/PRNewswire-USNewswire/ -- The following is a statement from Betsy McCaughey, Ph.D., Chairman/Founder of Committee to Reduce Infection Deaths:
Americans need to know how the health provisions hidden in the recently enacted stimulus package will affect them. To inform the public about these provisions and the dangers, especially for seniors, I wrote an analysis for Bloomberg.com on February 10th. Lori Robertson, an employee of FactCheck.org, challenged the accuracy of my analysis in her February 20 critique posted on Newsweek.com. Readers of Robertson's critique should consider these facts.
Robertson begins by portraying me as a Republican politician out to score partisan points. I am a Democrat and a patient advocate leading a national campaign to prevent hospital infections.
Robertson also states that I am not a journalist and therefore lack the qualifications to analyze the stimulus package. In fact, I am a widely published author who has won three prestigious journalism prizes, including a National Magazine Award, an H.L. Mencken Award, and the 2003 Media Award from the American Association of Anesthesiologists. In addition, I earned a Ph.D. in constitutional history from Columbia University, wrote two books on the U.S. Constitution, and served as Lt. Governor of a large state. What are Robertson's credentials to analyze this legislative document? She holds a B. A. in advertising.
Robertson interviewed me by telephone and writes that "throughout our conversation McCaughey spoke of an 'unprecedented' award of authority to the secretary (of Health and Human Services). That's a matter of opinion on which we won't weigh in."
But that is the most important issue. And it's a matter of fact, not opinion. How much power is given to the HHS Secretary over your health care, and what choices are left to you and your doctor?
The goals of the National Coordinator for Health Information Technology are to ensure that "all individuals in the United States" have their medical treatments entered into an electronic database and to guide physicians "at the time and place of care" so as to reduce costs and eliminate "inappropriate care".
Are these guidelines voluntary? Hardly. Physicians and hospitals that fail to meet the HHS Secretary's standard of "meaningful use" will be subject to financial penalties from Medicare. How much leeway will there be to use experimental treatments and off label drugs? Will doctors be able to meet the needs of the atypical patient or provide more care than the guidelines recommend? It's hard to say, because the HHS Secretary is empowered to determine what "meaningful use" means and to make the definition more "stringent" over time.
"Perhaps so," writes Robertson. "But the fact remains that the law does not impose any federal treatment guidelines or require the government to do so." Robertson concedes that "perhaps" such interference with the doctor-patient relationship "will indeed come to pass some time in the future. Who knows?" she says. "But the law doesn't require it."
Require it? No. Allow it to happen? Absolutely. The point of analyzing legislation is to understand what could happen once the law is passed. In this case, there is a transfer of power from patient to government. Robertson fails to address that.
In the early 1990s, HMOs used a financial penalty called a "withhold." HMOs would withhold as much as 10% of a physicians' reimbursement until the end of the year and give it back only to physicians who met stringent targets for limiting how many diagnostic tests, referrals to specialists, and days in the hospital their patients got. What a doctor ordered for a patient came out of the doctor's own pocket. Patient advocates like me acted quickly to demand that the withhold be outlawed. Now the HHS Secretary would be permitted to do virtually the same thing by withholding Medicare reimbursements.
Robertson also concludes that the creation of a Federal Council on Comparative Effectiveness Research should not alarm seniors. Comparative effectiveness is code for limiting care based on a patient's birth date. Treatments for the elderly, who have fewer years to benefit, are likely to be deemed too costly. This is already happening in England and several European countries. Numerous recent articles in Health Affairs, the inside-the beltway manual for health policy makers, describe comparative effectiveness research as the tool to reduce Medicare spending.
U.S. Senators were so concerned about the meaning of comparative effectiveness that the Senate version of the stimulus replaced that term with "clinical effectiveness". However, the change was overturned when House and Senate conferred on a final version. Representative Charles Boustany Jr. from Louisiana, a heart surgeon, told The New York Times he feared the research would be used to "deny life-saving treatment to seniors and disabled people."
Finally, Robertson fails to explain why these health provisions were slipped into a stimulus package with no expert testimony and no opportunity for input by patient advocates, seniors, or physicians' groups. If these provisions are so good for patients, why avoid public scrutiny and debate? Secretary of HHS nominee Tom Daschle advised the president to do just that, even if it meant "attaching a health plan to the federal budget."
Americans should demand that these health provisions be repealed and offered as separate legislation so their impact can be further assessed.
Betsy McCaughey, Ph.D., is Chairman/Founder of Committee to Reduce Infection Deaths and former Lt. Governor of New York State.
Showing posts with label stimulus package. Show all posts
Showing posts with label stimulus package. Show all posts
Monday, February 23, 2009
Tuesday, February 17, 2009
Economic Experts: Will the 2009 Stimulus Act Fizzle?
As a strangled credit market and record-breaking job cuts spur comparisons with the Great Depression of the 1930s, the Obama administration and Congress appear poised to agree on the American Recovery and Reinvestment Act of 2009, an $789 billion broad-based stimulus package designed to kick-start the economy.
