Citizens' Council on Health Care
CCHC HEALTH eNEWS
Friday, August 17, 2001


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Providing news and commentary on health care policy,
health insurance issues, and medical confidentiality.
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* D.C. CHILDREN'S ID CARD SYSTEM PLANNED -- AND OPPOSED

* NATIONAL HEALTH TRACKING SYSTEM PROPOSED -- IN CONGRESS

* JUDGES DISLIKE COMPUTER SURVEILLANCE OF THEIR ACTIVITIES

* LOWER HEALTH COSTS OR LONGER LIVES?

* MEDICARE'S FISCAL FORECAST BLEAKER THAN BEFORE

* MEDICAID RECIPIENTS AND UNINSURED (SICKER FOLKS) MORE LIKELY TO DIE

* EVERY CLONE A KING OR QUEEN?

* "MEDICAL NECESSITY" IS A VAGUE STANDARD

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D.C. CHILDREN'S ID CARD SYSTEM PLANNED

The D.C. Council has agreed to implement a Youth Identification
Card. The Washington Times calls it a "branding program" similar
to the ID cards of Nazi Germany or the passcards of Apartheid-ridden
South Africa.

South Africa's passbook system and computerized registry on blacks,
otherwise called the Book of Life file, includes data on name, sex,
birthdate, race, address, marital status, school or employment,
drivers license information, fingerprints and a photo. The passbooks
were automatically given to black youth at the age of 16, and used
to discriminate in employment and opportunity.

D.C. wants to start at age 2 with their computerized database. The
Times calls it a "presage to racial profiling", and the "ultimate
Peeping Tom." Scott McDonald of ScanThisNews at the Fight the
Fingerprint website, reports that he has contacted the D.C. Council,
who appears to be backpedaling, saying that the program hasn't been
finalized.

To offer your opinion on the matter call D.C. Council Chairman
Linda Cropp (202-724-8000) and Mayor Williams (202-727-2980).

CCHC COMMENTARY: This is not the first such initiative. The
Jacob Wetterling Foundation, named after the 11-year old child
abducted from his home 12 years ago teamed up this year with the
St. Paul Police Department, Tony's Pizza, Schwan Consumer Brands
of North America, Imation, Metro Transit, and Explorer Post 454
to fingerprint children at the "A Taste of Minnesota" festival
in July. Photos were taken and little fingers were smudged in ink
as parents tried to get assurance against the kidnapping of their
child. Instructions for collecting DNA were provided. The child
identification kits are available through the St. Paul Police
Department, and are to be kept at home in case the child ever
turns up missing. Meanwhile, the process is teaching children that
fingerprinting is acceptable for all citizens, rather than only
for criminals.

Source: "Apartheid on the Potomac," Deborah Simmons, Washington
Times, August 17, 2001,
http://www.washtimes.com/op-ed/20010817-29228120.htm

-Citizens' Council on Health Care
-August 17, 2001


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NATIONAL HEALTH TRACKING SYSTEM PROPOSED

ATTACHED TO A LETTER FROM THE OFFICE OF U.S.
REPRESENTATIVE NANCY PELOSI (D-CALIF):

------------------------------------------------------------------------
Health and Environment Assessment, Rapid Response
and Tracking Act (The HEARRT Act)

Each year in the United States:

* 150,000 babies are born with significant birth defects;
* 183,000 American women are diagnosed with breast cancer;
* 8000 children are diagnosed with cancer;
* 1.8 million Americans visit hospital emergency rooms because of Asthma.

In many cases, these diseases have been linked to environmental factors. However, our public health system does not have the ability to track when and where exposure to environmental pollutants leads to disease. Chronic diseases cause the deaths of 70 percent of Americans, yet we do not fully understand their causes, and we are not prepared to find or assist communities that may be at an elevated risk for such diseases.

Each year over 1,000 requests for investigations of cancer clusters are made to state agencies, but most states do not have the necessary personnel or capacity to investigate clusters of chronic diseases. Tracking programs that do exist at the state and local levels are a patchwork due to the lack of agreed-upon minimum standards or requirements for environmental health tracking. Moreover, there is no Federal infrastructure to support, coordinate, and respond to such investigations, nor is there significant integration of data systems and collaboration between environmental health professionals and other parts of the public health system.

Nationwide Health Tracking Network
The Health and Environment Assessment, Rapid Response and Tracking Act (HEARRT Act) creates a Nationwide Health Tracking Network to collect, analyze, and report data on the rate of chronic disease and the presence of relevant environmental factors and exposures. The Network would coordinate national, state, and local efforts to inform communities, public health officials, researchers, and policymakers of potential environmental health risks. This information will be used to target resources and strengthen our capacity to identify, understand, rapidly respond to, and prevent chronic disease.

Key components of the proposed Network:
* Instructs the CDC to develop national standards for data collection and reporting, and provide technical assistance to states as they build the capacity to meet those standards.
* Ensures the public dissemination of data through a National Environmental Report Card.
* Makes grants to states to collect, analyze, and report data by county regarding the rate of priority chronic diseases and the presence of relevant environmental factors and exposures.
* Strengthens the capacity of states, in collaboration with the federal government, to identify, investigate and rapidly respond to potential environmental health risks.
* Establishes five regional biomonitoring laboratories to support state efforts.
* Funds state pilot programs to improve tracking methods and respond to regional concerns;
* Dedicates resources to training public health students to specialize in environmental health.

