Published in the Current and the American Journal
The lawyer for convicted murderer Jeffery Gorman says the Maine Supreme Court made a mistake when it upheld Gorman’s conviction, and will ask the court to reconsider. He may also ask the U.S. Supreme Court to take the case.
Last week, the Maine Supreme Court unanimously upheld Gorman’s conviction for the murder of Amy St. Laurent after a night out in the Old Port in October 2001. In 2003, Gorman was sentenced to 60 years in prison for the crime.
Gorman initially asked the Law Court to reverse his conviction, saying the prosecution’s key evidence should not have been heard by the jury. That evidence was a tape recording of testimony given by Gorman’s mother, Tammy Westbrook, to a Cumberland County grand jury.
Westbrook told the grand jury that Gorman called her Dec. 9, 2001, the day after St. Laurent’s body was found buried in a wooded area off Route 22 in Scarborough.
In that conversation, Westbrook said, Gorman confessed to the crime, and told his mother something nobody but the killer knew: St. Laurent had been shot once in the head.
During the trial, Westbrook testified she had no recollection of speaking to a grand jury, and no memory of any conversation with her son about St. Laurent. She also testified that she was receiving psychiatric treatment for delusions and post-traumatic stress disorder.
The prosecution argued an audio tape recording of Westbrook’s grand jury testimony should be presented as evidence during the trial. Superior Court Judge Nancy Mills agreed.
The evidence figured strongly in the prosecution’s case against Gorman, and jurors in the criminal trial asked to see a transcript of the recording during their deliberations. That was not permitted, but they were allowed to hear the tape played again.
After five hours of deliberation, the jury unanimously convicted Gorman of the murder.
Gorman appealed the conviction, claiming that the tape should not have been played because Westbrook could not be cross-examined about the statements she made in the recording.
The right to cross-examine witnesses is guaranteed in the Sixth Amendment to the U.S. Constitution. Westbrook could not be effectively cross-examined because she did not recall making the statements, or any discussions regarding the case, said Christopher MacLean, an attorney who represented Gorman during the appeal.
In a February interview, MacLean said there might have been enough evidence to convict Gorman of manslaughter, but not murder.
Asking for reconsideration Monday, MacLean reacted to the judgment of the Law Court, which upheld the admission of Westbrook’s recorded grand jury testimony, the murder conviction and the 60-year prison sentence.
“I’m disappointed,” he said. MacLean will ask the court to reconsider its decision, “focusing on the fact that the Maine Law Court really didn’t deal with the problem” of what is and is not admissible testimony.
The appeal process was halted earlier this year when a U.S. Supreme Court decision clarified some aspects of admitting recorded testimony into evidence. Lawyers for Gorman and the Attorney General’s Office updated their arguments before the Maine Supreme Court in light of that ruling.
But in its written decision last week, the Maine judges did not address the issue fully, MacLean said. The new decision demanded that “cross examination really take place,” he said. At Gorman’s trial, “clearly there was no cross-examination on the subject matter” of Westbrook’s testimony.
The Law Court could deny the request or ask for MacLean and the Attorney General’s Office to submit new arguments, either in writing or orally.
Taking the case to Washington
MacLean also said he would discuss with Gorman an appeal to the U.S. Supreme Court.
“We haven’t made any firm and final decisions in that regard,” MacLean said. He had not yet talked to Gorman, though he had left a phone message at the Maine State Prison and had mailed Gorman a copy of the Maine Supreme Court’s ruling.
“I’m very interested in getting this before the U.S. Supreme Court,” MacLean said. He assumes Gorman will approve the move, which MacLean admitted is “a bit of a long shot.”
A case appealed to the U.S. Supreme Court is not automatically taken up by the country’s highest judges. Instead, lawyers must ask the court to review the case, a request the judges can either accept or deny.
“Who knows whether they would take a case like this,” MacLean said. “The vast majority of requests to the U.S. Supreme Court are denied.”
MacLean, who has never before asked the U.S. Supreme Court to take a case, and has never handled a case before the court, said he believes the court may take the case because it has “public policy” implications, particularly for
domestic violence cases, in which witnesses make statements to police and later claim they cannot remember what they said.
If statements recorded earlier but later disclaimed by witnesses are still admissible, “I shudder to think” of what could happen in large numbers of cases across the country, MacLean said.
A ruling from the U.S. Supreme Court would clarify the rules regarding that type of testimony, even if the justices affirmed the decision of the Maine judges.
Wednesday, August 4, 2004
Thursday, July 29, 2004
Editorial: Covering suicide
Published in the Current
When I spoke to Tim Thompson, father of Timothy L. Thompson II, Tuesday morning, he expressed his hope that "something good" comes of his son's suicide. Several times, he urged me to "be sensitive," saying the community needs togetherness and healing. He also told me that he did not want the issue of suicide "swept under the rug."
In my Page 1 article, I have tried to respond to the community's very public grief, and to provide the assistance a newspaper can: information, context and resources.
The numbers are chilling: 1 in 11 Maine high school students attempt suicide each year. And 1 in 5 of them have seriously considered it. Also, according to Ingraham, 58,000 Mainers call the crisis hotline at 774-HELP every year.
That demonstrates a powerful need. Parents and teachers of young people need to watch for signs of depression and suicidal leanings in every child. Friends need to keep a close watch on each other. Mental-health workers and agencies need to get anti-suicide programs deeper into our schools. A crisis hotline, though an important start, is not enough.
Suicide is something that society at large has typically not addressed directly. Newspapers, as a part of and mirror of society, have followed that lead. But this issue is important, and should not be ignored.
It is heartening that members of the Cape Elizabeth community are joining together to grieve. That may turn, in time, into action.
The decision to cover - and how to cover - Thompson's suicide has been the most difficult of my 10-year career in community journalism.
Initially, my reaction was not to cover it at all, to let the family and friends grieve in private. But when a community grieves, we at the newspaper grieve with you. One way we do that is by telling stories and sharing information.
During my conversations with media ethicists, friends, colleagues, mentors and others - including members of the Thompson family, other Cape residents and mental-health experts - I came to the conclusion that the issue, and this incident as an example of it, is too important to turn our backs on.
Suicide is an important issue in our society, but it is a topic newspapers have traditionally handled poorly.
While older studies created concern that media coverage could lead to additional suicides, more recent studies have shown sensitive and educational news coverage can help teach people about suicide, and may even help reduce risk.
Without news coverage, "the consequence for the community is that a very important issue is not discussed," said Kelly McBridge, an ethicist at the Poynter Institute, a research and education organization for journalists.
In writing the story, I tried to avoid elements that research indicates could have negative effects, and remained sensitive to the concerns of the family and the community.
Please let me know what you think.
When I spoke to Tim Thompson, father of Timothy L. Thompson II, Tuesday morning, he expressed his hope that "something good" comes of his son's suicide. Several times, he urged me to "be sensitive," saying the community needs togetherness and healing. He also told me that he did not want the issue of suicide "swept under the rug."
In my Page 1 article, I have tried to respond to the community's very public grief, and to provide the assistance a newspaper can: information, context and resources.
The numbers are chilling: 1 in 11 Maine high school students attempt suicide each year. And 1 in 5 of them have seriously considered it. Also, according to Ingraham, 58,000 Mainers call the crisis hotline at 774-HELP every year.
That demonstrates a powerful need. Parents and teachers of young people need to watch for signs of depression and suicidal leanings in every child. Friends need to keep a close watch on each other. Mental-health workers and agencies need to get anti-suicide programs deeper into our schools. A crisis hotline, though an important start, is not enough.
Suicide is something that society at large has typically not addressed directly. Newspapers, as a part of and mirror of society, have followed that lead. But this issue is important, and should not be ignored.
It is heartening that members of the Cape Elizabeth community are joining together to grieve. That may turn, in time, into action.
