Will the Real John Ashcroft Please Stand Up?

Missouri's junior senator says he is a pro-consumer health-care reformist. But the insurance companies, HMOs and big business, which give him millions, think he's on their side.

On Oct. 7, the House passed the Norwood-Dingell Patients' Bill of Rights 275-151, with 68 Republicans voting in favor.

As campaign year 2000 began in earnest, the House and Senate versions of the Patients' Bill of Rights were on a collision course. The key differences would have to be resolved in a joint conference committee. And groups like the Business Roundtable began a media blitzkrieg to tout the Senate version -- and to pay back friends in the Senate like Ashcroft.

"Congress is working on health-care reform," says a narrator as the TV ad, which aired on St. Louis stations, opens. "But what's right for you?" Then a worker in a uniform says: "Hey, watch the cost. I can only afford to pay so much." Next a shop owner asks: "What about the millions who don't have insurance? Help them." Finally a construction worker adds: "Just let doctors make medical decisions -- that's their job." The narrator closes by saying: "Sen. Ashcroft has voted for health-care reforms that are right for Missouri families and employers. Thanks, Sen. Ashcroft. Good job."

Ken Vuylsteke, chairman of the medical legal committee of the Missouri Bar Association, says Ashcroft's amendment "is another roadblock on the way to getting needed care.... It's really illusory and, in fact, would reduce the rights consumers already have."
Greg Lahann/Newsmakers Photos
Ken Vuylsteke, chairman of the medical legal committee of the Missouri Bar Association, says Ashcroft's amendment "is another roadblock on the way to getting needed care.... It's really illusory and, in fact, would reduce the rights consumers already have."
John Ashcroft, who from 1994-98 accepted more than $600,000 in campaign contributions from the Business Roundtable and about $250,000 from the health-insurance industry, became a zealous supporter of a patients' bill of rights that the American Medical Association called "a sham."
Richard Ellis/Newsmakers Photos
John Ashcroft, who from 1994-98 accepted more than $600,000 in campaign contributions from the Business Roundtable and about $250,000 from the health-insurance industry, became a zealous supporter of a patients' bill of rights that the American Medical Association called "a sham."

According to published reports, the Business Roundtable spent $500,000 on the television ads for five Republican senators, including Ashcroft.

On June 8, as the Senate finalized the Defense Authorization Bill, Democrats pulled a fast one by offering the AMA's Patients' Bill of Rights as an amendment. As it had before, it proposed giving all 161 million Americans with private insurance freer access to emergency rooms and medical specialists, plus the right to sue health plans in state courts.

Republicans, including Ashcroft, voted to table the amendment, but this time they did it with only one vote to spare -- four Republicans sided with the Democrats. Seeing the close vote, the AMA immediately zeroed in on three Senate Republicans who had voted against the bill and who faced tough Democratic challengers in their re-election bids back home. "A lot of these people are going to be voted out," says Reardon of the AMA, "and I think Sen. Ashcroft is an example of a very tight race. Eighty percent of the people want this, and if he doesn't support it, we're going to let the people know. These guys are feeling the pressure."

Ashcroft, now officially at the top of the hit list, was told to expect full-page newspaper ads starting on June 22 condemning his repeated votes against patients' rights.

But public pressure was crashing in from all sides, especially for lawmakers like Ashcroft who faced healthy challengers in the November 2000 election. At the same time, the working public's cry for managed-care reform hit its crescendo, as did senior citizens' call for a Medicare drug benefit.

That was because Medicare does not pay for prescription drugs and the price of pharmaceuticals was skyrocketing. For about one-third of the 39 million beneficiaries, the ones without private supplemental insurance to cover drug costs, the out-of-pocket expenses for many drugs are twice as much as they are for insurance companies with bulk-buying power. And the situation is projected to only get worse. According to a recent New England Journal of Medicine editorial, drug costs are increasing by an average of 15 percent every year and will soon surpass the cost to insurance companies of physicians and hospitalization.

But it's not just because Americans are using more drugs. "The top 10 drug companies are reported to have profits averaging about 30 percent of revenues, a stunning margin," the Journal editorial states. "Over the past few years, the pharmaceutical industry as a whole has been far more the profitable industry in the United States." The editorial adds that "the pharmaceutical industry enjoys extraordinary government protections and subsidies."

So the demand to help Medicare beneficiaries -- who tend to be registered voters -- pay their rising drug bills also meant reining in the excesses of the pharmaceutical industry in general.

"We are concerned about the monopoly position that drug companies have over pharmaceuticals in this country, and we want some way for prices to be moderated," says Dan Schulder, legislative director for the National Council of Senior Citizens in Washington, D.C. "What has happened over the past 20 years has been a cost shift in terms of profits from other countries, where the governments have forced down prices, to this country, where the government has a hands-off policy. So people here pay an exceedingly high price for pharmaceuticals."

Congress jumped on the issue like a fumbled football, and at least 30 bills were introduced last year dealing with Medicare and the prescription-drug benefit. In general, Democrats proposed offering a blanket benefit to all Medicare recipients, with low copays and deductibles. The Republicans, predictably, looked to the industry for a private-sector solution.

Horrified by the thought of the Medicare program's bulk-buying power's being used to push down drug costs and profits, the Pharmaceutical Research and Manufacturers of America (PhRMA), the main trade association, pushed for federal subsidies to private insurance companies, which would then theoretically offer cheaper drug coverage.

Mila Becker, legislative representative for AARP in Washington, D.C., says there was frenzied lobbying on the issue: "This is really intense, because this is one of the major focal points of the Congress. What is interesting is that the consumers' attention has definitely been caught here. And it's not just 85-year-olds. It's the consumers taking care of their parents or getting close to retirement age as well. It's a huge group of people."

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