Investing in prevention through these key components is estimated to cost the federal government $275 million annually - less than 0.1 percent of the current annual economic cost of treating and living with chronic disease.

For more information contact Scott Boule (Rep. Nancy Pelosi) at 5-4965.


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JUDGES DISLIKE COMPUTER SURVEILLANCE OF THEIR ACTIVITIES

Federal judges in a Washington, D.C. office disabled computer
software that they say is monitoring their activities illegally,
and unethically. The software was installed to detect downloading
of music, videos, and pornography.

These judges, of the U.S. Court of Appeals in the Ninth Circuit in
San Francisco, will be some of the individuals ruling on privacy and
surveillance court cases. The Judicial Conference of the United State,
the ultimate governing body over these matters, will meet September 11
to resolve the issue.

The technology was shut down for a week in May, affecting one-third of
all judicial systems. The Administrative Office of the Courts countered
by saying that "as much as 3 to 7 percent" traffic which is unlikely to
relate to official business.

In the private sector, a survey by the American Management Association
this year found that 63 percent of companies monitored employees'
computer use.

Source: "Rebels in Black Robes Recoil at Surveillance of Computers,
NEIL A. LEWIS, The New York Times, August 8, 2001 http://www.nytimes.com/2001/08/08/technology/08COUR.html

-Citizens' Council on Health Care
-8/14/01

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HEALTH COSTS AND LONGER LIVES

Rapidly rising health-care costs have some people searching for a
restraint mechanism. But those increases must be balanced
against increases in life expectancy. A study by Harvard
University researcher David Cutler and Stanford University's Mark
McClellan, forthcoming in the journal Health Affairs, takes up
this issue.

o In 1984, Medicare spent nearly $4 billion in 2001 dollars
paying for the treatment of heart attacks, a figure which
exceeded $6 billion in 1998 -- even though the number of
heart attacks had fallen almost 10 percent.

o But while heart attack victims in 1984 lived slightly less
than five years longer on average, victims in 1998 lived
an average of six years longer.

o Each heart attack cost Medicare nearly $12,000 more in
1998 than it did in 1984.

o But many would say that extra cost is worth the extra year
of life.

The lesson the researchers draw is that a misguided race to hold
down health-care costs can retard technological progress.

Source: David Wessel, "Capital: Rising Medical Costs Can Be a
Good Thing," Wall Street Journal, July 26, 2001.

For WSJ text
http://interactive.wsj.com/articles/SB996097559682583547.htm

Source: Taken directly from the Daily Policy Digest, National Center
for Policy Analysis, http://www.ncpa.org, 8/3/01


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MEDICARE'S FISCAL FORECAST BLEAKER THAN BEFORE

Medicare is unsustainable and its financial outlook is much
bleaker, says U.S. Comptroller General David M. Walker, head of
the General Accounting Office. In 2016, the same year Social
Security outlays are expected to exceed tax revenues, Medicare
hospital outlays will exceed payroll tax revenues.

[Medicare's Hospital Insurance (HI), or Part A, is financed
through payroll taxes, and Supplementary Medical Insurance (SMI),
or Part B, covering outpatient services, is 75 percent financed
by general revenues and 25 percent by beneficiary premiums.]

The Medicare Trustees now estimate spending in the long-term will
grow 1 percentage point above per-capita gross domestic product
(GDP) each year -- about 1 percentage point faster than previous
projections.

o Medicare spending is running 7.5 percent higher than last
year, for the first 8 months of fiscal year 2001.

o Total Medicare spending will double to 5 percent of GDP by
2035 -- and grow to 8 percent of GDP in 2075.

o In just one year, the net present value of the shortfall
in HI revenues over the next 75 years increased 75
percent, from $2.6 trillion to $4.6 trillion.

By 2030, warns Walker, Social Security, Medicare, and Medicaid
will consume more than three-quarters of total federal revenue --
without outpatient prescription drug coverage.

o Today, restoring solvency to the HI trust fund would
require benefit cuts of 37 percent or tax increases of 60
percent.

o Postponing action until 2029 would require more than
doubling the payroll tax or cutting benefits by more than
half.

o Overall, Medicare and the federal portion of Medicaid
together will grow to 14.5 percent of GDP in 2075 -- not
including the state and local shares of Medicaid
expenditures.

Absent reform, says Walker, "sometime during the 2040s government
would do nothing but mail checks to the elderly and their health
care providers."

Source: David M. Walker (Comptroller General of the United
States), "MEDICARE: New Spending Estimates Underscore Need for
Reform," Testimony Before the Committee on the Budget, House of
Representatives, July 25, 2001, GAO-01-1010T, General Accounting
Office, Washington, D.C.