But just as a predecessor initiative—the $700 billion Troubled Assets Relief Program (TARP) pumped money into banks by letting the U.S. Treasury buy equity stakes in financial institutions—appears to have done little to aid the larger economy, the latest taxpayer-funded program may stall out if it doesn’t pump more cash into businesses that can create jobs, say Emory University faculty and other experts.
Washington Tries to Thaw Credit Freeze
The big question, according to Charles F. Goetz, an adjunct professor of organization and management and a distinguished lecturer in entrepreneurship at Emory University's Goizueta Business School, is whether or not the new stimulus bill will truly thaw the capital freeze that is currently blocking business activity.
“Funding, not consumer spending, is the core issue for small businesses,” he says. “Right now lenders are hesitant to extend money to commercial borrowers even when they have a good track record, and in some cases are actually calling in loans that they have already funded.”
He acknowledges that a falloff in revenue is hurting small businesses and notes that the stimulus package could improve that, but says the bill will only fix a very small part of the problem.
“The freeze in funding is hurting small businesses much more than the shortfall in sales is hurting them,” Goetz says. “Without the necessary cash to grease the gears and keep the business going, companies have had no choice but to reduce costs. And that, unfortunately, results in a cutback on capital expenditures and a need to lay off workers. So cash, in the form of loans, is the mechanism that is most important, but the stimulus bill can do little to help in that regard."
So where will that help come from?
"It's going to have to come from the $350 billion still remaining in the TARP; or possibly even more from a future son-of-TARP,” Goetz says. “Whether the TARP is used for a Good Bank/Bad Bank strategy [similar to the Resolution Trust Corp. created after the Savings and Loan failures of the 1980s], or to put direct investment into troubled banks, the only vehicle that has any real chance of freeing up bank lending and truly helping small business is the TARP or some reincarnation of it.”
Treasury Secretary Timothy F. Geithner appeared to allude to a similar plan in his February 10 comments calling for a $500 billion, Public-Private Investment Fund “targeted to the legacy loans and assets that are now burdening many financial institutions.”
Meanwhile, says Goetz, “When consumers are worried about keeping their jobs, they spend less and save more, which results in lower sales for companies and exacerbates the whole cycle.”
Small businesses in particular are concerned that the stimulus package misses the boat. Small businesses are defined as companies with fewer than 10 employees, and they account for almost 80 percent of all U.S. companies, according to the National Federation of Independent Business (NFIB) lobbying group. Small businesses are credited with generating about 70 percent of all new jobs.
“By increasing the federally guaranteed portion of Small Business Administration (SBA) loans, and giving more power to the SBA to expedite loan approvals, we believe we can turn around the dramatic decline in SBA lending we have seen in recent months,” said Geithner.
But Goetz was not very impressed, since the package calls for only about $500 million for the Small Business Administration’s loan-guarantee programs, which he says "is a drop in the bucket" compared to the total drop-off in bank loans.
“Banks, particularly through the SBA guaranteed loan programs, have the potential to help both existing and new small businesses to expand and hire more employees,” he says.
In a February 6 message to the membership of NFIB, the organization’s chief executive officer Dan Danner asks, “Have you heard anything about what Congress is providing for small businesses in the current economic stimulus package being debated in Washington? Unfortunately, the answer is ‘No.’"
Did TARP Spring a Leak?
In fact, Goetz says, the remaining $350 billion in the federal TARP program could do a lot to spur business activity, if it is designed differently.
“Maybe TARP has not been used in the most effective way to date,” observes Goetz. “It was passed in a hurry, and apparently there were no direct requirements for banks to actually make more loans. Instead, many institutions have tightened lending standards and used the funds for things like purchasing other banks, instead of making more loans.”
Although the U.S. Treasury has invested about $350 billion into financial institutions under TARP, about 70 percent of U.S. banks reported they tightened standards on loans to small firms, according to the most recent Bank Lending Practices survey taken by the Federal Reserve Board.
“Perhaps the creation of a Good Bank/Bad Bank entity like the Resolution Trust Corp. (RTC) would have been a better use of the funds,” says Goetz, referring to a limited-life federal organization, created in the wake of the savings and loan crisis of the late 1980s, which managed and resolved financial institutions placed under conservatorship or receivership from January 1, 1989, through August 9, 1992.
“If my memory is correct, the government actually made money on the RTC and put money back into the banking system that got individuals and business to start spending again,” he says. “And contrary to what most people think, this is actually a good time to start a new business and to expand if you already have a small business. This is because in a recession, competition often shrinks at a pace even faster than demand does.”
Competitors that grew “fat and happy” in an easier time are falling by the wayside as they are unable to adjust in a more difficult environment, Goetz says. “In addition, you can pick up some very good employees that you would not have been able to in a better market. And even if you're not interested in starting a new business, the difficult economic environment means you can often purchase a company that is up and running at a fraction of what it would have cost just six months earlier.”
Some Goizueta faculty members are even more disenchanted with the stimulus proposal.
