When Cooking The Books, Rick Scott Only Likes His Own Recipe

April 24, 2009 10:59 am ET

On the evening of April 23, 2009, The Hill posted a letter written by Rick Scott regarding health care reform titled "Healthcare reform in reality is dreadful 'stealthcare' plan."  Evidently, Rick Scott is under the impression that his executive experience as leader of a hospital company that paid billions to settle a government fraud investigation makes him an expert on the future of the health care industry.

Scott Would Have Taxpayer Money Sent To Fund Research Without A Dedicated Board To Disburse The Funds

Scott: "Health reform radicals howl when it's pointed out that the board's true mission is to determine which treatments are 'cost-effective,' claiming that language in the law prohibits them from making specific recommendations based on cost. But that's just smoke and mirrors designed to distract Americans from the truth: the board controls a $1.1 billion budget and will recommend how to direct future research dollars. Clearly, cost-effectiveness is the primary metric the board will measure." [The Hill, 4/23/09]

No Matter How You Frame It, Comparative Effectiveness Research (CER) Is A Necessary Project Of ANY Health Care System

CER Supplements Physicians' Knowledge To Ensure The Best Treatment Is Provided To The Patient.  David Dale, MD of the American College of Physicians testified in a House Ways and Means Committee hearing: "The availability of valid, comparative effectiveness data supplemented by the physician's clinical experience and professional knowledge, helps ensure that an effective treatment choice is made-one that meets the unique needs and preferences of the patient." [American College Of Physicians' Statement for the Record, 6/12/07]

Without CER, Medical Procedures May Be Used Without Thorough Trials.  According to a December 2007 report released by the Congressional Budget Office titled Research on the Comparative Effectiveness of Medical Treatments: "Medical procedures, which account for a much larger share of total spending on health care than drugs and devices to [sic] , can achieve widespread use without extensive clinical evaluation." [CBO.gov, 12/07]

CER Studies Examine Both The Treatments and Diagnoses Of Diseases.  According to a December 2007 report released by the Congressional Budget Office titled Research on the Comparative Effectiveness of Medical Treatments: "studies can examine not only treatments for health problems but also different procedures to screen for the presence of a disease.   [CBO.gov, 12/07]

Would Scott Trust Sensitive Clinical Trials To Biased Private Firms?

Scott: "Four hundred million dollars went to the Department of Health and Human Services, another $400 million to the National Institutes of Health, and finally $300 million more to yet another nest of bureaucrats you've never heard of called the Agency for Health Care Research and Quality. In all, $1.1 billion has been budgeted for 'comparative effectiveness research.'" [The Hill, 4/23/09]

An Impartial Third Party Conducts The Most Accurate Comparative Effectiveness Research

Conducting Research Trials Is Not Always Financially Beneficial For Private Companies. According to a December 2007 report released by the Congressional Budget Office titled Research on the Comparative Effectiveness of Medical Treatments: "For drug manufacturers, the costs of conducting additional trials to demonstrate safety and efficacy for a broader set of patients or conditions may outweigh the benefits from the increased sales that would result; in particular, the potential gains from finding a favorable result for a different population would have to be weighed against the risk that safety and efficacy could not be demonstrated conclusively." [CBO.gov, 12/07]

Private Companies Only Compare Two Different Drugs When Required By The FDA.  According to a December 2007 report released by the Congressional Budget Office titled Research on the Comparative Effectiveness of Medical Treatments: "Clinical trials of new drugs must compare them to alternative medications only when the manufacturer wants to make a claim of superiority in its FDA-approved marketing materials or when giving trial participants a placebo would be unethical (for example, in the case of a study of AIDS drugs)." [CBO.gov, 12/07, parenthesis original]

"Comparative Trials Can Be Risky For Manufacturers To Conduct."  According to a December 2007 report released by the Congressional Budget Office titled Research on the Comparative Effectiveness of Medical Treatments: "A trial of two statin drugs, which was sponsored by the maker of one of those drugs, found that its competitor's product was more effective both at lowering cholesterol levels and at reducing the risk of mortality - illustrating the point that comparative trials can be risky for manufacturers to conduct." [CBO.gov, 12/07]

Funding Comparative Effectiveness Research Is Not A New Practice

NIH Had A Budget Of $335 Million For Comparative Effectiveness Research Last Year.  According to Steven Pearlstein of the Washington Post, "there's nothing particularly new about comparative effectiveness research -- the National Institutes of Health, along with the Agency for Healthcare Research and Quality, have been doing it for years, with a budget last year of about $335 million." [Washington Post, 2/13/09]

"Congress Has Aggressively Expanded" Medicare - A True Statement, If Scott Is Referring To The Republican Congress

Scott: "There have been other steps toward socialized medicine as well. Congress has aggressively expanded the funding and relaxed the rules of eligibility for Medicare, Medicaid and the State Children's Health Insurance Program, which already provided government healthcare to children and adults alike who are above the poverty level and arguably could afford private coverage." [The Hill, 4/23/09]

