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27-Aug-2004, 10:54 PM
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| .. Medicare could go broke by 2019 What if there was nothing left? Social Security disaster looms, Greenspan warns By Jay Fitzgerald and Andrew Manuse Saturday, August 28, 2004 Federal Reserve Chairman Alan Greenspan warned yesterday of a generational time bomb that will go off once millions of baby boommers retire and tax the Social Security and Medicare systems beyond their capacity. Greenspan, a man who normally speaks in deliberate gobbledygook to calm markets, instead used blunt language about ``increasingly stark choices'' facing Americans on how to pay for boomers' benefits after they finish working and start retiring in huge numbers in coming years. Experts said even the latest remarks from the Fed chairman were muted compared with the grim reality of the situation. ``It's much worse than what (Greenspan) is saying,'' said Laurence J. Kotlikoff, chairman of Boston University's economics department and co-author of the new book ``The Coming Generational Storm.'' Lawmakers better get their act together, Kotlikoff said. ``The country is already bankrupt. We can't wait 10 years to act.'' Stopping short of proposing specific ideas on how to plug looming Social Security and Medicare deficits, Greenspan did say time is running out ``to recalibrate our public programs.'' ``If we delay, the adjustments could be abrupt and painful,'' Greenspan told a central bank conference in Wyoming. The U.S. budget deficit, which the Congressional Budget Office already projects to reach a record $420 billion this fiscal year, will widen ``substantially'' as the percentage of the population over 65 nearly doubles by 2035, he said. Social Security tax receipts, equal to 12.4 percent of a worker's salary, won't cover the entire cost of outlays starting in 2018, according to the Social Security Trustees' 2004 report. Economists applauded the remarks by Greenspan, who has made Social Security reform one of his pet causes over the years. But economists said they weren't holding their breath that action will be taken soon by a reluctant Congress, which is loath to take on issues involving possible tax hikes and spending cuts - let alone tax hikes and spending cuts relating to a problem that won't surface until about 2018. ``We don't have a crisis yet to pressure lawmakers to compromise,'' said Douglas Lee, president of Economics from Washington, an economic consulting firm for financial-services firms. BU's Kotlikoff, 53, himself a classic baby boomer with two kids, said he fears his children will be stuck with paying for his generation's current government deficits, as well as his generation's retirement benefits. ``There's a limit to how much we can impose on them,'' he said. Kotlikoff warned of possible generational resentment among the young - a resentment that appeared here already yesterday. ``I'm not going to be retired for many years, and I'm giving my money to some little old crazy person,'' bemoaned Desirea Moore, 19, of Dorchester. Moore, who works for a local insurance company, said she has about $30 to $40 a week deducted for Social Security from her paycheck each week. ``I hope when we retire we get a big check too,'' she added. ``It kind of stinks for anyone who's not in that generation,'' said Tim Jacques, 36, a North Andover resident who works at a Boston financial firm. ``We're going to be paying into the system all our working years and not getting any benefit from it. I'm certainly not too happy about it.'' |
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28-Aug-2004, 03:24 PM
#32 | |||||
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Think we can afford to put our SS checks into bombs at 450 billion a year? When it comes time to retire, they'll pay you in spent uranium. |
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02-Sep-2004, 06:52 AM
#33 | |
| Ford and GM seem to be in a bind: LINK Quote:
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04-Oct-2004, 07:48 AM
#34 | |
| Something to consider and notice.......neither Bush nor Kerry are addressing this looming crisis: excerpt: Economist James Galbraith ~~~ the U.S. government isn't going to go broke because it can print money." ~~( government subsidized wallpaper )http://www.usatoday.com/news/nation/...bt-cover_x.htm Quote:
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04-Oct-2004, 01:57 PM
#35 |