“In my judgment, this is a very poorly designed package,” says Ray Hill, an adjunct professor of finance. “I believe that only a small portion of the huge debt we will incur will produce any stimulus within any reasonable time frame.”
First, he says, “A big part of the [proposed] package is temporary tax relief directed to individuals. Economic theory and repeated experience—including the tax rebates of the 2008 stimulus package under the Bush administration—tell us that consumers save or pay down debt most of any change in income they perceive to be temporary, including the so-called tax ‘refunds’ to people who don't pay taxes.”
Both versions of the stimulus packages call for billions of dollars to be spent on infrastructure and other “shovel ready” projects that are projected to create jobs. “Although spending on infrastructure is commendable, this spending will take time, even for so-called ‘shovel ready’ projects,” says Hill.
“I believe that the Congressional Budget Office's own projections forecast that most of these funds will be spent in 2010 or later,” he says. By then the economy may already be recovering and the spending will either be inflationary or will take resources from private sector investment.”
Hill also faults proposed investments in alternative energy, noting that “we already have a glut of solar panels so no one is going to start producing a lot more until whole projects are underway, which can take years. Of course, you hear venture capitalists supporting this part of the stimulus package, but that is pure self interest.”
The stimulus package being discussed by Congress may indeed help the economy in some ways, concedes Hill.
“It may provide funds to states and prompt them to maintain spending that would otherwise be cut,” he says. “But it may also have unintended consequences. I have in mind the extension and improvement in unemployment benefits.”
Extending benefits in the weak economy may be good policy, "but we have to recognize that the inevitable result will be a longer duration of high unemployment than would otherwise be the case,” Hill notes.
Some observers argue that permanent tax cuts will provide the most effective and immediate stimulus, Hill notes, adding that “I think experience shows that this probably is the case.”
Car Dealers Suffer as Sales Stall
Automobile dealers, which were hammered by high energy prices and the tight credit market, are one of the economic downturn’s latest casualties.
Based on falling sales, about 5,000 car dealers across the U.S., or nearly 25 percent of the estimated total, would have to close in 2009 to enable average sales per dealer to match 2007's results, according to a study released in January by the accounting firm Grant Thornton LLP.
At least one industry observer who attended a recent National Automobile Dealers Association convention is worried that the stimulus package won’t do much to help those at-risk dealers, many of which are family-owned businesses.
“Banks may be getting TARP financing, but they’re still skittish about providing floor financing [revolving loans that dealers use to finance their inventory],” says Richard Kotzen, a partner in the Dealership Services Group of Crowe Horwath LLP, a Florida-based CPA firm. “Further, some of the TARP money is being diverted to U.S. automobile manufacturers, which encourages them to build more cars and press dealers to take delivery and pay for even more units that may end up sitting on their lots.”
Kotzen says he believes the industry as a whole will eventually recover, but notes that so far, federal stimulus programs have not generated a “trickle down” effect.
“The ‘shovels in the dirt’ approach of the stimulus plan as it stands now will generate jobs down the road, but auto dealers and other retailers need money now,” he says. “Permanent tax relief for consumers and retailers might help. Tax rebates, the ability to depreciate assets faster, and the extension of loss carrybacks [offsetting prior-year profits with current year losses] to five years from the current two, could also help businesses to regain their footing.”
Increased SBA funding in the stimulus package could provide some rapid assistance to small businesses, says Andrea Hershatter, who teaches entrepreneurship and serves as associate dean and director of the BBA program at Goizueta.
“Typically, the propensity for risk taking goes down in a weak economy,” she says. “The typical rounds of early stage financing from friends and family and angel investors depends on excess capital. Reduced wealth means that these usual sources of early venture financing are unavailable to entrepreneurs. Additionally, in the current environment, many banks are not willing or able to provide loans or lines of credit, leaving very few options for entrepreneurs.”
Hershatter points out that the stimulus package must spur the economy on a wide scale basis in order to have a positive long-term impact for entrepreneurs. In the meantime, additional sources of credit for small businesses are needed to help them get off the ground, she adds.
But Hershatter cautions that federal assistance to new and fledgling businesses must employ the same criteria that the private sector would consider, funding only those businesses with the highest likelihood of success.
Additionally, it is crucial to consider the sectors most likely to thrive in the coming years, she says, noting that “funding that flows to businesses whose goals are consistent with the broader ambitions of the federal government have a higher probability of benefitting from the first wave of economic growth.”
The Obama administration “has committed itself to a number of segments, including improvements in healthcare, education and energy efficiency,” says Hershatter. “If economic stimulus funds help to set up or grow businesses that contribute to these agendas, there is good alignment. On the other hand, if the stimulus package simply provides a pool of funds that lend to businesses that are not viable in the long term, it could be a waste of taxpayer money.”
But just as a predecessor initiative—the $700 billion Troubled Assets Relief Program (TARP) pumped money into banks by letting the U.S. Treasury buy equity stakes in financial institutions—appears to have done little to aid the larger economy, the latest taxpayer-funded program may stall out if it doesn’t pump more cash into businesses that can create jobs, say Emory University faculty and other experts.