The "Socialism" Taunt Is Getting Old

"Inaccurate Rhetoric About Socialized Medicine And Government-Run Health Care Is A Distraction" From The Policy Debate.  According to a report on socialized medicine issued by the Urban Institute, "the core issue in health reform is not specifically the role of government, but what policies yield the best possible consequences for the American public.  Such results include the number of people with health coverage, individuals' access to quality care, curbing cost growth, and consumers' ability to make choices about their health care and health coverage.  Inaccurate rhetoric about socialized medicine and government-run health care is a distraction from these much more fundamental concerns." [Urban.org, 4/2008]

 But While We're On The Subject, George W. Bush And His Republican Friends In Congress Greatly Expanded Medicare Benefits And Thus The Government's Role In Public Health

Bush Asked Congress For "The Biggest Expansion Of Government Health Benefits Since The Great Society."  The Economist reported that in 2003 Bush was "urging Congress to expand state health care for the elderly to cover some of the costs of prescription drugs--an action President Clinton's Medicare adviser says would be 'the biggest expansion of government health benefits since the Great Society.' In all, the Bush administration in its first three years increased government spending by 21%. " [The Economist, 11/8/03, emphasis added]

Bush Campaigned for Re-election on Largest Expansion of Medicare in 38 years.  Going into the 2004 presidential election, the New York Times reported that Bush advisers "say the president will campaign as having already delivered the biggest expansion of Medicare in 38 years, adding prescription drug benefits for the elderly, and can thus be trusted to improve the health care system for all. 'The question now is who has the track record,' a Bush campaign adviser said." [New York Times, 1/14/04, emphasis added]

Scott Apparently Is Unaware That Most Americans Think All Children Should Have Health Coverage

More Than 80% Of Americans Want All American Children To Have Health Care.  A poll "commissioned by First Focus, a bipartisan children's advocacy organization," found that Americans widely support "a renewal of the State Children's Health Insurance Program (SCHIP) by a margin of 82-10 percent." [FirstFocus.net, 12/18/08, bold original]

When Cooking The Books, Scott Only Likes His Own Recipe

Scott: "Translation: 'Cook the books.' When CBO's array of supercomputers can't make the math work, the Senate plans to just ram government healthcare down America's throat no matter what -- even if it means inserting healthcare reform into the budget reconciliation process, which only requires a simple majority as opposed to support from 60 senators normally needed for all other legislation." [The Hill, 4/23/09]

Under Scott's Leadership, The Columbia/HCA Hospital System Was Investigated For Medicare Fraud

HCA Investigated For Medicare Fraud.  According to the New York Times: "Officials at a number of Federal agencies began investigating whether Columbia hospitals engaged in practices such as fraudulently overstating their expenses to increase their compensation from Medicare, and regularly conducting unnecessary blood tests. Last week, law enforcement agents raided Columbia offices and hospitals in seven states, seizing documents related to business practices." [New York Times, 7/26/97]

Evidence Collected In HCA Investigation Included Documents "Stamped With Warnings That They Should Not Be Disclosed To Medicare Auditors."  According to the New York Times: "The investigation of HCA's cost reporting began in 1993, when James Alderson, a former chief financial officer of one of its former hospitals, filed a whistle-blower suit contending that the expense documents were rife with fraud. The government began a civil investigation and obtained critical evidence: second sets of cost reports and worksheets maintained at HCA hospitals that contained significantly lower expenses than in reports submitted to the government. Some of those documents were stamped with warnings that they should not be disclosed to Medicare auditors." [New York Times, 12/18/02]

Columbia "Hospitals Were Knowingly Inflating The Numbers Reported To The Government." The New York Times reported: "In particular, these people said, investigators are examining accusations of significant differences between the cost reports submitted by certain Columbia hospitals to the Government and separate reports -- known as reserve cost reports -- that were kept at hospitals. Investigators were said to believe that these second reports, along with work sheets prepared by analysts working with the company, provided evidence that at least some hospitals were knowingly inflating the numbers reported to the Government in the cost report to improperly raise total compensation." [New York Times, 7/17/97, emphasis added]

HCA Paid "More Than $1.7 Billion In Civil And Criminal Penalties."  The New York Times reported that a settlement was reached in the HCA fraud investigation: "Under the terms, HCA would pay $630 million in fines and penalties to resolve all outstanding civil litigation with the Justice Department. An additional $250 million would be paid by HCA to the Medicare program to resolve expense claims submitted by the company to the government...Combined with previous settlements HCA has negotiated with the government involving fraud accusations -- including its agreement in 2000 to plead guilty to 14 felonies -- the company will be paying a total of more than $1.7 billion in civil and criminal penalties, by far the largest amount ever secured by federal prosecutors in a health care fraud case." [New York Times, 12/18/02, emphasis added]