MEDICARE SPENDING: Pork Barrel Deals in the Budget?

Although the budget deal President Clinton signed last week does not include sweeping changes such as a broad overhaul of Medicare or a prescription drug benefit, the New York Times reports that the bill "tinkered with the details of the program," which determine how billions of dollars are spent each year. Health care lobbyists' success in arguing that with more federal money they can better serve their Medicare patients illustrates "several hard truths about the politics of health care in Washington" -- lobbyists "can block big schemes to which they object, and rarely agree on any big schemes of their own." By pursuing narrowly defined objectives, they can score some victories and the senators and representatives that push them can win, too:

The new law includes a provision instructing the HHS secretary to make "an additional payment" to cover the cost of drugs provided by injection or infusion in the outpatient department of a hospital or in a doctor's office. That particular provision was pushed by the Pharmaceutical Research and Manufacturers of America, the Biotechnology Industry Organization and the Health Industry Manufacturers Association -- all of which are organizations that represent drug companies, biotechnology companies or medical device and diagnostic manufacturers. Rep. Rob Portman (R-OH) added a provision that guaranteed extra payments for any "device of brachytherapy," a treatment for prostate cancer that Indigo Medical, located in his district, manufactures parts for.
Extra payments are also required for radiopharmaceutical drugs which are detected by a special camera and then can visualize organs to diagnose or treat illnesses. The most popular drug of this type, Cardiolite, is used to detect heart problems. Sen. William Roth (R-DE) pushed for this addition, as DuPont, which sells Cardiolite, is located in Wilmington, DE.
HHS Secretary Donna Shalala previously could reduce Medicare payments she found "inherently unreasonable" or "grossly excessive," but the new law states that the secretary may not use that authority again until congressional investigators reviewed her actions or she provides new criteria to identify excessive payments. At the same time, Congress gave money to a "few favored hospitals" by reclassifying the counties in which they are situated, as hospitals in larger urban areas receive higher Medicare payments. The law now considers Lee County, IL, represented by House Speaker Dennis Hastert (R), to be part of the Chicago metropolitan area. The move nets $750,000 a year in extra Medicare money for the Katherine Shaw Bethea Hospital in Dixon, IL. Similarly, Brazoria County, TX, represented by House Whip Tom Delay (R), is now part of the Houston area and the Angleton Danbury Medical Center will see an additional $380,000 a year because of it.

Critics have said that the new law is not "a good way to legislate," but the beneficiaries of the new law insist that it is not pork-barrel spending. Barbara Austin, whose University of Mississippi Medical Center also benefited from the law, said, "When you invest in health care, you could never call it pork- barrel spending" (Pear, 12/6). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.