Eye On Health

Monthly Review & Commentary On Health Policy Issues From A Rural Perspective - May 1st, 1998

Darwin, Congress & Slopping Hogs

This essay is by Glen Grady, CEO at the Memorial Medical Center in Neillsville, Wisconsin and a director of the RWHC. He is serving on a task force with the federal agency that runs the Medicare program, the Health Care Financing Administration:

The Balanced Budget Act of 1996 along with a fairly robust national economy seem to have put us on track to achieving a goal that we as a nation have not achieved since 1969--our government may actually take in as much money as it spends next year. However, this Act has also created a new and potentially dangerous dynamic in the Medicare reimbursement program for hospitals. Now, any time reimbursement formulas are changed to recognize higher than expected or budgeted cost in one area, that change must be "budget neutral". That means if you are going to increase reimbursement to one group of hospitals, you must take an equal amount of money away from another group.

I am involved in a committee that is about to recommend one of these major shifts for next year. This involves what is called the Medicare Wage Index. And after attending two meetings of this group, I have determined that, of the twenty or so people on this committee, I am the only one actually employed by a hospital and the only one that represents a rural interest. The rest of the members either represent the Health Care Finance Administration and don't really care who gets the dollars as long as no more money is spent, or they represent hospital associations, all of which are largely funded by large urban hospital systems dues.

The particular change the committee is now suggesting makes no logical sense to anyone looking at this objectively. But of course all the association representatives are pushing for it. This change, not surprisingly, will move several millions of dollars between states, with New York, which has two representatives on this committee, gaining over $80 million and rural hospitals nationally losing over $34 million.

This has been a real interesting experience for me. I was a lot more naive about how these things work than I like to admit. I thought we would all sit down and look at the data and try to make it as fair and right as possible. I thought participation at the meetings would be meaningful. But it appears that most issues are decided among those connected and in the know long before the meeting--those well connected and in the know all happen to represent big money. The committee has only token representation of those who could actually be put at risk by the group's actions; they seem to be used only to add legitimacy to some pretty illogical conclusions.

All of this has given me cause to pause and reflect that this whole process is, as one noted radio spin doctor dubbed it, like "pigs at the trough". But I wonder if dear Rush has the same understanding of what that phrase means that I do. I grew up on a farm in the 50's and I had occasion to slop the hogs on almost a daily basis for over ten years. And as anyone who has ever had the pleasure of engaging in this activity will tell you, it is a truly Darwinian experience. It is a premier example of the theory of "the survival of the fittest."

I use to take my two five gallon buckets and dip them in the whey barrow and fill them up, (we got the whey for the price of hauling it from the local cheese factory so they wouldn't have to dump it in the river) and I would carry the buckets down and pour them over the wooden fence into a long wooden pig trough. Each time I did this I observed the same scenario. First of all the pigs knew I was coming. They were either really hungry, had a good sense of the time of day that I came calling and/or could hear the racket I made when dipping the whey. The next thing I noticed was that the biggest, heaviest pig was the one closest to the head of the trough. He always made sure he ate first and most. At times he would have to shove another pig out of the way or step on or over him to get there, but he was always first. And as I looked down the line and listened to the oinking and sucking, the pigs tended to be aligned at the trough according to size, from largest to smallest. This caused a particular and ongoing problem, because as the whey ran down the length of the trough, it sometimes didn't reach the end where the smallest pigs were before it was inhaled by the big guys. And some troughs weren't long enough to serve everybody, so sometimes the runts got nothing at all. The fat got fatter and the skinny sometimes died for lack of nutrition.

And when I would try to set a round cement trough off to the side and fill it for the runts when the others were gorging themselves at the long wooden trough, the larger pigs would invariably catch me in my enterprise and come over and step in the trough, shove the runts out of the way, and suck down whatever they had not sloshed out on the ground with their feet and nose. It never occurred to me that these big guys wanted to be mean to the runts or wanted them to die, they just couldn't curb their greed and gluttony. Although their actions were extremely injurious and potentially even fatal to many of their own species, that was not their intent.

So it appears to me that this "budget neutral" stuff is indeed making the health care industry act more like pigs at the trough than ever before. And it is not real encouraging to know that rural hospitals are considered the runts at the end of the trough or being bullied out of the cement feeders. We know we can never get big enough to have a fair chance with the big bores. We can only hope that the guys carrying the slop (Congress) are strong enough to shove a few of the big guys out of our way or pen us and feed us separately. The only advantage we may have is that we can still squeal. But more of us are going to have to squeal a lot louder if we expect any real consideration.