The decision to cover - and how to cover - Thompson's suicide has been the most difficult of my 10-year career in community journalism.
Initially, my reaction was not to cover it at all, to let the family and friends grieve in private. But when a community grieves, we at the newspaper grieve with you. One way we do that is by telling stories and sharing information.
During my conversations with media ethicists, friends, colleagues, mentors and others - including members of the Thompson family, other Cape residents and mental-health experts - I came to the conclusion that the issue, and this incident as an example of it, is too important to turn our backs on.
Suicide is an important issue in our society, but it is a topic newspapers have traditionally handled poorly.
While older studies created concern that media coverage could lead to additional suicides, more recent studies have shown sensitive and educational news coverage can help teach people about suicide, and may even help reduce risk.
Without news coverage, "the consequence for the community is that a very important issue is not discussed," said Kelly McBridge, an ethicist at the Poynter Institute, a research and education organization for journalists.
In writing the story, I tried to avoid elements that research indicates could have negative effects, and remained sensitive to the concerns of the family and the community.
Please let me know what you think.
Community grieves Thompson's death
Published in the Current
The Cape Elizabeth community is mourning Timothy L. Thompson II, a recent Cape High School graduate who died by suicide Saturday.
The incident has sparked community discussion of the issue of suicide, which is the second-leading cause of death for young adults in Maine. Thompson's family is calling for the public to become more aware of suicide, and has helped to organize several grief-counseling sessions for local teens.
Thompson's is not the only recent suicide in town. In the past few years, two other Cape Elizabeth residents have died by suicide, Cape Police Chief Neil Williams said. One was an older man and the other was a male teenager.
The community response to Thompson's death included a public grief-counseling session Tuesday at the Cape Community Center.
About 250 people - teens, parents, teachers and other community members - attended the meeting, which began with Cape High School Principal Jeff Shedd saying the community needs to "support one another" in the grieving process for "Timmy Thompson, whose smile we all remember."
Thompson was a three-sport athlete who graduated from Cape High School in June. He was planning to attend Bridgton Academy this fall.
Thompson's father, Tim, spoke to the crowd Tuesday, as he has been doing at other private grief gatherings over the past few days. He urged the teens in the room to "try to talk this out." There is no point in asking "what if," Thompson said.
He said Timmy had been struggling with some emotional issues lately, and the support of the community helped immensely. "We really couldn't have done any more than we were doing. We need to heal as a community," he added.
He said facing their grief together is something his son would want them to do.
"He was a good friend. He was a loyal friend," Thompson said, asking the community to be strong, supportive friends for each other.
After a brief speech by fifth-grade teacher Kathy Walsh, who taught Tim in 1996-97, Anne Lynch, executive director of the Center for Grieving Children, spoke.
She told the teens in the room, "Your parents are very worried about you, and they will be checking on you more than you would like. You may need to check on them, too."
She said teens heading off to college are especially vulnerable because they will be far from their usual support networks.
Mental-health experts agree there is no way to explain why a person commits suicide. That often makes it even harder for survivors to cope with their grief.
Lynch encouraged people to talk about their memories and to give voice to their sadness. "It breaks down the walls of isolation" and helps young people grieve in healthy ways, she said.
In a Wednesday interview, Lynch said people at Tuesday's gathering had "pretty typical concerns," including parents' worries about their kids' safety, and kids' hopes to keep Thompson's memory alive.
She told parents they should work with their children, to help them stay safe while still allowing the kids space and time to mourn. "Right now the teens have a real need to be together," Lynch said. But, parents want to preserve some kind of family structure, such as having everyone home at mealtimes.
Lynch said eating properly and getting rest are important to the grieving process. "What is naturally starting to happen is these kids are starting to hang out at people's homes," which is good because it allows some parental supervision without being intrusive.
Help is available
Suicide is the second-leading cause of death for Mainers between the ages of 15 and 24, after car accidents, according to the Maine Youth Suicide Prevention Program. Each year there are about 20 suicides of young adults in Maine.
The problem also affects other age groups. Between one and three children under the age of 15 commit suicide in Maine each year.
The demographic group with the highest suicide rate in Maine is single white males between the ages of 55 and 70, according to Scott Hutcherson, clinical director of crisis services at Ingraham, a statewide non-profit social service agency.
Nationally, suicide rates have risen since 1950. Maine's suicide rate has generally followed national trends, though Maine's incidence is slightly higher than the national average. The state has the 19th-highest suicide rate in the country.
According to statewide self-reporting surveys, 1 in 11 high school students in Maine attempt suicide each year. Nationwide, nearly 1 in 5 high school students has seriously considered suicide.
There are a number of agencies able to help people considering suicide or dealing with other emotional and psychological issues.
Among them are Ingraham and Sweetser, which run a crisis hotline (774-HELP) operating around the clock all year. Anyone can call the hotline, and get both immediate assistance and help finding further aid, including referrals to counselors.
In fact, 58,000 people call the hotline each year, Hutcherson said. Most are "clients feeling so hopeless that they're suicidal." Counselors work to keep them safe and help them find ways to seek treatment.
The Cape schools also have counselors who are available to talk with students and other young people in need. The Cape police, when they are called upon, typically take distressed people to the hospital for evaluation.
Even non-professionals can help identify people at risk, and can encourage them to seek professional help.
Hutcherson said there are two common myths about discussing suicide. The first is that "if you talk about suicide, someone will become more suicidal." In fact, he said, the reverse is true. Talking to a person about suicide can reduce the risk of them attempting suicide. Just suggesting there are other options for solving problems, no matter how serious they seem, can be a big help.
The second myth is that mentioning suicide will give someone the idea. Instead, Hutcherson said, talking about suicide can open a line of communication that can help save a life. He said it's important to have someone who can listen without judging, and to urge a person to seek help.
While many people have sad or depressed feelings, it is the loss of hope that can lead a person to consider suicide, Hutcherson said.
A person begins to feel as if there are only two options: living with whatever pain and problems are in the present, and suicide. They lose sight of the possibilities of the future, and lose focus on the potential for change. Friends and counselors can help people see other options, and can help offer solutions to problems, he said.
How to get help
If you or a loved one needs help, call the Crisis Service Hotline at 774-HELP. Open 24 hours a day, seven days a week, 365 days a year, it is supported by both Ingraham and Sweetser, mental-health support agencies with long histories in Southern Maine. A statewide hotline is at 1-888-568-1112. Counselors can help deal with immediate crises and will develop long-term plans for handling mental-health issues.
For help with grieving, call the Center for Grieving Children at 775-5216 for information on grief support and counseling.
What to look for in young people
Not all adolescent attempters may admit their intent. Therefore, any deliberate self-harming behaviors should be considered serious and in need of further evaluation.
Many teenagers may display one or more of the problems or "signs" detailed below. The following list describes some potential factors of risk for suicide among youth. If observed, a professional evaluation is strongly recommended.:
-Presence of a psychiatric disorder (e.g., depression, drug or alcohol use, behavior disorders, conduct disorders [e.g., runs away or has been incarcerated]).
-The expression/communication of thoughts of suicide, death, dying or the afterlife (in a context of sadness, boredom or negative feelings).
-Impulsive and aggressive behavior; frequent expressions of rage.
-Previous exposure to other's suicidality.
-Recent severe stressor (e.g., difficulties in dealing with sexual orientation; unplanned pregnancy or other significant real or impending loss).
-Family loss or instability; significant family conflict.
---American Association for Suicidology
The Cape Elizabeth community is mourning Timothy L. Thompson II, a recent Cape High School graduate who died by suicide Saturday.
The incident has sparked community discussion of the issue of suicide, which is the second-leading cause of death for young adults in Maine. Thompson's family is calling for the public to become more aware of suicide, and has helped to organize several grief-counseling sessions for local teens.
