Washington Beat

By Michael Pretzer, Washington Editor

Congress: Who'll be calling the shots on health care?

Grassley and Baucus. Jeffords and Kennedy. Thomas, Johnson, and Tauzin. These legislators aren't exactly new to Washington. (Johnson, the least experienced, has been on Capitol Hill for 18 years.) But in the 107th Congress, they'll exert newfound influence over health care legislation.

Sen. Chuck Grassley (R-IA) now chairs the Senate Committee on Finance, which has jurisdiction over federal health care programs. In the past, the independent-minded Grassley has advocated tough antifraud laws—his 1986 amendments to the False Claims Act "have become the government's most effective weapon against health care fraud," according to the senator's office. And as you'd expect from someone who grew up on a farm, Grassley has crusaded for better rural health care.

Grassley wants to pass a Medicare prescription drug benefit this year; he's leaning toward a program in which seniors would buy coverage from the private sector. And he wants to tackle Medicare reform, perhaps starting with the appointment of yet another commission—one that would make recommendations by midyear.

Sen. Max Baucus (D-MT), the ranking Democrat on the Finance Committee, has power nearly equal to Grassley's because the Senate is evenly divided between the two major parties this term. Like Grassley, Baucus is from a rural state and concerned about health care in less populated parts of the country. "Montana has absolutely no Medicare HMOs," says Baucus. "And very few seniors there have Medigap coverage that includes a prescription drug benefit."

Expect Baucus to join Grassley's push for Medicare drug coverage. (And expect most health care lobbyists to put a rural spin on their agenda this year.)

Sen. James Jeffords (R-VT) chairs the Committee on Health, Education, Labor, and Pensions—as he did last term. He has supported a patient-protection act, so long as it doesn't give anyone a broad right to sue an HMO. He has worked vigorously to give seniors a drug benefit. "It doesn't make sense to reimburse hospitals for surgery but not provide coverage for the drugs that might prevent surgery," he says.

Last year, Jeffords introduced two bills to help needy seniors buy drugs while Congress debates a comprehensive drug program. Look for him to reach across party lines to continue this effort. "This issue is far too important to be bogged down by political gamesmanship," Jeffords says.

Sen. Edward M. Kennedy (D-MA), the ranking Democrat on Jeffords' committee, has been trying to advance numerous health care reforms—including a medical-errors reporting system, a Medicare drug benefit, and universal coverage. He's likely to intensify his efforts, given the Senate's 50-50 split.

Kennedy and Jeffords have worked together on health care issues before, though they disagree on the extent HMOs ought to be held liable. The two men are expected to cooperate this year. Already, Kennedy and Sen. John McCain (R-AZ) are drafting a new patient protection act for the Senate's consideration.

Rep. Bill Thomas (R-CA) chairs the House Committee on Ways and Means. (Previously, he chaired the Ways and Means' subcommittee on health.) Thomas favors radically changing Medicare from a defined-benefits system (in which the government determines what health coverage it will offer to seniors) to a defined-contribution system (in which Uncle Sam subsidizes seniors as they purchase insurance from competing private plans).*

Thomas has been critical of employer-based insurance, and he's no fan of the Health Care Financing Administration. In response to the Clinton proposal that HCFA administer a nationwide Medicare drug program, he said, "If we can't rely on HCFA to manage its current responsibilities, how can we trust HCFA to deliver a monumentally more complicated benefit for which it has absolutely zero experience?"

Thomas is both abrasive and pragmatic. If the practical aspect of his personality defines his chairmanship, he could be instrumental in devising drug coverage for seniors and making other Medicare reforms.

Rep. Nancy Johnson (R-CT) has taken Thomas' old job, chair of the Ways and Means health subcommittee. She has more direct contact with medicine than any of the other new power brokers: Her husband is an ob/gyn. Johnson has championed legislation to improve women's and children's health care. Last fall, she campaigned for additional funds to support Medicare+Choice plans.

The moderate Johnson, whose recent appointment has been praised by the Connecticut chapter of the American Association of Retired Persons, says her top priority is a drug benefit for seniors, and she vows to take a bipartisan approach. "I'm eager to work with colleagues from both sides of the aisle," she promises.

Rep. Billy Tauzin (R-LA), who switched from the Democratic Party to the GOP in 1995, has initiated no health care legislation thus far. And the Energy and Commerce Committee, which Tauzin chairs, hasn't had much of a health care agenda in recent years. But this may change: Tauzin has restructured the committee, creating a subcommittee to focus on health.

Will this session's legislative leaders be friendly to physicians? At the least, they ought to give doctors a fair hearing. The AMA's political action committee gave nearly $2 million to federal candidates during the 1999-2000 election cycle, according to the watchdog Center for Responsive Politics. Several of the power brokers were beneficiaries of the AMA's largess. Thomas received $10,000, Tauzin $5,000, Kennedy $3,500, and Jeffords and Johnson $2,000 each. Grassley and Baucus, however, got zilch.

The American Society of Anesthesiologists also was generous. It contributed more than $1 million to candidates. Thomas got $10,000, Jeffords $9,000, Kennedy $1,500, and Baucus $1,000.

*See the cover story, "A new day dawns . . . When patients buy their own health care," March 5, 2001.

Public Disclosure: Are patients ready to evaluate doctors scientifically?

Federal laws, court decisions, and bureaucratic regulations seem increasingly inclined toward letting the public know about physicians' mistakes and producing more evaluative data on doctors. And that's apparently just what Americans want. According to a survey by the Kaiser Family Foundation and the Agency for Health Care Research and Quality, a substantial majority of the population think medical errors and malpractice suits are the most important considerations in evaluating physicians. More people worry about their fate when they're receiving medical care than when they're flying in an airplane.

Yet few Americans are willing to pore over relevant appraisals and other data on their own. "People are interested in information on the quality of health care services, but they don't actively seek out that information," says John M. Eisenberg, AHRQ's director.

Of the more than 2,000 adults surveyed, only 25 percent had ever bothered to look at data comparing quality for health plans, 15 percent at data for hospitals, and 10 percent at data for physicians. A mere 7 percent had turned to the Internet for health quality information. (About 70 percent said they trust information coming from their doctor—more than twice the percentage that trusts data from Web sites.)

So, although Americans pay lip service to a more scientific evaluation of physicians and other health care providers, they still make their decisions the old-fashioned, subjective way, the survey concludes: They rely on recommendations from friends, family, and, yes, their personal physician.

 

Michael Pretzer. Washington Beat. Medical Economics 2001;6:24.