For text http://www.gao.gov/new.items/d011010t.pdf

Source: Taken directly from the Daily Policy Digest, National Center
for Policy Analysis, http://www.ncpa.org, 8/2/01


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SICKER INDIVIDUALS MORE LIKELY TO DIE

Medicaid and Medicare beneficiaries and uninsured individuals
are more likely to die of a heart attack than people with private
health coverage, Scripps Howard News/Nando Times reports.

A new study conducted by researchers at Illinois' Governors State
University and released in the August issue of Health Services
Research tracked hospital records for more than 95,000 patients in 11
states who were diagnosed either with a heart attack or "presumed
heart attack complication." Lead study author Jay Shen said that
Medicaid beneficiaries and people without insurance were 20% and 30%
more likely, respectively, to die in the hospital than Medicare
beneficiaries, while patients with private insurance were 20% less
likely to die than Medicare beneficiaries.

Shen said that race and income did not significantly alter the
risk of death after a heart attack. The study found, however,
that participants "in the most unfavorable circumstances" -- those
who lived in a low-income area, lacked insurance or were enrolled
in Medicaid -- were "not only ...more likely to die, but also were
sicker, stayed in the hospital longer, were less likely to receive
certain procedures for heart disease and had higher hospital bills
compared to privately insured patients who lived in more affluent
neighborhoods."

Shen said that "given the higher costs posed" by such individuals,
"an increased focus on improving treatment of heart attack patients
bearing multiple low socioeconomic attributes may be in the public
interest" (Bowman, Scripps Howard News/Nando Times, 7/31).

Source: Taken directly from " Heart Attack Patients With Medicaid,
Medicare or No Insurance More Likely to Die Than Those With Private
Coverage, Study Finds," KAISER DAILY HEALTH POLICY REPORT, August 1,
2001, http://www.kaisernetwork.org/daily_reports/rep_hpolicy.cfm


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EVERY CLONE A KING OR QUEEN?

Human cloning presents many moral and ethical quandaries.
However, the economic impact of cloning is usually not
considered. While many governments ban or are in the process of
banning cloning, many believe that it will proceed anyway.

Researcher Gilles Saint-Paul suggests that, economically, cloning
high-talent individuals is the only sensible measure. And even
then, cloning would only be economically justifiable if ability
is transmitted genetically. This is an unresolved empirical
issue:

o Correlated test scores among separated twins support the
view that DNA matters; but the high returns to education
suggest a more limited role for inheritance.

o However, unlike the offspring of highly talented people
today, a clone would be assured of having the desirable
genetic traits of the original.

How might a company profit from cloning? Since most nations
recognize human rights, slavery or serfdom would not be an
option. The author hypothesizes that:

o Companies could sell clones information about their
heritage.

o Companies could copyright certain genomes for other
cloning companies.

o Top universities could invest in cloning high-ability
individuals to increase attendance and the quality of
their students.

Source: "Brave New World," Economic Intuition, Spring 2001; based
on Gilles Saint-Paul, "The Economics of Human Cloning," Center
for Economic Policy Research, Discussion Paper No. DP2674.

For more on Economic Intuition research summaries
http://www.economicintuition.com

Source: Taken directly from the Daily Policy Digest, National Center
for Policy Analysis, http://www.ncpa.org, 8/10/01


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"MEDICAL NECESSITY" IS A VAGUE STANDARD

A major aim of the Patients' Bill of Rights (PBOR) is to expand
the ability of patients to sue their health plan when they are
denied coverage for a "medically necessary" treatment and suffer
harm as a result.

The problem is that rather being a standard of care, "medical
necessity" is a vague phrase with no generally accepted
definition among insurers, doctors or patients.

o At one extreme, an intervention may be understood as
medically necessary only if it is essential to improve or
cure a disease -- which could preempt many currently
standard interventions, such as epidural anesthesia for
normal vaginal childbirth.

o By contrast, Medicare defines "reasonable and necessary"
interventions as those which are "safe and effective, not
experimental, and appropriate."

o Another common definition is "sufficiently accepted within
the medical community to be covered as acceptable medical
care."

A uniform definition might not help much. Medicare ostensibly
provides uniform benefits, even though various insurers act as
intermediaries. But a General Accounting Office study found wide
variations:

o Medicare payment for a chest x-ray was 451 times more
likely to be denied in Illinois than in South Carolina.

o Payment of a physician office visit was almost 10 times
more likely to be denied in Wisconsin than in California.

o And payment for real-time echocardiography was nearly 100
times more likely to be denied by Transamerica Occidental
than by Blue Shield of California.

Yet many health plan contracts specify that they will cover all
"medically necessary" treatments. When patients sue on the basis
of such vague promises, they win.

If health plans spelled out in their contracts precisely what is
covered, and how coverage guidelines are developed and revised,
experts say consumers could compare what is actually offered,
instead of vague promises open to differing interpretations.

Source: E. Haavi Morreim (University of Tennessee), "The Futility
of Medical Necessity," Regulation, Summer 2001, Cato Institute,
1000 Massachusetts Avenue, N.W., Washington, D.C. 20001, (202)
842-0200.

For text http://www.cato.org/pubs/regulation/regv24n2/morreim.pdf

Source: Taken directly from the Daily Policy Digest, National Center
for Policy Analysis, http://www.ncpa.org, 8/3/01

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