If we want more evidence-based practice, we need more practice-based evidence.*

If we want more evidence-based practice, we need more practice-based evidence.*

Chapter 21
- Archives of Headlines
Personal Health Care Services and Resources


Panel: Diversify medical workforce. WASHINGTON (AP, Dec. 9, 1998) - The nation's health system must recruit a more diverse workforce to face the complex health problems of an increasingly multiracial America, a commission concludes in a sweeping report released Wednesday. Blacks, Hispanics and other racial minorities are becoming a larger portion of the population, yet with the exception of Asian Americans, few become doctors and the number entering medical school has dropped over the last couple of years. Minorities are much more likely to work in inner cities and other underserved minority communities, making recruitment a crucial issue, argues the fourth and final report from the Pew Health Professions Commission, which has been working for a decade.

AMERICANS WITHOUT HEALTH INSURANCE UP 10 MILLION IN 1990'S: Nearly every state affected despite economic growth, study finds (Press Releases, PHYSICIANS FOR A NATIONAL HEALTH PROGRAM, 332 S. Michigan, Suite 500, Chicago, IL 60604, Phone (312) 554-0382, Dec. 30, 1998, based on article in AJPH Jan. 1999). Economic growth hasn't stopped the number of Americans without health insurance from climbing by 10 million people since 1989, to 43.4 million, according to a study in today's American Journal of Public Health.

"By the time Congress finishes with the impeachment debate, another half- million people will have lost their health insurance," according to Dr. David Himmelstein, an author of the study and Associate Professor of Medicine at Harvard. "Unfortunately, none of them will be members of Congress."

The study, the first comprehensive look at insurance trends in the 1990's, found that the number of uninsured is rising at a rate of over 100,000 people losing coverage every month, despite the nation's strong economic growth -- including more than a 25% increase in the Gross National Product and a doubling of the Dow Jones industrial average since 1989. One in six Americans (16%) is now uninsured, up from one in seven (13.6%) at the start of the decade.

"Not having health insurance is a major catastrophe for patients -- medically, financially, and emotionally," said Dr. Quentin Young, National Coordinator of Physicians for a National Health Program and an internist in Chicago. "It's a silent, devastating epidemic sweeping across the nation."

Among those most affected by the loss of insurance are young adults aged 18-39, blacks, and hispanics. From 1989 to 1993 the majority of the increase was among low-income families, but since 1994 middle-income families have been increasingly affected as well.

In several southern and western states (Texas, Arkansas, New Mexico, Arizona), nearly one in every four persons is uninsured. However, northeastern states (New Jersey, New York, Connecticut, Massachusetts, and Maine) had the largest increases in the percentage of their residents without coverage since 1989.

"Incremental reforms have had no impact on the rising number of uninsured," noted Dr. Olveen Carasquillo, co-author of the study and an internist at New York's Columbia Presbyterian Hospital.

"Two states which have been held up as models of reform -- Oregon and Hawaii -- both have experienced increases. The Kennedy-Kassebaum Insurance Portability Act has helped few people between jobs keep their insurance, and the Children's Health Insurance Plan is not and will not stem the rising tide of uninsurance among children." The number of uninsured children increased from 8.5 million in 1989 to 10.7 million in

"The tragedy is that this a preventable epidemic. Every other industrialized country, from Denmark to Japan, Canada to Australia, Norway to Germany, England to Taiwan, has a national system of universal coverage," said Dr. Young.

"They aren't perfect, and you may have to wait a few weeks for an MRI, but almost uniformly you can choose your physicians, receive excellent primary and specialty care at the same or higher quality as in the U.S., and the health outcomes are better. It's time for the U.S. to adopt a national health program once and for all."

The study analyzed Census Bureau data from 1989 to 1996. An additional year of data was analyzed by the authors after the article went to press, and is available from PNHP.

