MSAs — What’s Next?
Drs. John C. Goodman and Merrill Matthews of the Dallas-based National Center for Policy Analysis (NCPA) writing an updated analysis on the impact of MSAs (NCPA Brief Analysis, May 1, 1997), suggest MSAs should be expanded from the ceiling of 750,000 placed by the Kassebaum-Kennedy Bill, “to meet people’s health care needs.”
They suggest that MSAs be offered to federal employees as an option in the Federal Employee Health Benefit Program (FEHBP), and to Medicare beneficiaries, allowing seniors to become prudent consumers of health care and avoid waste (i.e., Medicare continues to grow at 10 percent).
They discuss the concept of the Super IRA (i.e., expanding present IRAs into MSAs): “Unspent contributions would be automatically rolled over each year, and if health expenditures in a given year are unusually high — e.g., for experimental procedures or cosmetic surgery not covered by a high deductible insurance policy — people would be able to withdraw money from their Super IRAs.” (President Clinton is said to favor expanding IRAs to save for retirement years.)
The good news is that Congress is considering a four-year test of Medicare MSAs beginning in 1999 — as an initiative by Rep. Bill Thomas (R-CA). Beneficiaries would be allowed to pay for catastrophic coverage and deposit the rest in the MSA.
And, kudos to AAPS members Drs. Stephen Barchet and Robert Soley for their work in promoting MSAs. (Physicians Weekly, 7/14/97.)
The budget deal that Vice President Al Gore calls “historic” and Senator Majority Leader Trent Lott calls “revolutionary” is nothing but a betrayal of the “conservative revolution,” and more of the same, beltway “government-as-usual.”
Although the budget “miracle” is alleged to have been made possible by a $220 billion revenue windfall “recently discovered” by the CBO, the reality, as Ed Rubenstein decries in National Review (June 2, 1997), is that the data “rests on a highly implausible assumption: that economic growth will continue at or near the first quarter’s breakneck rate, 5.6 percent.”
Moreover, the claim that “spending will be cut by $250 billion over 5 years” is hogwash. As usual the cuts are only projected decreases in government spending. The reality is that the era of big government is not over but in fact continues unabated with total outlays in 2002, at least $240 billion or 15.2% above 1997. And to make things worse, this much-vaunted budget “miracle” will not “stave off Medicare insolvency to at least 2007.” Rubenstein writes, “The agreement calls for $115 billion in Medicare savings over five years, most of it from cutting the growth of fees paid to doctors, hospitals, and HMOs. Every budget deal in recent history has tried such price controls without success.” Budget negotiations preserved the Hospital Insurance Trust Fund (Part A) which was going bankrupt by shifting its rapidly growing home health care portion to the Medical Insurance Trust Fund (Part B) which pays physicians.
With welfare benefits eliminated in last year’s reform restored and $193 billion more discretionary spending added over the next 5 years, Senator Phil Gramm (R-TX) alone asks, “Is this a compromise?”
And, The New American (June 23, 1997) has called this whole debate a “charade” with good cause. I call it another instance of GOP pre-emptive surrender!
A Well-Deserved Salute
Frank A. Rogers, M.D., an AAPS member, has for 35 years struggled both in the California Medical Association and the AMA’s House of Delegates on behalf of private medical care, MSAs coupled with true indemnity medical insurance.
He denounced HMOs before they became popular and sacred cows such as Social Security and Medicare were not immune. He urged organized medicine to militate for privatization and to support these efforts on principle — to no avail. For his voice of dissension he was often attacked in news articles as a “radical.” In a letter to me he wrote: “I blame doctors for the loss of private medicine and health care. The assault on the profession began 40 years ago and then continued to escalate almost exponentially...nobody listened.”
In AMNews, Dr. Harry Schwartz wrote, “[Dr. Rogers] is not afraid to file motion after motion that he knows will be defeated, or to sound a lonely voice in comments before the House. He is convinced that he must educate his colleagues no matter how long it takes or what personal sacrifices it requires of him.”