| The problem of the Internal deficit (Budget Deficit) is compounded by the external (Current Account) Deficit. And dwarfed by it too. If the Fed were to print more money at this time, then money supply (Mo,M1, M2, M3 etc) would become even more out of balance and would drive down the US$ against the Euro, £ etc, making funding the external debt even harder and more costly. The present huge Sword of Damocles is that at present, circa 80% of US Current Account Debt, is funded by mainly China and Japan: other states fund it by holding US$ as reserve currency. Printing more dollars, would cause huge sellers to enter the Forex markets, driving the US $ even further down, thus making imports cost more and exacerbating the problem. Worse, scare off the reserve currency holders and then the USA would have to pay interest (at high risk rates!) to re-finance its deficit. Which would increase both Prime and Discount rates: which would increase the domestic rates of borrowing: which would trip the US even deeper into recession, etc. As I stated some months ago, the phrase, painting yourself into a corner seems apposite. Paq
__________________ Retreated To Relative Sanity! |
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05-Oct-2004, 06:54 AM
#36 | |
| Big changes are comming in Social Security and Medicare no matter who controls Congress or occupies the President's office. USAToday Quote:
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05-Oct-2004, 08:41 AM
#37 | |||||
| I am glad that others are coming around to the position that PAQ and I took many months ago, and having been like the Ancient Mariner telling whoever past by. Our economy is in terrible trouble aggrivated greatly by the Bush economic policy. I know GB Mulder and other pundits without an international perview said "Bah" "Humbug" but here we are now and even UStoday is jumpimg on the bandwagon. I do so love being correct. (Today is a banner day for that, just started and several articles to post hee hee). |
05-Oct-2004, 09:05 AM
#38 | |||||
| Republicans try to keep tax shelters I do believe that Mr. Mulder suggested that tax shelters "do not exist" Perhaps he just doesn't know how to provide them -------------------------------------------------------------------------------- October 5, 2004 Republicans Try to Dilute Provisions in Tax Bill By EDMUND L. ANDREWS ASHINGTON, Oct. 4 - Despite widespread agreement that abusive tax shelters are costing the federal government billions of dollars a year, House Republicans are working to eliminate or dilute provisions in a new corporate tax bill aimed at cracking down on illegal shelters. The provisions, opposed by a range of business lobbyists and tax lawyers, are part of a larger battle in Congress over how hard to attack the rapidly expanding use of complex transactions that turn real-world profits into tax-world losses. The issue is coming to a boil in a House-Senate conference committee that Monday night resumed considering a corporate tax bill that would provide up to $170 billion in tax breaks. With only a few days left before Congress is supposed to adjourn, lawmakers are trying to make hundreds of last-minute changes that could affect tens of billions of dollars in tax revenue. Business groups, ranging from the National Association of Manufacturers to the Business Roundtable, have worked with tax lobbyists and accounting firms to protect the tax shelters. A study prepared last year for the Internal Revenue Service estimated that abuse of tax shelters cost the federal government $12 billion to $18 billion a year. A study last week by Citizens for Tax Justice, a liberal research organization, reported that 82 of the nation's most profitable companies paid no corporate taxes in at least one of the last three years. Both the House and Senate have passed bills that would raise billions of dollars by shutting certain kinds of tax shelters. But House Republicans have balked at several provisions that the Senate passed with broad bipartisan support. One crucial Senate provision, for example, would greatly increase penalties on people who spin complex transactions that serve no other purpose except to avoid taxes. Supporters of the Senate bill say it would address a glaring weakness of the system: even when a court finds that a tax deal is abusive, it rarely imposes penalties beyond making a company or a person pay back taxes. "Multinational corporations use complicated schemes to claim they've had losses when they've really had gains," said Representative Lloyd Doggett, a Texas Democrat who has been pushing for such a provision since 1999. "These schemes are so complicated that even the experts have difficulty getting to the bottom of them. One way of challenging these apparent tax losses is to say this complex scheme that may involve many different entities has no economic substance." The nonpartisan Joint Committee on Taxation, which provides the revenue estimates on proposed tax bills, estimated that just one of the disputed provisions would raise about $15 billion over the next 10 years. But House Republicans oppose that measure. Representative Bill Thomas, chairman of the House Ways and Means Committee, said two weeks ago that the provision was unnecessary and would have a chilling effect on legitimate business deals. Mr. Thomas also opposes a provision in the Senate bill that would