Copies of "Going Bare: Trends in Health Insurance Coverage, 1989-1996" by Carasquillo, Himmelstein, Woolhandler, and Bor, American Journal of Public Health, with an additional year of data (1997) and state by state figures are available to press at (312) 554-0382.  Physicians for a National Health Program is an organization of over 8,000 physicians who support universal access to health care. PNHP was founded in 1987.   Dr. Quentin Young is an internist in Chicago and National Coordinator of Physicians for a National Health Program. Dr. Young is also the Past President of the American Public Health Association.  Dr. Olveen Carrasquillo is Assistant Professor at Columbia University's College of Physicians and Surgeons. He practices internal medicine at New York Presbyterian Hospital (212) 305-9782.  Dr. David Himmelstein is Associate Professor of Medicine at Harvard Medical School and co-founder of PNHP. He is an internist.

TORONTO, Dec. 7, 1998 /CNW/ - Chatelaine, CTV and The Medical Post recently spoke to 1501 Canadian adults and 201 family physicians, examining physician-patient relationships. Their poll, conducted by The Angus Reid Group, revealed a breakdown in communication between doctors and patients.  Unfortunately, this isn't new news. The Bayer Institute for Healthcare Communication was founded in 1997 to respond to this very problem. The Institute is a non-profit organization dedicated to improving how Canadian health care professionals communicate with their patients.   According to The Bayer Institute, a doctor typically engages in more than 100,000 clinical interviews during his or her career. Studies show that such communication between doctor and patient is the more common procedure used to diagnose and treat illness, as well as a major factor in determining patient satisfaction.  And yet, according to patients, doctors aren't always the best communicators. Did you know that:  - Of the 1,566 complaints investigated in 1995 by the Ontario College of  Physicians and Surgeons, 612 cited a breakdown in communications. One random survey of 1,000 adults found that 25 per cent of people reported they had stopped seeing a particular physician because of communication problems.
Studies have shown that when clinicians communicate well with their patients, this leads to improved diagnosis, better compliance with treatment, greater satisfaction for both the health care provider and the patient, and fewer malpractice complaints.

Members of the Institute's faculty are available to comment on the importance of effective interaction between health care providers and patients and how to achieve this - especially in a time when there are growing pressures on the system and concerns that doctors don't have the "extra" time to spend with their patients.

For further information: Jennifer Schipper and Linda Artuso, Environics Communications, (416) 920-9000, ext. 253 or ext. 281

Brundtland Calls for Youth-Friendly Health Services (PANA Wire Service, Dec. 1, 1998) by Dzisah, Melvis - The director-general of the World Health Organization, Dr. Gro Harlem Brundtland, called on health services to become more youth-oriented to help stop the spread of HIV. She cited a study of pregnant South African teenagers aged 15 to 19 that found 13 percent of participants were infected with HIV, 9.5 percent of whom contracted the virus before the age of 15. Speaking as part of World AIDS Day, Brundtland noted that unfriendly staff, excessive paperwork, and the perceived lack of confidentiality can all contribute in deterring young people from health services.

THE YEAR 2000 COMPUTER PROBLEM AND CONSUMER HEALTH PROTECTION A more detailed report on this issue is at: http://www.cnn.com/ALLPOLITICS/stories/1998/09/24/dodd.ap/

The Food and Drug Administration's site on Year-2000 technology issues, including medical equipment, is at: http://www.fda.gov/cdrh/yr2000/year2000.html

Sen. Christopher Dodd (D-CT) is working to stir up public pressure to force more medical device manufacturers to reveal which of their products could falter or fail because of the Year 2000 computer glitch, in which computers that represent the year in dates with just two digits will interpret Year 2000 ("00") as Year 1900. The problem is variously referenced as the Y2K issue and the "millennium bug" (although the millennium runs on the calendar from January 1, Year 1 through December 31, 2000, so that the new millennium will begin January 1, 2001).

"In the health field there are life-critical systems," Dodd said Wednesday (Sept. 23) on the Senate floor, as he submitted for publication a 25-page list of companies believed to have not yet told the Food and Drug Administration about potential problems.

With certain heart monitors, "we are told that if it fails, patients could lose their lives," said Dodd, D-Conn., a member of the Senate Special Committee on the Y2K [Year 2000] Technology Problem.

The list of companies is to be published in Wednesday's Congressional Record, a volume of floor proceedings that is available in bound form or on the Internet.

