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Big changes in health care could be coming to the Baton Rouge area. Under
a proposed plan, Our Lady of the Lake would
expand to become LSU's teaching hospital and Earl K. Long would close. News
2's Chris Nakamoto gets answers on how the changes
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Lombardi tells LSU system to finalize cuts
Business Report | 06.12.09
LSU System President John Lombardi today issued orders for
LSU's academic, health care and research institutions to finalize
preparations for steep cuts in spending, effective July 1. Delivering the bad
news today to chancellors, administrators and chief financial officers via
conference call, Lombardi says action now is necessary in order "to
specifically address job cuts and program eliminations in a transparent,
orderly and responsible way.”
In April, LSU's 11 institutions proposed preliminary plans
for $102 million in potential budget cuts -- part of more than $219 million
in overall reductions for higher education -- to help balance the state's
$1.7 billion budget shortfall.
Gov. Bobby Jindal's pledge to
limit higher education cuts to 10% of state funding is appreciated but still
isn't enough for the LSU System to avoid "major reductions" in the
current fiscal year and the prospect of further reductions in coming years,
The budget cuts will entail the elimination of hundreds of
jobs, losing academic programs and the realignment of academic units. Also,
4% merit raises have been suspended throughout the system and the furlough of
non-academic employees without contracts is a possibility, he says.
"We have to be accountable and effective in acting
responsibly for today and the future even if the overall budget cut is reduced,"
Lombardi says. "These cuts are real, and we must begin now to address
the consequences for our students, employees and other commitments to the
state of Louisiana."
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By Naomi King
— The son of a former state lawmaker, Norbert “Norby”
Chabert, announced his candidacy for the open state
senate seat that covers most of Terrebonne and Lafourche parishes.
The seat is being vacated by Reggie Dupre,
who is resigning to head up the Terrebonne Conservation and Levee District. Dupre’s resignation is effective at month’s end to
coincide with the conclusion of the ongoing legislative session.
The election for state Senate District 20 is set for Aug.
1 with a runoff, if necessary, scheduled for Aug. 29. Qualifying is set for
There are 39,289 Terrebonne residents and 28,760 Lafourche
residents registered to vote in the district.
33, is the son of Leonard J. Chabert and brother to
Marty Chabert, who each held the senate seat Norby is seeking. He grew up
along Bayou Little Caillou and supports continued
operations at the state-owned charity hospital that bears his father’s name.
“My father used to say, ‘It doesn’t matter if you’re poor
and you’re sick, you’re still sick and someone needs to take care of you,’ “ Norby Chabert
said. Leonard Chabert died in 1991.
said he wants to continue the work his father started.
“It is essential that we elect someone who will keep
fighting for the funding that is needed to take care of the people of this
region,” he said. “No one will fight harder than I will to protect Chabert
Though running as a Democrat, Norby
has worked with and behalf of both major parties.
He worked with Republicans Hunt Downer, a former state
representative, and Billy Tauzin, a former congressman. He also worked with
the state Democratic Party and served as an aide to U.S. Sen. Mary Landrieu,
So far, state Rep. Damon Baldone,
D-Houma, is the only other candidate to formally announce his candidacy.
Others who’ve expressed interest include Republican
Wallace Ellender of Bourg, a sugar-cane farmer
defeated by Baldone during last year’s House
District 53 race; Terrebonne Parish Councilman Clayton Voisin,
in his third and final term on the council; and former Lafourche Parish
Councilman Brent Callais.
Chabert resigned in May from his
job as associate director for marketing at his alma mater, Nicholls State
University in Thibodaux. State ethics laws prohibit him
from holding a position at the state-run university while running for office.
Chabert owns Chabert
Development, a Chauvin-based real-estate company.
But campaign organizers said Chabert’s
bid for office is his primary focus right now.
“I offer my service to an office that I hold in the
highest regard,” Chabert states in his
announcement. “I pledge to be accountable to you, the citizens of Terrebonne
and Lafourche parishes.
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Research led by Ashok Aiyar,
PhD, Associate Professor of Microbiology at LSU Health Sciences Center New
Orleans, showing that a single gene can control growth in cancers related to
the Epstein-Barr virus and that existing therapeutics can inactivate it, will
be published in the June 12, 2009 online issue of PLoS
The Epstein-Barr virus (EBV) is closely associated with
many human cancers such as Burkitt's lymphoma,
Hodgkin's lymphoma, AIDS-related lymphomas, post-transplant lymphoproliferative disease, cancers of the nose and
throat, and stomach cancer. In many of these malignancies, proteins made by
EBV are necessary for tumor cells to grow indiscriminately. This is
especially true of AIDS-related lymphomas and post-transplant lymphoproliferative disease, which are serious
complications of AIDS and transplant surgery. These cancers are responsible
for thousands of deaths each year in the United States.
The LSUHSC research team, which also includes Kenneth
Johnston, PhD, Professor of Microbiology, and Timothy Foster, PhD, Assistant
Professor of Microbiology and faculty of the LSUHSC Gene Therapy Program,
investigated a small region of a certain Epstein-Barr virus protein called
EBNA1, to determine the role it plays in the activation of the EBV genes
responsible for the indiscriminate growth of tumor cells in these cancers.
Their research shows that EBNA1 is controlled by oxidative stress (pathologic
changes in response to excessive levels of free radicals) within the
EBV-infected cells. Varying levels of oxidative stress change EBNA1's ability
to activate EBV genes responsible for indiscriminate tumor cell growth.
"We have shown that in vitro, existing therapeutics
such as Vitamin K that can change oxidative stress within cells, inactivate
EBNA1," notes Dr. Aiyar, who is also a member
of the faculty of the LSUHSC Stanley S. Scott Cancer Center. "As a
consequence, EBV genes required for proliferation are no longer expressed,
and malignantly transformed cells stop proliferating."
The research was funded by grants from the National Cancer
Institute, the Louisiana Cancer Research Consortium, and the Department of
Microbiology, Immunology, and Parasitology at LSU
Health Sciences Center New Orleans School of Medicine.
"It is our hope that this research will lead to new
ways of controlling EBV-associated diseases in humans," concludes Dr. Aiyar.
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RUSTY COSTANZA / THE TIMES-PICAYUNE
Ken Muneoka, a professor of
cell and molecular biology at Tulane, is leading a team that will study limb
regeneration in the axolotl, or Mexican salamander.
If a salamander can grow back a severed limb, why not a
With $6.25 million in new research support from the U.S.
Department of Defense, a Tulane
professor hopes to answer the question.
Ken Muneoka, a professor of cell
and molecular biology at Tulane, is leading a team -- including biologists
from the University of Kentucky and the University
of California at Irvine -- that will study limb regeneration
in the axolotl, or Mexican salamander. The research group will compare genes
of the salamander to the genes of a mouse, which serves as a model for humans
because of their similar genetic traits.
"What we want to do is a detailed analysis of
regeneration in mice for comparison to regeneration in axolotl," Muneoka said. "At the same time, we're looking
closely at what goes on when you don't regenerate" and instead find a
wound left by a missing limb and ultimately covered over with scar tissue,
the professor said. In the latter, common scenario, he said, the team hopes
to "deduce what is missing and what (genetic makeup) correlates with a
The axolotl has a complex limb repair process in which the
cells form a structure called blastema that enables
regeneration. When the limb of a mouse or human is amputated, the wound
healing process forms scar tissue and doesn't form blastema,
thereby preventing regeneration of limb cells. However, Mexican salamanders,
humans and mice share a cell called a fibroblast that, in the case of the
salamanders, allows for growth of new body parts.
And that fuels a belief among researchers that human limb
regeneration might be possible.
"The grant allows us to do something that wasn't
really possible before," said Stephen Randal Voss, associate professor
of biology at the University
"Until now, we haven't had the resources or the funding to identify the
genes in the salamander genome, and we really need to have that information
before we can build a model of molecular regeneration."