Thompson's is not the only recent suicide in town. In the past few years, two other Cape Elizabeth residents have died by suicide, Cape Police Chief Neil Williams said. One was an older man and the other was a male teenager.
The community response to Thompson's death included a public grief-counseling session Tuesday at the Cape Community Center.
About 250 people - teens, parents, teachers and other community members - attended the meeting, which began with Cape High School Principal Jeff Shedd saying the community needs to "support one another" in the grieving process for "Timmy Thompson, whose smile we all remember."
Thompson was a three-sport athlete who graduated from Cape High School in June. He was planning to attend Bridgton Academy this fall.
Thompson's father, Tim, spoke to the crowd Tuesday, as he has been doing at other private grief gatherings over the past few days. He urged the teens in the room to "try to talk this out." There is no point in asking "what if," Thompson said.
He said Timmy had been struggling with some emotional issues lately, and the support of the community helped immensely. "We really couldn't have done any more than we were doing. We need to heal as a community," he added.
He said facing their grief together is something his son would want them to do.
"He was a good friend. He was a loyal friend," Thompson said, asking the community to be strong, supportive friends for each other.
After a brief speech by fifth-grade teacher Kathy Walsh, who taught Tim in 1996-97, Anne Lynch, executive director of the Center for Grieving Children, spoke.
She told the teens in the room, "Your parents are very worried about you, and they will be checking on you more than you would like. You may need to check on them, too."
She said teens heading off to college are especially vulnerable because they will be far from their usual support networks.
Mental-health experts agree there is no way to explain why a person commits suicide. That often makes it even harder for survivors to cope with their grief.
Lynch encouraged people to talk about their memories and to give voice to their sadness. "It breaks down the walls of isolation" and helps young people grieve in healthy ways, she said.
In a Wednesday interview, Lynch said people at Tuesday's gathering had "pretty typical concerns," including parents' worries about their kids' safety, and kids' hopes to keep Thompson's memory alive.
She told parents they should work with their children, to help them stay safe while still allowing the kids space and time to mourn. "Right now the teens have a real need to be together," Lynch said. But, parents want to preserve some kind of family structure, such as having everyone home at mealtimes.
Lynch said eating properly and getting rest are important to the grieving process. "What is naturally starting to happen is these kids are starting to hang out at people's homes," which is good because it allows some parental supervision without being intrusive.
Help is available
Suicide is the second-leading cause of death for Mainers between the ages of 15 and 24, after car accidents, according to the Maine Youth Suicide Prevention Program. Each year there are about 20 suicides of young adults in Maine.
The problem also affects other age groups. Between one and three children under the age of 15 commit suicide in Maine each year.
The demographic group with the highest suicide rate in Maine is single white males between the ages of 55 and 70, according to Scott Hutcherson, clinical director of crisis services at Ingraham, a statewide non-profit social service agency.
Nationally, suicide rates have risen since 1950. Maine's suicide rate has generally followed national trends, though Maine's incidence is slightly higher than the national average. The state has the 19th-highest suicide rate in the country.
According to statewide self-reporting surveys, 1 in 11 high school students in Maine attempt suicide each year. Nationwide, nearly 1 in 5 high school students has seriously considered suicide.
There are a number of agencies able to help people considering suicide or dealing with other emotional and psychological issues.
Among them are Ingraham and Sweetser, which run a crisis hotline (774-HELP) operating around the clock all year. Anyone can call the hotline, and get both immediate assistance and help finding further aid, including referrals to counselors.
In fact, 58,000 people call the hotline each year, Hutcherson said. Most are "clients feeling so hopeless that they're suicidal." Counselors work to keep them safe and help them find ways to seek treatment.
The Cape schools also have counselors who are available to talk with students and other young people in need. The Cape police, when they are called upon, typically take distressed people to the hospital for evaluation.
Even non-professionals can help identify people at risk, and can encourage them to seek professional help.
Hutcherson said there are two common myths about discussing suicide. The first is that "if you talk about suicide, someone will become more suicidal." In fact, he said, the reverse is true. Talking to a person about suicide can reduce the risk of them attempting suicide. Just suggesting there are other options for solving problems, no matter how serious they seem, can be a big help.
The second myth is that mentioning suicide will give someone the idea. Instead, Hutcherson said, talking about suicide can open a line of communication that can help save a life. He said it's important to have someone who can listen without judging, and to urge a person to seek help.
While many people have sad or depressed feelings, it is the loss of hope that can lead a person to consider suicide, Hutcherson said.
A person begins to feel as if there are only two options: living with whatever pain and problems are in the present, and suicide. They lose sight of the possibilities of the future, and lose focus on the potential for change. Friends and counselors can help people see other options, and can help offer solutions to problems, he said.
How to get help
If you or a loved one needs help, call the Crisis Service Hotline at 774-HELP. Open 24 hours a day, seven days a week, 365 days a year, it is supported by both Ingraham and Sweetser, mental-health support agencies with long histories in Southern Maine. A statewide hotline is at 1-888-568-1112. Counselors can help deal with immediate crises and will develop long-term plans for handling mental-health issues.
For help with grieving, call the Center for Grieving Children at 775-5216 for information on grief support and counseling.
What to look for in young people
Not all adolescent attempters may admit their intent. Therefore, any deliberate self-harming behaviors should be considered serious and in need of further evaluation.
Many teenagers may display one or more of the problems or "signs" detailed below. The following list describes some potential factors of risk for suicide among youth. If observed, a professional evaluation is strongly recommended.:
-Presence of a psychiatric disorder (e.g., depression, drug or alcohol use, behavior disorders, conduct disorders [e.g., runs away or has been incarcerated]).
-The expression/communication of thoughts of suicide, death, dying or the afterlife (in a context of sadness, boredom or negative feelings).
-Impulsive and aggressive behavior; frequent expressions of rage.
-Previous exposure to other's suicidality.
-Recent severe stressor (e.g., difficulties in dealing with sexual orientation; unplanned pregnancy or other significant real or impending loss).
-Family loss or instability; significant family conflict.
---American Association for Suicidology
Friday, June 11, 2004
Summer feast: Maine's theaters fire up the footlights
Published in the Portland Phoenix
The time has come for me to shift focus and leave the world of reviewing theater for the Phoenix. But that doesn’t mean I’m going to stop attending or enjoying Maine’s myriad theatrical offerings.
The time has come for me to shift focus and leave the world of reviewing theater for the Phoenix. But that doesn’t mean I’m going to stop attending or enjoying Maine’s myriad theatrical offerings.
Here is the list I’ll use to plan my summer theater outings.
First, close to home are several great options.
• At Ogunquit Playhouse, make sure to see Les Miserables, performed entirely by students, running from June 17 through 19. And for five days only, June 21 through 26, catch Sally Struthers and Christa Jackson back this summer in Always...Patsy Cline. A three-week run of Cats will be a highlight in the midsummer, from July 27 through August 14. Ogunquit always gets good people to perform, with strong direction and a great sound system in an air-conditioned space. Tickets are $29 to $45; call (207) 646-5511.
• Among the offerings at Maine State Music Theatre in Brunswick is the story of a hidden village’s centennial reappearance, and the love that springs from its discovery. Brigadoon will run from July 21 through August 7. Maine’s only professional music theater, MSMT always does a great job finding singers and performers who enrapture audiences and enchant the stage, so a story like Brigadoon is a natural match. Tickets run from $26 to $44. Call (207) 725-8769.
• At the Children’s Theatre of Maine in Portland, kids from 2 to 92 will be enthralled by the magical world of Fairy Houses, adapted by CTM Artistic Director Pamela DiPasquale from the book by Tracy Kane. It follows a young girl on vacation in Maine who finds fairy shelters and wonders what happens inside them. Runs from July 7 through August 7. Call (207) 828-0617. Tickets cost $7 for children and seniors, $9 for adults.
