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October 10, 2000, Tuesday, Home Edition

SECTION: Part A; Part 1; Page 3; Metro Desk

LENGTH: 1764 words

HEADLINE: CALIFORNIA AND THE WEST;
CALIFORNIA ELECTIONS / U.S. SENATE;
2 APPROACHES TO REMEDYING HEALTH CARE;
FEINSTEIN AND CAMPBELL AGREE THAT IMPROVEMENTS ARE NEEDED, BUT SHE SUGGESTS RELYING ON BUDGET SURPLUSES AND HE PUTS THE EMPHASIS ON COST CONTAINMENT.

BYLINE: JOHN JOHNSON, TIMES STAFF WRITER

BODY:
Opinion polls consistently reveal voter anxiety over the future of health care. Insurance is too expensive, HMOs are callous bean-counters and doctor waiting rooms are packed tighter than a jar of cotton swabs. Sure, the economy's good. Just don't get sick.

Against this backdrop, Sen. Dianne Feinstein and her opponent, Republican Rep. Tom Campbell, have put forth sweeping remedies for the sickly health care system. They say their plans will guarantee coverage to poor children, add drug-cost benefits for the elderly, and make things better for everyone in between.

Both plans are greater parts sugar pill than bitter medicine. But there are differences. While Feinstein relies on budget surpluses to support Medicare and other health care programs, Campbell appears to focus on cost containment. "I do strongly support helping people in need," said Campbell, a moderate Republican from San Jose who remains far behind the Democratic incumbent in most polls. But he says something needs to be done to halt the hemorrhaging of Medicare dollars. He also advocates a "loser pays" system to deter frivolous lawsuits.

Campbell also strenuously opposes making the federal government "the only provider" of health care. Translation: No Hillary Rodham Clinton-style national health care.

A priority for Feinstein, the daughter and former wife of doctors, is a broad patients' bill of rights that will allow people to get the care they need without clearing every procedure with a bureaucrat in an office hundreds of miles away.

"It's extraordinarily difficult to sort it all out," she said of the medical quagmire in a recent stump speech in Oxnard. "All our health care facilities are in financial crisis: hospitals, nursing homes, home health agencies."

Seven million Californians are uninsured, including 2 million children. In the past four years, more than 40 hospitals have closed, and 64% are losing money, Feinstein said. Three hundred physician groups have gone bankrupt since 1996.

The same trends are evident in long-term care. About 12% of the 1,376 nursing homes in the state filed for bankruptcy in the last two years. Add to this the nursing shortage that has led to the recruitment of large numbers of foreign nurses.

"When my dad was chief of surgery at UC San Francisco medical center he had one secretary," Feinstein said. "He charged those who could afford to pay and not those who couldn't. I go to the doctor today and it's a frantic situation. Today, business is in medicine. It's a tragic element that my father and husband would roll over in their graves if they saw it."

On Labor Day, Feinstein broke her leg in a fall at her vacation home in Aspen, Colo. She was covered by her husband's private plan and was operated on by the doctor for the U.S. Olympic ski team.

The 67-year-old senator described her care as "top notch," but recognizes that most Californians, who have been herded into health maintenance organizations, are not so fortunate.

Feinstein blames a series of cost-control measures for many of the problems. California was the first state to go into managed care, and as a result premiums are lower here than in other states.

Second, the Balanced Budget Act of 1997 reduced payments to hospitals and home health care providers by $ 200 billion, much more than expected. Third, California has one of the lowest Medicare reimbursement rates in the nation.

All these things contributed to the failure of hospitals. Physician income has dropped by an average of $ 20,000 a year, Feinstein said, and that's why doctors are leaving the state, dropping California from eighth to 12th in the proportion of doctors to population.

To solve these problems, Feinstein advocates "add-back" amendments to the Balanced Budget Act to restore billions of dollars in payments to health care providers. She said Gov. Gray Davis' recent proposal to increase Medi-Cal payments by 10% is not enough. A 25% boost is needed to prevent more hospital closures.

To protect Medicare, she said, money should be set aside from the federal budget surplus after bailing out Social Security. Feinstein would also add prescription drug coverage to Medicare.

She does advocate Medicare reform. "I don't think millionaires should have full Medicare benefits ," she said. "Above a certain level, people should pay the full cost of $ 5,500 rather than $ 460."

More must also be done to make sure that poor children are cared for properly, she said. Only about 50% of those eligible are enrolled in the Healthy Families program, which insures children for a maximum rate of $ 27 a month.

"We are still having children die from not being vaccinated for whooping cough. That's not acceptable," Feinstein said.