The grant was provided as a result of the Department of
Defense's Multidisciplinary University Research Initiative, following a
national competition. In a prepared statement, representatives of MURI said
medical advances that allow the option of cell regeneration are important to
burn victims as well as amputees. Any positive research findings "would
have a huge impact, not only on returning wounded warriors, but on society as
a whole," MURI said.
David Gardiner, a professor of developmental and cell
biology at UC Irvine, said the research meshes with ongoing efforts by the
military to tend to the needs of returning troops with severe wounds.
But Muneoka, who has studied
limb regeneration issues for nearly three decades, and his colleagues agree
that the search for answers could take several years.
Even though the salamander is the only animal capable of
regenerating lost appendages, including limbs, the spinal cord and the jaw,
children and mice can grow back the tip of a severed finger.
As far-fetched as it may sound for an adult human to grow
back an entire arm or leg, Muneoka believes that
goal isn't beyond reach.
"I think we are getting to a place where the study
emerges from fantasy to real reasoning, where it can produce results,"
he said. "And I think that is worth a shot."
Tulane will employ 10 researchers and lab technicians to
work with Muneoka during the next five years. The
project is set to begin within the next month.
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By MICHELLE MILLHOLLON
Advocate Capitol News Bureau
State funding for higher education, small towns, road
improvements and senior citizen programs is ensnared in a political struggle
between the Louisiana House and the state Senate.
The spending is built into House Bill 1, the $28.7 billion
state budget legislation, based on contingencies. Whether the House will
agree to the Senate’s revenue-generating plan is one of many issues in a
roiling battle over the budget.
Added up, about $280 million is at stake, including money
to reduce budget cuts to agriculture, the arts and the state’s public
colleges and universities.
In order for the funding to materialize, the House would
have to agree to the Senate’s proposal to delay a tax break and tap into the
state’s “rainy day” fund — both unlikely scenarios.
The House agreed to the Senate’s version of the budget
bill Thursday. But the approval was far from an endorsement of the Senate’s
The contingencies that the state Senate put in the budget
hinge on legislation the House is likely to let die, making their inclusion
in the budget meaningless.
The House’s actions infuriated many in the Senate who
expected the House to reject the Senate’s changes and force the two chambers
to work out a compromise.
Instead, the House one-upped the Senate by approving it
without a revison.
“There’s certainly a lot of very
pitched emotion or feelings between the House and the Senate and that has
obviously played out and come to the surface,” said Jim Brandt, president of
the Public Affairs Research Council.
The budget now goes to Gov. Bobby Jindal.
Should little change between now and June 25, the last day of the session,
the state’s budget would include deep cuts for higher education and health
The efforts of both chambers to lessen the impact of the
budget cuts would be negated, assuming the House does as its
members have promised and refuse to approve the contingency sources of
funding the Senate wants.
House members are promising to fashion a solution,
especially to help higher education. Time is short. The session ends in less
than two weeks.
Barry Erwin, president of the Council for A Better
Louisiana, said the House left itself with few options other than to put
together a piecemeal solution.
He said tempers flared between the House and the Senate,
resulting in a budget that fails to give higher education the time to make
strategic cuts in the face of financial challenges that are expected to
linger several years.
“I’m stunned by the fact that they would want to limit
their options to such a great degree with only two weeks left,” Erwin said.
State revenue is expected to drop by more than $1.3
billion in the fiscal year that starts July 1. Like the rest of the nation, Louisiana is feeling
the pinch of the recession.
State Sen. Lydia Jackson said colleges and universities
need time to prepare for a leaner, more-efficient system.
D-Shreveport, said she sponsored the tax break delay legislation to allow
higher education to make prudent decisions about downsizing.
“Slash-and-burn politics is not going to get us quality in
our (higher education) institutions,” she said.
Other legislators feel that colleges and universities need
to face reality and rein in spending.
“They need to become efficient, to look at which
universities have duplicate programs and start making adjustments,” said
state Rep. Eddie Lambert, R-Prairieville and vice chairman of the House
Lambert said the House is willing to reduce the higher
education cuts to somewhere between about $100 million and $120 million.
Jindal proposed an operating
budget that would have cut state funding to higher education by 15 percent,
or about $219 million.
Prodded by four of the five living governors who served
before him, Jindal last week promised to keep
higher educations cuts below 10 percent. His predecessors told him that
anything more would set back the state.
“What we need is leadership,” said former Gov. Buddy
Roemer, who spearheaded the effort. “There are no easy answers.”
The House wants to use $50 million in proceeds from a
proposed tax amnesty program to lessen the cuts to higher education. Where
the rest of the money would come from is unclear.
Jackson and the Senate suggested generating $118 million
for colleges by delaying an income tax break. That suggestion proved
unpopular with the governor, and House Speaker Jim Tucker, R-Terrytown, said the legislation itself is
A Senate resolution to tap into the state’s rainy day fund
also is stalled. The fund, formally known as the Budget Stabilization Fund,
was set up to tide the state over during a budget deficit.
Also included in the budget is more than $25 million for
projects in legislators’ districts. The projects include community
organizations, museums and purchases such as a fire truck for a small town.
The Senate tied those projects to the tax break delay,
saying the funding could not go forward unless the delay occurred.
The funding for the projects, however, comes from a
dormant insurance fund.
said the Senate did not want to make the statement that local projects are
more important than health care and higher education.
She said she is waiting to see if the governor uses his
line-item-veto power to free up the projects by removing the conditional
language tying them to the tax break delay.
“The public will have to decide whose priorities are
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The most recent statewide study revealed the rate of
uninsured adults, aged 19 to 65, is 21.2 percent.
This translates into almost 720,000 adults with no health insurance living
and working in Louisiana.
The Calcasieu Community Clinic, located in the Nursing Building
on the McNeese
campus, was established by a group of concerned physicians to address the
needs of the growing population of low-income, working uninsured persons in Southwest Louisiana. Their goal was to provide free,
quality healthcare to persons who helped themselves, but were unable to
provide for their own health needs. The first Clinic was held in February of
Almost eight years later, with an unduplicated patient
base of over 2100 persons, the Community Clinic has provided close to $3
million in total medical services to the community. Every Thursday evening
during clinic hours, volunteer physicians and nurses provide on site health
care while volunteer pharmacists staff the Clinic pharmacy to dispense the
medications prescribed. Patients are referred out for lab tests, mammograms,
or specialized services not available at the clinic. This is done at no
charge to the patient.
Seventy-eight percent of the clinic’s population is
female. Many of these women have never received mammogram services prior to
their treatment at the Clinic. In 2002 the staff at the Clinic began a
Mammogram Screening Program which was initially funded with grants. The
Clinic now holds an OB/GYN clinic once each quarter, and to date they have
provided over $30,000 in mammogram screenings. In addition to mammogram
screenings, diagnostic tests and ultrasounds are being made available in an
effort to ensure our patients are given the best health care that the Clinic
can provide. Pap tests from OB/GYN patients are referred to local labs for
All of the patients receive free medications from the
Clinic’s state approved pharmacy located inside. While many of the
medications prescribed must be purchased, the clinic receives donations of
medication from physician’s offices and nursing homes. The Clinic also subscribe
to patient assistance programs offered through various pharmaceutical
The Calcasieu Community Clinic is financially dependent on
the community it serves. McNeese State
University has provided
a facility, free of charge, since the Clinic’s inception in 2000. The local
Medical Society has remained steadfast in their support, and in addition to
private donations and grants, the Clinic is supported by the United Way of Southwest Louisiana.
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by Bill Barrow, The Times-Picayune
BATON ROUGE -- Adding a new layer of policy and political
intrigue to the ebbing legislative session, Senate President Joel Chaisson II has invoked a rare procedural move to delay
delivery of the budget to Gov. Bobby Jindal,
effectively ensuring that lawmakers cannot consider overriding any
gubernatorial vetoes of spending items.
The tactic, which pits Chaisson
against House Speaker Jim Tucker, intensifies House-Senate tensions as the
two chambers continue to haggle over cuts to higher education and health care
while trying to find money for legislators' favored projects.