Washington Tries to Thaw Credit Freeze
The big question, according to Charles F. Goetz, an adjunct professor of organization and management and a distinguished lecturer in entrepreneurship at Emory University's Goizueta Business School, is whether or not the new stimulus bill will truly thaw the capital freeze that is currently blocking business activity.
“Funding, not consumer spending, is the core issue for small businesses,” he says. “Right now lenders are hesitant to extend money to commercial borrowers even when they have a good track record, and in some cases are actually calling in loans that they have already funded.”
He acknowledges that a falloff in revenue is hurting small businesses and notes that the stimulus package could improve that, but says the bill will only fix a very small part of the problem.
“The freeze in funding is hurting small businesses much more than the shortfall in sales is hurting them,” Goetz says. “Without the necessary cash to grease the gears and keep the business going, companies have had no choice but to reduce costs. And that, unfortunately, results in a cutback on capital expenditures and a need to lay off workers. So cash, in the form of loans, is the mechanism that is most important, but the stimulus bill can do little to help in that regard."
So where will that help come from?
"It's going to have to come from the $350 billion still remaining in the TARP; or possibly even more from a future son-of-TARP,” Goetz says. “Whether the TARP is used for a Good Bank/Bad Bank strategy [similar to the Resolution Trust Corp. created after the Savings and Loan failures of the 1980s], or to put direct investment into troubled banks, the only vehicle that has any real chance of freeing up bank lending and truly helping small business is the TARP or some reincarnation of it.”
Treasury Secretary Timothy F. Geithner appeared to allude to a similar plan in his February 10 comments calling for a $500 billion, Public-Private Investment Fund “targeted to the legacy loans and assets that are now burdening many financial institutions.”
Meanwhile, says Goetz, “When consumers are worried about keeping their jobs, they spend less and save more, which results in lower sales for companies and exacerbates the whole cycle.”
Small businesses in particular are concerned that the stimulus package misses the boat. Small businesses are defined as companies with fewer than 10 employees, and they account for almost 80 percent of all U.S. companies, according to the National Federation of Independent Business (NFIB) lobbying group. Small businesses are credited with generating about 70 percent of all new jobs.
“By increasing the federally guaranteed portion of Small Business Administration (SBA) loans, and giving more power to the SBA to expedite loan approvals, we believe we can turn around the dramatic decline in SBA lending we have seen in recent months,” said Geithner.
But Goetz was not very impressed, since the package calls for only about $500 million for the Small Business Administration’s loan-guarantee programs, which he says "is a drop in the bucket" compared to the total drop-off in bank loans.
“Banks, particularly through the SBA guaranteed loan programs, have the potential to help both existing and new small businesses to expand and hire more employees,” he says.
In a February 6 message to the membership of NFIB, the organization’s chief executive officer Dan Danner asks, “Have you heard anything about what Congress is providing for small businesses in the current economic stimulus package being debated in Washington? Unfortunately, the answer is ‘No.’"
Did TARP Spring a Leak?
In fact, Goetz says, the remaining $350 billion in the federal TARP program could do a lot to spur business activity, if it is designed differently.
“Maybe TARP has not been used in the most effective way to date,” observes Goetz. “It was passed in a hurry, and apparently there were no direct requirements for banks to actually make more loans. Instead, many institutions have tightened lending standards and used the funds for things like purchasing other banks, instead of making more loans.”
Although the U.S. Treasury has invested about $350 billion into financial institutions under TARP, about 70 percent of U.S. banks reported they tightened standards on loans to small firms, according to the most recent Bank Lending Practices survey taken by the Federal Reserve Board.
“Perhaps the creation of a Good Bank/Bad Bank entity like the Resolution Trust Corp. (RTC) would have been a better use of the funds,” says Goetz, referring to a limited-life federal organization, created in the wake of the savings and loan crisis of the late 1980s, which managed and resolved financial institutions placed under conservatorship or receivership from January 1, 1989, through August 9, 1992.
“If my memory is correct, the government actually made money on the RTC and put money back into the banking system that got individuals and business to start spending again,” he says. “And contrary to what most people think, this is actually a good time to start a new business and to expand if you already have a small business. This is because in a recession, competition often shrinks at a pace even faster than demand does.”
Competitors that grew “fat and happy” in an easier time are falling by the wayside as they are unable to adjust in a more difficult environment, Goetz says. “In addition, you can pick up some very good employees that you would not have been able to in a better market. And even if you're not interested in starting a new business, the difficult economic environment means you can often purchase a company that is up and running at a fraction of what it would have cost just six months earlier.”
Some Goizueta faculty members are even more disenchanted with the stimulus proposal.
“In my judgment, this is a very poorly designed package,” says Ray Hill, an adjunct professor of finance. “I believe that only a small portion of the huge debt we will incur will produce any stimulus within any reasonable time frame.”
First, he says, “A big part of the [proposed] package is temporary tax relief directed to individuals. Economic theory and repeated experience—including the tax rebates of the 2008 stimulus package under the Bush administration—tell us that consumers save or pay down debt most of any change in income they perceive to be temporary, including the so-called tax ‘refunds’ to people who don't pay taxes.”