Dodd has been critical of companies that haven't yet revealed which products need fixing, despite pleas from doctors and hospitals. Hospitals asked Congress in July to force them to comply, and Dodd threatened to identify those that didn't. But so far, only about 755 of 1,935 domestic and foreign manufacturers of medical devices that could be affected by the glitch have submitted the necessary information to the FDA, Dodd said.

The Health Industry Manufacturers Association, which represents more than 800 companies, said Dodd's figures are outdated. Just over half of the 1,935 targeted firms have responded, it said. Others are still working to identify potential problems with their products, and still others may have responded but aren't registered as complying because they may be subsidiaries of larger corporations, the association said. Even so, "We recognize that more companies need to respond," said Alan Magazine, the association's president. Last month, the group wrote to 6,000 companies, urging them to ensure their products are fixed and to inform the FDA and customers of their compliance status.

The FDA cannot force companies to publicly announce potential problems before they occur, but it is pressuring companies to post on its Internet site a list of all computer-glitched products. The FDA has cautioned that, so far, it doesn't appear that the Year 2000 glitch will cause a crisis for patients. The page also provides links to other governmental and non-governmental Web sites that address the Year-2000 issue.

THE POST-ELECTION HEALTH INITIATIVES IN WASHINGTON, DC President Clinton and Democratic congressional leaders met yesterday (Wed., Nov. 4, 1998) and declared that the first priority of the next Congress should be passing a health-care patients' bill of rights.

Speaking to reporters after the Oval Office meeting, the President said of Tuesday's elections, "The American people sent us a message that would break the eardrums of anybody who was listening. They want their business tended to. [...] They want people and their issues taken care of."

The lengthy strategy meeting included the President, Vice President Al Gore, House Minority Leader Richard Gephardt (D-MO), and Senate Minority Leader Tom Daschle (D-SD).

President Clinton also said he had spoken with House Speaker Newt Gingrich (R-GA) and Senate Majority Leader Trent Lott (R-MS). He said he asked them to join his effort to overhaul Social Security.
Noting that the administration's version of a patient's bill of rights had failed in the House this year by only five votes, Clinton said he was optimistic now that Democrats gained five House members.

"So, what we want to do is to reach out to like-minded people in the other party, to try to heed the admonition of the American people ... and get to work together. We're looking forward to it, and this is where we think we should begin."

Also Wednesday, the President met with his economics advisers to plan for a December conference on reforming Social Security.

President Bill Clinton and congressional Democratic leaders reiterated Thursday (Nov. 5, 1998) that they hope to pass a health insurance reform bill early next year.

"What we want to do is to reach out to like-minded people in the other party, to try to heed the admonition of the American people in the direction that we certainly agree we ought to take, and get to work together," Clinton said.

"We believe the best way to start is by taking up the patients' bill of rights," the president told reporters after meeting with House Democratic leader Richard Gephardt (D-MO) and Senate Minority Leader Tom Daschle (D-SD).

Democrats gained five seats in the House in Tuesday's election, cutting the Republican margin to 223-211, with one independent. The Democrats held their own in the Senate, with a 55-45 Republican majority. have focused less on the scandal and more on policy.

White House spokesman Joe Lockhart said the "patients' bill of rights" would be introduced "as soon as Congress returns" next year. "Obviously the Republicans decide when something gets brought up, but we're going to push hard to make it the first order of business," he said.

President Clinton intends to revive the a package of regulations for health maintenance organizations (HMOs), which would expand access to emergency room care and treatment by specialists and allow patients to sue HMOs for wrongfully denied coverage. In the last session of Congress, the Democratic bill lost by five votes in the House and came close to passing the Senate.

"It need not be a partisan issue," Clinton said.
Gephardt said: "I feel very strongly that we can get this done. And if you have a sick family member you want it done now, so we're going to work very hard to see if we can get it done in the early part of next year."

President Clinton said in his weekly radio address today (Sat., Oct. 11, 1998) that he would work to revive patients' rights legislation in the next session of Congress, after reform efforts died in the U.S. Senate Friday.

The U.S. Senate killed HMO health reform on a procedural vote Fri., Oct. 10, quashing a last-ditch effort by Senate Minority Leader Tom Daschle at 10:20 a.m. EDT. The vote was 50 to 47, with four Republicans joining 43 Democrats in voting to bring the measure to the floor.