Rural Advocacy--No Time for Laurels

From "Rural Health Care Delivery and Finance: Policy and Politics" by Keith Mueller in Health Politics and Policy, 3rd edition, Delmar Publishers:

"Rural advocates have succeeded in placing their interests on the policy agenda in recent years, and have achieved at least modest success in policy enactments. But can this work be sustained, even enhanced? The simple answer is yes. The mere presence of the Rural Health Coalition in the U.S. House of Representatives and the Rural Health Caucus in the Senate assures continued attention to rural health issues. The successes of those two groups in the past twelve years, achieved with bipartisan support, are proof positive. Unless it falls prey to budget reductions, the Federal Office of Rural Health Policy continues to monitor administrative decisions relative to rural health. The growth in state offices of rural health (from a handful in 1990 to fifty in 1994 and in state rural health associations from a few to nineteen in 1994 (edit. note-there are thirty today with another ten forming) will mean at least some increased attention to rural health issues in state governments."

"The most important reason for optimism about the future of rural health, though, is that past policy successes have resulted in better placement of rural interests in the policy process. The ever-increasing analytical capacity of rural health advocates is attributable to the policies of the mid-1980s, which supported (and continue to support) rural health research centers, rural health researchers, and demonstration programs related to rural health systems. The quantity and quality of analytical activities that can contribute to policy debates has expanded geometrically since 1983. The issue network in health policy has expanded to include participants in rural health policy research and analysis."

"Of course analysis still needs advocates. Rural interests have found policy entrepreneurs in Congress, through the Coalition and Caucus, to propose and pursue legislative initiatives. They have done so using the same legislative vehicles as others in the 1980s and 1990s--omnibus legislation that can be amended to include modest advances for rural health. Those advances have been quite modest in the context of a trillion-dollar federal budget."

"The successes of rural health policy, however, are in jeopardy despite the growing strength of advocates. If politics becomes completely defined by ideology based on reducing government presence in any and all markets, rural programs are threatened. With the exception of community and migrant health clinics, the federal government is not involved directly in providing services to rural residents. Programs that assist others in providing services are more difficult to defend when deep budget cuts are made. Rural Advocates have to rely on arguments of self-determination for rural providers and communities, and equity in terms of availability of services. These are powerful ideological arguments, often appealing to the same ideology that wants to reduce government spending. Those who champion rural interest in Congress and state legislatures can use these arguments as the basis for withholding their votes from other initiatives until basic rural demands are met."

NRHA Current Policy Papers On-line

Issue or "white" papers adopted by the National Rural Health Association's Health Policy Board are available on-line at <www.nrharural.org> or can be requested via pubs@nrharural.org or (816) 756-3140; current papers include:

· A Vision for Rural Health Reform Models
· The Role of Telemedicine in Rural Health Care
· Funding of Graduate Medical Education
· HIV/AIDS in Rural America
· Rural and Frontier Emergency Medical Services
· Rural Health Clinics in Rural America
· Need for National Limited-Service Hospitals
· Antitrust and Rural Health
· Managed Care as a Delivery Model in Rural Areas
· Essential Community (Access) Providers
· The Impact of Entitlement Programs on Rural Health

Rural Archive of Maps On-line

The Cecil G. Sheps Center for Health Services Research <http://www.schsr.unc.edu> is the home of the North Carolina Rural Health Research Program (NCRHRP), one of five designated Rural Health Research Centers funded by the U.S. Office of Rural Health Policy (ORHP). "NCRHRP is working to identify problems in the rural health arena through policy-relevant analysis, the geographical and graphical presentation of data, and the dissemination of information to organizations and individuals in the health care field who can use this material for policy or administrative purposes." Its new "Cartographic Archive" contains on-line (and downloadable) a collection of over 70 color U.S. maps regarding rural demographics, health status indicators, professional supply and health care services (example on page 3). The same maps are available as a bound collection, MAPPING RURAL HEALTH, The geography of health care and health resources in rural America by calling the ORHP clearinghouse at 301-656-3100. Either or both are well worth your time and a major aid in better understanding rural health.

"Keep Friends Close, Enemies Closer"

From "Partnering With PSOs: HMO Companies Offer Administrative Assistance" by Louise Kertesz in Modern Healthcare, 4/13/98:

"With profits shrinking, medical costs rising and legislators turning up the heat on managed-care plans, it's no wonder HMOs view competition from provider-sponsored organizations as a threat. Last year's balanced-budget law allows these new provider networks to enter risk contracts directly with Medicare beginning in 1999. HMOs aren't taking the threat lying down."

