Citizens’ Council on Health Care
CCHC HEALTH eNEWS
Friday, December 21, 2001


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Wishing you a very merry and blessed Christmas!

Twila Brase
President, CCHC
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Providing news and commentary on health care policy,
health insurance issues, and medical confidentiality.
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* FAT CONTROL: THE NEXT PUBLIC HEALTH TARGET

* THE POLITICAL AGENDA OF PUBLIC HEALTH GROUPS

* ORACLE ADVANCES MEDICAL ID SYSTEM

* TAX CREDITS WOULD GIVE SELF-INSURED A BREAK

* CHANGES TO DE-IDENTIFIED DATA REQUIREMENTS SOUGHT

* STUDY: ADVERTISING LEADS TO MORE PHARMACEUTICAL SPENDING

* COURT: MISSOURI HMOS CANNOT LIMIT QUANTITIES OF DRUGS

* NEW: CLIPS AND SNIPS: NOTABLE NEWS IN BRIEF

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 CCHC Commentary included
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FAT CONTROL: THE NEXT PUBLIC HEALTH TARGET

Surgeon General David Satcher released a report on December 13
calling communities to get involved in controlling the weight of
individuals: “The Surgeon General’s Call to Action to Prevent and
Decrease Overweight and Obesity.”

Blaming the “modern environment” HHS Secretary Tommy Thompson
challenged communities to help solve the obesity problem. Satcher
said that the problem is not just a personal problem. Communities
should address it.

The report claims that 300,000 U.S. deaths per year are associated
with obesity and being overweight, societal costs total $117 billion
in 2000, an estimated 61 percent of U.S. adults and 13 percent of
children and adolescents are overweight, less than 1/3 of American
exercise according to federal recommendations, and only 3 percent
following federal eating guidelines. In addition, obesity is more
prevalent in lower income families.

Strategies to lower the weight of Americans include:

* required physical education for all grades
* healthy food options on school campuses
* safe and accessible recreational facilities in all communities
* physical activity at work sites.
* less time watching television
* education for expectant parents
* change perception of obesity to emphasize health, not appearance
* behavioral and medical research on causes of obesity, with
emphasis on economic and racial/ethnic disparities

Satcher claimed community responsibility for the problem: “When there
are no safe places for children to play, or for adults to walk, jog,
or ride a bike, that’s a community responsibility. When school
lunchrooms or workplace cafeterias don’t offer healthy and appealing
food choices, that is a community responsibility. When new or
expectant parents are not educated about the benefits of breast-
feeding, that’s a community responsibility. And when we don’t require
daily physical education in our schools, that is also a community
responsibility.”

Note: Obesity and overweight is defined by Body Mass Index, a
calculation of a person’s weight in kilograms divided by the square of
their height in meters. An overweight has a BMI between 25 and 29.9,
while an obese adult has a BMI of 30 or higher.

The Surgeon General’s Call to Action to Prevent and Decrease Overweight
and Obesity is available at http://www.surgeongeneral.gov/topics/obesity.

Source: “OVERWEIGHT AND OBESITY THREATEN U.S. HEALTH GAINS,” HHS Press
Release, December 13, 2001.

-Citizens’ Council on Health Care
-December 21, 2001


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THE POLITICAL AGENDA OF PUBLIC HEALTH GROUPS

In the month following the Sept. 11 attack, the American Public
Health Association (APHA) compiled “Guiding Principles for a
Public Health Response to Terrorism.” But instead of offering
a blueprint focusing on bioterrorism threats such as anthrax and
smallpox with plans to update labs and improve our response to
epidemics, the first points on the APHA’s 12-point plan are to:

o “Address poverty, social injustice and health disparities
that may contribute to the development of terrorism.”

o “Provide humanitarian assistance to [those] . . . directly
or indirectly affected by terrorism.”

”Promote nonviolent means of conflict resolution.”Not until point
four does the APHA address public health needs, such as improving
laboratory and surveillance systems.

The guidelines then mix calls for greater vaccine availability
and data collection systems with appeals for the prevention of
hate crimes, elimination of nuclear weapons and for “dialogue
among peoples.”

Thus five of the 12 guidelines deal with the APHA’s “social
engineering” agenda, says physician Sally Satel, with no
reference to anything traditionally associated with public
health.