(There are 55 Republicans and 45 Democrats in the Senate.) Congress adjourns early next week for the mid-term elections.

"Rest assured, I will ask the next Congress to guarantee your right to see a specialist, to receive the nearest emergency care, to keep your doctor throughout your course of treatment, to keep your medical records private and have other basic health care rights," the President said. "I hope next year we'll have a Congress that agrees."

Although patients' rights were championed by both political parties and polls showed the issue to be the public's top priority for Congressional action, the bill became "a victim of political maneuvering by both sides," said Senator Arlen Specter (R-PA).

As Congress prepared to recess for the mid-term elections, the heightened partisan atmosphere brought about by the impeachment process hurt chances for a number of health-related legislative efforts, including patients' rights, child care legislation, and tobacco reform. "Everything became totally politicized," said Sen. Dan Coats (R-IN).

Responding to the overshadowing of pressing national priorities by the White House scandal, an Internet campaign has been launched urging Congress to drop impeachment proceedings and instead censure the President. Petition "signatures" are being gathered at the campaign's Web site: http://www.moveon.org .
Online citizens are urged by the campaign's originators to widely publicize the Web address via their email contacts. More than 200,000 people have joined the petition in 15 days.

On managed-care reform, some commentators said legislators seemed more intent on gaining advantage in public opinion than on cooperating to pass legislation. In this atmosphere, the President has stepped in to change policies by executive decree in areas where he has authority, such as regulations for insurance programs that cover Federal workers and other recipients of Federal health benefits.

A split has also developed within the health-care industry in the past year, with several large nonprofit HMOs calling for greater Federal regulation, while the American Association of Health Plans argued that its members are voluntarily adopting changes demanded by the public.

But voluntary action by insurers is not satisfactory to all observers. "It's certainly a sad state of affairs when we need to seek protection of patients from the health care system," said Nancy Dickey, president of the American Medical Association. She predicted that health reform would be a top priority again next year.

More information may be found in several recent articles on the World Wide Web, including:

Pittsburgh Post-Gazette: HMO, Health Reform Falls Victim of Rush to End Term:

"Censure and Move On" Campaign at: http://www.moveon.org
San Francisco Chronicle Article about this effort:

Health warning on new blood pressure monitors HONG KONG (AP, Sept. 18, 1998) - Finger-type electronic blood pressure monitors are less accurate and consistent than the arm and wrist types, the Consumer Council has found. The study, initiated by the Consumer Council and the Diabetic Center of the Queen Mary Hospital, tested 13 models of blood pressure gauges, priced between $880 and $1,480. The readings on the samples were compared with those on the mercury-type blood pressure gauge (shygmomanometer), considered to be a reliable device generally used by medical workers. The results varied among models, but some arm and wrist types were found more accurate and consistent than those used on fingers. The finger types had greater deviations, with some of the systolic (upper) readings differing by more than 10 mmHg on average. A false reading may pose a threat to users, warns the Consumer Council.

Health Minister announces project to improve management of waiting lists for medical procedures (7 September 1998)   Health Minister Allan Rock today announced funding of a national project that could help provide a standardized, manageable system for dealing with waiting lists for medical procedures. The project, called From Chaos to Order: Making Sense of Waiting Lists in Canada, will work to standardize what is meant by ‘waiting time' and develop pilot tools and information systems based on five conditions or procedures to assist health decision makers with allocating resources for health care services and the management of waiting lists.   For more information, visit http://www.hc-sc.gc.ca/english/media/releases/1998/98_52e.htm

U.S. medical schools offer unorthodox alternatives. CHICAGO (Reuters). September 1, 1998. More than half of U.S. medical schools are offering future doctors courses in such alternative forms of medicine as acupuncture and herbal therapy, according to a study published Tuesday. "Patients are increasingly seeking to identify a physician who is solidly grounded in conventional, orthodox medicine and is also knowledgeable about the values and limitations of alternative treatments," the Harvard Medical School study said. The study, published in this week's Journal of the American Medical Association, was based on a survey sent to all 125 U.S. medical schools as listed in the Directory of American Medical Education.

