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Why hasn't the Washington establishment done anything about the health care crisis? Follow us inside the comfy world of presidential and congressional health care....

Until recently, when you thought of Oregonians you probably envisioned Birkenstock-shod tree huggers earnestly sorting plastic from paper in the nation's recycling capital. But if you've tuned in to the nightly news lately, you may have a slightly different image--one of hospitals and doctors and sick people. Legions of reporters have besieged Oregon in the past few months trying to get a look at one of the country's first broad-based efforts to resuscitate an ailing health care delivery system.

For the past five years, as Congress and the White House noodled around on health care reform, Oregon grappled with all the tough issues--cost, access, quality--and came up with a plan to make primary health care available to all the state's residents, regardless of income. Other state legislatures, from Hawaii to Florida to Minnesota, have made moves as well, providing subsidized and even free health care to the working poor. And with all the heat they're now taking from the Bush administration and health care industry representatives, you'd be excused for forgetting that they're an exceptional breed of politicians: ones getting knocked for actually doing something about health care.

So how is it that a few states have the guts to tackle the issue while the Bush administration ducks and Congress covers? Is it Oregon's bracing air? Minnesota's clear water? Or is it that the politicians who make up those legislatures are still real people--people who don't

V have to read policy tomes to see that America's health care system is in crisis.

Oregon's legislators, for instance, meet once every two years; they're police officers, farmers, electricians, housewives, union bosses, small business owners, real estate agents, and professors who spend the majority of their time in their own communities working regular jobs with regular people. Unlike Bush and members of Congress, who enjoy an extensive network of low-cost medical benefits and perks, Oregon legislators don't need Pennsylvania Senator Harris Wofford to tell them that people are worried sick about health care. Most of the year, they see it firsthand.

Maybe it's asking too much to wish that every U.S. congressman could experience America's health crisis as directly as the average electricians sees it. But a trek through the cushy health care empire of Washington politicians should chill the average Joe's ticker. Few lines, minimal costs, a galaxy of options, and guaranteed coverage make the federal government and Capitol Hill just about the only places in America where health care isn't in crisis. And it also makes one wonder whether the real explanation behind Washington's failure to act on health care isn't a matter of insurance industry PACs or pleas from small business or the other usual suspects, but a product of plain old insulation. Of course, the point isn't that congressmen and other officials should be denied adequate health care. It's that the rest of America should be afforded it, too.

Executive privilege

Even the plushest hospital couldn't be mistaken for a Ritz-Carlton with catheters; hospitals can be miserable places. But some are less miserable than others, especially when you're North Carolina Rep. Bill Hefner. Last June, when Hefner arrived at Walter Reed Army Medical Center for bypass surgery, there were no suspicious inspections of his insurance card, no long waits in cold rooms full of screaming kids. Instead, he was greeted by an orderly who helped him check in and then escorted him to the Eisenhower Executive Nursing unit. This is a high-security, extra-private VIP wing that sports a stereo (circa 1956) compliments of John Foster Dulles and is decorated with artwork donated by Jackie Onassis and the Eisenhowers. Hefner spent nearly a week and a half being tended by Walter Reed's elite cadre of cardiologists before going under the knife. After surgery, he was afforded eight days to recuperate.

Had Hefner been a private citizen and undergone the same surgery at George Washington University med center, a private hospital a few miles away, the charges would have mounted fast. The actual surgery would have been $8,000, and he would have been charged $2,789 for each day he spent in intensive care and $1,000 a day for a regular room, for a grand total of about $40,000. But as a member of Congress, Hefner paid nothing for his medical care. The only bill he received for his stay was for the room and food (at a relatively cheap $701 daily rate)--the entire sum of which was promptly picked up by his Blue Cross health insurance, provided through the federal government.

Granted, most people with decent health insurance would probably have their bypasses at least partially covered, too. But then again, they might not. Medical costs have risen so steeply that insurance companies now resort to all sorts of creative ways to pinch pennies, such as delaying claim payments, limiting the amounts they pay for some treatments, and subjecting consumers to long waiting periods before they are eligible for coverage. Excluding preexisting conditions from coverage is almost standard. So it should come as little surprise that, according to a recent study, almost half the patients who were unable to pay their hospital bills actually had insurance but their policies simply wouldn't cover their treatments.

And then, of course, there are the 37 million people who have no health insurance.

Rep. Hefner surely had plenty to worry about while in the hospital, but unlike many other Americans, one worry wasn't potential bankruptcy. Perhaps that's why, when you call Hefner's office to find out his position on health care reform, you're told that he doesn't have one. "He hasn't settled on his view of what should be done," explains a staffer.

Not that it's fair to single out Hefner. Every day, thousands of Washington policymakers--members of Congress, the Cabinet, the White House staff--receive similarly user-friendly medical treatment through the federal insurance plan that the Office of Personnel Management (OPM) negotiates for 9 federal employees. Under the plan, employees pay, on average, 28 percent of the premium (which works out to $100 a month); the government pays the rest. The plan is so good it's often considered a model for national health care that includes the private insurance industry.