allow the Internal Revenue Service to demand that companies promoting tax shelters turn over a list of their customers. Opponents of the Senate bill's tax shelter provisions are particularly incensed about a provision that has strong support from Senator Charles Grassley, Republican of Iowa and chairman of the Senate Finance Committee. That provision would tighten the definition of tax shelters, putting into legislation the well-established judicial doctrine that a financial transaction has to have "economic substance," which means it has to have a purpose beyond reducing taxes. Kenneth J. Kies, a prominent corporate tax lobbyist in Washington who has defended some of the biggest tax shelters, said the Senate bill would have ensnared scores of companies engaged in routine transactions. "This is a much broader provision than its being made out to be," Mr. Kies said. "It would set up a standard for economic substance that would be very hard for garden-variety business transactions." But supporters said the provision would simply add some teeth to a concept that courts have used for years. The dispute goes to the heart of all kinds of tax shelters, but it could have a big impact on one of the biggest kinds of transactions in recent years: leasing deals in which cities, including New York City, sell subway trains and other public infrastructure to private investors, who then lease them back and take advantage of tax write-offs for equipment depreciation. The goal of the deals is to give investors tax breaks that are of no use to municipal governments, including many cities and organizations outside the United States, that pay no federal taxes. For the cities, the deals reduce the cost of new equipment at the expense of the federal Treasury. Both the House and Senate bills would prohibit such deals in the future, but the Senate bill could invalidate many deals that are already in existence. As a result, the Senate bill would raise about $45 billion over 10 years, while the House bill would raise about $19 billion. But if the final law includes the Senate provisions on "economic substance," investors who entered into such deals could face stiff penalties on top of losing their tax shelters. Joseph Bankman, a professor of tax law at Stanford University, says California has already reaped $1.3 billion from a similar provision it passed one year ago. The California law declared that any tax shelter that fails the test for economic substance could be subject to penalties but it offered an amnesty to people who came forward voluntarily. "It is still very much the exception rather than the rule that people have to pay penalties," Mr. Bankman said. Calvin Johnson, a professor of tax law at the University of Texas in Austin, said the Internal Revenue Service would have to impose "gargantuan" penalties before it really frightened off companies or individuals trying to shelter tens of millions of dollars. But Mr. Johnson said there was a pressing need to attack the widespread view, which he said was generally accurate, that people can avoid penalties simply by obtaining an opinion from tax lawyers in advance of a deal that says the transaction fits the letter of the law. "There is a common view that you can set up an elaborate scheme and that if you have the opinion of a respectable attorney that you can't be assessed any penalties," he said. But the conventional wisdom may be changing. In a decision that electrified tax-shelter promoters, a court ruled in August that Long-Term Capital Management, the huge hedge fund that nearly went bankrupt in 1998, took $106 million in improper tax deductions and owed $56 million in taxes and penalties. "The Long-Term Capital case showed that the I.R.S. has many arrows in its quiver," said Tim McCormley, executive director of the Tax Executives Institute, an association of tax professionals who work at major corporations. "In the past, taxpayers had what they viewed as a 'get out of jail free' card if they had an opinion from a highly respected law firm. That's not the case anymore." Copyright 2004 The New York Times Company | Home | Privacy Policy | Search | Corrections | RSS | Help | Back to Top |
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05-Oct-2004, 09:10 AM
#39 |
| Well, PLS, it is perhaps comforting for you and I be in the same camp as the the Head of the IMF, Mr Greenspan, and a whole raft of noted economists throughout the Western World. The present problem is, perhaps summed up by the attitude and approach of California's present Governor, Mr Terminator. Those who use cogent analysis, rather than either political rhetoric or media propoganda, are labelled "Girliemen". Almost as bad a sobriquet as a "Liberal" I guess! Margaret Thatcher's apology for a government had a similar approach to what appears to be that of the US Right-Wing, presently. If one ignores it for long enough, hopefully, it will go away. She also seemed to demonstrate - repeatedly - a sort of philosophy of, "Don't confuse me with the facts, we already have an answer; a solution a policy; a strategy; etc." Ah me, 'twas ever thus.............................. Paq
