Jeremy Breningstall

Lives For Sale?

Where does George W. Bush turn for advice on health care? For her day job, Deborah Steelman is paid to influence legislation on behalf of corporate clients such as Aetna, Cigna, Pfizer, Prudential, United Healthcare Corporation, and the Healthcare Leadership Council. These days, she's working overtime. She's the top dog on George W. Bush's health care team."I'm his senior advisor," says Steelman, without a hint of embarrassment. Despite her firm's $2 million dollar lobbying retainer to influence the very legislation she's now hoping to help write, she insists her role is not a conflict of interest. "I'm a public person. People are free to accept my views or not or not accept them. I don't get paid by the campaign."But as evidenced by early drafts of health care principles, Bush has been quite receptive to her ideas. His limited list of goals -- privatizing Medicare, providing pharmaceutical drug benefits, and limiting a patient protection legislation -- all mesh closely with policies Steelman has been advocating in her lobbying capacity on the Hill all year. Bush is staying miles away from any sweeping reform of the health care industry, and the needs of 45 million uninsured Americans -- a number expected to rise to as high as 60 million in the next decade.Bush's reputation for cozy relations with business was productive in raising $37 million for his campaign, a figure which included $7 million in donations from the Financial/Insurance/Real Estate sector, $1.3 million from the Health sector, $3.2 million from the Lawyers and Lobbyists sector -- and that's just as of June 30. Top executives at Aetna, Cigna, Johnson & Johnson, and Prudential were among those who coughed up the $1,000 maximum contribution.Bush's senior advisor on health care policy is well-credentialled, intelligent, and highly versed in the intricacies of health care policy. And she is not new to criticism for conflict of interest. When Steelman chaired a Medicare panel during senior Bush's presidential years, consumer groups denounced her for pushing ideas the industry favored. More recently, she was criticized for failing to disclose in a June briefing before the House Republican Conference her financial stake in the issue at hand: prescription drug insurance for Medicare recipients. A GOP strategist told the Washington Post that Steelman's policy briefing was like "the NRA coming in and writing gun legislation, except with her there was no disclosure."I.e., Steelman's clients aren't exactly disinterested parties in the Medicare debate. "Medicare is a huge chunk of health care that the insurance companies would like a piece of," says Dr. Ira Hellander of Physicians for a National Health Care Program. "The problem is that every research shows they do a bad job. They cherrypick the healthy patients."Marvin Olasky, an ethics professor at the University of Texas and informal advisor to the Bush campaign, defends Steelman's role. "If the publisher of the Washington Monthly is asked to speak on a First Amendment question, is that conflict of interest? The experience I've had on a team is that it's a team. She's one person there among five people. I would not want to rule out that expertise."Olasky compares bias against lobbyists to classism or racism. "It's an individual matter, not a group identity. I am not willing to consider lobbyists as a subcaste of human beings," he says.Ron Pollack of Families USA believes that the problem is more complicated. "Someone representing the pharmaceutical companies is probably aware of all the reasons why it's best not to have discounts on pharmaceuticals," he says. "That's predicated on purely bottom line considerations. Securing higher profit margins for the pharmaceutical company is not synonymous with the best interests of senior citizens."The other members of Bush's health care team also have close ties to profit margins. The team is composed of John Goodman, from the National Center for Policy Analysis, a conservative think tank; R. Glenn Hubbard, a market-leaning economics professor at Columbia University; Donald Moran, president of a health care consulting group, Timothy Muris, a law professor and recently a consultant for Aetna in an anti-trust case; and William Roper, senior vice president at Prudential HealthCare before becoming dean of the School of Public Health at the University of North Carolina-Chapel Hill. None are practicing physicians or consumer advocates, and their philosophy is decidedly not patient-oriented.Professor Hubbard defends the Bush campaign's market-leaning perspective. "We have the best health care in the world and we pay a lot for it." As for the team's restricted composition, he justifies it, saying, "The governor has received input from every possible policy proposal."But Ron Anderson, president of the Texas Hospital Association and someone who sees health care realities every day, doesn't think much of the limited proposals the Bush team is tossing about. "Most of those are dancing till the ship goes down," he says. "When the Titanic went down, the band kept playing