Both versions of the stimulus packages call for billions of dollars to be spent on infrastructure and other “shovel ready” projects that are projected to create jobs. “Although spending on infrastructure is commendable, this spending will take time, even for so-called ‘shovel ready’ projects,” says Hill.
“I believe that the Congressional Budget Office's own projections forecast that most of these funds will be spent in 2010 or later,” he says. By then the economy may already be recovering and the spending will either be inflationary or will take resources from private sector investment.”
Hill also faults proposed investments in alternative energy, noting that “we already have a glut of solar panels so no one is going to start producing a lot more until whole projects are underway, which can take years. Of course, you hear venture capitalists supporting this part of the stimulus package, but that is pure self interest.”
The stimulus package being discussed by Congress may indeed help the economy in some ways, concedes Hill.
“It may provide funds to states and prompt them to maintain spending that would otherwise be cut,” he says. “But it may also have unintended consequences. I have in mind the extension and improvement in unemployment benefits.”
Extending benefits in the weak economy may be good policy, "but we have to recognize that the inevitable result will be a longer duration of high unemployment than would otherwise be the case,” Hill notes.
Some observers argue that permanent tax cuts will provide the most effective and immediate stimulus, Hill notes, adding that “I think experience shows that this probably is the case.”
Car Dealers Suffer as Sales Stall
Automobile dealers, which were hammered by high energy prices and the tight credit market, are one of the economic downturn’s latest casualties.
Based on falling sales, about 5,000 car dealers across the U.S., or nearly 25 percent of the estimated total, would have to close in 2009 to enable average sales per dealer to match 2007's results, according to a study released in January by the accounting firm Grant Thornton LLP.
At least one industry observer who attended a recent National Automobile Dealers Association convention is worried that the stimulus package won’t do much to help those at-risk dealers, many of which are family-owned businesses.
“Banks may be getting TARP financing, but they’re still skittish about providing floor financing [revolving loans that dealers use to finance their inventory],” says Richard Kotzen, a partner in the Dealership Services Group of Crowe Horwath LLP, a Florida-based CPA firm. “Further, some of the TARP money is being diverted to U.S. automobile manufacturers, which encourages them to build more cars and press dealers to take delivery and pay for even more units that may end up sitting on their lots.”
Kotzen says he believes the industry as a whole will eventually recover, but notes that so far, federal stimulus programs have not generated a “trickle down” effect.
“The ‘shovels in the dirt’ approach of the stimulus plan as it stands now will generate jobs down the road, but auto dealers and other retailers need money now,” he says. “Permanent tax relief for consumers and retailers might help. Tax rebates, the ability to depreciate assets faster, and the extension of loss carrybacks [offsetting prior-year profits with current year losses] to five years from the current two, could also help businesses to regain their footing.”
Increased SBA funding in the stimulus package could provide some rapid assistance to small businesses, says Andrea Hershatter, who teaches entrepreneurship and serves as associate dean and director of the BBA program at Goizueta.
“Typically, the propensity for risk taking goes down in a weak economy,” she says. “The typical rounds of early stage financing from friends and family and angel investors depends on excess capital. Reduced wealth means that these usual sources of early venture financing are unavailable to entrepreneurs. Additionally, in the current environment, many banks are not willing or able to provide loans or lines of credit, leaving very few options for entrepreneurs.”
Hershatter points out that the stimulus package must spur the economy on a wide scale basis in order to have a positive long-term impact for entrepreneurs. In the meantime, additional sources of credit for small businesses are needed to help them get off the ground, she adds.
But Hershatter cautions that federal assistance to new and fledgling businesses must employ the same criteria that the private sector would consider, funding only those businesses with the highest likelihood of success.
Additionally, it is crucial to consider the sectors most likely to thrive in the coming years, she says, noting that “funding that flows to businesses whose goals are consistent with the broader ambitions of the federal government have a higher probability of benefitting from the first wave of economic growth.”
The Obama administration “has committed itself to a number of segments, including improvements in healthcare, education and energy efficiency,” says Hershatter. “If economic stimulus funds help to set up or grow businesses that contribute to these agendas, there is good alignment. On the other hand, if the stimulus package simply provides a pool of funds that lend to businesses that are not viable in the long term, it could be a waste of taxpayer money.”
Tuesday, January 27, 2009
Statement on Comparative Effectiveness Research Under Senate Appropriations Committee Stimulus Bill
/PRNewswire-USNewswire/ -- "The Senate today improved on a comparative effectiveness research (CER) package from the House by focusing the $1.1 billion dollar research effort on clinical effectiveness," said Dr. Jane L. Delgado, President and CEO of the National Alliance for Hispanic Health, the nation's leading Hispanic health advocacy group. She added, "The Senate Appropriations Committee has rejected House report language that put cost over quality and was a prescription for bad health.