In addition to advancing practical techniques for disease and
injury prevention, enforcing standards of scholarship, and
educating policy makers, the APHA is preoccupied with tangential
national and international policy issues. This year, for example,
the APHA put forth policy resolutions against national missile
defense, the war in Southwest Asia, and the General Agreement on
Trade in Services.

Other public health organizations, such as the American College
of Epidemiologists and the World Health Organization, seem
preoccupied with social justice issues—whereas traditional
public health concerns are now a matter of national defense.

Source: Sally Satel (American Enterprise Institute), “Public
Health? Forget It. Cosmic Issues Beckon,” Wall Street Journal,
December 13, 2001.

For text
http://interactive.wsj.com/articles/SB1008206405162382080.htm

For more on Response to Terrorism http://www.ncpa.org/iss/ter/

Source: Taken directly from the Daily Policy Digest, National
Center for Policy Analysis, 12/13/01.


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ORACLE ADVANCES MEDICAL ID SYSTEM

HealthSouth, a company that runs rehabilitation centers
and hospitals,is building a new digital age facility in Birmingham,
Alabama. The hospital will use Oracle technology to build centralized
electronic storage for medical records, screens by patient beds for
physician access to the Internet and a wireless network to update
patient information. Doctors will be able to access patient data
anytime from anywhere. The $125 million hospital in scheduled to be
up and running in two and one-half years. Oracle’s CEO, Larry
Ellison, who has been in the news lately trying to encourage the
federal government to use his technology to create national ID
cards for all citizens said about the latest venture:

”All the information about you as a patient would be in one spot...
The idea here is to stop collecting paper.”

Source: “A Hospital for the Digital Age,” Jennifer Couzin
The Industry Standard, March 26, 2001. http://www.thestandard.com/article/display/0,1151,23131,00.html?mail

-Citizens’ Council on Health Care
-December 21, 2001


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TAX CREDITS WOULD GIVE SELF-INSURED A BREAK

House Ways and Means Committee chairman Bill Thomas (R-Calif.)
has proposed including up to $10 billion to help laid-off workers
keep health insurance in the economic stimulus package. Workers
would be given vouchers to buy insurance on their own.

While some conservatives feel government should not use the tax
code to influence behavior (sometimes called “social
engineering”), supporters point out that government tax policy is
not now neutral when it comes to health insurance. In fact,
there is already an enormous entitlement that applies only to
people who get health insurance through their employer—a
benefit not available to the uninsured or to those who buy their
own coverage.

o Compensation in the form of health insurance benefits
isn’t considered income and is thus free of taxes - thus
government loses $140 billion each year in revenue.

o Employer-sponsored health insurance (ESHI) is already the
third biggest entitlement program in the country, trailing
only Social Security and Medicare.

o But those who buy their own coverage or who have none get
no tax advantage except for a tax deduction for those
expenses in excess of 7.5 percent of their gross income.

A tax credit, proponents argue, would begin to level the playing
field between ESHI and individual health insurance coverage. Such
a credit should approximate the tax subsidy available for ESHI --
about $1,000 per person. It could be done for roughly $30 billion
a year, much of which we already spend on services to the
uninsured. It isn’t a new entitlement; rather, it makes the same
entitlement available to everyone.

Source: Greg Scandlen (NCPA), “ Health care tax credit benefits,”
Washington Times, December 13, 2001.

For text http://www.washingtontimes.com/commentary/20011213-25452768.htm

Source: Taken directly from the Daily Policy Digest, National
Center for Policy Analysis, 12/14/01.


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CHANGES TO DE-IDENTIFIED DATA REQUIREMENTS NEEDED FOR ANTI-TERRORISM

The bioterrorism threat has prompted pharmacy sales data collection
companies to ask HHS to take a new look at its definition of
de-identified data under the HIPAA privacy rule. The firms are asking
HHS to modify the definition of de-identified data to expand zip codes
from only three digits to five-digits.

The tracking of pharmaceutical sales, the companies explained, provide
an early warning of possible bioterrorist attacks by tracking increases
in the sale of specific products. Without the increased precision in the
zip codes, the usefulness of the data from a public health perspective
will be severely curtailed.