__________________ Retreated To Relative Sanity! |
05-Oct-2004, 09:17 AM
#40 | |||||
| PAQ I remember a story I used to read to my kids by Edmond (?) Lear: starting: The Pobble who had no toes once had as many as we. When told he could loose them all He said: Fish fiddle-de-de |
05-Oct-2004, 09:48 AM
#42 | |||||
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![]() Well I followed my nose and transferred some funds into Euros when it was still in the 85 cent range. But then I am very attached to my toes |
05-Oct-2004, 11:09 AM
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| I must admit their getting better Getting so much better all the time Reuters Print this article Close This Window U.S. Job Cuts at 8-Month High in Sept. Tue Oct 5, 2004 10:06 AM ET NEW YORK (Reuters) - U.S. planned job cuts soared to an eight-month high in September while new hiring rose only slightly, a report said on Tuesday. Employment consulting firm Challenger, Gray & Christmas Inc. said employers announced 107,863 layoffs in September, 41 percent more than in September 2003 and 45 percent more than in August of this year, when 74,150 were laid off. The September figure was the largest since January 2004, when employers laid off 117,556 workers. The September figure brings third-quarter job cuts to 251,585, 19.9 percent more than the 209,895 registered in the previous quarter and 4 percent more than the 241,548 for the third quarter of 2003. Job losses in September were particularly heavy in the computer, transportation, telecommunications and consumer products industries, the report said. Adding to the glum jobs picture was the slow pace of new hiring in September. The report said employer hiring announcements revealed only 16,166 new job openings in that month compared with 132,105 in August. "Historically, the period from September 1 through December 31 is when we see the heaviest downsizing and this year appears to be on track to repeat that trend," said John Challenger, chief executive officer of the firm. "This period can also be a time for hiring since companies are looking ahead to the new year and making budget and staffing decisions. Weak hiring announcements last month are not a good indication of stronger job creation to come," he said. One Friday, the government will report on the U.S. employment situation in September. It will be the last official report before the presidential elections. Economists polled by Reuters forecast a 148,000 rise in non-farm payrolls for September compared with a 144,000 rise in August. © Copyright Reuters 2004. All rights reserved. Any copying, re-publication or re-distribution of Reuters content or of any content used on this site, including by framing or similar means, is expressly prohibited without prior written consent of Reuters. Quotes and other data are provided for your personal information only, and are not intended for trading purposes. Reuters, the members of its Group and its data providers shall not be liable for any errors or delays in the quotes or other data, or for any actions taken in reliance thereon. © Reuters 2004. All rights reserved. Republication or redistribution of Reuters content, including by caching, framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world. |
05-Oct-2004, 01:05 PM
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| CLOSED, FOR BUSINESS Energy bill a special-interests triumph By Susan Milligan, Globe Staff | October 4, 2004 Second of three parts WASHINGTON -- Robert Congel has grand plans and a heady vision for his upstate New York shopping complex. Billed as the biggest mall in the world, the yet-to-be-built DestiNY USA would be filled with 400 retailers, thousands of hotel rooms, a 65-acre glass-enclosed indoor park, a rock- and ice-climbing wall, and a theater suitable for Broadway shows. And if its patrons in Congress get their way, the mega-mall would be partially funded through the federal energy bill, which would provide $100 million in public money. A fervent lobbying campaign by Congel paid dividends on Capitol Hill. When members of the House voted last winter to ramp up domestic oil production, they also voted to help Congel build the giant mall through tax-exempt "greenbonds." The greenbonds initiative -- so named because the developments it funds are supposed to be energy efficient -- was among scores of items stuck into the energy bill by lawmakers meeting behind closed doors. These provisions had no official sponsors and weren't part of the original documents approved by the House and Senate, but were added later by unseen hands as the 816-page bill was crafted in a secret conference. Intended to lay out an energy policy for the nation