It's grand that federal employees are so well taken care of, but compare their plan with what the rest of us face. The federal government gives employees the option of several private insurance plans, all of which provide mental health care, substance abuse treatment, and some dental benefits, while regular folks are often at the mercy of a single insurer, chosen by their employer. If federal employees are unhappy with the plan they choose, they can try another one during "open season," once a year, without risking loss of coverage, because OPM makes sure that none of the plans exclude preexisting conditions. The vast majority of us never have this luxury. When John McGann, an employee at H&H Music Co. of Houston, developed AIDS, his company switched insurers and presented him with a policy that capped his benefits at $5,000. He spent the last few year of his life on Medicaid. A member of Congress, on the other hand, could develop AIDS and cancer and become an alcoholic simultaneously and his policy wouldn't flinch.

For congressmen, good insurance is only the beginning. Members also have at their disposal a wide range of supplementary medical services--from free outpatient use of top-flight military medical facilities to the Capitol clinic and on-site private pharmacy. Got a sore throat, Senator Hatch? Think you have a fever, Speaker Foley? Just walk down the hall, see the nurse, and say "ahh." Need a checkup, Rep. Gingrich? Prostate acting up again, Rep. Bateman? The attending physician will send you over to the Naval med center pronto. In fact, he'll make the appointment himself, and an orderly will meet you at the front desk to make sure you don't have to linger with hoi polloi waiting in line.

No wonder it took until last year, when Wofford won his Senate seat in a Pennsylvania special election by stressing the need for universal health care , for congressional policymakers to realize, at least momentarily, that the issue is a serious source of anxiety for many Americans. In Wofford's wake, they flooded the Hill with 79 different health care bills. But the flurry of paperwork and fiery speeches has resulted in little more than the public illusion that Congress is addressing the issue. Not one of these 79 bills has a prayer of passing this year.

Of course, members will quickly note that they are not as personally insulated from the crisis as they used to be. Since the House bank scandal, a few medical perks have been curtailed. For instance, senators now pay $520 a year to use the office of the attending physician, rather than billing the taxpayer. But on the House side, they're still doing it the old-fashioned way: We pay for it. And when members say that they now shell out for the prescriptions they have received free for years, what they really mean is that they pay 25 percent of the bill for drugs--the cost that their insurance won't cover.

Congressional distance from the health frustrations of ordinary Americans becomes jarringly clear when members start to speechify about it. For example, those who have opposed adopting a single-payer system like the Canadian model by arguing that we would have long lines to see a doctor apparently haven't tried making an appointment in our system lately. At George Washington University's health maintenance organization (HMO), for instance, it takes three weeks for a woman to get an appointment to see a physician's assistant to get a refill of birth control pills. And she'd better bring something thick to read when that day arrives. Even routine appointments can take two hours.

Need to see a full-fledged gynecologist? Take two Midol and see him in two months.

Credit canard

Of course, it's not just the routine annoyances that our representatives are insured against; it's the extraordinary indignities as well. Consider the case of Helen Sanders, a 74-year-old woman in Largo, Florida, who saw a doctor at her Humana HMO in January 1991, when she started losing control of her facial muscles for hours at a time. Her doctors believed that an artery in her neck was 80 percent blocked--a level of blockage that could prompt a stroke at any time. While a series of crucial yet expensive tests were

V recommended, Sanders couldn't get Humana to approve payment for them. She camped out in the clinic every day for weeks trying to shame the staff into approving the tests. Four months after Sanders' initial diagnosis, a clerk at the clinic told her that her file had been lost and that her doctor was on vacation, so she couldn't get the tests anyway. Skeptical, Sanders went home and called the clinic that day without using her name and was told her doctor was in the office seeing another patient.

It wasn't until the state insurance commissioner in Tallahassee aggressively intervened that Sanders got served by Humana. But by that time, her doctors concluded that she had a 99 percent blockage of the left carotid artery. She could have had a stroke while sitting in the waiting room. Sanders had surgery that day.

Could a Canadian-style system be much worse?

George Bush thinks so, and the GOP convention joke about "the efficiency of the House bank and the compassion of the KGB" pretty much sums up the nuances in his argument against nationalized health care. And come to think of it, it's not too surprising that compassion and efficiency are highly prized by the big man: His own health plan--government-provided, of course--offers them in spades. In addition to a private ambulance and a mom at Bethesda Naval Medical Center kept ready and waiting just for him, the president has his own personal physician, Dr. Burton Lee III, zealously devoted to monitoring every presidential burp and wheeze. Think Bush was perplexed by those electronic supermarket scanners? Imagine how mystified he'd be by the clerks demanding credit histories from bleeding patients in an inner-city emergency room.