till it sank."Anderson argues that Bush took a pretty relaxed view on health issues for Governor of Texas, a state with one of the highest uninsured health care rates in the entire country. Anderson recalls that when it came time to pass the Children's Health Insurance Program (CHIP) bill, which provided health insurance for children who don't qualify for Medicaid, Bush urged the legislature to limit the program to 133 percent-150 percent of federal poverty level -- which, as one of the narrowest programs in the nation, would have left a lot of working families in the lurch. CHIP, ironically, is not even being directly funded by Texas taxpayers; it is covered by a combination of federal tax and tobacco settlement dollars.As to the far-reaching Texas Patient's Protection Act, this was passed overwhelmingly by Republican and Democrat support in the state legislature. Bush had little involvement with the bill himself.Bush's absence of leadership on health care has been felt administratively as well as legislatively. Medicaid, Texas-style, is one of the most restrictive in the nation, points out a former employee of Bush's administration. Recipients must submit a full re-application and asset review every few months to maintain coverage, something not required in the new CHIP legislation. Parents in Texas who can't take off time from work are left without Medicaid coverage, yet cannot apply for CHIP, because they are considered "Medicaid eligible".As a result, six hundred thousand children eligible for Medicaid in Texas remain uninsured.Insurance isn't the only problem health care consumers in Texas face. In the wake of cuts mandated by the federal government's Balanced Budget Amendment, hospitals and research facilities in Texas are struggling to stay open to serve anyone at all. Prestigious Baylor Hospital in Houston, for example, posted its first loss in history, says Anderson. Now, along with many other hospitals, it is busy cutting a host of services.Meanwhile, Bush is out across the country making speeches. "We don't see the kind of concern that we should see in our own state leaders, including the governor," Anderson says. "We anticipate 50 hospitals on the brink of closure in Texas alone."Anderson reports that in health care financing across the U.S. as a whole, 23 percent plus is spent on administration, whereas in Canada it's 8 percent. He says, "You have to have an army of people in the hospital to see who's eligible for Medicaid and the CHIPS program."Dr. Hellander compares the present health care approach to early fire insurance. "You used to have this thing that you'd buy, a fire insurance medallion that you'd put up on your house. People quickly realized how ridiculous that system was. The fire next door effects me too."While the fire of health care need rages on, Bush drop murmurs periodically that he would be willing to throw a few drops of water on it. In a recent article for National Journal, he indicated that he was considering mild tax incentives as a means of addressing the working uninsured. These types of proposals, vague enough to be politically expedient, have a long tradition of being tossed out by presidential candidates.If the proposal sounds a little too familiar, think of when the elder Bush was in office. In 1992, President Bush proposed a plan that included 1) tax credits of $3,750 for families below the federal poverty level, 2) tax deductions of up to $3,750 for families of incomes less than $80,000, 3) limiting the ability of insurers to deny coverage on the basis of pre existing conditions, and 4) facilitating the formation of pools of small business and individuals into larger groups.At the time, critics did not take that proposal seriously, noting that 1) the plan did not include a funding mechanism, 2) tax deductions would be inadequate for most families in income brackets between 150 percent and 200 percent of the federal poverty level, who would only be receiving a deduction of a few hundred dollars, 3) its unclear how money dispensed as a tax credit can cover health care costs over the course of year, 4) it would cause borderline employers to drop coverage, and 5) it would lead to inflated premium costs.In short, we would be left with the same problem we have today: millions of Americans holding down jobs but not being able to afford health insurance, and very little being done to cut administrative costs.However, with the number of uninsured increasing at a rate of about two a minute today, any measly proposal is likely to be taken seriously. Hellander observes, "There's 125,000 more people uninsured every month. I don't see a tax credit even keeping up with the rate of increase."She says that she feels that tax incentives might be one last step the country has to take before realizing it's time for a national health care program that truly aims at universal coverage.That goal is a far cry from the program advocated by the Governor Bush and the members of his team. Maybe it's time some other voices were brought to the table.Jeremy Breningstall is a Staff Writer with Gazette Newspapers in Maryland.