for the first time in more than a decade, the energy bill became a cash bonanza for corporate interests in and out of the energy arena. The bill, which is stalled because of a Senate filibuster but which is still one of President Bush's top legislative priorities, features initiatives to encourage production of new and existing energy sources. But it has also become a phonebook-sized symbol of modern Washington lawmaking, in which policy is driven by those who have money, power, and access to a relatively small group of decision-makers. A Globe analysis of tens of thousands of pages of lobbying records shows that entities with a stated interest in energy policy spent $387,830,286 lobbying Washington last year. They also paid tens of millions of dollars in campaign contributions to officials putting together the package at the White House and on Capitol Hill. The Globe analysis shows that the corporations and others, including some universities, were rewarded in the bill with tax breaks, construction projects, and easements of regulations that would save them much more than they spent making their arguments to the government. In some instances, the beneficiaries were specific companies like Home Depot, which spent $240,000 lobbying in hopes of gaining tens of millions in savings. Home Depot -- whose PAC contributed the maximum $5,000 to Bush's 2004 campaign and whose employees have contributed $226,400 to Bush and the Republican National Committee this cycle -- benefits from a two-paragraph section in the bill to eliminate tariffs on Chinese ceiling fans. The change would save Home Depot and other companies a total of $48 million, according to the bipartisan Joint Committee on Taxation. In other instances, entire industries spent tens of millions of dollars to leverage billions in government funding and deregulation. The nuclear industry, which spent some $71,405,955 lobbying Capitol Hill, would get $7.37 billion in tax breaks and projects, including federal funds to construct a $1 billion nuclear plant in Idaho. The plant, which would be the first nuclear plant commissioned in decades, would also benefit the hydrogen fuels industry, because the nuclear facility is intended to create hydrogen fuels. Several large power companies, which spent tens of millions lobbying, won a historic deregulation of their industry that would strip away controls dating from the Depression on how they spend their money and allow them to become conglomerates -- with little recourse for ratepayers if the companies' speculative investments go sour. Bush's biggest supporters would profit handsomely from the bill. Sixty of Bush's 400 Pioneers and Rangers -- those who have committed to raising at least $100,000 and $200,000, respectively, for the Bush-Cheney reelection effort -- would benefit from the tax breaks, subsidies, and deregulation in the bill, according to an estimate by the Sierra Club. Massey Energy of West Virginia -- whose director, James H. "Buck" Harless, is a major Bush fund-raiser --would get hundreds of millions of dollars in loan guarantees for a coal gasification plant. Harless served on President Bush's energy transition team, a precursor to Vice President Dick Cheney's Energy Task Force, which developed the critical blueprint for the energy package on Capitol Hill. "The problem is that this has just turned into more of a special interests bill," said Charlie Coon, an energy specialist with the Heritage Foundation, a conservative think tank. "The bottom line is, it's not going to provide the power that's needed for the economy so people can turn on their lights. It's such a farce." Behind closed doors The construction of the bill reflects the way business is done in Washington in 2004: With Republicans enjoying control of both chambers of Congress, plus the White House, GOP leaders in the House craft giant bills behind closed doors, freezing out the minority party and squelching dissent from moderate Republicans and lobbyists whose agendas are unsympathetic to the GOP's goals, according to interviews with members of both parties and former House members. And while other bills have included their share of earmarked projects or handouts to various industries or interest groups, the energy bill is considered by consumer and environmental groups to be one of the most extreme examples of excessive corporate giveaways. "What's really amazing is how a combination of energy industry, oil and gas industry, utility industry guys, coal industry guys, through a whole host of policy decisions -- through the Environmental Protection Agency or the energy bill -- literally got billions of dollars in payback for millions of dollars" in contributions and lobbying expenses, said Mark Longabaugh, senior vice president for publicaffairs for the League of ConservationVoters. The bill first began to come together as an outgrowth of Cheney's energy task force, a committee of