It's not just Bush whose health care comes hermetically sealed. Lee's medical unit cares for all the health emergencies of the White House staff and Cabinet

members. While it doesn't offer regular checkups (Bush gets those free at Bethesda), the office does work as a referral service, so if Louis Sullivan (or any of his friends, for that matter) starts having chest pains, Dr. Lee will see to it that he gets proper attention.

"We'll make sure you get into the best location at the best price," Lee says. "I generally make the phone calls myself, call the doctors myself, make the arrangements myself."

That George Bush's doctor makes Marcus Welby seem heartless is good in one respect: It reminds us that there are still compassionate physicians out there. But the White House's enjoyment of such solicitous service may be one reason Bush's solution to the health care crisis, like many other free-marketeers', is a few milquetoasty tax credits, which do little to address some of the basic health-care problems of less pampered patients.

Bush has favored giving tax credits to people too wealthy to qualify for Medicaid but too poor to afford insurance as a way of providing universal coverage without adopting the "socialist" Canadian system. While a tax credit may seem an appealing small government approach, his administration seems to grossly underestimate the size of the credit many uninsured Americans would need to pay for insurance. So you're diabetic who can find coverage for her preexisting condition only under a plan with a $5,000 deductible--the $1,000 tax credit being bandied around by Republicans isn't exactly a great deal. To cover many of the people who can't afford

V health insurance, Congress may have to extend tax credits for premiums that are larger than some of the recipients' annual incomes.

Michael Jones, a former loan officer for a real estate finance firm, showed the Senate Labor and Human Resources Committee at a June hearing that paying out more in health care costs than you take in as income is a real possibility. Jones has been disabled by a rare neuro-muscular disease and is no longer able to work. Knowing his condition, Jones purchased catastrophic health insurance in 1982 while he was still working, at which time the premium was about $2,300 a year for unlimited benefits. By 1991, he was forced to drop the policy because the premiums would have cost $17,000 a year-substantially more than the Supplemental Social Security Income he lives on.

A root problem tax credits don't address is the fact that health care costs continue to skyrocket. By the year 2000, the average family will have seen a greater than 400 percent increase in health care bills since 1980. Business payments for health insurance will have increased sevenfold in the same period. But since those figures are as familiar as they are daunting, one might wonder why the press and other Washington powerbrokers haven't worked up a full head of steam; why editorials, placards, and banners demanding Storm the barricades! Health care reform now! aren't as ubiquitous as Mao posters used to be in China. Well, it may be because those guys aren't exactly waiting in line at Medic-24, either.

While management at the 14th Street McDonald's in downtown Washington, D.C., doesn't even offer medical benefits to most employees, reporters and editors at The Washington Post can choose from an array of policies, none of which exclude preexisting conditions. A paltry $2.50 a week buys them generous dental, optical, and mental health care benefits in addition to gold-plated coverage for maternity and hospitalization.

The Washington elite, and increasingly only the elite, tends to have excellent and expensive health coverage, paid for by its generous employers. And that's one reason that, at Georgetown dinner parties, the capital gains tax is a far hotter topic than health care. Storm the barricades? What's the hurry?

Fixing American health care will demand a full flexing of qualities that seem lately to be in short supply outside of Oregon: leadership, cooperation, and the courage to fight the health care PACs and to make hard choices about what we can and cannot afford. It would be nice to think that that kind of political will can be mustered through intense meditation over Heritage Foundation white papers.


Unfortunately, the Washington leadership's personal investment has always had a way of sharpening political urgency.

But if you're still determined to believe that the D.C. establishment's comfy personal health care system has nothing to do with the dismal health care prospects the rest of us face, consider one last thing: the force behind Harris Wofford's decision to seize the health care issue--his wife.

Plagued by chronic health problems, she had received expensive care at the University of Pennsylvania, covered by the sturdy federal insurance he got when he was appointed to the Senate to replace John Heinz. If Wofford had lost the election--which for a while looked like a real possibility--he had more than just his political career to worry about. He had to face the possibility that he wouldn't be able to get health coverage as a private citizen because of his wife's condition. Sure, PAC money talks, but sick husbands and wives and children tend to talk even louder.

Of course, it's not too genteel to wish that Jesse


Helms had to lay awake nights worrying that his heart condition could cost him his house, but one can't help imagining the result if he did. If Wofford's brush with America's grim health care reality can put the issue on the table, hundreds of similar brushes might turn the talk into action. Still, maybe there's a kinder, gentler alternative: Imagine enough Washington politicians suddenly stricken with embarrassment about how good they have it that they finally summon up the will to share the health with the rest of us.

Stephanie Mencimer is a Washington writer.
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Title Annotation:Congressmen's medical benefits and perks
Author:Mencimr, Stephanie
Publication:Washington Monthly
Date:Oct 1, 1992
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