Under election year pressures, Congress has been pushing to pass legislation to regulate managed care. Four main bills are being considered:
The House Republican leadership's bill (HR4250), sponsored by Speaker Newt Gingrich (R-GA), has been passed in the House. The President has threatened to veto it.
The Senate Republican leadership's bill (S2330), sponsored by Sen. Don Nickles (R-OK) will be considered in September.
The Democratic leadership's bill (HR3605 / S1890), sponsored by Rep. John Dingell (D-MI) and Sen. Tom Daschle (D-SD), was defeated in the House but is still live in the Senate.
A "compromise bill" (S2416), sponsored by Senators. John Chafee (R-RI) and Bob Graham (R-FL) will also be considered in September.

After the Senate passes a bill, legislators will convene a conference committee to negotiate differences.

The four bills differ substantially over such issues as access to specialists, continuity of care, emergency room coverage, and the ability to sue for damages. They also differ in their focus on research.

==> To read the bills: http://thomas.loc.gov/bss/d105query.html
Families USA, a supporter of the Democratic bill, provides a comparison chart: http://www.familiesusa.org 
==> To contact your legislators: http://www.congress.org

Health Minister Releases Commissioned Report on Waiting Lists
OTTAWA, ONTARIO SEPTEMBER 1, 1998 --Health Minister Allan Rock today released a   report commissioned by Health Canada to gain a better  understanding of the perceptions and realities about waiting lists in Canada. The report, "Waiting Lists and Waiting Times for  Health Care in Canada", is based on the work of three independent  research teams.

Key conclusions of the researchers include:
- there are no standardized sources of data currently available for compiling national information on waiting lists;
- where waiting list data are carefully and accurately compiled and routinely monitored, the public clearly benefits; and
- there is an urgent need for a national investment in the design and development of information and management systems that can provide the public with a greater sense of confidence about access
to, and quality of care.

"This report clearly demonstrates the need for a more standardized approach to the development of waiting lists," said Mr. Rock. "We need objective, reliable data that can give us an accurate picture of the waiting list situation and guide decisions that will help ensure that Canadians have access to quality care."

In conducting their research, the teams of health care experts synthesized Canadian and international literature on waiting lists, obtained data from, and interviewed representatives of  provincial/territorial governments, hospitals, regional health authorities, cancer organizations, administrative and consumer groups. The team of experts were from the University of British Columbia (Morris Barer, Sam Sheps, and Claudia Sanmartin); Queen's University (Sam Shortt and colleagues); and the Saskatchewan   Health Services Utilization and Research Commission (Steven Lewis, Paul McDonald, and colleagues).

The $150,000 project was funded in October 1997 through Health Canada's Research and Knowledge Development Division (RKDD). The RKDD funds innovative, peer-reviewed research that contributes to policy development and program planning in support of the Department's mission and health priorities.

The researchers have presented their preliminary findings to federal, provincial and territorial Deputy Ministers of Health as well as to the Federal/Provincial/Territorial Advisory Committee on Health Services.

A summary of the report entitled Waiting Lists and Waiting Times for Health Care in Canada is available on the Internet http://www.hc-sc.gc.ca/hppb/nhrdp .

Health Canada news releases are available on the Internet at http://www.hc-sc.gc.ca/english/media/index.html

NHRDP Information  (613) 954-8549; (613) 954-7363 (FAX) E-Mail: nhrdpinfo@hc-sc.gc.ca
or Office of Allan Rock, Derek Kent; (613) 957-1515   Public Inquiries; (613) 957-2991

Canadian Association on Gerontology, Association canadienne de gerontologie #500 - 1306 rue Wellington Street, Ottawa (Ontario) K1Y 3B2 613-728-9347 (Phone) - 613-728-8913 (Fax)  cagacg@magi.com (E-mail)  www.cagacg.ca