Washington officials that met in private to draft a sweeping national energy policy shortly after Bush took office. A study by the nonpartisan General Accounting Office last year found that the energy task force received advice from private "energy stakeholders," mainly the petroleum, coal, nuclear, natural gas, and electricity industries. The report said it was unable to determine the extent of the influence these industries had on policy, because of the limited information made available to the GAO. But other records released under a court order show that 15 energy-related entities known to have had contact with the task force ended up winning provisions in the energy policy that would benefit them. The Edison Electric Institute, which had contact with the task force 14 times and spent $12 million lobbying Washington last year, secured a historic deregulation of the electricity industry analysts believe could be worth billions of dollars. The Nuclear Energy Institute, which won billions in tax credits and projects, had 19 contacts with the task force and dumped $1,280,000 into lobbying efforts in 2003. The nuclear industry also would benefit from an extension and expansion in the energy bill of the Price Anderson Act, which caps the financial liability nuclear power plant owners face in case of a nuclear accident. While no new nuclear power plant has been commissioned in decades, the bill envisions a rebirth of the controversial power source. Southern Company, an electricity company that spent $990,000 on lobbying, would benefit from relaxed regulations on emissions of mercury, a toxin released from power plants. Southern's executive vice president and a paid lobbyist met with the task force, according to records released pursuant to a lawsuit filed by the Natural Resources Defense Council. The Environmental Protection Agency, which is set to issue final rules next year, estimated that the deregulation of mercury rules would save US power plants a total of $2.7 billion. Members of the American Petroleum Institute, which had contact with the task force six times and spent $3,140,000 lobbying last year, would be eligible for billions in tax breaks and subsidies to encourage domestic oil production. Environmentalists, who were shut out of the task force, won little in the final package after spending a small fraction of what the energy industry spent on lobbying. The League of Conservation Voters, for example, spent just $46,516 on lobbying last year; the Natural Resources Defense Council spent $920,000, and the Union of Concerned Scientists $150,000, according to an analysis of lobbying reports. Industries that had contact with Cheney's task force had a critical advantage, said Larry Noble, an analyst for the Center for Responsive Politics, because they were able to plead their cases in the early stages of the development of the energy policy. "They have gotten what they wanted from the first day," Noble said. "What all lobbyists know is that it's important to be there when the policy is being drafted, before the laws are being written. By the time the bill's written, it's a little late. You're playing a defensive game." The conference committee After Cheney's task force issued its recommendations, the job of drafting the bill went to House and Senate committees, where members of the Republican majority kept many of the proposals intact. Then, in hopes of forging an agreement between the House and Senate, congressional leaders appointed members to a conference committee. But the conference committee began adding projects that had never appeared in either version of the bill. And lobbyists peppered members of the committee with requests to get favored projects, including Congel's mall, appended to the legislation. The addition of projects like Congel's especially irks government-waste watchdogs. Even though DestiNY USA had promised to be a model of energy efficiency, critics wonder what a shopping mall has to do with forging a national energy policy. The greenbonds initiative wasn't part of the original House or Senate bills that went through public hearings and floor debate. It was added by the conference committee, a panel that excluded Democrats for all but two of the meetings held to craft the bill. The final, massive bill was released on a Saturday, giving House Democrats and any Republicans not made privy to the negotiations barely three days to study it before being asked to vote on it on the House floor. Representative Edward Markey, a Malden Democrat who is a veteran member of the Energy and Commerce Committee, said he was forced to follow developments in his own committee's bill by talking to Washington lobbyists. "We could not keep track of what was going on," Markey said. "All we had were leaks. What they did on this energy bill was unprecedented. It was disrespectful of the Democrats, but more importantly of the environmental and consumer