• Arundel Barn, a great spot with great ability to draw strong performers, will end their summer season with tick, tick...BOOM!, a show by Rent author Jonathan Larson, offering insight into the mind of a composer feeling stuck (August 3 through 14); and Idols of the King (August 17 through September 4), exploring the fans and myths of Elvis Presley. Tickets are $19 to $24. Call (207) 985-5552.
Those crossing the border to New Hampshire can enjoy not only sales-tax-free shopping, but strong theater performances as well.
• At the Players’ Ring in Portsmouth, NH, every Tuesday night from June 15 through August 24 will bring something new, with Tuesday Night Improv, hosted by local theater troupe Stranger Than Fiction. Other strong showings at the historic building near Prescott Park will include I Know This Is Not Goodbye, a pair of new one-acts by Seacoast playwright Lars Trodson (July 9 through 11); Dead Lawyers, about a "totally dysfunctional" law firm and how the American legal system really works, based on interviews with citizens about their lawyers (July 23 through 25); the Harvey Fierstein play Tidy Endings, about the aftermath of a death from AIDS (August 6 through 8); and a pair of true Cold War spy stories by Alan Bennett (Single Spies: An Englishman Abroad from August 8 through 10, and Single Spies: A Question of Attribution from August 20 through 23). Call (603) 436-8123. Tickets are $10.
• Pontine Theater has finished a new community collaborative project called Portraits of the Past, based on the history of Portsmouth’s Rundlet-May House. The text is drawn from an 1852 article from Portsmouth’s Daily Morning Chronicle about James Rundlet, the merchant who built the house in 1807; a family history written by Ralph May, the last descendant of James Rundlet; and letters written by family members. The play will be performed twice, on June 20 and June 26. Admission is free. Seating is limited, however, so reservations are encouraged. Call (603) 436-6660.
And for planning your field trips and weekend getaways, look at these shows in fantastic destination spots around Maine:
• When you’re in Bar Harbor, stop off at Acadia Repertory Theater, where the amazing relationship between Alfred Steiglitz and Georgia O’Keeffe is explored in Lanie Robertson’s play Alfred Stieglitz Loves O’Keeffe from June 28 through July 11. The solid, if rustic, performances at Acadia Rep are very enjoyable, especially when you’re relaxed from a day on the beach or hiking the hills of Mount Desert Island. And from July 13 through 25 Acadia Rep will also put on the Marie Jones play Stones In His Pockets, the Maine premiere of a play about Hollywood invading a small Irish town. The comparison between that town and Waterville’s Empire Falls experience last summer could be fascinating. Call (207) 244-7260 for tickets, which cost $20 for general admission.
• At Lakewood Theater near Skowhegan are several shows Mainers have liked at other local venues, including the musical romantic comedy I Love You, You’re Perfect, Now Change (July 1 through 10); the noir comedy Red Herring (July 15 through 22); and the Pulitzer Prize-winning drama Proof (August 26 through September 4). Call (207) 474-7176 for tickets, from $18 to $26.
• Theater at Monmouth, always well worth the drive, will show off its Shakespearean strength in As You Like It (July 2 through August 21) and Antony and Cleopatra (July 30 through August 19), as well as comic range in The Liar (July 8 through August 21), Idiot’s Delight (July 23 through August 20), and The Complete History of America, humorously abridged to fit into two hours including intermission (August 10 and 17). Call (207) 933-9999 for tickets, which range from $20 to $26.
• A quick-hit festival not to be missed is the ≤15 Minute Festival in Belfast, honoring pieces that take less than 15 minutes to perform. The festival will have performances of winning pieces August 27 and 28 and staged readings of the runners-up August 20 and 21. Several workshops will be held in the intervening week. For more information, call (207) 338-1615.
Tuesday, June 1, 2004
Healthcare reform plan
Won an Honorable Mention in a healthcare reform contest run by CodeBlueNow
Executive summary
This proposal is based on the principles in the Health Care Magna Carta, at www.oconnorhealthanalyst.com/magnacarta.html and included in Appendix 1.
It is important that sweeping change in the U.S. healthcare system take place in a short period of time. This document lays out the changes and transition plans, as well as an ongoing plan for funding and support for a new style of healthcare system, which will result in high-quality affordable healthcare for all Americans.
The problems are legion and well-known: cost shifting from government onto the sick and the infirm; lack of choice for medical expense coverage, leaving either an all-or-nothing plan, or payment out-of-pocket for everything; money squandered providing insurance rather than care; and lack of individual choice of care, provider or payment method.
The opening moves in this renovation of healthcare can only be made by government, which is the sole group with the power to bind itself and others to a process of change.
Therefore, the Congress shall enact, and the president shall sign, a sweeping healthcare reform bill, based on the principles that the U.S. government is bound to protect the interests of all Americans; many Americans have no healthcare and many more have trouble affording it; and it is the duty of Congress to act to cause healthcare to be accessible and affordable to all Americans.
Contained within that legislation will be:
1. A continuation of Medical Savings Account laws, with some important clarifications.
2. Malpractice liability will be capped, limiting liability for all medical professionals and facilities.
3. Reform prescription drug coverage.
4. Reforming government administration of Medicare and Medicaid.
5. Providing incentives to businesses to participate in this new system,
6. Creating national, regional and statewide health planning boards to allocate healthcare resources effectively across the nation.
Proposal: A reformed U.S. healthcare system
This proposal is based on the principles in the Health Care Magna Carta, at www.oconnorhealthanalyst.com/magnacarta.html and included in Appendix 1.
It is important that sweeping change in the U.S. healthcare system take place in a short period of time. This document lays out the changes and transition plans, as well as an ongoing plan for funding and support for a new style of healthcare system, which will result in high-quality affordable healthcare for all Americans.
The problems are legion and well-known: cost shifting from government onto the sick and the infirm; lack of choice for medical expense coverage, leaving either an all-or-nothing plan, or payment out-of-pocket for everything; money squandered providing insurance rather than care; and lack of individual choice of care, provider or payment method.
The opening moves in this renovation of healthcare can only be made by government, which is the sole group with the power to bind itself and others to a process of change.
Therefore, the Congress shall enact, and the president shall sign, a sweeping healthcare reform bill, based on the principles that the U.S. government is bound to protect the interests of all Americans; many Americans have no healthcare and many more have trouble affording it; and it is the duty of Congress to act to cause healthcare to be accessible and affordable to all Americans.
Contained within that legislation will be:
1. A continuation of Medical Savings Account laws, with some important clarifications. Contributions of after-tax dollars to MSAs will become tax-deductible. Distributions from MSAs will become non-taxable. In keeping with a recent IRS ruling, funds remaining in MSAs at the end of a calendar or fiscal year will be able to be rolled into the following year without tax penalty.
Two incentive programs will be created to encourage people to use MSAs, and to permit them to use their money intelligently.
First, the federal government will pay $1,000 to each American citizen and legal permanent resident each year, into the person’s MSA. If a person does not have an MSA, the money is not paid. This money is intended to provide funds for preventive care and treatment for small routine illnesses that occur throughout the year.
Second, MSAs will be able to be held jointly by, and for the benefit of, immediate family members, such as married people or parents and their dependent children. When joint holders of an MSA no longer wish to hold their funds jointly, they may divide them in any mutually agreeable way, but the money must remain in someone’s MSA. That is, funds cannot be withdrawn from one MSA without being put into another one immediately, much like an IRA rollover.
Rationale: (HCMC 1, 2, 3, 5, 6, 8, 9, 10) People and employers will be able to contribute amounts they can afford on a regular basis into their MSAs, making money available for later use to pay for medical expenses. The present system requires people and employers to contribute amounts they cannot afford toward the profits of private companies, pulling that money out of the pool available for people to pay for actual medical care. In effect, they pre-pay large sums for the privilege of paying even larger sums when they actually need services. If they do not use medical care in any given year, that money has been spent for no useful purpose.