"The strategy allows the HMOs to enter new Medicare markets without shelling out the millions of dollars it takes to do so... This partnership trend represents a smart move by HMOs, which fought easy access to the Medicare market by PSOs. 'The law was passed; they lost the legislative war. Why not put yourself in the position to maximize your opportunities' in the marketplace, says Gary Davis, an attorney and co-chair of the healthcare group at Steel, Hector & Davis in Miami."

"For HMOs, partnering with PSOs "follows the Machiavellian rule that you keep your friends close and your enemies closer," he says."

"So far, a number of models have emerged for HMOs that want to partner with PSOs to serve Medicare beneficiaries. One model, introduced by Humana in January, uses a new subsidiary called MedStep. MedStep will provide computer, marketing and customer services to help PSOs build an operating infrastructure for a private-label health plan. It also will help with state and federal filings. In return, MedStep will receive a percentage of the PSO's per-enrollee reimbursement. In February, MedStep signed a multiyear arrangement with United Health of Wisconsin Insurance Co., a managed-care plan owned by Appleton-based United Health Group and Milwaukee-based Aurora Healthcare."

"United Health Group is a community-owned not-for-profit health system that operates two acute-care hospitals: 146-bed Appleton (Wis.) Medical Center and 216-bed Theda Clark Medical Center in Neenah, Wis.. The system employs about 100 physicians and affiliates with about 800, says Gregory Devine, United's executive vice president. Aurora, which operates 13 hospitals, is Wisconsin's largest system."

"United's managed-care plan has 100,000 HMO enrollees, 130,000 PPO enrollees and 10,000 Medicaid enrollees but no Medicare business. "We were really looking for an opportunity to develop a partnership to get into Medicare risk that would allow us to tap into an organization that had substantial experience in managing a Medicare HMO,' Devine says."

"But United also wanted an arrangement 'that would allow us to take advantage of what we worked very hard to develop in our local communities through our own system. And even if we felt we could ultimately accomplish some of the same things on our own, we thought we would be more successful more quickly by working with an experienced partner,' he says. United hopes to receive contract approval from HCFA in the fall and start enrollment in early 1999, Devine says."

Columbia/HCA--Scapegoat or Criminal?

The following is a brief summary of high points from an energetic "debate" in the March/April 1998 issue of Health Affairs --a bared knuckle discussion of a type not often seen in a journal known to run to the dry side. In "A Paradigm Lost: The Case For Columbia/HCA," J.D. Kleinke writes a defense of what is easily health care's most disliked company; then three prominent analysts responded:

J.D. Kleinke (Kleinke is a medical economist and author based in Denver. At the time this paper was written, Kleinke was vice-president of corporate development at HCIA Inc., a publicly traded health care products and systems company. Columbia/HCA is a major HCIA client.):

"Every issue raised by the current investigation into the business practices of Columbia/HCA serves as a signpost for the progress and problems inherent in market-driven health care reform. Actions against Columbia/HCA by regulators reveal deeply rooted resistance to the profit-motivated reforms embodied in the company's philosophy: the public's reluctance to accept necessary reductions in excess hospital capacity; the legal and cultural obstacles to the overdue alignment of physician and hospital economic interests; and the myriad reimbursement and accounting problems involved in the vertical integration of health care delivery. The investigation also underscores the antiquation of the reimbursement mechanisms and control systems in place for financing the delivery of care to Medicare beneficiaries."

Jeff Goldsmith (Jeff Goldsmith, a health care forecaster and strategist, is president of Health Futures, Inc., in Charlottesville, Virginia.):

"J.D. Kleinke's thesis that Columbia/HCA was punished by a vengeful federal government for preemptively "reforming" the health care system reads much more like a failed Oliver Stone movie pitch than a story of miscarriage of justice by reactionary health policy. It is hard to argue with much of his critique of our health system's unfinished business: excess capacity, antiquated payment methodologies, misaligned incentives."

"However, to characterize what Columbia/HCA was attempting to do as "reform" not only reveals a fundamental lack of understanding of the company's goals, values, and operating philosophy, but also insults those who advocate real reform. Columbia/HCA simply encouraged its managers to "push the envelope" of legally permissible business practices to grow the company's earnings. The story is no more complicated or socially meaningful than that."

