate debate, ending in a partisan vote for a Republican bill that is not expected to survive a Presidential veto, took up just one tiny part of a much larger health care crisis...

...Mortimer Caplin, the Internal Revenue Commissioner in President John E Kennedy's Administration, notes a Congressional report, not widely read, showing a revenue loss of $372 billion from the top 10 tax breaks last year...

...I have a special sense of chagrin about the evolution of the HMO from patient care to investor care, because I was present at the creation of this system intended to minimize financial incentive...

...Neither did a proposal made by President Jimmy Carter's Administration geared to lowincome people...

...In the Mississippi delta he went from hovel to rat-infested hovel, muttering, "This is unacceptable...

...The Clinton Administration is betting that its plan will appeal to liberals as a way of combating poverty and to conservatives for its reliance on the free market...

...Thus encouraged, President Bill Clinton's Administration produced a comprehensive health insurance scheme...

...A proposal advanced by President Lyndon B. Johnson's Administration for Medicare-like coverage of children— Kiddycare—did not get very far...

...The judgment runs against experience, but there is a first time for everything...

...It put on a $ 13 million media blitz featuring "Harry and Louise," a fictitious couple who thought "there must be a better way...

...Senate race, in large part by emphasizing the need for national health insurance...

...Lobbyists Boost McCain Campaign," headlines the Washington Post...

...A woman who fell 40 feet down an embankment was taken unconscious by a Medivac helicopter to the nearest hospital emergency room...

...In 1998, Meg Greenfield, the late editorial director of the Washington Post, described a "landscape teeming with demystified, antiheroic, ethically compromised leaders...

...This time the American Association of Health Plans, the Business Roundtable and other self-interest groups saturated the TV channels with $20 million worth of commercials featuring attractive individuals worried about regulation...

...A Historic Shift Looking back on the Senate debate, I remember North Dakota Democrat Byron Dorgan telling one of those managed care horror stories...

...So here is my modest proposal...

...Many of us have long worried abut the baneful effects of money in politics...

...For 50 years, since President Harry S. Truman first urged comprehensive health insurance, I have watched as initiatives to put the United States on a par with other industrialized countries in this critical area have blossomed and then withered under the resistance of the organized doctors, the hospitals and, more recently, the health care managers...

...Last year almost a hundred HMOs dropped out of Medicare because they found it unprofitable...

...A catastrophic illness insurance plan was adopted by Congress and signed by President Ronald Reagan in 1988, but it was repealed ina firestorm of protests over increased premiums...

...But black poverty, white poverty, Native American poverty, and Hispanic poverty remain with us...

...Fast forward to mid-July '99: The Clinton Administration and Congressional Democrats push a modest patients' bill of rights that would make health maintenance organizations liable to lawsuits in those horror story cases where death is a consequence of vital treatment having been denied...

...Campaign money has become not simply a wherewithal but an end in itself, a way of keeping score...

...Over the years, however, as insurance companies began to market HMOs, too many of them became more interested in profits than patients...

...It collapsed in 1994 without even a vote in Congress...

...The plan represents "New Democratic priorities in Republican clothing," says Robert Reischauer, a former Director of the Congressional Budget Office who is now at the Brookings Institution...

...With health care costs continuing to skyrocket, accountants rather than doctors were assigned the task of deciding what kinds of treatment patients could get...

...In my 1970 book, I said the trouble was that the doctor, not the consumer, was the ultimate decision maker, and the situation was leading to a crisis...

...If money is the mother's milk of politics, isn't it time to recognize a Political Mother's Day and forget about primary day...

...His bankroll was less than S8 million behind Vice President Al Gore's $19.5 million at the end of June...

...based on experience, I would not predict an early solution to this crisis...

...But the scorekeepers are not impressed...

...Tax incentives represent an almost invisible way of spending money, not to mention of eluding the appropriations process...

...This would obviate primaries, and maybe even conventions, which the public is getting bored with anyhow...

...But who is there to bargain for the patient...

...In 1938, seeking to lure workers to remote construction sites, he offered to look after their health for a nickel a day...

...The President is addressing it by advocating something called the "New MarketsPlan...

...Her health plan refused to pay because she had not gotten advance authorization...

...A Modest Proposal Since the Presidential election is only 15 months away and the campaign is already running at full throttle, let me offer —with apologies to Jonathan Swift—"A Modest Proposal...

...Former Vice President Dan Quayle, who is lagging, is bitter about Bush's "big sucking machine...