She would like to add coverage for parents, which would save money by curbing expensive visits to the emergency room by uninsured adults.

Finally, Feinstein supports the Norwood-Dingell Patients' Bill of Rights as a sword to hold over HMOs to force them to be more responsive to the ill.

"I received letters from women who said they had a radical mastectomy at 7:30 in the morning; at 4:30 they were pushed out onto the streets, heavily impacted by anesthesia, not knowing how they were going to care for themselves," she said in the Oxnard speech to health care professionals.

She acknowledged that she and Campbell differ over a provision giving patients the right to sue their HMOs. "My view is, it's the only thing that will force change," she said.

The Norwood-Dingell bill passed the House last year, but failed in the Senate.

Campbell said lawsuits, particularly runaway punitive damage awards, already impose unacceptable costs on health care. Twenty percent of the amount doctors pay for malpractice insurance is a direct result of frivolous lawsuits, he said.

Though Feinstein said she supports tort reform, Campbell said her voting record shows she has sided more consistently "with trial lawyers than ratepayers."

He advocates adoption of a "modified English rule," under which a losing plaintiff would pay the legal costs of the defense, up to the amount of his own lawyer's expenses.

In Campbell's view, the crisis in health care was not provoked by bad patients, bad doctors or bad insurance companies. It is simply the way the system is set up, with third party insurance companies paying the bills. "The patient will ask for every service," he said. "The doctor will pass it along."

That's one reason why Medicare costs have risen faster in recent years than any other single federal program, he said. Without intervention, the system will be bankrupt in 15 years, according to Campbell.

He would attempt to limit the growth of Medicare by allowing the system to expand only to keep pace with inflation and population growth. That would allow a 43% increase in costs over the next seven years, compared to a projected 94% increase.

That would double the amount of time before the program's bankruptcy.

Other money-saving strategies include encouraging competition among care providers. He also wants to cap federal payments to the states. He thinks care can be improved by allowing doctors to organize so they can demand more independence from HMOs.

Despite urging cost containment, he said the federal government has a role to play in making sure that those who can't afford insurance receive good and cheap medical care.

"Government ought to contract with insurers to carry the business for those who cannot afford it," he said.

Campbell agrees with Feinstein that pharmaceutical coverage should be added to Medicare benefits for the poor. Both candidates said there should be some guarantees that the rich will pay their share.

The added drug benefits would cost at least $ 16 billion a year, and the money would come from the budget surplus, Campbell said.

"There's no question that some of the surplus will be devoted to health care, and I agree," he said.

The Issues

Here are some major differences between Democratic U.S. Sen. Dianne Feinstein and her November challenger, Republican Rep. Tom Campbell on the subject of health care.

The Uninsured

Feinstein says only about 50% of those eligible are enrolled in the Healthy Families program, which provides health care to poor children for a maximum rate of $ 27 a month. She says more should be done to enroll children, as well as their parents.

Campbell would have the federal government negotiate with managed care providers to cover the underinsured.

Medicare

Campbell would limit the growth of Medicare by allowing the system to expand only to keep up with inflation and population increases. That would allow a 43% increase over the next seven years, compared to the currently projected 94% increase, doubling the period of time before bankruptcy.

Feinstein says money left in the budget surplus after bailing out Social Security should be set aside for Medicare.

Quality of Care

Feinstein supports a patients bill of rights, in particular the Norwood-Dingell bill in the House, to allow emergency room visits without prior authorization from an HMO, provide for greater access to specialists, and guarantee access to obstetric and gynecological care without authorization.

Campbell would allow doctors to organize to bargain with HMOs to gain the ability to practice their profession as they see fit. He criticizes Norwood-Dingell as too expensive, and opposes any move toward national health care.

Prescription Coverage

Campbell would add pharmaceutical coverage to Medicare coverage for the poor, the cost of which would be at least $ 16 billion a year. He says premiums should be income-related.

Feinstein would also add drug coverage to Medicare. The added costs would be funded by the surplus.

Holding Down Costs

Feinstein's plan suggests that many extra costs could be covered by state and federal surpluses, and that money could be saved by expanding low-cost insurance to reduce the number of emergency room visits by the uninsured. She also advocates capping punitive damage awards in lawsuits against hospitals and doctors.

Besides advocating increased competition among care providers and capping payments to the states by the federal government, Campbell favors tort reform. Under a "modified English rule," a losing plaintiff would pay the legal costs of the defense, up to the amount of his own lawyer's costs. This is meant to deter frivolous lawsuits, which he says add 20% to malpractice insurance costs for doctors, who then pass them on to patients.

LOAD-DATE: October 10, 2000