Our kudos and warmest appreciation go to Dr. Rogers!
Another Bridge for the 21st Century?
Organized medicine and public health are “building bridges” of cooperation “as to create a symbiosis between these two previously divergent sectors,” reports AMNews, April 28, 1997. For example, a “continued blurring of the roles” was propounded in a meeting sponsored by the Robert Wood Johnson Foundation, the AMA, and the American Public Health Association held this past spring in New York City. Medicaid managed care has been prognosticated to be the building link in this blurring partnership because “scarce resources” have made it exigent by the “smaller pot of public health resources left behind when private and managed care plans tap into Medicaid revenues.”
Doctors on the NET
The Medical Board of California (MBC) is now publishing information about all licensed physicians on its website. According to California Physician (July 1997), information listed includes “license number, medical school, practice location, MBC disciplinary actions, disciplinary actions in other states, criminal convictions, and malpractice judgments over $30,000.” Physicians are exhorted to visit the site at www.medbd.ca.gov.
Books in Brief
Our Enemy the State, by Albert Jay Nock. Fox and Wilkes, San Francisco, CA, 1935 (Reprinted 1973, 1994),118 pp., ISBN: 0-930073-04-5, (Soft cover).
At age 40, Albert Jay Nock abandoned his family and the Episcopelian priesthood, but not his studies and knowledge of the classics, to begin a new life as a journalist and political science scholar. He launched his new career as editor of the American Magazine and founded The Freeman (1920-1924). In his wake, he left us a dozen books including Our Enemy the State that in this edition includes, “On Doing the Right Thing.” Nock’s philosophy of libertarianism embodies natural rights, self-autonomy, self-responsibility, voluntarism, and freedom of choice. For him, “libertarianism meant liberating the art of choice from the inhibiting forces of the State.” In the Introduction to this edition, Prof. Walter E. Grinder writes, “Most States don’t turn to harsh measures as long as the game is still going along smoothly. It is not until people begin to catch on to the nature of the systematic plunder...that the State does, in fact, turn brutish.”
In his famous theory of the Remnant, Nock believed that only a select few possess the intelligence and wisdom to appreciate liberty and comprehend the predatory nature of the state. Yet, violent revolution was suicidal and would lead to the strengthening of the position of those in power, or if victorious, to the replacement with others who might be worse.
The Libertarian Reader, edited by David Boaz, The Free Press, New York, 1997, 458 pp., ISBN: 0-684-83200-3, (Hard cover).
A marvellous collection of seminal essays and other writings by classical liberal authors at the cutting edge of the rapidly growing libertarian movement changing the face of American politics. Authors include Thomas Paine (Common Sense), Alexis de Tocqueville (Democracy in America), Isabel Patterson (The God of the Machine, “The Humanitarian with the Guillotine”), John Locke, Thomas Jefferson, Frederic Bastiat, Adam Smith, Milton Friedman, and many others.
Unintended Consequences, by John Ross, Accurate Press, 1996, 863 pp., ISBN: 1-888118-04-0, $28.95 plus $5.00 shipping and handling, (Hard cover).
“A virtual overnight, underground classic, exceeding all sales records from Freedom’s Forum Books...The novel traces opposition to government tyranny from the Warsaw Ghetto to Waco and Ruby Ridge. It shows what could happen if government continues to trample over the rights of the citizenry. Not for the squeamish.”
AAPS Member Prepares Policy Paper for The Heritage Foundation
Robert Cihak, M.D. with Bob Williams, president of the Evergreen Freedom Foundation, and Peter J. Ferrara, general counsel for Americans For Tax Reform, prepared a paper entitled, “The Rise and Repeal of the Washington State Health Plan: Lessons For America’s State Legislators (June 11, 1997).” The paper explains how Washington State served as a failed experiment of the Clinton-style health care plan. The citizens of Washington State through their legislators had it repealed, sooner rather than later!
Originally published in the Medical Sentinel 1997;2(4):120-121. Copyright © 1997 Association of American Physicians and Surgeons (AAPS).