"House stimulus package language had urged that those treatments found 'more expensive, will no longer be prescribed.' The Senate instead calls for the CER program to focus specifically on clinical effectiveness. The Senate language recognizes that a decision on the best treatment for an individual patient must be made between the patient and their provider, not a federal research or rulemaking body.
"While the Senate language is an improvement , it is important that further steps be taken to ensure that research and governance reflect those that the research seeks to serve."
According to Dr. Delgado two outstanding issues are critical.
1. Final legislation must specifically enforce current policies for inclusion in research. House language was silent on inclusion of gender, race, ethnicity, and disability. While the Senate improves on House language, the final legislation should specifically call for research to be in compliance with the federal Agency for Healthcare Research and Quality Policy on the Inclusion of Priority Populations in Research.
2. Governance must be changed from an all federal board to include majority governance by patient and provider groups. Current House language calls for a 15 person governance board of only federal officials to oversee the $1.1 billion CER program. An all federal panel will not reflect the real-life concerns of patients and providers and inevitably lead to science and spending that does not meet the needs of patients for better quality care.
"We appreciate the work of the Senate Appropriations and Finance Committees and in particular thank Senators Baucus, Conrad, Harkin, and Inouye for their leadership on improving the CER program under the stimulus package. We look forward to our work with the Senate and House in the days ahead to develop a package that puts patients and quality first."
"House stimulus package language had urged that those treatments found 'more expensive, will no longer be prescribed.' The Senate instead calls for the CER program to focus specifically on clinical effectiveness. The Senate language recognizes that a decision on the best treatment for an individual patient must be made between the patient and their provider, not a federal research or rulemaking body.
"While the Senate language is an improvement , it is important that further steps be taken to ensure that research and governance reflect those that the research seeks to serve."
According to Dr. Delgado two outstanding issues are critical.
1. Final legislation must specifically enforce current policies for inclusion in research. House language was silent on inclusion of gender, race, ethnicity, and disability. While the Senate improves on House language, the final legislation should specifically call for research to be in compliance with the federal Agency for Healthcare Research and Quality Policy on the Inclusion of Priority Populations in Research.
2. Governance must be changed from an all federal board to include majority governance by patient and provider groups. Current House language calls for a 15 person governance board of only federal officials to oversee the $1.1 billion CER program. An all federal panel will not reflect the real-life concerns of patients and providers and inevitably lead to science and spending that does not meet the needs of patients for better quality care.
"We appreciate the work of the Senate Appropriations and Finance Committees and in particular thank Senators Baucus, Conrad, Harkin, and Inouye for their leadership on improving the CER program under the stimulus package. We look forward to our work with the Senate and House in the days ahead to develop a package that puts patients and quality first."
Consumer Watchdog Calls on Google to Cease Lobbying Effort to Allow Sale of Patient Medical Records
Consumer Watchdog Calls on Google to Cease Lobbying Effort to Allow Sale of Patient Medical Records; Urges Congress to Adopt Privacy Protections in Economic Stimulus Bill
PRNewswire-USNewswire/ -- The non-partisan Consumer Watchdog called on Google today to cease a rumored lobbying effort aimed at allowing the sale of electronic medical records in the current version of the Economic Stimulus legislation. Consumer Watchdog called on Congress to remove loopholes in the ban on the sale of medical records and include other privacy protections absent from the current bill such as giving patients the right to an audit detailing who had accessed their medical records and how the records were used.
Reportedly Google is pushing for the provisions so it may sell patient medical information to its advertising clients on the new "Google Health" database: https://www.google.com/health/
Download Consumer Watchdog's letter urging Congress to refuse Google's amendments and detailing five areas of needed patient privacy improvements: http://www.consumerwatchdog.org/resources/PrivacyLetterCongress.pdf
In the letter sent today, Consumer Watchdog wrote:
"Americans will benefit from an integrated system capable of making our medical records available wherever we may need them, but only if the system is properly used.
"The medical technology portion of the economic stimulus bill does not sufficiently protect patient privacy, and recent amendments have made this situation worse. Medical privacy must be strengthened before the measure's final passage, rather than allowing corporate interests to take advantage of the larger bill's urgency. ...
"First and foremost, electronic medical records should be designed to benefit patients, not the corporate interests lobbying hard on Capitol Hill to get a piece of the $20 billion in taxpayer subsidies provided for this project."
The 5 patient privacy protections that Consumer Watchdog urged Congress to adopt in the electronic medical record section of the Economic Stimulus bill, include:
1. Retain & Strengthen Prohibition on Sale of Private Medical Data. Our private medical information, including which prescription drugs we take and which illnesses we have, is extremely valuable to the medical-insurance complex. Some want to market to us, others want to use this information to deny us access to insurance coverage. For instance:
-- Google is said to be lobbying hard this week to weaken the ban
currently in the draft measure on the sale of our private medical
records. Google must not be allowed to destroy this basic privacy
protection.
-- On Friday, Representative Roy Blunt (R-MO) added an amendment to the
House version of the stimulus bill allowing pharmacists to sell our
private medical information without our knowledge. This amendment must
be removed.