It also raises questions about how leverage is distributed
among the various players, including Jindal, as the
session nears a conclusion.
Chaisson, D-Destrehan, said
Saturday that he was holding the $28.7 billion budget until today, the
maximum three days allowed after the House, in a surprise maneuver of its own,
ratified the Senate version of the spending plan Thursday.
The lower chamber voted with the assumption that the
budget would go to Jindal in time to require that
any line-item vetoes be made before the session's final adjournment June 25.
Lawmakers now must consider the remaining money bills -- which are tied to
the larger spending plan -- without knowing what the bottom line will be
after Jindal's review of the budget, or which of
their pet projects he has preserved.
"I wanted to think about it and make an informed
decision," Chaisson deadpanned about his
strategic use of presiding officers' typically ceremonial role in signing
bills before they are sent to the governor. "Why? Is there an
A Jindal spokesman said the
governor's staff is not working this weekend and does not expect to receive
the budget until Monday, 10 days before the session's final gavel.
State law gives the governor 12 days, when the Legislature
is in session, to return veto messages. If that deadline comes before the
session ends, it gives lawmakers a chance to override any vetoes and, in this
case, would offer more context for considering other
pieces of the fiscal puzzle.
The Legislature still has the option of calling a
veto-override session in the summer if both chambers agree, but lawmakers
have not taken that option since Louisiana's
current constitution was ratified in 1974, and it would represent a marked
departure for the House to buck Jindal.
A frustrated Tucker and an unapologetic Chaisson, who both assumed their leadership roles last year with Jindal's
blessing, offered different interpretations of how the gamesmanship played
The speaker said the two leaders met Wednesday with their
respective chambers' budget chairmen and top staffers to discuss differences
between the two chambers' spending plans for the fiscal year that begins July
The House version added money for higher education, health
care and legislative earmarks from an insurance incentive fund and a proposed
tax-amnesty program. Senators restored even more money for those areas, but
made it contingent on approval of separate bills, which Tucker promises will
not pass, to postpone a scheduled income tax break and tap the state's
"rainy day" savings account.
Chaisson wanted to push the
budget to a conference committee representing both chambers while angling
continued on the other measures.
Tucker and House budget Chairman Jim Fannin
essentially called the Senate's bluff by gathering 69 votes to move the bill
to Jindal's desk. They told House members the
remainder of the budget picture, including Jindal's
promise to ease higher education cuts, can be settled in spending bills yet
"You would think the speaker would have asked whether
I planned to sign the bill," Chaisson said of
their discussions before the House vote.
Tucker said he had not decided at that time about the
strategy of concurring in the Senate bill.
Efforts to reach Fannin,
D-Jonesboro, and Senate budget Chairman Mike Michot,
R-Lafayette, were not successful.
Chaisson said he later
"communicated that (a delay) might be a possibility," but Tucker
said he has not talked directly with the Senate president since the House
Of Jindal and his aides'
involvement in his latest move, Chaisson said,
"I think they are pretty much on the sidelines."
The Senate president broke with the administration and
House earlier this session when he announced his support for freezing income
tax deductions as a way to shore up higher education. And he has blistered
House members -- not including Tucker -- for signing a pledge to oppose that
bill before it even cleared the Senate.
Sen. Robert Adley, R-Benton,
said he and several other senators urged Chaisson
to get the budget to Jindal quickly. Adley said Jindal's power is
unnecessarily enhanced by delaying the opportunity to override vetoes until
after final adjournment.
Chaisson disagreed. "I
think the Senate has all the leverage. The bills that would fix the
budget," including those that Fannin and Tucker
touted to their members, "solidly rest within the purview of the
Senate," he said.
Those measures would have to go back to the House before
reaching Jindal, but senators could delay returning
them to the lower chamber until the final hours of the session, too late for
a conference committee compromise.
Tucker said any leverage Chaisson
may believe he has secured for the freeze on income tax deductions is
illusory. "I'm telling you right now that raising new revenue is not an
option," Tucker said.
He declined to discuss House-Senate relations or his
professional relationship with Chaisson, saying he
wants to avoid a session "meltdown."
Chaisson is scheduled to present
two budget-policy bills Monday before the House Appropriations Committee.
"It ought to be interesting," he said.
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Louisiana's former governors do an intervention
with Bobby Jindal
by Jarvis DeBerry, Columnist,
To hear Louisiana
officials complain about needing more industry even as they slash the budget
for higher education is like hearing a guy who's desperate for a date vow to
reduce his spending on toothpaste.
Just like an attractive woman has options beyond a dude
with halitosis, an industry looking to build or expand has no reason to
pursue a relationship with a state that can't be bothered to make itself presentable.
Bill Haber / The Associated PressFormer
Louisiana Gov. Buddy Roemer, center, addresses a news conference at the state
Capitol in Baton Rouge
Thursday. Roemer is joined by, from left, former Gov. Kathleen Blanco,
current Gov. Bobby Jindal, and former Govs. Mike
Foster and Dave Treen in talking about the
importance of finding ways to lessen cuts to higher education in the state
However, this entire session of the Louisiana Legislature
has pitted those who comprehend the value of a strong network of public
colleges against those who maintain a philosophical opposition to all taxes.
To the rigid anti-tax crowd, which unfortunately has included Gov. Bobby Jindal, spending on higher education is still spending.
And spending is inherently wasteful. The word "investment" is not
in their lexicon.
Not that Louisiana
has properly positioned itself to avoid these battles. With a state Constitution
that protects spending levels on just about everything else, higher education
and health care are among the few places the budget can be slashed when hard
times befall us. However, lawmakers have suggested additional taxes on
cigarettes to help protect the state's health-care budget and the
postponement of a scheduled income-tax break to protect the state's colleges.
No dice, Jindal said, to both ideas.
Lower taxes, apparently, are preferable to both a
healthier population and a smarter one, a strange position to hold for a
governor who once ran the state's Department of Health and Hospitals and was
later president of the University
of Louisiana System.
Jindal's stubbornness earned him
a Thursday visit from every former Louisiana
governor who is not in prison: David Treen, Buddy
Roemer, Mike Foster and Kathleen Blanco. The four came together in defense of
the state's higher education system after Jindal
seemed so determined to sacrifice the state's colleges to maintain his
ideological purity by thoughtlessly slashing their budgets by 15 percent.
After the governors emerged from their meeting, Treen said cutting the money to colleges "would be
devastating in my opinion."
"The worst this budget can do is gut
our colleges and universities," Roemer said, "foreclosing us to a
system of mediocrity."
Blanco challenged Jindal's idea
has "got to do more with less," saying, "You cannot do more
with less. That's an impossible task. You do less with less, and that drives
us to mediocrity."
Foster, who first hired Jindal
for the DHH position, masterfully spoke as if Jindal
was not in opposition to his predecessors, but in lockstep with them.
"I'm glad the governor agrees with us" that higher education is
important, he said.
Jindal said he'd been convinced
to cut the higher education budget by no more than 10 percent,
that he believes higher education is important for economic
development and quality of life and that Louisiana can't advance without a strong
He should show us he means that. As Roemer put it,
"Lead, governor. We are prepared to follow."
Leadership, however, requires making tough choices.
Heretofore, Jindal has shown the tendency to be
more dogmatic than pragmatic, to hold fast to a position no matter the
circumstances, no matter the consequences.
If he does what he told his predecessors he'd do -- cut no
more than 10 percent from the state's higher education budget -- the state's
colleges will still feel some pain, but not as much as it could have been. At
the same time, Jindal will have demonstrated that
he has "a persuadable mind," a compliment bestowed upon former
Supreme Court Justice Sandra Day O'Connor.
And he'll have made his state more attractive to outside
industry than an unyielding no-tax philosophy ever could. He'll have shown
that when Louisiana
says it wants outside attention, it doesn't skimp on those things that make
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by Jan Moller, The
BATON ROUGE -- It is a lean budget year in state
government, with health care and higher education programs trying to stave
off deep cuts as lawmakers grapple with a $1.3 billion drop in revenue.