Revamping this system will permit more money to be used to pay for actual medical services, without putting additional pressure on working people to pre-pay for medical care they may not use. Further, it will allow them to save that money to pay for medical care they actually use in the future.
Funding: Find out how much people and businesses pay in insurance premiums vs. how much they pay for actual healthcare
Impact on healthcare services: Services will remain as accessible as before, but people’s access to them will improve dramatically. Rather than paying expensive premiums for future discounts on services, all of the money spent will go directly to providing healthcare. A family that pays, say $300 a month for insurance today will be able, instead, to visit the physician for preventive checkups from time to time, using that same $300.
Impact on healthcare costs: Costs will not go down or up, but people’s ability to afford the costs will increase. Money for insurance premiums, now taken away from the pool for spending on actual healthcare, will become available again for buying actual care.
2. Malpractice liability will be capped, limiting liability for all medical professionals and facilities. Malpractice liability must remain in existence to protect patients from accidental wrongdoing by medical professionals. However, to protect the public from malicious professionals, malpractice claims resulting from wilful wrongdoing or wilful negligence will have no liability cap.
In cases, however, where the intent of the medical professionals and facilities was to help, and there was no intent to harm, the liability cap will be:
• For a procedure of which the damage can be repaired, the amount of the cap shall calculated by:
-Figuring the amount of any money paid by a patient, government or private company for a procedure or other action that is deemed to be malpractice. Fees for services provided by parties not judged guilty of malpractice shall not be included in the cap.
-Adding the costs of the procedure to repair the damage.
-Adding the patient’s actual lost income and wages while repairs are made.
-Doubling the sum total, to include actual damages plus a penalty.
• For a procedure of which the damage cannot be repaired, the amount of the cap shall be calculated by:
-Figuring the amount of any money paid by a patient, government or private company for a procedure or other action that is deemed to be malpractice. Fees for services provided by parties not judged guilty of malpractice shall not be included in the cap.
-Adding the amount required to perform the procedure properly (e.g., amputate the correct leg).
-Adding the amount required to cover appropriate, medically necessary amelioration of the situation (if the wrong leg has been amputated, for example, add in the cost of prosthetics).
-Doubling the sum total.
-Adding the compensation that would be available under the standard Accidental Death or Dismemberment insurance policy offered by airline carriers at the time of the miscarried procedure.
Rationale: (HCMC 1, 3, 6, 7, 8) This will permit patients who have suffered at the hands of medical professionals to recoup losses and cause the responsible parties to feel some punitive damages. And it will permit medical professionals and facilities to keep a better handle on their insurance premiums, which are one of the factors driving up the cost of healthcare.
Funding: In 2000, doctors paid $6.4 billion in insurance premiums. All of this cost was shifted to patients, insurance companies and government agencies paying for healthcare. Reducing this amount would reduce upward pressure on doctors’ prices. (According to the National Association of Insurance Commissioners, Statistical Compilation of Annual Statement Information for Property/Casualty Insurance Companies in 2000, (2001).)
Impact on healthcare services: Services would be no more or less available than they are today. Some medical professionals might actually begin offering services they had not before because of high insurance costs.
Impact on healthcare costs: A major factor in the high cost of some procedures is the malpractice coverage required for professionals who conduct those procedures. This would reduce some of the cost pressure, resulting in lower costs and increased access to services by all Americans.
3. Reform prescription drug coverage. Prescription drugs may be paid for by money from MSAs. Pharmaceutical companies who refuse to sell their drugs at Medicare-negotiated rates to all purchasers will have their drugs subjected to prior review by Medicare. That requires state or federal approval before a doctor can prescribe a medication. Drugs and companies subjected to this will effectively cut themselves out of the Medicare market.
Drug companies will be prohibited from advertising their products to the general public, whether on television, on radio or in newspapers, magazines or on-line advertisements.
Drug companies will be allowed to have their company web sites describe the drugs they sell, but those pages and descriptions must be approved by the FDA as including full disclosure of results of all clinical studies.
Drug companies will be allowed to advertise their products to doctors, under FDA rules that require full disclosure of the results of all clinical studies and only making FDA-approved claims for treatment or prevention of diseases or conditions.
Drug companies will be prohibited from sponsoring conferences for medical professionals.
Drug companies will be permitted to send marketing personnel to meet with doctors, but may only drop off FDA-approved literature, and may not purchase meals, gifts or other small items (including office supplies) for medical professionals.
Rationale: (HCMC 1, 4, 7, 8) Companies that make revolutionary drugs that they want to make large profits on will remain allowed to do so, but not at the expense of taxpayers and private citizens who want important medical services.
Drug companies today spend more money on marketing than they do on research and development, and take less in corporate profit than they spend on marketing. If marketing budgets were reduced, drug companies would have more money to do research and development of products, and would still be more profitable than they are today.
This ensures doctors would have access to complete information about drugs they might prescribe.
Further, members of the general public would not be subjected to advertisements for things they have no power to actually procure for themselves. Members of the public would also be able to learn more about important drugs, but would have access to the full range of information given to doctors about the drug, rather than just a phone number to call. This limitation on advertising is an extension of the existing FDA rules on drug advertising, but ensures that marketing spending by drug companies is limited, allowing them to focus on their core function to their shareholders and society: making drugs and finding new ones.
Funding: FDA approval costs are covered in application fees for licensing and regulation. FDA fees may increase for drug companies, but no more money will be needed from taxpayers or healthcare consumers.
Impact on healthcare services: Some drug companies may change operations or cease some operations. This could disrupt prescription drug development in the short term, but will provide better access and information in the middle and long terms.
Impact on healthcare costs: There will be decreased upwards pressure on costs of prescription drugs. While they may not drop, drug companies will see public pressure brought to bear on their profiteering. They will still be allowed to charge money for their drugs, and to make a profit, but their role as providers of important public services and needs will be recognized and held to account for the public’s well-being.
4. Reforming government administration of Medicare and Medicaid. Government will pay the full amounts of “accepted reasonable costs” for services provided to Medicare and Medicaid patients.
Rationale: (HCMC 2, 3, 4, 8, 9) The government is now hiding, from the public and from itself, the true cost of treating the elderly and the poor with proper medical care. Those costs are being shifted onto private insurance carriers and people who pay out of their own pocket for medical care, in effect taxing the sick and the injured.
This would require the entire society to pay the true cost of treating the people who need help. It would prevent government from hiding the costs, and would create a built-in incentive system to improve access to preventative care for the poor and the elderly, to cut costs overall while improving the public health.
Funding: According to the Centers for Medicare and Medicaid Services (CMS), in 2002 Medicare paid $256 billion. Medicaid paid $258 billion, to match on a 2-to-1 basis $129 billion from state funds for Medicaid. This represents 80 percent of the total cost of care to Medicare and Medicaid beneficiaries, leaving $161 billion in unpaid Medicare and Medicaid benefits to be covered by people with private insurance. Reducing this burden will lessen upward pressure on medical prices for private payers.
Impact on healthcare services: Services would be no more or less available than they are today.
Impact on healthcare costs: This will appear to make Medicare and Medicaid costs go up. That appearance is false, however, and will merely reflect a readjustment of the cost structure now in place for medical care. Medicare and Medicaid will be charged the full cost of caring for beneficiaries, while private-payers and third-party insurance companies will see cost savings because they will pay only the full cost of caring for their beneficiaries, without also paying for services rendered to other patients.
5. Providing incentives to businesses to participate in this new system, by encouraging them to contribute to MSAs and assist with sponsoring major medical insurance coverage for catastrophic medical needs. Specifically, creating tax exemptions as follows:
-Business contributions to employee/family health insurance plans are only considered tax-deductible business expenditures if the insurance plans have a deductible over more than $4,999 for a single person or $9,999 for more than one person.