-- Currently, the stimulus bill makes an exception to the ban on the sale
of private medical information for purposes of "research." This
loophole is large enough to allow drug companies, marketers and health
insurers to buy our private health information for purposes of
"researching" consumer advertising for the newest health products, or
to decide which of us to insure.
-- Another broad exception would allow companies to sell or exchange a
patient's records if the sale or exchange is "to a business associate
for activities ... that the business associate undertakes on behalf of
and at the specific request of" the company holding the private
information.
These blatant attempts to weaken privacy protections all must be turned back.
2. Provide an "Audit Trail" To Track Who Accesses Our Records. Under the current version of the bill, a patient is not able to track which medical personnel access their medical records or how that information is used. The measure must be amended to allow patients to request an "audit trail" detailing when their medical record was accessed, by whom, and for what purpose.
3. Make Database Holders Accountable for Keeping Our Medical Records Private. Companies developing electronic medical record technology must be fully accountable for the safe keeping of our information. "Safe harbor" provisions in the current legislation that would insulate these interests from accountability must be removed. For example, the current version of the bill shields database holders from telling patients when possible identity thieves access their private information as long as the data disclosure was "unintentional" and the company acted in "good faith."
4. Allow States To Adopt More Protective Standards. Currently the bill allows states to establish additional privacy regulation and enforce existing requirements. These provisions must remain part of the final proposal. Other federal health care laws, like HIPPA, Medicaid, and COBRA, provide a model for a federal-state partnership rather than federal pre-emption of more protective state standards. States have traditionally been the laboratories of innovation in patient privacy. In fact, the gold standard for medical privacy is the California Confidentiality of Medical Information Act, which bars the sharing, selling, or using for marketing or otherwise, any private medical information.
5. Retain House Amendments Protecting Private Information. Last week, Congressman Edward Markey (D-MA) added amendments to the House bill requiring the holders of health information databases to make protected health information "unusable, unreadable, or indecipherable" to unauthorized individuals. This amendment will help to ensure that databases are appropriately protected to keep sensitive medical information out of the hands of identity thieves and black market information aggregators.
PRNewswire-USNewswire/ -- The non-partisan Consumer Watchdog called on Google today to cease a rumored lobbying effort aimed at allowing the sale of electronic medical records in the current version of the Economic Stimulus legislation. Consumer Watchdog called on Congress to remove loopholes in the ban on the sale of medical records and include other privacy protections absent from the current bill such as giving patients the right to an audit detailing who had accessed their medical records and how the records were used.
Reportedly Google is pushing for the provisions so it may sell patient medical information to its advertising clients on the new "Google Health" database: https://www.google.com/health/
Download Consumer Watchdog's letter urging Congress to refuse Google's amendments and detailing five areas of needed patient privacy improvements: http://www.consumerwatchdog.org/resources/PrivacyLetterCongress.pdf
In the letter sent today, Consumer Watchdog wrote:
"Americans will benefit from an integrated system capable of making our medical records available wherever we may need them, but only if the system is properly used.
"The medical technology portion of the economic stimulus bill does not sufficiently protect patient privacy, and recent amendments have made this situation worse. Medical privacy must be strengthened before the measure's final passage, rather than allowing corporate interests to take advantage of the larger bill's urgency. ...
"First and foremost, electronic medical records should be designed to benefit patients, not the corporate interests lobbying hard on Capitol Hill to get a piece of the $20 billion in taxpayer subsidies provided for this project."
The 5 patient privacy protections that Consumer Watchdog urged Congress to adopt in the electronic medical record section of the Economic Stimulus bill, include:
1. Retain & Strengthen Prohibition on Sale of Private Medical Data. Our private medical information, including which prescription drugs we take and which illnesses we have, is extremely valuable to the medical-insurance complex. Some want to market to us, others want to use this information to deny us access to insurance coverage. For instance:
-- Google is said to be lobbying hard this week to weaken the ban
currently in the draft measure on the sale of our private medical
records. Google must not be allowed to destroy this basic privacy
protection.
-- On Friday, Representative Roy Blunt (R-MO) added an amendment to the
House version of the stimulus bill allowing pharmacists to sell our
private medical information without our knowledge. This amendment must
be removed.
-- Currently, the stimulus bill makes an exception to the ban on the sale
of private medical information for purposes of "research." This
loophole is large enough to allow drug companies, marketers and health
insurers to buy our private health information for purposes of
"researching" consumer advertising for the newest health products, or
to decide which of us to insure.
-- Another broad exception would allow companies to sell or exchange a
patient's records if the sale or exchange is "to a business associate
for activities ... that the business associate undertakes on behalf of
and at the specific request of" the company holding the private
information.
These blatant attempts to weaken privacy protections all must be turned back.
2. Provide an "Audit Trail" To Track Who Accesses Our Records. Under the current version of the bill, a patient is not able to track which medical personnel access their medical records or how that information is used. The measure must be amended to allow patients to request an "audit trail" detailing when their medical record was accessed, by whom, and for what purpose.