Uwe E. Reinhardt (Uwe Reinhardt is a professor at the Woodrow Wilson School of Public and International Affairs, Princeton University.):

"One can agree with Kleinke that the reimbursement methods adopted by Congress for home and skilled nursing care were dubious from the outset. The question is whom one should blame for this clumsy approach. The custom among executives in the private health sector is to blame the Health Care Financing Administration (HCFA), as if it were a legislative body, a state within a state, governed by the American analog of China's Red Guards, which woke up every morning wondering whom next to torment in the defense of a dying ideology. It is as refreshing as it is remarkable that Kleinke does not succumb to that myth. As he correctly observes in passing, HCFA merely fine-tunes and administers compensation methods that have been concocted as part of that never-ending game between members of Congress and the legions of lobbyists who besiege the Capitol and who busily help Congress write the laws that it passes. If the private-sector executives who chafe under the complexity of government regulation wished to discover the culprits behind that complexity, and if they wanted to be brutally honest with themselves, they would look into the mirror first, look at Congress next, and only then look at the government bureaucrats who administer the laws hatched out by the former two."

Bruce Vladeck (Bruce Vladeck is a professor of at Mount Sinai Medical Center in New York City.):

"Whether or not Columbia/HCA under its prior management was good or bad is truly an irrelevant question, as the HCFA leadership always believed it to be (although the current management of Columbia/HCA certainly seems to have some strong opinions on the subject). What matters is whether, in a nation also committed to a government of law and to markets governed by laws, laws were broken. If they were, the lawbreakers, both individual and corporate, deserve to be punished, not because they embodied one set or another of policy predilections or approaches to the problem of health care, but because they broke the law."

Wisconsin Outlaws Midnight Hospital Raids

Acquisitions in Wisconsin of a nonprofit hospital (including longterm leasing) now requires State review and approval. (Hospitals sold or leased to another nonprofit corporation are generally exempt.) An application for review must describe the terms of the proposed agreement, the sale price or rental charges, and include a copy of the acquisition agreement along with a financial and economic analysis and report by an independent expert. Interested members of the community may submit written comments about the hospital acquisition to the State; a public meeting is required where any person may file written comments or make a statement at the meeting.

The Attorney General, the Office of the Commissioner of insurance and the Department of Health and Family Services must all approve applications that meets the following standards (as well as some not noted here):

· the hospital exercised due diligence
· conflict of interest are disclosed
· management contract is for reasonably fair value
· proceeds used for charitable health care purposes
· proceeds used in the communities affected
· proceeds controlled independently of the purchaser

In strict alphabetical order, but otherwise with real sincerity, RWHC would like very much to thank Attorney General Doyle, Governor Thompson, and the Members of the Wisconsin Legislature for the timely promotion and adoption of Senate Bill 365.

The full text (as originally proposed) with the two amendments added can be read at the Wisconsin Legislature's web site found via <www.state.wi.us/>.

Call for Nonprofits to Heal Themselves

From For A Good Cause? by John Hawks:

"Nonprofit groups in the United States have historically exerted a much stronger influence on the country's development than have those in any other nation. Moreover, nonprofit groups have grown to be more important in the daily lives of Americans than the socialistic welfare programs practiced widely today in the European countries from which many American's ancestors emigrated in the first two hundred years of U.S. history. Interestingly, the United States followed a pattern of 'institutionalized' charity, a social model in which volunteer societies and tax-exempt organizations have largely replaced the family influences common to the heritage of Asian, Hispanic, American Indian, and African-American cultures."

"What makes America most different from other countries around the world is not the free enterprise economy in which the U.S. commercial sector operates or the universal involvement of U.S. citizens in their political processes. Instead, says nonprofits consultant Richard Cornuelle, 'Americans for nearly a quarter of a millennium have found better and better ways to act directly on their common problems by forming literally millions of voluntary organizations of every imaginable shape and size."

The heart of this book can best be described by simply noting the titles of its middle chapters, collectively entitled "The Seven Deadly Sins Of Nonprofits":

1. What Do You Think We Are--A Charity?
2. Over-the-Top Overhead
3. Robbing Peter to Pay the Fund Raisers
4. Donations Gone Astray
5. Crossing Into Profitable Territory
6. Too Much Time in Gucci Gulch
7. Outright Swindles

"America's nonprofits exemplify the core values of this country." John Hawks wrote For A Good Cause? "to stimulate debate on the future of these groups and to issue a call urging them to focus again on the basic tenets of faith, hope, charity, and love that constitute their true mission."