-Business contributions of any amount to employee MSAs are tax-deductible business expenses. Contributions may not be made based on discrimination of any kind, but need not be equal in amount for each employee. (That is, employees with families may be eligible for additional MSA funding. Also, employees are free to make arrangements for part of their salaries to be allocated directly to MSAs.)
Further, the law will put a 5 percent payroll tax on all businesses employing two or more people, to cover federal and state healthcare expenditures (This will be less than those businesses would pay in medical premiums under the present system.)
Rationale: (HCMC 2, 4, 5, 6, 9) Businesses are key to this, because of their historic role in providing or helping to provide medical insurance. They also are used to spending money to benefit employees, and are used to getting tax credits for it. Major medical insurance is much closer to a single-pool insurance system, despite the fact that different providers offer it. There is much less demographic variation in who could be hit by a bus or fall off a cliff than with other conditions or illnesses.
Funding: Based on the U.S. Department of Commerce’s Bureau of Economic Analysis, total payroll in 2002 was $8.276 trillion. A 5 percent payroll tax would raise $414 billion, more than twice as much as necessary to cover the Medicare/Medicaid shortfall detailed in section 4, leaving plenty left over to fund the remainder of the programs prescribed in this document, especially if future cost savings are incorporated into the healthcare cost system to further offset cost increases.
Impact on healthcare services: Services would be no more or less available than they are today.
Impact on healthcare costs: Healthcare costs would not necessarily change, but people’s ability to afford healthcare certainly would. Today many employers cite cost as the major reason they do not provide any health insurance, or only limited health insurance, to employees. They are locked into an impossible choice: provide a plan that neither company nor worker can afford, or provide nothing at all. With this system, employers would be free to allocate as much as they want to afford towards employee healthcare. Further, the money spent would go to providing actual healthcare, rather than paying in advance for discounts if and when healthcare is provided.
6. Creating national, regional and statewide health planning boards to allocate healthcare resources effectively across the nation. At present, for-profit companies determine where they will build new hospitals or other healthcare facilities. Profit is the motive for locating these important centers of public health and well-being.
Instead, the motive should be intelligent design of services, so that all people will have reasonable access to all levels of care, with quality practitioners providing top-level care in well-maintained facilities not subject to cost-cutting by corporations seeking shareholder revenue.
The boards would plan where new healthcare facilities will be constructed or moved, and what services will be provided at those facilities. They would take into account existing facilities, patient demand and utilization, cost-sharing opportunities of regionalization, and medical importance of immediate access.
Government representatives, medical professionals and community members will collaborate to determine where services shall be provided, such that everyone has access to quality medical care, with more basic and often-used services provided at more locations and specialized high-level services centralized regionally, all spread intelligently across an area of human and physical geography.
Each type of medical service requires a certain level of usage to keep medical professionals skilled and up-to-date. Specialized services, such as open-heart surgery, shall be provided at regional centers, rather than out at primary care centers.
These boards will also become venues for healthcare advocacy, urging people to take better care of themselves and each other.
Rationale: (HCMC 1, 3, 7, 8, 9, 10) Profit is the wrong driving factor for choosing locations of healthcare facilities. Instead, the goal should be to provide services equably to everyone.
Funding: This will pay for itself. Rather than just going out and constructing a hospital or other care facility in one place, a company will have to justify the location and services to regional planners. Competing companies will not be able to build two similar hospitals on the same city street and leave rural areas in the same region without services.
Impact on healthcare services: Specialized services will be somewhat less immediately accessible in some areas, but more accessible in many other areas. Further, the quality of care will be higher, because medical professionals at the centralized specialty facility will have better and more consistent practice to keep their skills fresh.
Impact on healthcare costs: Costs will see downward pressure, because services will be provided more effectively and more efficiently across a region. All people will have relatively easy access to all ranges of healthcare, and all medical professionals will have a workload that neither overwhelms them nor leaves them idle to forget specialized skills.
Appendix 1
Health Care Magna Carta
www.oconnorhealthanalyst.com/magnacarta.html
Copyright July 2002
Kathleen O’Connor
1. We believe we must all participate in health care decisions and that health care is too important to be left to someone else. Just as war is too important to be left to the generals, our health care is too important to be left to the industry and employers.
2. We believe everyone who participates in the health care system should pay for it—individuals, businesses and government. If we all benefit, we all must participate and support it. No one gets services without paying for them, at least in part.
3. We believe all people should have access to a common set of health care services that promote the health and well-being of our nation, including access to preventive services, full maternity and well-child care, childhood immunizations, and full dental and mental health services for children, as well as comprehensive health services for seniors. We believe that this includes culturally sensitive health care services that recognizes the diversity of our nation and that includes complementary and alternative therapies, as well.
4. We believe no person should face bankruptcy because of catastrophic health care costs and needs.
5. We believe in the freedom of employers to offer more than a common set of health care services; but in return, large employers should not oppose the needs of small businesses to offer at least a common set of benefits, so people don’t live in fear of insufficient insurance.
6. We believe we should all be in the same risk pool rather than separate our society into smaller and smaller segments.
7. We believe we all need clear and succinct information about health care services and benefits, and that information about services and benefits should be written for the average reader, not just for lawyers, physicians and government employees.
8. We believe we need central standards and management of health care financing and services, just as we have central standards and management for the banking industry. We need an independent national board, but we also need local flexibility to meet the specific health care needs of our communities. We also need to define care standards for ourselves, our providers and our communities.
9. We believe funds for health care services should not be dictated by the specific health care categories as we now have, so we can be more flexible in meeting the wide range of needs of clients vs. the compartmentalized requirements of each separate system as we now have.
10. We believe we must all assume personal responsibility for our health and help our friends and family members do the same. We encourage individuals, employers and community groups to put their efforts into health promotion and disease prevention and reduction.
Executive summary
This proposal is based on the principles in the Health Care Magna Carta, at www.oconnorhealthanalyst.com/magnacarta.html and included in Appendix 1.
It is important that sweeping change in the U.S. healthcare system take place in a short period of time. This document lays out the changes and transition plans, as well as an ongoing plan for funding and support for a new style of healthcare system, which will result in high-quality affordable healthcare for all Americans.
The problems are legion and well-known: cost shifting from government onto the sick and the infirm; lack of choice for medical expense coverage, leaving either an all-or-nothing plan, or payment out-of-pocket for everything; money squandered providing insurance rather than care; and lack of individual choice of care, provider or payment method.
The opening moves in this renovation of healthcare can only be made by government, which is the sole group with the power to bind itself and others to a process of change.
Therefore, the Congress shall enact, and the president shall sign, a sweeping healthcare reform bill, based on the principles that the U.S. government is bound to protect the interests of all Americans; many Americans have no healthcare and many more have trouble affording it; and it is the duty of Congress to act to cause healthcare to be accessible and affordable to all Americans.
Contained within that legislation will be:
1. A continuation of Medical Savings Account laws, with some important clarifications.
2. Malpractice liability will be capped, limiting liability for all medical professionals and facilities.
3. Reform prescription drug coverage.
4. Reforming government administration of Medicare and Medicaid.
5. Providing incentives to businesses to participate in this new system,
6. Creating national, regional and statewide health planning boards to allocate healthcare resources effectively across the nation.
Proposal: A reformed U.S. healthcare system
This proposal is based on the principles in the Health Care Magna Carta, at www.oconnorhealthanalyst.com/magnacarta.html and included in Appendix 1.
It is important that sweeping change in the U.S. healthcare system take place in a short period of time. This document lays out the changes and transition plans, as well as an ongoing plan for funding and support for a new style of healthcare system, which will result in high-quality affordable healthcare for all Americans.