groups of the country." Congel himself is a successful, if controversial, developer who Forbes magazine estimates is worth some $700 million. Congel and his company, Pyramid Management, were sued by dissident partners in 2000 for fraud; the case is still pending. Pyramid ultimately paid more than $800,000 back to a tenant company, The Limited, which claimed the developer had overcharged it by submitting phony tax bills. State and federal prosecutors took no action against the company. Congel and DestiNY USA failed to respond to repeated requests for comment. Three other shopping mall projects -- one in Georgia, one in Louisiana (home of the former chairman of the House Energy and Commerce Committee, Republican Representative Billy Tauzin), and one in Colorado -- would also benefit from the greenbonds proposal, although it takes some sleuthing to figure that out from the language in the bill. Called the "brownfields demonstration program for qualified green building and sustainable design projects," the greenbonds section in the bill makes no mention of the specific projects or states. But the guidelines conform to no other projects, according to both congressmen and watchdog groups who have studied the bill. "They weren't named, but everyone knew who they were, based on the language," said Keith Ashdown, vice president for policy at Taxpayers for Common Sense. A Republican senator joked that the bill might as well have required that one of the projects be located in a venue "whose nickname is the 'Cajun State,' " to underscore that one of the projects would be in Shreveport. Congel has been an aggressive advocate for government financing of his project. He set up a political action committee, the Green Worlds Coalition Fund, which has raised $82,897, much of which has been contributed to Bush's campaign and the campaigns of congressmen key to the energy bill. In addition, Congel, his family, and employees of DestiNY USA and Pyramid contributed an additional $69,084 to congressional campaigns and to Bush, according to filings analyzed by the nonpartisan Center for Responsive Politics. The project's proponents also have made a big investment in lobbying, spending $140,000 last year and $60,000 this year to convince Congress -- which already gave DestiNY USA $1.7 million last year for construction around the development site -- to approve the greenbonds proposal. Meanwhile, Congel labored to help key lawmakers. Congel, his family, and business associates gave heavily to Representative Bob Beauprez, a Colorado freshman who also wants financing assistance for a development project in his district. Congel also hosted a fund-raiser attended by Cheney. While most of Congel's and DestiNY USA's campaign contributions went to Republicans, the project's advocates have also looked out for New York's Democratic senators, Hillary Rodham Clinton and Charles Schumer, both of whom received contributions from the Green Worlds PAC and from Congel himself. Schumer, in a seemingly contradictory tactic common in Washington, fought mightily to get the greenbonds provision included in the energy bill, even as he was also battling to defeat the entire bill. "I thought it was a good project," Schumer said of the $2.2 billion DestiNY USA, which developers claim will bring more than 100,000 long-term, tourism-related jobs to economically troubled upstate New York. Schumer said he nonetheless opposed the energy bill because it gave relief from liability to producers of a gasoline additive that has poisoned groundwater in New York and other states. On the House side, Representative James Walsh, a Syracuse Republican, has been championing the DestiNY project, which would be located in his district. Walsh, who said he went to high school with Congel, defended the project as a valuable prototype of how a mall can be powered with renewable energy such as solar power. And he said the jobs would be important to his district. "This is the only guy knocking on my door willing to spend $2 billion," Walsh said. But congressional waste-watchers and environmentalists wonder why the federal government should be helping a multimillionaire developer build a shopping mall and resort. "It's apparent that the only green Bob Congel has ever been interested in is the green in his back pocket," said Chuck Porcari, communications director of the League of Conservation Voters. When the energy bill stalled in December, Senator Pete Domenici, the New Mexico Republican who heads the Senate Energy and Natural Resources Committee, pared it down to make it more palatable to an unconvinced Senate. A newer version, which has not officially replaced the original bill, does not include the greenbonds provision. But with Schumer's help, DestiNY USA may get another shot at the federal money pie. Schumer and Senator Zell Miller, a Democrat whose home state of Georgia is also vying for a greenbonds project, introduced