But that has not stopped legislators from earmarking money
for the Natchitoches Christmas Festival. Or the Bunny Friend Neighborhood
Association, the New Orleans Oral School, the Northeast Louisiana Children's
Museum and the village of Dry Prong.
Major state and regional projects
The projects -- and hundreds like them -- all are financed
in the $28.7 billion budget bill sent to Gov. Bobby Jindal
on Thursday. It is an annual rite of spring in Baton Rouge, jealously guarded by
legislators who see it as a key part of their job to bring money back home to
The earmarks survive despite annual criticism from
government watchdogs and attempts by Jindal and
others to add accountability and transparency to the process.
"It's almost business as usual, despite the toughest
budget cycle in decades and the huge unmet needs in health care and higher
education, " said Jim Brandt, president of the nonpartisan Public
Affairs Research Council, which has long been a critic of earmarks.
"Some of these projects no doubt are extremely
worthwhile . . . but the way they are funded is a problem, particularly given
the state's dire need for operating capital."
$28 million in projects
The projects total at least $28 million and include
earmarks for "nongovernmental organizations, " as well as cash
grants to hundreds of towns, villages, parishes, councils on aging and
similar local needs.
This year, however, the money could be in jeopardy, as the
Senate added language to the budget bill that ties the "member
amendments" to passage of other bills, including a controversial measure
to postpone an income-tax break that stands little chance of passing. That
means the earmarks might not get financed.
But House Speaker Jim Tucker, R-Algiers, said lawmakers
are already looking for other spending bills they can use for the earmarks in
case they do not stay in House Bill 1.
"The money is there. It's just a matter of which
vehicle does the appropriating, " Tucker said.
Rep. Jim Fannin, D-Jonesboro,
who is chairman of the budget-writing House Appropriations Committee and
whose amendments include $150,000 for the Louisiana Political Hall of Fame in
Winnfield, said the earmarks meet critical needs in rural areas, where local
municipalities do not have the political clout of larger urban areas.
"Those of us in the rural areas don't have strong
chambers (of commerce) to go down and lobby for money, "
Fannin said. "We're the only
representation. Rural areas contribute a lot to this state in severance tax,
and at the same time we don't have any other way to bring it back."
Fannin admitted the process
still functions like a spoils system, where members of the "money
committees" get to control which amendments are added. Legislators who
do not sit on the budget panels are forced to curry favor with their members.
New rules in effect
Under rules adopted last year, any nongovernmental
organization applying for a state earmark must fill out a detailed request
form, available for inspection on the Legislature's Web site, describing what
the organization does, who is in charge and how the money will be spent.
Jindal, meanwhile, has informed
legislators that any nongovernmental organization earmarks must also have a
statewide or regional impact, must have been presented or openly discussed
during the session and must be a priority of a state agency.
Using those guidelines, Jindal
last year struck 258 projects totaling $16 million from the spending bill.
But that still left more than $30 million in earmarks -- only slightly more
than what is in next year's budget.
In addition to nonprofit groups, millions more gets
steered to local governments, such as $300,000 to St. Charles Parish for land
purchase for a boat launch on U.S. 90, or the $25,000 earmarked for the city
with no details of how the money is supposed to be used.
Fannin said he has urged members
to be careful about their amendments to avoid getting a veto.
"House members, I think, were very aware of what
happened last year and wanted to work within the criteria and the guidelines
to make sure they were not vetoed and were able to help the folks back home, " Fannin said.
Brandt said a better approach would be to set up a grant
or loan program for local governments that would use objective criteria to
decide which infrastructure projects get financed. Similarly, he said,
nongovernmental organizations could be financed through a competitive grants
process that would leave it open to all nonprofits, not just those with an
influential friend on a money committee.
"There is a little bit more transparency this year,
which is fine, but the system itself has not changed,
" Brandt said.
[BACK TO TOP]
The Associated Press
(AP) — WASHINGTON -
President Barack Obama continues to promote his health care proposals, urging
doctors gathered in Chicago
to support wider insurance coverage and targeted federal spending cuts.
Obama planned to tell the American Medical Association's
annual meeting in his hometown on Monday that overhaul cannot wait and that
bringing down costs is the most important thing he can do to ensure the
country's long-term fiscal health, a senior administration official said.
The official spoke on the condition of anonymity to
discuss the president's remarks before they were delivered.
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doctors, like many other groups, are divided over the president's proposals
to reshape the health care delivery system.
About 50 million Americans are without health insurance.
The government provides coverage for the poor and elderly, but most Americans
rely on private insurance, usually received through their employers. However,
not all employers provide insurance and not everyone can afford to buy
coverage for themselves or pay medical bills out of pocket.
The White House anticipates heavy spending to cover
uninsured Americans and has taken steps in recent days to outline just where
that money could be found.
For instance, Obama wants to cut federal payments to
hospitals by about $200 billion and cut $313 billion from Medicare and
Medicaid, the government health programs for the elderly and poor. He also is
proposing a $635 billion "down payment" in tax increases and spending
cuts in the health care system.
To an audience of doctors Obama plans to say the United States
spends too much on health care and gets too little in return. He says the
health industry is crushing businesses and families and is leading to
millions of Americans losing coverage, the administration official said.
Obama's turn before the 250,000-physician group in his
latest effort to persuade skeptics that his goal to provide health care to
all Americans is worth the $1 trillion pricetag it
is expected to run during its first decade.
The president plans to acknowledge the costs, but also
will tell the doctors it is not acceptable to a nation that leaves so many
without insurance, the official said.
Unified Republicans and some fiscally conservative
Democrats in Congress have signaled they are nervous about how the
administration plans to pay for Obama's ideas.
Obama has been speaking privately with lawmakers about his
ideas and publicly with audiences, such as a town hall-style meeting last
week in Green Bay, Wisconsin,
in the Midwest. Obama and his administration
officials have blanketed the nation in support of his broad ideas, and Vice
President Joe Biden on Sunday said it's up to Congress to pin down the
details on how to pay for them.
"They're either going to have to agree with us, come
up with an alternative or we're not going to have health care," Biden
said on NBC television.
"And we're going to get health care."
the president's remarks are likely to focus on how his ideas might affect the
His proposed cuts in federal payments would hit hospitals
more directly than doctors, but physicians will be affected by virtually
every change that Congress eventually agrees to. Many medical professionals
are not yet convinced Obama's overhaul is the best for their care or their
Broadly, the AMA supports a health care
"reform"-a term that changes its definition based on who is
speaking-although the specifics remain unclear.
In a statement welcoming Obama, AMA president Dr. Nancy
Nielsen said the medical profession wants to "reduce unnecessary costs
by focusing on quality improvements, such as developing best practices for
care and improving medication reconciliation."
She also said doctors need greater protection from malpractice
lawsuits and antitrust restrictions.
Many congressional Republicans, insurance groups and
others oppose Obama's bid for a government-run health insurance program that
would compete with private companies. On Sunday, Senate Republican leader Mitch
McConnell described a government plan as a "nonstarter."
"There are a whole lot of other things we can agree
to do on a bipartisan basis that will dramatically improve our system,"
To that end, lawmakers were considering a possible compromise
that involved a cooperative program that would enjoy taxpayer support without
direct governmental control. The concessions could be the smoothest way to
deliver the bipartisan health care legislation the administration seeks by
its self-imposed August deadline, officials said.
"There is no one-size-fits-all idea," Health and
Human Services Secretary Kathleen Sebelius said
Sunday on cable network CNN.
"The president has said, 'These are the kinds of
goals I'm after: lowering costs, covering all Americans, higher-quality
care.' And around those goals, there are lots of ways to get there."
Momentum might be on Obama's side. Aaron Carroll, an Indiana University
medical professor who has surveyed doctors' views on U.S. health care delivery, said
59 percent "favor government legislation to establish national health
insurance," an increase over a previous poll's finding.