The problems are legion and well-known: cost shifting from government onto the sick and the infirm; lack of choice for medical expense coverage, leaving either an all-or-nothing plan, or payment out-of-pocket for everything; money squandered providing insurance rather than care; and lack of individual choice of care, provider or payment method.
The opening moves in this renovation of healthcare can only be made by government, which is the sole group with the power to bind itself and others to a process of change.
Therefore, the Congress shall enact, and the president shall sign, a sweeping healthcare reform bill, based on the principles that the U.S. government is bound to protect the interests of all Americans; many Americans have no healthcare and many more have trouble affording it; and it is the duty of Congress to act to cause healthcare to be accessible and affordable to all Americans.
Contained within that legislation will be:
1. A continuation of Medical Savings Account laws, with some important clarifications. Contributions of after-tax dollars to MSAs will become tax-deductible. Distributions from MSAs will become non-taxable. In keeping with a recent IRS ruling, funds remaining in MSAs at the end of a calendar or fiscal year will be able to be rolled into the following year without tax penalty.
Two incentive programs will be created to encourage people to use MSAs, and to permit them to use their money intelligently.
First, the federal government will pay $1,000 to each American citizen and legal permanent resident each year, into the person’s MSA. If a person does not have an MSA, the money is not paid. This money is intended to provide funds for preventive care and treatment for small routine illnesses that occur throughout the year.
Second, MSAs will be able to be held jointly by, and for the benefit of, immediate family members, such as married people or parents and their dependent children. When joint holders of an MSA no longer wish to hold their funds jointly, they may divide them in any mutually agreeable way, but the money must remain in someone’s MSA. That is, funds cannot be withdrawn from one MSA without being put into another one immediately, much like an IRA rollover.
Rationale: (HCMC 1, 2, 3, 5, 6, 8, 9, 10) People and employers will be able to contribute amounts they can afford on a regular basis into their MSAs, making money available for later use to pay for medical expenses. The present system requires people and employers to contribute amounts they cannot afford toward the profits of private companies, pulling that money out of the pool available for people to pay for actual medical care. In effect, they pre-pay large sums for the privilege of paying even larger sums when they actually need services. If they do not use medical care in any given year, that money has been spent for no useful purpose.
Revamping this system will permit more money to be used to pay for actual medical services, without putting additional pressure on working people to pre-pay for medical care they may not use. Further, it will allow them to save that money to pay for medical care they actually use in the future.
Funding: Find out how much people and businesses pay in insurance premiums vs. how much they pay for actual healthcare
Impact on healthcare services: Services will remain as accessible as before, but people’s access to them will improve dramatically. Rather than paying expensive premiums for future discounts on services, all of the money spent will go directly to providing healthcare. A family that pays, say $300 a month for insurance today will be able, instead, to visit the physician for preventive checkups from time to time, using that same $300.
Impact on healthcare costs: Costs will not go down or up, but people’s ability to afford the costs will increase. Money for insurance premiums, now taken away from the pool for spending on actual healthcare, will become available again for buying actual care.
2. Malpractice liability will be capped, limiting liability for all medical professionals and facilities. Malpractice liability must remain in existence to protect patients from accidental wrongdoing by medical professionals. However, to protect the public from malicious professionals, malpractice claims resulting from wilful wrongdoing or wilful negligence will have no liability cap.
In cases, however, where the intent of the medical professionals and facilities was to help, and there was no intent to harm, the liability cap will be:
• For a procedure of which the damage can be repaired, the amount of the cap shall calculated by:
-Figuring the amount of any money paid by a patient, government or private company for a procedure or other action that is deemed to be malpractice. Fees for services provided by parties not judged guilty of malpractice shall not be included in the cap.
-Adding the costs of the procedure to repair the damage.
-Adding the patient’s actual lost income and wages while repairs are made.
-Doubling the sum total, to include actual damages plus a penalty.
• For a procedure of which the damage cannot be repaired, the amount of the cap shall be calculated by:
-Figuring the amount of any money paid by a patient, government or private company for a procedure or other action that is deemed to be malpractice. Fees for services provided by parties not judged guilty of malpractice shall not be included in the cap.
-Adding the amount required to perform the procedure properly (e.g., amputate the correct leg).
-Adding the amount required to cover appropriate, medically necessary amelioration of the situation (if the wrong leg has been amputated, for example, add in the cost of prosthetics).
-Doubling the sum total.
-Adding the compensation that would be available under the standard Accidental Death or Dismemberment insurance policy offered by airline carriers at the time of the miscarried procedure.
Rationale: (HCMC 1, 3, 6, 7, 8) This will permit patients who have suffered at the hands of medical professionals to recoup losses and cause the responsible parties to feel some punitive damages. And it will permit medical professionals and facilities to keep a better handle on their insurance premiums, which are one of the factors driving up the cost of healthcare.
Funding: In 2000, doctors paid $6.4 billion in insurance premiums. All of this cost was shifted to patients, insurance companies and government agencies paying for healthcare. Reducing this amount would reduce upward pressure on doctors’ prices. (According to the National Association of Insurance Commissioners, Statistical Compilation of Annual Statement Information for Property/Casualty Insurance Companies in 2000, (2001).)
Impact on healthcare services: Services would be no more or less available than they are today. Some medical professionals might actually begin offering services they had not before because of high insurance costs.
Impact on healthcare costs: A major factor in the high cost of some procedures is the malpractice coverage required for professionals who conduct those procedures. This would reduce some of the cost pressure, resulting in lower costs and increased access to services by all Americans.
3. Reform prescription drug coverage. Prescription drugs may be paid for by money from MSAs. Pharmaceutical companies who refuse to sell their drugs at Medicare-negotiated rates to all purchasers will have their drugs subjected to prior review by Medicare. That requires state or federal approval before a doctor can prescribe a medication. Drugs and companies subjected to this will effectively cut themselves out of the Medicare market.
Drug companies will be prohibited from advertising their products to the general public, whether on television, on radio or in newspapers, magazines or on-line advertisements.
Drug companies will be allowed to have their company web sites describe the drugs they sell, but those pages and descriptions must be approved by the FDA as including full disclosure of results of all clinical studies.
Drug companies will be allowed to advertise their products to doctors, under FDA rules that require full disclosure of the results of all clinical studies and only making FDA-approved claims for treatment or prevention of diseases or conditions.
Drug companies will be prohibited from sponsoring conferences for medical professionals.
Drug companies will be permitted to send marketing personnel to meet with doctors, but may only drop off FDA-approved literature, and may not purchase meals, gifts or other small items (including office supplies) for medical professionals.
Rationale: (HCMC 1, 4, 7, 8) Companies that make revolutionary drugs that they want to make large profits on will remain allowed to do so, but not at the expense of taxpayers and private citizens who want important medical services.
Drug companies today spend more money on marketing than they do on research and development, and take less in corporate profit than they spend on marketing. If marketing budgets were reduced, drug companies would have more money to do research and development of products, and would still be more profitable than they are today.
This ensures doctors would have access to complete information about drugs they might prescribe.
Further, members of the general public would not be subjected to advertisements for things they have no power to actually procure for themselves. Members of the public would also be able to learn more about important drugs, but would have access to the full range of information given to doctors about the drug, rather than just a phone number to call. This limitation on advertising is an extension of the existing FDA rules on drug advertising, but ensures that marketing spending by drug companies is limited, allowing them to focus on their core function to their shareholders and society: making drugs and finding new ones.
Funding: FDA approval costs are covered in application fees for licensing and regulation. FDA fees may increase for drug companies, but no more money will be needed from taxpayers or healthcare consumers.
Impact on healthcare services: Some drug companies may change operations or cease some operations. This could disrupt prescription drug development in the short term, but will provide better access and information in the middle and long terms.
Impact on healthcare costs: There will be decreased upwards pressure on costs of prescription drugs. While they may not drop, drug companies will see public pressure brought to bear on their profiteering. They will still be allowed to charge money for their drugs, and to make a profit, but their role as providers of important public services and needs will be recognized and held to account for the public’s well-being.