Red Cross Works Toward Smooth Hand-over
OTTAWA, August 19 /CNW/ - The Canadian Red Cross will move forward as quickly and effectively as possible to transfer its blood services to new operators, following a decision today by the Ontario Court (General Division) to approve an agreement between the Red Cross and the two purchasers of the national blood program, Canadian Blood Services and Héma-Québec. The federal and provincial governments supported the plan proposed by the Red Cross to seek court approval for the transfer of blood operations. ``We will make every effort to expedite the procedure and have so instructed our lawyers,'' said Dr. Pierre Duplessis, Secretary General of the Canadian Red Cross. ``We hope to make the transfer as quickly as possible, but we also appreciate the need to do this in a climate of harmony, with the support and understanding of the broadest possible range of victims of the blood tragedy of the past, so we will make whatever adjustments are required.''
An agreement signed July 10 between the Red Cross and the new operators, Canadian Blood Services and Héma-Québec, provides for a total purchase price of $132.9 million for the Red Cross facilities, plus an estimated $30 million for inventory. The Red Cross intends to deposit the net proceeds of the transaction -- after debts have been paid -- into a fund to assist victims of the blood tragedy.
``Our continuing commitment is to provide the most financial assistance we can for victims of the blood tragedy, to transfer the blood operations to the new system operators in an effective and seamless manner, and to ensure that the Canadian Red Cross is in a position to pursue its humanitarian mission,'' said Dr. Duplessis.
Since its establishment more than 100 years ago, the Canadian Red Cross has assisted millions of people in Canada and throughout the world by providing disaster relief, water safety programs, first aid training, community health care, abuse prevention services, and international aid.

For further information: Suzanne Meunier, Public Affairs - Canadian Red Cross, (613) 739-2266; Internet: www.redcross.ca

New HMO Rules Announced Aug. 10, 1998.
President Clinton announced that the administration had ordered managed-care companies that insure federal
workers to eliminate "gag rules" which restrict what a doctor can tell a patient about treatment options.

The order will cover some 9 million federal employees and their families in the Federal Employees Health
Benefits Program.

The order is the latest step Clinton has taken administratively to give the protections proposed in
his legislation to the 85 million Americans enrolled in all federal health programs, such as Medicare and
veterans' programs.

Eliminating the "gag rule" allows doctors to discuss all medical options with a patient, regardless of cost
or whether they are covered by that specific health plan.

In his weekly radio address (Saturday, August 1, 1998), President Clinton said that all Americans urged Congress to reject a Republican plan for managed health care that he said fell short of the protections Americans need.

"Whether in managed care or traditional care, every single American deserves quality care," Clinton said in the address, which was broadcast live from a red brick fire station in this trendy Long Island town and witnessed by some 60 health care professionals.

As Republicans and Democrats offer competing versions of a patients' bill of rights to ensure quality care for Americans in health maintenance organizations (HMO), Clinton said he has worked with lawmakers of both parties to "pass a strong, enforceable" bill.

He said that "Congress should rise to its responsibilities and guarantee a patients' bill of rights, and they should reject proposals that are more loophole than law."

House Republicans last week narrowly passed a health bill on a mostly party-line vote. The Senate has not yet begun its debate.

Democrats claim the Republican approach leaves too much power in the hands of insurance companies and fails to give adequate decision-making authority to patients and doctors. They say it also does not give adequate access to specialists or emergency care.

In Washington, Maine Sen. Susan Collins delivered the Republican response and defended the bill backed by Senate Republican leaders as a measure that "will promote quality care without creating costly and burdensome federal controls and mandates that could cause some people to lose their health insurance altogether."

The Senate Republican bill creates an appeals system but does not offer the right to sue, and Republicans have said going to court would only prolong fights over care and add to the cost. They say it will help lawyers more than patients.

"Our plan differs from the Democrats' bill in a fundamental respect: it places treatment decision in the hands of doctors, not lawyers," Collins said

House Republicans Friday passed a "patients' bill of rights" they say will protect patients and expand health insurance options, but it faces harsh criticism from Democrats and the threat of a presidential veto.

The "Patient Protection Act" passed 216-210, a six-vote margin, shortly after a Democratic alternative failed by only five votes. The narrow margins reflect concerns among a small group of Republican moderates who would prefer a compromise.

The White House has said the House bill is unacceptable in its present form, but hopes to work out bipartisan agreements in the House and Senate on what it calls an enforceable patient bill of rights this year.