He noted that many doctors are not AMA members, and
therefore the association's views should not be overrated.
[BACK TO TOP]
By JANET ADAMY and JONATHAN D. ROCKOFF
Hospitals and other medical-industry groups are pushing
back against President Barack Obama's proposal to cut $313 billion in
government health spending as the White House intensifies its effort to
revamp the nation's health system.
Mr. Obama will seek to build doctors' support for a health
overhaul in a speech Monday to the influential American Medical Association
He will make the case for controlling costs and expanding coverage, and he
plans to detail more of what he wants to see in a government-run plan that
would compete with private insurance companies, an administration official
Mr. Obama is pressing Congress to pass legislation to
overhaul the country's health-care system by October. His plan would expand
insurance coverage to the nation's 46 million uninsured, an effort estimated
to cost at least $1 trillion over a decade.
Under pressure to amplify its payment plan, the White
House on Saturday outlined $313 billion in additional spending cuts over that
period to health-care providers paid through Medicare and Medicaid, the
federal health programs for the elderly and poor. That would bring total cost
savings and tax increases identified by the Obama administration to help pay
for the overhaul to nearly $950 billion.
The sharp response from the hospital industry, which under
the proposal faces reductions in subsidies exceeding $100 billion over 10
years, illustrates the administration's challenge in winning the deep concessions
from industry needed to pay for the overhaul. After agreeing in May to
contribute to a $2 trillion reduction in health spending over 10 years, the
hospital industry is now bristling at the prospect of more givebacks -- this
time, cuts that would be set in law.
"We're certainly disappointed," said Rich Umbdenstock, chief executive of the American Hospital
Association, an industry group. "It will be very, very difficult for
hospitals to live with cuts of that magnitude." He said what concerns
the group is that the cuts were being laid out before lawmakers have agreed
on concrete proposals for reducing the number of uninsured.
A spokeswoman for the White House Office of Health Reform
said that as more Americans get insurance coverage, the need for the
government to subsidize hospitals for covering the uninsured will decline.
The pharmaceutical industry recently has been negotiating
with the White House and Congress over how much it would contribute to the
cuts, said several people familiar with the negotiations. Drug companies were
initially asked to contribute $100 billion over the next decade, but pressed
for their contribution to be closer to $60 billion, they said. The industry
argued that giving up too much in payments would cut into spending to develop
"Otherwise we might all just become generic drug
companies," said one industry official familiar with the talks. The
White House on Saturday said it would save $75 billion over 10 years by
paying better prices for drugs under the Medicare Part D prescription drug
The Access to Medical Imaging Coalition, which represents
makers of medical-imaging equipment, said the administration's proposed cuts
"will impair access to diagnostic imaging services and result in
patients' delaying or forgoing life-and-cost savings imaging
So far, the hospital association, as well as other major
groups representing doctors, insurance companies and drug makers, support
legislation aimed at expanding health-insurance coverage and putting the
nation's health system on a more sustainable path. Such changes would benefit
the industry by increasing their customer base through a fresh batch of
One hospital advocate said he saw the White House proposal
as "trying to give cover to the Hill," as congressional committees
work out final details of their health packages, including spending cuts to
pay for it all.
"This takes some pressure off of them," the
advocate said. If Congress were to propose less-severe reductions, interest
groups could greet the plan with some relief, noting it could have been
New York City
offers a window into what could happen when payments to safety-net hospitals
are cut. Already running at a deficit, the city's public hospital system is
looking at $150 million in state Medicaid cuts for next year. Next month, it
will close some outpatient services, such as community-based primary and
"We are in a position already where we are making
painful decisions that require us to reduce access and services," said
Alan D. Aviles, president and chief executive of the system, known as the
Health and Hospitals Corp.
[BACK TO TOP]
The Washington Post | 06.15.09
Robert J. Samuelson
It's hard to know whether President Obama's health-care
"reform" is naive, hypocritical or simply dishonest. Probably all
three. The president keeps saying it's imperative to control runaway health
spending. He's right. The trouble is that what's being promoted as health-care
"reform" almost certainly won't suppress spending and, quite
probably, will do the opposite.
A new report from Obama's own Council of Economic Advisers
shows why controlling health costs is so important. Since 1975, annual health
spending per person, adjusted for inflation, has grown 2.1 percentage points
faster than overall economic growth per person. If this trend continues, the
CEA projects that:
-- Health spending, which was 5 percent of the economy
(gross domestic product) in 1960 and is reckoned at almost 18 percent today,
would grow to 34 percent of GDP by 2040 -- a third of the economy.
-- Medicare and Medicaid, the government insurance
programs for the elderly and poor, would increase from 6 percent of GDP now
to 15 percent in 2040 -- roughly equal to three-quarters of present federal
-- Employer-paid insurance premiums for family coverage,
which grew 85 percent in inflation-adjusted terms from 1996 to $11,941 in
2006, would increase to $25,200 by 2025 and $45,000 in 2040 (all figures in
"constant 2008 dollars"). The huge costs would force employers to
reduce take-home pay.
The message in these dismal figures is that uncontrolled
health spending is almost single-handedly determining national priorities.
It's reducing discretionary income, raising taxes, widening budget deficits
and squeezing other government programs. Worse, much medical spending is
wasted, the CEA report says. It doesn't improve Americans' health; some care
is unneeded or ineffective.
The Obama administration's response is to talk endlessly
about restraining health spending -- "bending the curve" is the
buzz -- as if talk will suffice. The president summoned the heads of major
health-care groups representing doctors, hospitals, drug companies and
medical device firms to the White House. All pledged to bend the curve. This
is mostly public relations. Does anyone believe the American Medical
Association can control the nation's 800,000 doctors or that the American
Hospital Association can command the 5,700 hospitals?
The central cause of runaway health spending is clear.
Hospitals and doctors are paid mostly on a fee-for-service basis and
reimbursed by insurance, either private or governmental. The open-ended
payment system encourages doctors and hospitals to provide more services --
and patients to expect them. It also favors new medical technologies, which
are made profitable by heavy use. Unfortunately, what pleases providers and
patients individually hurts the nation as a whole.
That's the crux of the health-care dilemma, and Obama
hasn't confronted it. His emphasis on controlling costs is cosmetic. The main
aim of health-care "reform" being fashioned in Congress is to
provide insurance to most of the 46 million uncovered Americans. This is
popular and seems the moral thing to do. After all, hardly anyone wants to be
without insurance. But the extra coverage might actually worsen the spending
How much healthier today's uninsured would be with that
coverage is unclear. They already receive health
care -- $116 billion worth in 2008, estimates Families USA, an advocacy
group. Some is paid by the uninsured themselves (37 percent), some by
government and charities (26 percent). The remaining "uncompensated
care" is either absorbed by doctors and hospitals or shifted to higher
private insurance premiums. Some uninsured would benefit from coverage, but
others wouldn't. Either they're healthy (40 percent are between ages 18 and
34) or would get ineffective care.
The one certain consequence of expanding insurance
coverage is that it would raise spending. When people have insurance, they
use more health services. That's one reason Obama's campaign proposal was
estimated to cost $1.2 trillion over a decade (the other reason is that the
federal government would pick up some costs now paid by others). Indeed, the
higher demand for health care might raise costs across the board, increasing
both government spending and private premiums.
No doubt the health program that Congress fashions will
counter this reality by including some provisions intended to cut costs
("bundled payments" to hospitals, "evidence-based
guidelines," electronic recordkeeping). In the past, scattershot
measures have barely affected health spending. What's needed is a fundamental
remaking of the health-care sector -- a sweeping "restructuring" --
that would overhaul fee-for-service payment and reduce the fragmentation of
The place to start would be costly Medicare, the nation's
largest insurance program serving 45 million elderly and disabled. Of course,
this would be unpopular, because it would disrupt delivery patterns and
reimbursement practices. It's easier to pretend to be curbing health spending
while expanding coverage and spending. Presidents have done that for decades,
and it's why most health industries see "reform" as a good deal.
