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Full text of WSJ article on SB 1028 by Dr. James Orient
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- Subject: Full text of WSJ article on SB 1028 by Dr. James Orient
- From: JMRoraback@aol.com
- Date: Tue, 4 Jun 1996 03:19:49 -0400
----------- forwarded message ----------------
Subj: Re: Kassenbaum-Kennedy bill - Bizarre Hazard to Fee-For-Service Care?
Date: 96-06-03 14:08:59 EDT
From: email@example.com (Robert C. Carson)
To: firstname.lastname@example.org (Div 12 Sect 3)
CC: Div12@vm1.nodak.edu (Division Clinical)
FYI, I am passing on some material I got from a D. G. Huffman
regarding the astounding provisions of the Kassenbaum-Kennedy health care
bill. APA, where are you on this one?
---------- Forwarded message ----------
Date: Mon, 3 Jun 1996 03:55:13 -0500
From: D. G. Huffman <email@example.com>
To: "Robert C. Carson" <firstname.lastname@example.org>
Subject: Re: Kassenbaum-Kennedy bill - Bizarre Hazard to Fee-For-Service
I have enclosed the full text of the article. It was in the Thursday Wall
Street Journal, 5/30/96. Feel free to pass it on.
Health Bill Would Shackle Doctors -- Literally
By James M. Orient
Sending doctors or patients to federal prison in order to protect health
plans from paying too much was one the most loathsome features of the
defeated Clinton Health Security Act. Now it's back, passed by both houses
of Congress, voted for by all 150 senators. However, all attention is
focused on the argument over revised tax treatment for medical savings
accounts, a feature of the House but not the Senate bill.
Here are some highlights of both versions of the Kassebaum-Kennedy health
care bill: five years in prison for making a misstatement to your health
plan (say you "forgot" to mention a pre-existing condition); 10 years in
prison for intentionally "misapplying" any assets of the plan (say to a
"medically unnecessary service that nonetheless relieves your symptoms): one
year in prison if the "misapplied" amount is less than $100; five years in
prison for failing to turn over a patient's records (say to a prosecutor who
wants to accuse him of making a misstatement to the plan); life in prison if
a plan is "defrauded" in connection with the care of a patient who dies.
And that's not all. The bill also calls for fines of $10,000 for each
instance of "incorrect" coding, even an honest mistake, on insurance claims
(there are thousands of codes and no consistent interpretation); fines
and/or prison for those who "transfer items or services for free or for
other than fair market value" (i.e., who provide unauthorized charity):
automatic seizure of all property paid for with the gross proceeds of any
"federal health care offense" (and all offenses related to any health
insurance plan, public or private, will be federal offenses).
The message sent by the Kassebaum-Kennedy bill is loud and clear: Any doctor
who practices fee-for-service medicine has to put it all on the line -- his
house, his car, his office, his bank account, and most of all, his liberty.
If he "fails to comply with a statutory obligation" to provide only
"medically necessary" services, correctly coded, he can be reduced to
lifelong poverty and imprisoned besides. The law enforcement machinery will
be vastly augmented to meet the challenge. There will be rewards to
informants, and prosecutors get to keep the fines and seized property. If
the enforcers need evidence, they can seize anybody's medical records
anytime (this will be even easier once the records are on a computer
When opponents of the Clinton plan pointed out provisions like this, nobody,
Democrat or Republican, actually tried to defend the criminalization of
medicine. The opponents were called "liars," but all they had to do was
carry a copy of the plan around and invite people to read it.
The Clintons made a big mistake: They tried to keep the work of the task
force a secret. That made people too curious. The Kassebaum-Kennedy bill is
no secret. And the criminal provisions are not discreetly buried in some
1,300 page document. The Kassehaum-Kennedy "antifraud" and "administrative
simplification" (forced computerization provisions are about a third of the
How, then, did this bill pass? I think the answer must be this: Nobody
reads. Congressmen don't read the bills: they just pate them. Sen. John
Chafee's (R, R.I.) staff actually told one constituent that the senator
didn't even care what was in the bill, as long as it passed! Reporters don't
read the hills either.
So here's the strategy: If you want to peas something that almost everyone
will hate, slip it into a bill that Congress is desperate to pass just
before an election so congressmen can say they "passed health care reform"
or something equally popular. And talk about your good intentions:
portability, "access" and (by the way) "tougher" sanctions against fraud and
waste (skip the devilish details).
Despite the current bill's Draconian enforcement provisions, much of the
debate over Kassehaum-Kennedy focuses on modifying the tax code, which now
discriminates against people who buy their own insurance or who have large
deductibles and pay most medical bills directly rather than through an
employer-provided insurance plan.
Some people think that medical sayings accounts, which allow individuals to
decide how to spend their health care resources, would be the death knell
for managed care. Why pay a third party or middleman to manage your money
(and deny you access to medical services you want) when you could make your
own decisions and keep any savings? If favorable tax treatment for medical
savings accounts makes it into Kassehaum-Kennedy and these "antifraud"
provisions survive, it will be a Pyrrhic victory. Sure, you can have an MSA.
But just try to find a doctor who will treat you. No wonder HMO executives
look so smug. They bash MSAs, but they don't have to worry very much; with
this bill, they win either way.
Doctors who do not aspire to martyrdom have a number of options under
Kassebaum-Kennedy: Open a pizza parlor, retire altogether (and hope they
don't get sick themselves), or sign a capitation contract with an HMO. If
they sign on, they may get $10 per month for each person they don't see. And
they need not live in fear of a knock on the door from the FBI. (If the HMO
runs afoul of the law, the HMO just has to file a corrections plan.) After
we finish eliminating fraud by individual doctors (by driving them out of
practice), maybe we can start on real campaign reform for congressmen: one
year in prison for misstating a campaign expenditure by $100 or less, and 10
years for misstatements involving more than $100.
It's a matter of equality under the law. If we can't hope for private
doctors to have the same due process rights as people accused of rape or
aggravated assault, let's at least assure that congressmen are treated as
well as private doctors and their patients
- - - - - - - - - - -
Dr. Orient is in solo private practice and is executive director of the
Association of American Physicians and Surgeons.