4. Reforming government administration of Medicare and Medicaid. Government will pay the full amounts of “accepted reasonable costs” for services provided to Medicare and Medicaid patients.
Rationale: (HCMC 2, 3, 4, 8, 9) The government is now hiding, from the public and from itself, the true cost of treating the elderly and the poor with proper medical care. Those costs are being shifted onto private insurance carriers and people who pay out of their own pocket for medical care, in effect taxing the sick and the injured.
This would require the entire society to pay the true cost of treating the people who need help. It would prevent government from hiding the costs, and would create a built-in incentive system to improve access to preventative care for the poor and the elderly, to cut costs overall while improving the public health.
Funding: According to the Centers for Medicare and Medicaid Services (CMS), in 2002 Medicare paid $256 billion. Medicaid paid $258 billion, to match on a 2-to-1 basis $129 billion from state funds for Medicaid. This represents 80 percent of the total cost of care to Medicare and Medicaid beneficiaries, leaving $161 billion in unpaid Medicare and Medicaid benefits to be covered by people with private insurance. Reducing this burden will lessen upward pressure on medical prices for private payers.
Impact on healthcare services: Services would be no more or less available than they are today.
Impact on healthcare costs: This will appear to make Medicare and Medicaid costs go up. That appearance is false, however, and will merely reflect a readjustment of the cost structure now in place for medical care. Medicare and Medicaid will be charged the full cost of caring for beneficiaries, while private-payers and third-party insurance companies will see cost savings because they will pay only the full cost of caring for their beneficiaries, without also paying for services rendered to other patients.
5. Providing incentives to businesses to participate in this new system, by encouraging them to contribute to MSAs and assist with sponsoring major medical insurance coverage for catastrophic medical needs. Specifically, creating tax exemptions as follows:
-Business contributions to employee/family health insurance plans are only considered tax-deductible business expenditures if the insurance plans have a deductible over more than $4,999 for a single person or $9,999 for more than one person.
-Business contributions of any amount to employee MSAs are tax-deductible business expenses. Contributions may not be made based on discrimination of any kind, but need not be equal in amount for each employee. (That is, employees with families may be eligible for additional MSA funding. Also, employees are free to make arrangements for part of their salaries to be allocated directly to MSAs.)
Further, the law will put a 5 percent payroll tax on all businesses employing two or more people, to cover federal and state healthcare expenditures (This will be less than those businesses would pay in medical premiums under the present system.)
Rationale: (HCMC 2, 4, 5, 6, 9) Businesses are key to this, because of their historic role in providing or helping to provide medical insurance. They also are used to spending money to benefit employees, and are used to getting tax credits for it. Major medical insurance is much closer to a single-pool insurance system, despite the fact that different providers offer it. There is much less demographic variation in who could be hit by a bus or fall off a cliff than with other conditions or illnesses.
Funding: Based on the U.S. Department of Commerce’s Bureau of Economic Analysis, total payroll in 2002 was $8.276 trillion. A 5 percent payroll tax would raise $414 billion, more than twice as much as necessary to cover the Medicare/Medicaid shortfall detailed in section 4, leaving plenty left over to fund the remainder of the programs prescribed in this document, especially if future cost savings are incorporated into the healthcare cost system to further offset cost increases.
Impact on healthcare services: Services would be no more or less available than they are today.
Impact on healthcare costs: Healthcare costs would not necessarily change, but people’s ability to afford healthcare certainly would. Today many employers cite cost as the major reason they do not provide any health insurance, or only limited health insurance, to employees. They are locked into an impossible choice: provide a plan that neither company nor worker can afford, or provide nothing at all. With this system, employers would be free to allocate as much as they want to afford towards employee healthcare. Further, the money spent would go to providing actual healthcare, rather than paying in advance for discounts if and when healthcare is provided.
6. Creating national, regional and statewide health planning boards to allocate healthcare resources effectively across the nation. At present, for-profit companies determine where they will build new hospitals or other healthcare facilities. Profit is the motive for locating these important centers of public health and well-being.
Instead, the motive should be intelligent design of services, so that all people will have reasonable access to all levels of care, with quality practitioners providing top-level care in well-maintained facilities not subject to cost-cutting by corporations seeking shareholder revenue.
The boards would plan where new healthcare facilities will be constructed or moved, and what services will be provided at those facilities. They would take into account existing facilities, patient demand and utilization, cost-sharing opportunities of regionalization, and medical importance of immediate access.
Government representatives, medical professionals and community members will collaborate to determine where services shall be provided, such that everyone has access to quality medical care, with more basic and often-used services provided at more locations and specialized high-level services centralized regionally, all spread intelligently across an area of human and physical geography.
Each type of medical service requires a certain level of usage to keep medical professionals skilled and up-to-date. Specialized services, such as open-heart surgery, shall be provided at regional centers, rather than out at primary care centers.
These boards will also become venues for healthcare advocacy, urging people to take better care of themselves and each other.
Rationale: (HCMC 1, 3, 7, 8, 9, 10) Profit is the wrong driving factor for choosing locations of healthcare facilities. Instead, the goal should be to provide services equably to everyone.
Funding: This will pay for itself. Rather than just going out and constructing a hospital or other care facility in one place, a company will have to justify the location and services to regional planners. Competing companies will not be able to build two similar hospitals on the same city street and leave rural areas in the same region without services.
Impact on healthcare services: Specialized services will be somewhat less immediately accessible in some areas, but more accessible in many other areas. Further, the quality of care will be higher, because medical professionals at the centralized specialty facility will have better and more consistent practice to keep their skills fresh.
Impact on healthcare costs: Costs will see downward pressure, because services will be provided more effectively and more efficiently across a region. All people will have relatively easy access to all ranges of healthcare, and all medical professionals will have a workload that neither overwhelms them nor leaves them idle to forget specialized skills.
Appendix 1
Health Care Magna Carta
www.oconnorhealthanalyst.com/magnacarta.html
Copyright July 2002
Kathleen O’Connor
1. We believe we must all participate in health care decisions and that health care is too important to be left to someone else. Just as war is too important to be left to the generals, our health care is too important to be left to the industry and employers.
2. We believe everyone who participates in the health care system should pay for it—individuals, businesses and government. If we all benefit, we all must participate and support it. No one gets services without paying for them, at least in part.
3. We believe all people should have access to a common set of health care services that promote the health and well-being of our nation, including access to preventive services, full maternity and well-child care, childhood immunizations, and full dental and mental health services for children, as well as comprehensive health services for seniors. We believe that this includes culturally sensitive health care services that recognizes the diversity of our nation and that includes complementary and alternative therapies, as well.
4. We believe no person should face bankruptcy because of catastrophic health care costs and needs.
5. We believe in the freedom of employers to offer more than a common set of health care services; but in return, large employers should not oppose the needs of small businesses to offer at least a common set of benefits, so people don’t live in fear of insufficient insurance.
6. We believe we should all be in the same risk pool rather than separate our society into smaller and smaller segments.
7. We believe we all need clear and succinct information about health care services and benefits, and that information about services and benefits should be written for the average reader, not just for lawyers, physicians and government employees.
8. We believe we need central standards and management of health care financing and services, just as we have central standards and management for the banking industry. We need an independent national board, but we also need local flexibility to meet the specific health care needs of our communities. We also need to define care standards for ourselves, our providers and our communities.
9. We believe funds for health care services should not be dictated by the specific health care categories as we now have, so we can be more flexible in meeting the wide range of needs of clients vs. the compartmentalized requirements of each separate system as we now have.
10. We believe we must all assume personal responsibility for our health and help our friends and family members do the same. We encourage individuals, employers and community groups to put their efforts into health promotion and disease prevention and reduction.
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