[BACK TO TOP]
The New York Times | 06.13.09
By SHERYL GAY STOLBERG
and ROBERT PEAR
WASHINGTON — The White House said Saturday that President
Obama intended to pay for his health care overhaul partly by cutting more
than $200 billion in expected reimbursements to hospitals over the next
decade — a proposal that is likely to provoke a backlash from struggling
medical institutions around the country.
Mr. Obama has insisted that his plan will not add to the
federal deficit. He had already set aside in his budget what he calls a $635
billion “down payment” toward the overall 10-year cost of the overhaul,
expected to top $1 trillion. But Republicans and some Democratic legislators
have been pressing him to provide details on how he would cover the rest. On
Saturday, he used his Internet and radio address to do so.
Mr. Obama said he had identified “an additional $313
billion in savings that will rein in unnecessary spending and increase
efficiency and the quality of care,” bringing the total to nearly $950
billion. He did not offer a specific breakdown, but advisers said that in
addition to the more than $200 billion in lowered hospital reimbursements,
the president expected $75 billion in savings over 10 years by getting better
prices for prescription drugs, and $22 billion in
“These savings will come from common-sense changes,” Mr.
Obama said in his address. “For example, if more Americans are insured, we
can cut payments that help hospitals treat patients without health
He added: “If the drug makers pay their fair share, we can
cut government spending on prescription drugs. And if doctors have incentives
to provide the best care instead of more care, we can help Americans avoid
the unnecessary hospital stays, treatments and tests that drive up costs.”
Saturday’s announcement came amid an intense push by the
White House to sell Mr. Obama’s health care plan, his highest legislative
priority. Broadly speaking, Mr. Obama wants to extend coverage to the
nation’s 45 million uninsured, preserve consumer choice and cut rising health
care costs. He has argued that fixing the nation’s health care system is
crucial to the economic health of the United States.
But as Congress contemplates the details of the
legislation, the question of how to pay for the plan is among the thorniest
it will face. Already, one of Mr. Obama’s early proposals — limiting tax
deductions for high-income people — has run into major roadblocks on Capitol
Hill. By providing details in his weekly address on Saturday, Mr. Obama may
be hoping to give lawmakers the political leeway to adopt other cost-saving measures.
The administration expects to achieve the lowered hospital
payments in two major ways, by slowing the growth of reimbursements. First,
said Mr. Obama’s budget director, Peter M. Orszag,
payments to hospitals will be reduced to try to encourage them to work more
productively and efficiently.
Mr. Orszag said hospitals could
figure out ways of treating patients “more effectively, through health
information technology, a nurse coordinator instead of an unnecessary
specialist,” for example. These “productivity adjustments” would account for
$110 billion in savings.
Second, the administration expects to lower payments to
hospitals that treat large numbers of low-income patients. Medicare and
Medicaid make special extra payments to these hospitals, but Mr. Orszag said those payments would become less necessary
over time, as more of the nation’s 45 million uninsured acquire coverage
through the new program. This would account for $106 billion in savings.
But hospital administrators, already nervous about lowered
reimbursements, are likely to oppose such cuts. Less than 24 hours before Mr.
Obama’s radio address, the president of the American Hospital Association,
Richard J. Umbdenstock, issued a call to action to
his members across the country, warning that Congress might cut provider
Mr. Umbdenstock asked hospitals
to “push back” against the proposed cuts. “Payment cuts are not reform,” he
said, denouncing “blunt cuts that cripple hospitals’ ability to do better for
Dr. Patricia A. Gabow, chief
executive of the Denver Health and Hospital Authority, which operates a
477-bed public hospital, said it would be “pretty risky” for Congress to cut
payments to safety-net hospitals before knowing whether new legislation
actually reduced the uncompensated care they must provide.
“What about homeless people, the chronically mentally ill,
substance abusers and people with low literacy?” Dr. Gabow
asked. “You think they will be using the federal health insurance exchange to
enroll in insurance plans? I don’t think so.”
Kenneth E. Raske, president of
the Greater New York Hospital Association, said the proposed cuts could be
“devastating to hospitals that serve inner-city communities.”
Mr. Raske pointed out that none
of the major proposals in Congress would provide health insurance to illegal
immigrants, and many of them would still be unable to pay their hospital
bills. In addition, he said, the federal payments will still be needed
because “Medicaid woefully underpays for outpatient clinics” and other
services in some states, including New
Senator Max Baucus, Democrat of Montana and chairman of
the Finance Committee, intends to introduce his plan this week. Aides said it
would include a proposal to tax some employer-provided health benefits, a
notion that Mr. Obama sharply criticized during his campaign for the White
House. Workers might, for example, have to pay income tax on the value of
family coverage exceeding $15,000 a year.
Labor unions, many employers and many House Democrats
oppose such a tax, saying it would destabilize the employer-based system of
[BACK TO TOP]
The Associated Press
(AP) — WASHINGTON
- The Senate's top Republican says that lawmakers should focus on making the
existing health care system work better before overhauling the way Americans
Senate Republican leader Mitch McConnell says that
President Barack Obama's proposed health overhaul would result in massive
government controls and would hurt the country.
The Kentucky Republican warns that if Obama gets his way,
Americans would need government permission before receiving health
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McConnell says that Obama's plan for a government health
insurance program to compete with private insurance companies is a nonstarter
for most Republican lawmakers.
McConnell appeared on CBS' "Face the Nation."
[BACK TO TOP]
Charles Babington, The Associated Press
WASHINGTON -- President Barack Obama is seeking to help
pay for his health care plan by sharply reducing the government's medical
spending, mainly by trimming payments to prescription drugmakers,
hospitals and other care providers.
His ambitions are thick but the details thin; the
president and his aides said specific ways for achieving the cuts will be
decided later. The negotiations could trigger fierce political battles
between powerful industries trying to protect their profits.
Overhauling the nation's health care system is one of
Obama's biggest ambitions, and lawmakers are working on a variety of plans. A
top goal is to reduce costs in the government's largest medical programs,
Medicare and Medicaid, which cover millions of elderly and low-income
Americans and involve thousands of doctors, hospitals, nursing homes and
In his weekly Internet and radio address Saturday, Obama
proposed cutting $313 billion from the programs over 10 years. That's in
addition to the $635 billion "down payment" in tax increases and
spending cuts in the health care system that he announced earlier.
Together, Obama's plans would provide $948 billion over a
decade in savings and/or tax increases to help cover the millions of
Americans who lack medical insurance and to slow the rate of soaring health
The status quo is unacceptable, Obama said. "America
spends nearly 50 percent more per person on health care than any other
The newly proposed $313 billion in savings, he said,
"will come from commonsense changes."
He would cut $106 billion from payments that help
hospitals treat uninsured people because his plan would cover nearly every
American. Payments for Medicare prescription drugs would fall by $75 billion
over 10 years.
And slowing projected increases in Medicare payments to
hospitals and other providers -- but not doctors -- would save $110 billion
over 10 years, the president said. His budget director, Peter Orszag, said the reductions are justified because health
care delivery is becoming more efficient.
But Orszag and Obama
acknowledged that many details remain to be worked out. Obama said simply,
"If the drugmakers pay their fair share, we
can cut government spending on prescription drugs."
A White House fact sheet said the pharmaceutical industry
"has committed itself to helping to control the rate of growth in health
care spending. There are a variety of ways to achieve this goal."
For instance, it said, drug reimbursements might be
reduced for people who receive both Medicare and Medicaid.
But the pharmaceutical industry is politically powerful. Drugmakers have successfully resisted price controls in
the Medicare prescription program so far, arguing that competition is enough
to get elderly Americans a good deal.
Other government programs, however, such as Medicaid and
the Veterans Affairs health system, may be paying less for many of the same
Billy Tauzin, president of the Pharmaceutical Research and
Manufacturers of America, issued a noncommittal statement.
"We remain committed to working with the administration
and Congress to help enact comprehensive health care reform this year,"
he said. "A lot of work remains to be done, but we will continue to
share ideas and seek solutions."