3. Make Database Holders Accountable for Keeping Our Medical Records Private. Companies developing electronic medical record technology must be fully accountable for the safe keeping of our information. "Safe harbor" provisions in the current legislation that would insulate these interests from accountability must be removed. For example, the current version of the bill shields database holders from telling patients when possible identity thieves access their private information as long as the data disclosure was "unintentional" and the company acted in "good faith."
4. Allow States To Adopt More Protective Standards. Currently the bill allows states to establish additional privacy regulation and enforce existing requirements. These provisions must remain part of the final proposal. Other federal health care laws, like HIPPA, Medicaid, and COBRA, provide a model for a federal-state partnership rather than federal pre-emption of more protective state standards. States have traditionally been the laboratories of innovation in patient privacy. In fact, the gold standard for medical privacy is the California Confidentiality of Medical Information Act, which bars the sharing, selling, or using for marketing or otherwise, any private medical information.
5. Retain House Amendments Protecting Private Information. Last week, Congressman Edward Markey (D-MA) added amendments to the House bill requiring the holders of health information databases to make protected health information "unusable, unreadable, or indecipherable" to unauthorized individuals. This amendment will help to ensure that databases are appropriately protected to keep sensitive medical information out of the hands of identity thieves and black market information aggregators.
Thursday, January 15, 2009
Economic Stimulus Package Could Impinge on Americans' Health Privacy
/PRNewswire-USNewswire/ -- "Before increasing federal spending on health IT, Congress should first fix the already-outdated 1996 HIPAA privacy rule to ensure individuals have control over their personal health information," says Sue A. Blevins, president of the Institute for Health Freedom (IHF). "Right now, the HIPAA privacy rule has too many loopholes to ensure true patient privacy," Blevins stresses.
IHF released the following analyses regarding proposed federal spending on health IT and its impact on health privacy:
What does Barack Obama's economic stimulus package have to do with your health privacy? A lot! If Obama creates electronic medical records for most Americans (as he's proposing) without first fixing the federal health privacy rule (to ensure patient consent), everyone would end up losing control over his or her personal health information. That's because the rule gives many entities the legal authority to share information without patients' consent for purposes related to healthcare treatment, payment, and overseeing the healthcare system. (See "What Every American Needs to Know about the HIPAA Medical Privacy Rule": www.forhealthfreedom.org/Publications/Privacy/PrivacyUpdatedNov2008.html.)
Obama is seeking support for a massive emergency spending package, warning that the U.S. recession could stretch on for years unless such steps are taken. A January 8 Reuters report noted that "Obama also wants to spend to help the healthcare industry create electronic medical records. Well over $100 billion could be spent on the various [electronic medical records] projects." CNNMoney.com reports that Obama's "audacious plan" is to "computerize all health records within five years." Obama would thus be advancing the health IT goals of the Bush administration. Its last budget set access to electronic health records as an objective to be achieved by 2014.
Moreover, the current HIPAA law would govern a nationally linked database. It is important to understand, however, that "HIPAA was never intended for the digital age, because the [1996 HIPAA law] never anticipated the emergence of Web-based records," according to David Brailer, former National Coordinator for Health Information Technology.
The bottom line is that Obama's spending plans may impinge on your privacy. There's a lot at stake with electronically transferring health data and paying claims within the $2.2 trillion healthcare industry. Concerned Americans should voice their concerns to their members of Congress and to Barack Obama.
IHF released the following analyses regarding proposed federal spending on health IT and its impact on health privacy:
What does Barack Obama's economic stimulus package have to do with your health privacy? A lot! If Obama creates electronic medical records for most Americans (as he's proposing) without first fixing the federal health privacy rule (to ensure patient consent), everyone would end up losing control over his or her personal health information. That's because the rule gives many entities the legal authority to share information without patients' consent for purposes related to healthcare treatment, payment, and overseeing the healthcare system. (See "What Every American Needs to Know about the HIPAA Medical Privacy Rule": www.forhealthfreedom.org/Publications/Privacy/PrivacyUpdatedNov2008.html.)
Obama is seeking support for a massive emergency spending package, warning that the U.S. recession could stretch on for years unless such steps are taken. A January 8 Reuters report noted that "Obama also wants to spend to help the healthcare industry create electronic medical records. Well over $100 billion could be spent on the various [electronic medical records] projects." CNNMoney.com reports that Obama's "audacious plan" is to "computerize all health records within five years." Obama would thus be advancing the health IT goals of the Bush administration. Its last budget set access to electronic health records as an objective to be achieved by 2014.
Moreover, the current HIPAA law would govern a nationally linked database. It is important to understand, however, that "HIPAA was never intended for the digital age, because the [1996 HIPAA law] never anticipated the emergence of Web-based records," according to David Brailer, former National Coordinator for Health Information Technology.
The bottom line is that Obama's spending plans may impinge on your privacy. There's a lot at stake with electronically transferring health data and paying claims within the $2.2 trillion healthcare industry. Concerned Americans should voice their concerns to their members of Congress and to Barack Obama.
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