Beneath Surface, Health Care Plan Is Offering Boons
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Embedded in the vast legislation to overhaul Medicare and Medicaid are a series of narrowly focused, widely overlooked provisions that would relax Federal regulation of doctors and their laboratories, reimburse private hospitals for some local taxes and grant benefits potentially worth hundreds of millions of dollars to manufacturers of prescription drugs and medical devices. The legislation would broadly reshape health care for millions of Americans. But in its fine print, it also serves as a vehicle for proposals pushed by segments of the health care industry, which have mobilized a small army of lobbyists to press their concerns. Republicans defend these measures, saying consumers will benefit if Congress lifts the heavy hand of Federal regulation from the industry. Democrats and consumer advocates denounce the provisions as giveaways to industry and unwanted inducements to win support for the bills. The American Medical Association endorsed the legislation this week, saying it would expand choices for Medicare beneficiaries, after the doctors were assured by House Republican leaders that their Medicare fees would not be reduced. A major purpose of the legislation is to control the cost of Medicare, the Federal health insurance program for the elderly and disabled, and Medicaid, which covers 37 million poor people. But the Congressional Budget Office says that some of the narrowly focused Republican proposals would actually increase costs. The House Medicare bill, scheduled for debate on the floor next week, is furthest along in the legislative process. Prosecutors say the bill would significantly weaken Federal laws prohibiting kickbacks, fraud and abuse in Medicare and Medicaid. It would allow doctors to refer Medicare patients to medical equipment suppliers and other companies in which doctors have financial interests — a practice now forbidden. The bill would eliminate most Federal regulation of medical laboratories in doctors’ offices. It would prohibit punitive damages in lawsuits involving drugs and medical devices approved by the Food and Drug Administration. And it would guarantee Medicare payments for some costs incurred in testing “investigational drugs” that have not been approved for marketing. At the same time, the bill would eliminate a provision of the Federal Medicaid law that requires drug companies to give discounts to public hospitals, AIDS clinics and community health centers serving low-income patients. Democrats and consumer advocates say these measures would undermine consumer protections and could harm public health, especially when combined with other Republican proposals that loosen Federal standards for nursing homes and make it more difficult for victims of medical malpractice to collect large judgments. “The greatest fear is that in trying to win health care providers’ support for major cuts in Medicare and Medicaid, anti-competitive changes will be instituted that drive up overall health costs and undercut consumer protections, increasing harm to patients,” said Gene Kimmelman, co-director of the Washington office of Consumers Union, the large advocacy group that publishes Consumer Reports magazine. More : query.nytimes.com |