Declining Occupancy Rates Bottoming Out?

From the federal Health Care Financing Administrations web site at <www.hcfa.gov>.

"Health Care Indicators contains data and analysis of recent trends in health care spending, employment, and prices. The Office of National Health Statistics tracks trends in health care related industries and presents this information in a quarterly article published in the Health Care Financing Review. These data are valuable for understanding the relationship between the health care sector and the overall economy. In addition, they allow the Office of National Health Statistics to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data."

Among "Key Trends in the Second Quarter of 1997":

· The adult occupancy rate at community hospitals increased in the second quarter of 1997, measured from the same period a year earlier. This increase, the third consecutive quarterly increase in the adult occupancy rate may signal a bottoming out of the trend in declining occupancy rates prevalent throughout the 1990's.

· AHA statistics on length of hospital stay, stratified by age group, suggest that the trend in the length of stay for the population over aged 65 may be converging with the trend for the population under aged 65.

· Overall and medical prices, as measured by the Consumer Price Index (CPI), continued to grow slowly in the second quarter of 1997.

· Average hourly earnings in private sector medical care establishments grew moderately in the second quarter of 1997, a sign that medical price growth may not accelerate in the near future.

Rural Health Policy Discussion Group

The Ad-Hoc Rural Health Policy Discussion Group met with Euphia Hsu-Smith, Senator Russ Feingold's staffer for health issues during a recent three day series of visits in Wisconsin. As is the group's tradition since it began meeting about seven years ago, the format was informal--no planned agenda and all discussion is off the record. The object is to share observations, speculation and questions about upcoming health policy issues of interest to rural Wisconsin.

The group meets 10:00 am through lunch at the RWHC Office in Sauk City on the second Wednesday of the last month of the quarter, in '98 this is June 10th, September 9th, December 9th. Please contact Tim Size if you would like to participate.

Grant Funds for Local Access Projects

The Robert Wood Johnson Community Health Leadership Program honors ten outstanding individuals each year for their work in creating or enhancing health care programs serving communities whose needs have been ignored and unmet. Each leader receives $100,000 which includes a $5,000 personal stipend and $95,000 for program enhancement over a three-year period. Anyone is welcome to submit a letter of intent at any time during the year. Call or write for a Letter of Intent form due to the Program Office be September 16th. Contact: Susan Bumagin, 617-426-9772, fax 617-451-5838, e-mail: chlp@tiac.net, 30 Winter Street, Suite 1005, Boston, MA 02108

"Just the Facts, Mam"

The following a fact sheet on Mammograms from the federal Centers for Disease Control--"Facts About Use of Mammograms Among Women 40 Years and Older, United States, 1989 and 1995" at < www.cdc.gov/>.

"The number of women 40 years and older who reported having had a mammogram within the past 2 years increased in at least 39 states from 1989 to 1995, according to data from the CDC's Behavioral Risk Factor Surveillance System, a monthly, random telephone survey."

"Efforts to encourage women age 40 and older to have initial mammography should continue, but women also need to be reminded to participate in routine re-screening."

"The increase in mammogram use in individual states during the 7-year period ranged from 9% in Minnesota (which already had a relatively high number of women who reported having had a mammogram within the past 2 years) to nearly 45% in West Virginia and New York."

"These large differences in self-reports of mammograms by state persisted throughout the 7 years. Mammography is the primary method of screening for breast cancer."

"The National Cancer Institute in 1997 recommended that women 40 years and older have a mammogram every 1 to 2 years."

"The proportion of women who reported receiving breast cancer screening in accordance with established guidelines increased from 31% in 1990 to 47% in 1995."

"In 1997, an estimated 180,200 women will be diagnosed with breast cancer, and 43,900 will die from the disease. Early detection coupled with timely and appropriate treatment can alter the progress of, and reduce mortality from, breast cancer."

The Mother of All Search Engines
Metacrawler <www.metacrawler.com> is a search tool on the internet that automatically combines the results from several popular single engines such as Yahoo, Altavista and Lycos and gives them back to you as a consolidated, ranked list; if you haven't tried it yet, you will be surprised at the difference.

JAMA Adds Women's Health Site On-line

The Journal of the American Medical Association has initiated a Women's Health Information Center at <www.ama-assn.org/special/womh/womh.htm>.