Lobbyists for hospitals, doctors and many other players
also have clout in Washington,
complicating Obama's mission.
Even if Obama and Congress could hit the overall goal of
$948 billion in health care savings over 10 years, it still might not be
enough to cover the nearly 50 million uninsured Americans. Outside experts
say the 10-year cost could range from $1.2 trillion to $1.8 trillion,
depending on factors such as how generous federal subsidies turn out to be.
One Senate proposal would subsidize families making as much as $110,000.
The administration wants to hold the cost to about $1
trillion, and Obama says the plan must not add to the federal deficit.
Orszag told reporters that $950
billion "is in the ballpark of many of the proposals floating
around," and that "there may well be some additional resources that
The administration will work with Congress, he said. But
the president's earlier package of $635 billion in spending cuts and tax
increases has gotten a cool reception from lawmakers, and there's no
indication the latest package will fare any better.
Medical providers from hospitals to doctors to drug makers
have agreed with Obama that there's enough waste in the system to cut $2
trillion over 10 years, but behind-the-scenes they are preparing to resist
[BACK TO TOP]
The New York Times | 06.13.09
By REED ABELSON
Congress appears ready to confront one of the nation’s
most contentious issues — health care reform — and arguments will fill the
air in the coming months.
Much of the discussion so far has focused on President
Obama’s proposal for a government-sponsored health plan that he says will
reduce costs. Insurers and doctors argue it will limit patient choice. Drug
companies warn that the quality of care could be compromised.
But Mr. Obama’s proposal is only one of many that await
Congress as it wrestles with how to rein in exploding health care costs while
taking care of the country’s nearly 50 million uninsured. The size and
complexity of the issue are daunting. To help understand what’s going on, you
need to follow the money.
Roughly $2.5 trillion is at stake, the amount the nation
spends each year on health care, nearly a fifth of the American economy. How
that money is divided up — or prevented from rising at its current pace — is
at the center of the debate. Many doctors, insurance companies and drug companies
say they fear that their revenues could shrink significantly and patient care
could be threatened.
Their arguments may prove to have merit. But “people are
voting with their own economic interests,” said Les Funtleyder,
a Wall Street analyst who is following the debate closely for Miller Tabak & Co. in New
When you hear nothing from one of the interest groups on
an issue that is part of the larger debate, you can assume the silence means
it has no financial stake in the outcome, he said. “You wouldn’t probably
weigh in if you don’t have any skin in the game because if you weigh in, it
makes you more of a target,” Mr. Funtleyder said.
What all of the interest groups reliably support is any
new program that would expand coverage to the uninsured. Such a program would
translate into tens of millions of new, paying customers for hospitals,
doctors, insurers and drug makers.
But what worries those groups is the accompanying talk in Washington about how
to address the skyrocketing cost of health care, since any decline in
spending would correspond to a reduction in revenues. The discussion has
become particularly heated over exactly how the government will find the
savings necessary to help generate the $1 trillion or so that the government
will need over the next decade to pay for universal coverage. The nation’s
doctors, for example, say they wholeheartedly support health care reform. But
the American Medical Association has a long history of being opposed to
legislation that threatens the status quo. It opposed the creation of
Medicare more than 30 years ago.
What concerns doctors about a government-run insurance
program that looks like Medicare is the possibility that it will pay like
Medicare, said Robert Laszewski, a health policy
consultant in Alexandria, Va. “Medicare pays doctors 80 percent of what an
insurance company pays,” he said. “If you get a public plan, the doctors are
going to get a 20 percent pay cut.”
But doctors are also likely to disagree among themselves
over how different types of physicians should be compensated. Congress is
thinking about raising the pay of primary-care doctors — general
practitioners, family physicians and the like — as a way to encourage them to
more actively oversee the care of patients and reduce expensive visits to
specialists and hospitals.
The specialists — the cardiologists, neurologists,
surgeons and others — may have a different take on the discussion, Mr. Laszewski noted, especially if Congress cannot raise
salaries of primary-care doctors without taking money from the highly paid
specialists. “The question is, how are you going to
help the primary-care doctors without cutting the cardiologist and the other
specialists?” he asked.
But even the family physicians, who stand to benefit the
most, say they are opposed to a government-run plan if it reimburses them at
the Medicare rate.
Another group with a lot to win or lose is the nation’s
private health insurers. With the number of people who are privately insured
through their employer or their own policy not increasing, insurers are eager
to find a new source of business. Health reform promises them at least some
new customers who cannot afford insurance now but who might receive
government help to pay for coverage.
But the trade association, America’s Health Insurance Plans,
has clearly staked out its opposition to any kind of government-run health
plan, which it says would have an unfair advantage. The trade group fears its
members would be driven out of business as the government uses its purchasing
power to demand much lower prices from doctors and hospitals.
Karen Ignagni, the chief
executive of the association, has criticized the government’s track record in
running Medicare as a good reason not to expand government health insurance
beyond the elderly and disabled. She says the program has done a poor job in
taking care of people when they are very sick. “Medicare has not effectively
coordinated care, addressed chronic illness, or encouraged high performance,”
she recently told Congress.
As one way of finding savings to pay for health reform,
Congress is also discussing lowering payments to private insurers who are now
being compensated to cover some Medicare patients. The A.M.A., perhaps
mindful that such savings would not come from doctors if it comes from
insurers, says it supports such cuts.
The hospitals have also voiced concerns about a
government-run plan. They, too, are paid much less by Medicare than they are
by private insurers.
The nation’s drug makers are also lining up against a
public plan, predicting that it would ultimately lead to a government
takeover of the entire system. “I don’t think that American patients would —
or should — accommodate themselves to the long waits for care, limited
options and other forms of rationing that inevitably accompany government
health care monopolies,” John C. Lechleiter, the
chief executive of the drug maker Eli Lilly & Co., recently told a
meeting of business leaders. “American doctors and patients need to retain
the ability to make choices based on the real value of treatment options.”
But drug companies are also wary of the government’s pull
in demanding lower prices for their products than the insurers they deal with
today. “The more government intervention you have, the less payment you
have,” said Mr. Funtleyder, the analyst.
These companies are also concerned that the government
will play a greater role in determining the effectiveness of different drugs
and medical devices and use that information to decide which should be
covered and how much the government will pay for those products. Insurers,
not surprisingly, support the government’s taking a harder line against drug
and medical device makers so they don’t have to.
As Congress gets closer to finalizing any legislation, the
opinions of the many stakeholders are likely to become more strident and
self-interested, Mr. Laszewski predicted. As in
watching the last lap of the Daytona 500, he said, there will be attempts by
some of these groups to break out of the pack. “When you get the last lap,
there are no friends — it’s me, me, me,” he said.
[BACK TO TOP]
The New York Times | 06.13.09
MEDICARE expenditures threaten to crush the federal
budget, yet the Obama administration is proposing that we start by spending
more now so we can spend less later.
This runs the risk of becoming the new voodoo economics.
If we can’t realize significant savings in health care costs now, don’t
expect savings in the future, either.
It’s not the profits of the drug companies or the overhead
of the insurance companies that make American health care so expensive, but
the financial incentives for doctors and medical institutions to recommend
more procedures, whether or not they are effective. So far, the American
people have been unwilling to say no.
Drawing upon the ideas of the Harvard economist David
Cutler, the Obama administration talks of empowering an independent board of
experts to judge the comparative effectiveness of health care expenditures;
the goal is to limit or withdraw Medicare support for ineffective ones. This
idea is long overdue, and the critics who contend that it amounts to
“rationing” or “the government telling you which medical treatments you can
have” are missing the point. The motivating idea is the old conservative
chestnut that not every private-sector expenditure
deserves a government subsidy.
Nonetheless, this principle is radical in its implications
and has met with resistance. In particular, Congress has not been willing to
give up its power over what is perhaps the government’s single most important
program, nor should we expect such a surrender of power in the future. There
is already a Medicare Advisory Payment Commission, but it isn’t allowed to
actually cut costs.