Source: Taken directly from PRIVACYSECURITYNETWORK, December 17, 2001


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STUDY: ADVERTISING LEADS TO MORE PHARMACEUTICAL SPENDING

The 50 “most advertised” prescription drugs “contributed
significantly” to the rise in the nation’s pharmaceutical
spending between 1999 and 2000, according to a new study,
the New York Times reports (Petersen, New York Times, 11/21).

The National Institute for Health Care Management Research
and Educational Foundation study, titled “Prescription Drugs
and Mass Media Advertising, 2000,” found that increased
sales of the 50 most advertised drugs accounted for 47.8% of
the $20.8 billion rise in retail spending on pharmaceuticals
from 1999 to 2000.

Sales of these 50 most advertised drugs rose 32% from 1999
to 2000, compared to 13.6% for the 9,850 other drugs studied.
According to the study, a rise in the number of prescriptions—which climbed 24.6% from 1999 to 2000 -- rather than an
increase in price, prompted the “sales surge” for the 50 most
advertised drugs. The number of prescriptions for the 9,850
other drugs rose 4.3% from 1999 to 2000.

The NIHCM Foundation said that the study “adds to the
circumstantial evidence” that direct-to-consumer advertising
”may be an increasingly important factor” in the expanded use
of new, more expensive prescription drugs. However, the study
found that an increase in the number of FDA-approved drugs for
chronic conditions, a rise in the number of patients with chronic
conditions, an aging population and an increase in spending to
promote drugs to doctors also contributed to the rise in
prescriptions.

Spending to promote prescription drugs increased to $15.7
billion in 2000 from $13.9 billion in 1999, while spending on
DTC advertising rose to $2.5 billion in 2000 from $1.8 billion
in 1999, the study found. “DTC ads are still a relatively small
component of all prescription drug promotion. But they are
clearly becoming an important influence,” Nancy Chockley, president
of the NIHCM Foundation, said. She added that “we still don’t know
whether these ads are leading to inappropriate prescriptions” for
patients (NIHCM Foundation release, 11/21).

Reaction

According to pharmaceutical companies, DTC advertising boosts
their “competitive edge” and prompts “consumers to pay more attention
to their health while exploring options” (Silverman, Newark Star
Ledger, 11/21). Alan Holmer, president of the Pharmaceutical
Research and Manufacturers of America, said, “We have an epidemic of
under-treatment of serious illnesses in the United States.

Surveys of both patients and physicians show that DTC advertising
leads patients who would otherwise go without medical care for these
terrible illnesses to seek treatment for the first time.” He added
that DTC advertising also may “help remind patients to keep taking
the medicines their doctors prescribe.” The New York Times reports
that physicians, lawmakers and consumer groups have criticized DTC
advertising for prescription drugs during the past year.

In June, the American Medical Association approved a resolution to
urge drug companies “voluntarily to place disclaimers on each ad”
that state, “Your physician may recommend other appropriate treatments”
(Petersen, New York Times, 11/21). The study is available online.

Source: Taken directly from “Study Finds 50 Most Advertised Drugs
’Contributed Significantly’ to Increased Pharmaceutical Spending in
2000,” KAISER DAILY HEALTH POLICY REPORT, 11/21/01


_____________________________________________________
COURT: MISSOURI HMOS CANNOT LIMIT QUANTITIES OF DRUGS

HMOs recently challenged two Missouri laws, using a defense that
included admission that HMOs are not insurance.

In 1997, Missouri passed two laws the impacted HMO management
of pharmacy benefits. The first required HMO to charge the same
copayment for prescription drugs filled by any network pharmacy
if the pharmacy meets the HMO contract’s product cost
determinations. The second law prohibits HMOs from limiting the
quantity of drugs that can be obtained at one time, unless the
limit applies to all pharmacy providers. These laws changed
previous practices of a 30 day supply and a higher copayment at
retail pharmacies than mail order pharmacies.

Express Scripts, Inc, the Missouri Chamber of Commerce and the
St. Louis Area Business Health Coalition challenged these laws
in court, arguing that the federal ERISA law preempted state law.
To keep companies from having to obey a hodge podge of laws
around the country, the Employee Retirement Income Security Act
(ERISA) exempts companies that have employees in various states
from following state laws that affect employee benefits. Per
federal law, ERISA “supersedes any and all state laws insofar as
they may now or hereafter relate to any employee benefit plan.”