The Senate, similarly divided along party lines, will take up health legislation, possibly next week or when it returns from its summer break in early September.

House Republicans say their bill will be able to curb excesses in health care system dominated by HMOs (health maintenance organizations) and managed care plans, without adding a great deal of extra regulation and cost.

Democrats and a handful of Republican allies said the GOP approach was riddled with loopholes that gave more protection to politicians than patients.

Most attention has focused on the different approaches to grievance procedures and the right to sue a health plan for malpractice.  Democrats do more to expand lawsuit options, saying that is an essential deterrent to make sure health plans to do the right thing, but Republicans say that their external review process will guarantee that patients get treatment, without getting tied up in court for years.

The House Republican bill does allow a lawsuit if a health plan ignores the external appeals ruling, and the GOP recently modified that plan to allow damages of $500 a day, up to $250,000. An earlier version of the plan had a $100,000 cap.

Democrats says insurers and health plans, not doctors or even outside experts serving on grievance and appeals panels, would still get to decide what is "medically necessary" under the Republican proposal, and say their approach provides for a more independent and medically-based outside appeal.

But beyond the liability and accountability issues, there are dozens of other differences, ranging from exactly how much access to emergency care a patient would get, to expansion of special tax-free medical accounts that Democrats oppose.

Rep. Greg Ganske of Iowa, the Republican who has come out most strongly against his own party's approach and co-sponsored the Democratic alternative, said the Republican bill falls short in numerous areas.

He said it does not do enough to guarantee that patients really will get emergency care, and it does not cover clinical trials, give a doctor the ability to prescribe a drug not on a plan's approved list, provide access to specialists, or make sure that patients can stay with their own doctors in certain situations even when the health plan makes a change.

Republicans counter that the Democrats load up the health plans with too many new rules and mandates. They say they will require plans to release more information about their benefits, allowing people to make more informed choices about their insurance.

An Associated Press article on this matter may be found on the Bergen (NJ) Record's World Wide Web site at:

Extensive advertising campaigns are being launched by health-care interests as part of a lobbying fight pitting labor and consumers, which want federal mandates to protect patients from health plan restrictions, against insurance companies and employers, which argue that new rules would make health benefits unaffordable.

In an AFL-CIO sponsored ad, a frustrated nurse goes up against Frankenstein's monster.

"These bureaucrats from the insurance companies: They routinely deny care and they make decisions that only doctors should be making," complains Chicago nurse Lynn Pius in the million-dollar radio and TV ad campaign.

"Washington should be careful how it plays doctor," counters a radio ad sponsored by The Health Benefits Coalition, which includes some of the nation's largest health insurers and business groups such as the National Association of Manufacturers.

In the radio ad, Sen. Edward Kennedy, D-Mass., a lead sponsor of a "patients' rights" bill supported by congressional Democrats and President Clinton, is portrayed as a bumbling, mad scientist.

"Our creation is reviving," says a voice intended to be Kennedy's that then sounds horrified at what he has created. "Oh no! Frankenstein's monster!"

The entire House of Representatives and a third of the Senate are up for re-election this fall, and polls indicate health care is a priority for voters.

President Clinton has helped Democratic lawmakers make a proposed "patients' bill of rights" a hot issue on Capitol Hill this summer. Republicans responded last week by introducing their own bills, and debate could begin as soon as this week.

Although the competing plans vary widely on the protection offered and to whom, both Democrats and Republicans are seeking new guarantees for millions of consumers when they use their health insurance. Payment for emergency room care in any apparent medical crisis is one example.

However, among their differences, Democrats support and most Republicans oppose lifting a federal law that currently protects many health plans from high-stakes lawsuits.

That prompted 1,000 businesses -- including Mobil Corp., Kmart, Eastman Kodak Co., and Hewlett-Packard -- to sign a letter sent Friday to members of Congress saying, "We would have no other choice but to reduce benefits, increase premiums and out-of-pocket costs, or eliminate coverage" if patients' rights to sue are expanded.

At the same time, consumer groups are flooding congressional fax machines with graphic stories and photos about Americans harmed by health plan decisions but unable to sue for anything more than the cost of the treatment they couldn't get.