Scholars have been applying comparative-effectiveness
research to Medicare for years, and the verdict is not altogether pretty. It
turns out that some regions spend more on Medicare than others — sometimes
two or three times as much, as documented by the Dartmouth Atlas Project. Yet
the higher-spending regions often fail to produce superior health care results.
Robin Hanson, professor of economics at George Mason
evidence demonstrating the ineffectiveness of many medical
expenditures in his 2007 paper, “Showing That You Care.”
If we are willing to take comparative-effectiveness studies
seriously, we could make significant cuts in Medicare costs right now. We
could cut some reimbursement rates, limit coverage for some of the more
speculative treatments, like some forms of knee and back surgery, and place
more limits on end-of-life-care.
Those cuts alone will not solve the fiscal problem, but if
we aren’t willing to take even limited steps to conserve resources, we
shouldn’t be spending any more money elsewhere.
Of course, we have not made such Medicare spending cuts
yet, and there are few signs that we will. A Kaiser Family Foundation poll
found that 67 percent of Americans believe that they do not receive enough
treatment and that only 16 percent believe that they have received
unnecessary care. If the Obama administration covers more people with
government-supplied or government-subsidized insurance, the political support
will broaden for generous benefits, their continuation and, indeed, expansion
of current expenditures.
Suggested ways to lower costs include an emphasis on
preventive care, the use of electronic medical records and increased
competition among insurers. But even if these are likely to improve the
quality of care, they are speculative and uncertain as cost-saving measures.
Keep in mind that while computers were remarkably powerful inventions, it
took decades before they showed up in the statistics as having improved
productivity in the workplace.
One idea embodied in a bill sponsored by Senator Ron
Wyden, Democrat of Oregon, and Senator Robert F. Bennett, Republican of Utah,
is to finance new health care programs by taxing health insurance benefits.
This makes sense in principle: why should insurance benefits be favored over
salary by our tax system? But employer-supplied insurance is a mainstay of
the current health care system, and there is no adequate replacement
immediately in sight.
IT’S also hard to convince the American public that the
solution to insufficient health insurance is to tax health insurance. And
such a one-time tax increase would postpone but not eliminate the need to
come to grips with ever-rising Medicare costs.
It sounds harsh to suggest that the Obama administration
cut areas of Medicare spending, but, too often, increased expenditures and
coverage are confused with good health care outcomes. The reality
is that our daily environment, our social status and our behavior — including
diet and exercise — have more to do with good health than does health
care more narrowly defined.
The demand for universal coverage sounds like a moral
imperative to “take care of everybody,” but in reality it would make only a
marginal difference when it comes to the overall health of the American
population. The sober reality is that universal coverage is another way to
spend money, which may or may not be a good idea.
The most likely possibility is that the government will
spend more on health care today, promise to realize savings tomorrow and
never succeed in lowering costs. It is rare that governments successfully cut
costs by first spending more money.
Mr. Obama has pledged to be a fiscally responsible
president. This is the biggest chance so far to see whether he means it.
Tyler Cowen is a professor of economics at George Mason University.
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The New York Times | 06.12.09
By WALECIA KONRAD
Brandon Sharp, a 37-year-old manager at an oil and gas
company in Houston,
has never had any real health problems and, luckily, he has never stepped
foot in an emergency room. So imagine his surprise a few years ago when he
learned he owed thousands of dollars worth of emergency-service medical
Mr. Sharp, as it turned out, was a victim of a
fast-growing crime known as medical identity theft.
At the time, Mr. Sharp was about to get married and buy
his first home. Before applying for a mortgage he requested a copy of his
credit report. That is when he found he had several collection notices under
his name for emergency room visits throughout the country.
“There was even a $19,000 bill for a Life Flight air
ambulance service in some remote location I’d never heard of,” said Mr.
Sharp, who made this unhappy discovery in 2003. “I had emergency room bills
from places like Bowling Green,
Kan., where I’ve never even
visited. I’m still cleaning up the mess.”
The last time federal data on the crime was collected, for
a 2007 report, more than 250,000 Americans a year were victims of medical
identity theft. That number has almost certainly increased since then,
because of the increased use of electronic medical records systems built
without extensive safeguards, said Pam Dixon, executive director of the
nonprofit World Privacy Forum and author of a report on medical identity
And uncountable, Ms. Dixon said, are the people who do not
yet know they are victims. They may not know that their medical information
has been tampered with for months or even years until, as in Mr. Sharp’s
case, it shows up in collections on a credit report.
Medical identity theft takes many guises. In Mr. Sharp’s
case, someone got hold of his name and Social Security number and used them
to receive emergency medical services, which many hospitals are obliged to
provide whether or not a person has insurance. Mr. Sharp still does not know
whether he fell victim to one calamitous perp who ended up in several emergency rooms or a ring of
In another variant of the crime, someone can use stolen
insurance information, like the basic member ID and group policy number found
on insurance cards, to impersonate you — and receive everything from a
routine physical to major surgery under your coverage. This is surprisingly
easy to do, because many doctors and hospitals do not ask for identification
beyond insurance information.
Even more common, however, are cases where medical
information is stolen by insiders at a medical office. Thieves download vital
personal insurance data and related information from the operation’s
computerized medical records, then sell it on the black market or use it
themselves to make fraudulent billing claims.
In a widely reported case in 2006, a clerk at a Cleveland
Clinic branch office in Weston, Fla., downloaded the records of more than
1,100 Medicare patients and gave the information to her cousin, who in turn,
made $2.8 million in bogus claims.
When people are not aware their medical identities have
been stolen, insurance companies may simply continue to pay the fraudulent
claims without the victim’s knowledge. The person might learn of the fraud
only when trying to make a legitimate claim, and the
insurance company informs them they have reached their lifetime cap on
Or victims may eventually discover erroneous information
in their medical files during a doctor or hospital visit. And that may pose a
bigger danger than the financial risks. The medical records may now contain
vital information like blood type, allergies, prescription drug use or a
history of disease that is just plain wrong. In an emergency, doctors could
treat you based on this erroneous information.
And there are none of the consumer protections for medical
identity theft victims that exist for traditional identity theft. Under the
Fair Credit Reporting Act you can get a free copy of your credit report each
year, put a fraud alert on your account and get erroneous charges deleted
from your record. If your credit card is stolen and the thief goes on a
spending spree, you’re not liable for more than $50 worth of the charges.
With medical identity theft, though, the fraudulent
charges can remain unpaid and unresolved for years, permanently damaging your
credit rating. Under the federal law known as Hipaa
— the Health Insurance Portability and Accountability Act — you are entitled
to a copy of your medical records, but you may have to pay a hefty fee for
Worse, Hipaa privacy rules can
actually work against you. Once your medical information is intermingled with
someone else’s, you may have trouble accessing your files. Privacy laws
dictate that the thief’s medical information now contained in your records
must be kept confidential, too.
Even when you are able to correct a record, say in your
doctor’s office, the erroneous information may have been passed on to dozens
of other health care providers and insurers. Victims must track down and
resolve these errors largely on a case-by-case basis, Ms. Dixon says.
Medical providers contend that they are taking precautions
against identity theft. At Cleveland Clinic, for example, security personnel
routinely audit electronic medical record systems and all records are
password-protected. Many Blue Cross Blue Shield insurers use software to
screen for spikes in claims from providers that look suspicious. They also
work with providers on encrypting medical files and carrying out data access
restrictions, said Calvin Sneed, senior antifraud consultant at the Blue
Cross and Blue Shield Association.
And some medical centers and doctors’ offices now require
patients to show photo ID and attach photos to patient charts.
But privacy advocates worry that these steps do not go
nearly far enough, especially in light of President Obama’s plans to spend
$20 billion to increase the use of electronic medical records nationwide as
part of the stimulus package. “Without aggressive safeguards, we could be
building an infrastructure for massive medical fraud,” said Ms. Dixon.
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