The US Court of Appeals for the Eighth Circuit disagreed. The Court
of Appeals affirmed the lower court’s decision that the laws were
not preempted by ERISA because of the savings clause. The savings
clause prevents certain state laws from being superceded by ERISA,
in particular, state laws that regulate insurance.

Express Scripts argued that the Missouri law did not regulate
insurance because HMO are not in the business of insurance. HMOs
provide prepaid health care services. They do not indemnify their
enrollees against risk. Missouri’s Department of Insurance argued
that HMOs are “an innovative form” of insurance. The court agreed
with the Department, holding HMOs to be insurers and finding the
laws to be enforceable.

Source: “Court Upholds Missouri Law Prohibiting HMOs From Limiting
Quantity of Drugs Provided to Enrollees,” Paula C. Ohliger, JD,
Legal Matters.

-Citizens’ Council on Health Care
-December 21, 2001


______________________________________
CLIPS AND SNIPS: NOTABLE NEWS IN BRIEF

Finding Bioterror Through Patient Surveillance:
Biosurveillance is being promoted as the best defense against
bioterrorism. Public health departments could scanning medical
records regularly for early signs of a threat. Cerner sells an
emergency-room software package called FirstNet that is a patient-
tracking system. Peter Swire, formeerly President Clinton’s
privacy adviser says that government entities would first have to
be required to follow the privacy regulations or patients would
not talk openly with their physicians. Source: “Computer
Programs Could Help Health Officials Track Bioterror, THOMAS E.
WEBER, THE WALL STREET JOURNAL November 26, 2001, http://interactive.wsj.com/fr/emailthis/retrieve.cgi?id=SB1006724249769815440.djm
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CCHC COMMENTARY: The privacy regulations PERMIT sharing data
with government officials, law enforcement and researchers without
patient consent. Swire knows but ignores this problematic detail
that has knowledgeable citizens already alarmed and unwilling to
talk openly with their physicians.

First Privacy Office:
California has opened up the “first-in-the-nation” Office of
Privacy Protection. It is located in the Department of Consumer
Affairs. Source: http://www.privacyprotection.ca.gov/

Global ID System:
The United Nations heard a plan to register every human being in
the world in Geneva. Universal identification, using fingerprints
and global registration would be initiated to fight illegal immigration
and people smuggling. Pascal Smet, head of Belgium’s asylum review
board introduced that idea, noting the technology is not a problem,
Instead, its “only a question of will and investment.” He also noted
that “It’s a basic rule of management that if you want to manage
something, you measure it. It’s the same with human beings and
migration.” Not everyone at the roundtable was convinced. Source:
”Refugees meeting hears proposal to register every human in Geneva,”
Maria Hawthorne, The Sydney Morning Herald, December 14, 2001
http://www.smh.com.au/breaking/2001/12/14/FFX058CU6VC.html

CA Sale of Personal Data Stopped:
Governor Gray Davis has halted California’s sale of birth and
death records from its state database after the San Jose Mercury
News reported that the data was found on the RootsWeb.com Internet
site. Geneology buffs defended the practice, noting that many
individuals had found family members they never knew as a result
of the information listed on RootsWeb.com and other geneology web
site. Source: “California Stops Selling Personal Data, Katie
Hafner, The New York Times, December 13, 2001.

London to Register Naughty Children:
London police plan to set up a database on children as young as
three who behave badly or commit misdemeanors so that they might
be monitored through out their life for criminal potential. The
database will be expanded throughout England after a pilot
project in London. The intent is to “create an intelligence nexus
which will hold sensitive information about large numbers of
children” to provide for “collective intervention.” Liberty groups
express concern. Source: “Naughty children to be registered as
potential criminals,” David Bamber, London Telegraph, November 25,
2001
http://news.telegraph.co.uk/news/main.jhtml?xml=/news/2001/11/25/ncrime25.xml&sS
%20heet=/news/2001/11/25/ixhomef.htm



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NOTE: These news items have been taken directly
from email received by CCHC or from Internet
newspaper publications. Titles in ALL CAPS are
CCHC creations except for those heading articles
from the National Center for Policy Analysis,
the Health Law Pulse, PrivacySecurityNetwork,
and LIST.HEALTHPLAN. Credit to the sending
organization or news service is listed at the
end of each article.
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