The American Medical Association is flying 100 doctors to Washington Tuesday to ask lawmakers to make it harder for insurance companies to interfere with medical decisions.

But while the AMA has made a public show of support for White House- backed legislation, it has given Republicans about 70 percent of its $1.2 million in political contributions during the 1997-98 election cycle, according to the Center for Responsive Politics. The AMA president plans to meet privately this week with House Speaker Newt Gingrich.

Republicans also have received 70 percent of the $1.8 million given to federal candidates and parties by the Health Insurance Association of America, the Blue Cross and Blue Shield Association and affiliated health plans, plus separate HMOs.

On the other side, trial lawyers, who would represent patients in new lawsuits, gave 89 percent of their $1.4 million in contributions to Democrats, according to the center's study.

Continuing to act by executive order as opposed to legislation in the face of an uncooperative Congress, President Clinton has announced a new initiative to pressure insurers to accept patients with pre-existing conditions, as required by law.

President Clinton (Tuesday, July 7) toughened enforcement of a law guaranteeing access to health insurance to people who lose their jobs by allowing the government to cancel contracts with firms that break that law.

Seizing on an issue that may prove useful to his fellow Democrats in the November 3 mid-term election, Clinton authorized the Office of Personnel Management (OPM) to cancel federal contracts with insurance companies violating the law.

Clinton's action is designed to step up enforcement of the 1996 Health Insurance Portability and Accountability Act, which seeks to guarantee access to health insurance for people who change or lose their jobs.
The law, crafted by Clinton and the Republican-controlled Congress before the last election, also requires insurers to sell coverage to small businesses and to end the practice of denying coverage to people with preexisting medical problems.

Critics say insurers have flouted the law by charging exorbitant premiums to individuals, by giving insurance agents incentives not to sign up people with preexisting conditions and by generally throwing up bureaucratic hurdles.

Clinton's action would do nothing about the high premiums, which are permissible under the law, but aims to punish firms that seek to skirt its requirements on preexisting conditions and on offering insurance to people who lose or switch jobs.


Pointers to related news reports on the World Wide Web are shown at the bottom of this report.  A new 17-member commission seeking to resolve Medicare's long-term financial problems held its first meeting Friday, March 6, 1998.

The commission, chaired by Sen. John Breaux (D-LA), has a year to recommend to Congress and the President a plan that will allow Medicare to absorb the 77 million baby boomers who begin retiring in about 12 years. (By comparison, Medicare today covers approximately 38 million people.) President Clinton has said he would like to see a Medicare plan adopted before he leaves office in 2001.

Breaux acknowledged the "very difficult task" facing the commission, made up of legislators and a range of experts, some of whom have sharply differing perspectives. Disagreements have already surfaced over the President's proposal to create a system allowing people to "buy in" to Medicare early, at age 55. Breaux and Rep. Bill Thomas (R-CA), the "adminstrative chairman" of the commission, said they would prefer that Congress hold off on taking any actions affecting Medicare until the commission has completed its work. Clinton has asked that the "buy-in" program be adopted by Congress soon.

The commission is scheduled to meet at least six times, with subcommittees meeting more frequently. Its report is due March1, 1999.

The commission's three subgroups will evaluate:
* whether an updated package of health coverages is needed in addition to financial reform
* relatively minor "fixes" such as raising the eligibility age, cracking down on waste, or providing for means-based eligibility criteria
* possibly, creating a new health system from scratch

Divergence of views became evident during the first meeting of the commission, whose members include Laura D'Andrea Tyson, economics profession at the University of California-Berkeley and former Presidential economic advisor; Rep. John Dingell (D-MI), a liberal who was in Congress when Medicare was created;
conservative Sen. Phil Gramm (R-TX); Samuel H. Howard, chair of Phoenix Healthcare Corporation (Nashville, TN); Rep. Jim McDermott (D-WA), who introduced a Canadian-style single-payer health plan in Congress in recent years; and Illene Gordon, Senate Majority Leader Trent Lott's Medicare staff member. The commission requires at least 11 votes out of 17 to adopt any recommendations.

Several commissioners discussed ways to bring public input to their deliberations, such as videoconferences linking some of the meetings to public gatherings across the country.


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