"The site is being launched with two modules supported by an unrestricted educational grant from Ortho-McNeil Pharmaceutical, one on contraception and the other on sexually transmitted diseases . Both will be produced and maintained by JAMA editors and feature a regularly updated collection of peer-reviewed resources. More modules may be added later."

Federal Web Site for Telehealth Subsidies

The Rural Health Care Corporation can be found at <www.rhccfund.org/ > but why do you need to know?

"It's a corporation established to administer a Universal Service support program authorized by Congress and designed by the Federal Communications Commission (FCC) to make telecommunications services - including the real cutting-edge ones - affordable for rural health care providers.

"Support applies to monthly telecommunications service charges and installation charges, but not terminal equipment costs. Welcome to the Rural Health Care Corporation's Web Site. The RHCC administers a program making telecommunication services affordable for rural health care providers."

"This Web Site will be one of the principle ways rural health care providers and telecommunications companies can learn about the program, submit applications, and receive support. We are still completing areas in the web site which will make the application process easier and provide more information to you."

What does this mean for non-profit rural providers?

· Support is available for any telecommunications service within maximum bandwidth of 1.544 Mbps.

· Support is also available for limited long distance charges to an Internet Service Provider (ISP).

· Your level of support depends on your location and the type of service you choose - it will be calculated individually for you."

· You can save on a service you already have or upgrade. You can find out what your level of support and total service charge will be before committing.

Violent Images--Cause or Effect?

One of the most troubling threats to our health, our misuse of guns, was back in the headlines; the following is from an essay by Lance Morrow's "Tragedy as Child's Play" in Time, 4/6/98:

"We ex-children have created an elaborate culture of fantasy. The more brilliantly our movie makers and television makers succeed in their work of the technological and artistic imagination, the more their audiences are transported back into the realm of the child id that is most hospitable to fantasy--a zone of suspended disbelief wherein all things become possible, including deeds of graphic violence. It is sometimes said that too many television shows and movies are cynically targeted at 12-year-olds. That's not exactly the point: the makers of those shows in effect appropriate the imaginative world of the child because the youthful brain is the environment most frictionlessly sympathetic to fantasy, no questions asked. The tiresome, responsible brain of the adult breaks into the action and says, Now wait a minute."

"We pay a moral price. Our profitable fantasy culture has set up a resonance by which, in the minds of children, a murderous dream of revenge, say, slips easily through the looking glass into actuality. The greater our creativity, in some sense the more we disturb the ecology, the balance of nature, between the universes of fantasy and actuality. Naturally, this disturbance is most dramatically manifested in children, who lack the reality-testing resources of experience and self-possession to make the necessary distinctions, and to subdue the animals that sometimes get loose in their brains. So when you link a fantasy culture to the wondrous American inventory of guns, you may now and then get a little terrorist. Guns fire vicious daydreams into the actual. Squint and point, and one magic trigger-finger's twitch, the merest spasm of impulse, may send the world into mayhem. That is a power so seductive that it might even have a little Satan in it."

New Health Insurance Tax Deductions?

From "House GOP plan: Buy insurance, get tax break" by Geri Aston, AMNews, 4/20/98:

"Influential House Republicans are working on election-year proposals that represent a GOP solution to the health insurance affordability problem. The Republican approach would use tax code changes to encourage people to purchase individual insurance.

"The most prominent proposal is that of Rep. Bill Archer (R, Texas), although many of its details have yet to be worked out. Archer, chairman of the House Ways and Means Committee, is expected to announce his plan in May or June, a spokesman said. His package would allow people who work for businesses that don't offer employee health coverage to deduct their individual health insurance costs from their taxes."

"In recent public addresses, House Speaker Newt Gingrich (R, Ga.) advocated giving individuals health insurance tax breaks similar to those businesses receive. 'Whether you are self-insured and you pay out of your own savings ... or you are insured by a corporation, you ought to get the same level of tax deductibility.'"

"Several groups said problems in the individual insurance market should be remedied before lawmakers pass a plan to encourage millions of people to enter that market. 'It would be a big mistake to enact new tax deductions for individual market policies without fixing the individual market," said Gail Shearer, director of health policy analysis for Consumers Union. The biggest problem is that individual insurance is often unaffordable, she said. People with health problems often face high insurance premiums, pre-existing medical condition exclusions or outright rejection from individual market insurers, Shearer said."

There will be no Eye On Health next month given the editor's need to use up some vacation days and the tough duty of attending a family wedding in England.

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