an amendment to add the projects onto a corporate tax bill with a higher likelihood of gaining congressional approval. A conference committee will begin writing that bill today. "It's like multiple warheads: Let's try the energy bill, let's try the transportation bill, let's try the appropriations bill. If we fire all these warheads, we'll be able to hit something," said David Williams of the nonpartisan Coalition Against Government Waste. Fattening the bill Congel's project wasn't the only one to find a new vehicle for funding, despite the hold-up of the entire bill. Senator Charles Grassley, an Iowa Republican who heads the Senate Finance Committee, and whose support for the energy bill was critical because of its tax provisions, wanted $50 million for a simulated rain forest in his corn-country state. Supporters said the project would be educational, but it was deleted before the energy bill went to the House floor. But Grassley got what he wanted in January, when the project was slipped onto an omnibus spending bill meant to fund federal agency operations for 2004. "Most egregious projects, if they are backed by a powerful politician, have nine lives," Ashdown said. Backers of the energy bill acknowledged that it was fattened with local projects, but said such inclusions were often needed to cobble together a voting coalition. "That's a function of the legislative process," said Frank Maisano, an energy industry lobbyist with the firm of Brace and Patterson. And the battle over the energy package surely has a philosophical dimension. Those who support it argue that the nation must produce more of its own energy to wean the country from reliance on foreign oil. Companies must be offered tax credits and subsidies to encourage that production, say industry officials and some lawmakers and analysts, because energy exploration and development are pricey undertakings. While environmentalists like to demonize the profitable oil industry, Maisano said, oil companies need financial incentives to search for reserves in untested areas. For example, some potential oil reserves are more expensive to get at, because they are deep in the earth; without a tax break, most companies wouldn't take the financial risk of drilling there, he said. But critics, who include many fiscally conservative Republicans along with Democrats, insist that the tax breaks got out of hand during all the closed-door meetings, with many benefiting interests as narrow as individual companies. When the original version of the bill was finished, it had an estimated $20 billion in tax credits and subsidies to the energy industry. But analysts believe the biggest financial windfall for the industry is in the deregulation provisions, which energy companies spent hundreds of millions of dollars to secure. First on the to-do list was the elimination of a longtime regulation called the Public Utility Holding Company Act. Little known outside the energy and financial world, the regulation is a critical issue for the electrical industry, whose vast team of lobbyists persuaded negotiators in Congress to eradicate the law. In the hundreds of lobbying reports filed by those seeking to influence the energy bill, getting rid of electricity industry regulations shows up 98 times. Electricity interests spent millions of dollars trying to kill the law. The Edison Electric Institute, which represents the electricity industry, spent $12,540,000 on a team of 35 lobbyists at its own shop and at 12 other firms to lobby Congress, the White House, and federal agencies against PUHCA and on other energy matters. Individual electricity companies and others against the landmark regulatory law dumped another $56,420,670 million on lobbying last year, according to reports filed with the clerks of the House and the Senate. Nor has the industry been stingy in handing out campaign contributions. Electricity industry PACs and executives gave a total of $7,733,941 for the 2004 election cycle, making the industry the 19th biggest contributor, according to the Center for Responsive Politics. Tauzin, the powerful former chairman of the House Energy and Commerce Committee, was especially enriched, receiving more than $150,000 in campaign funds from the energy industry as a whole, including nearly $76,000 from the electricity sector, according to the center. The effort was successful: Language killing the watershed regulatory law is included in all versions of the energy bill now on Capitol Hill. If the measure becomes law, both supporters and critics anticipate an explosion in energy investments. But where financiers see investment opportunities, consumer advocates see future Enrons in the making, because the law was intended to insulate utilities from the kind of energy-trading schemes that caused the Houston-based Enron to collapse in the greatest bankruptcy in history. Get rid of the rules restricting cross-investment by utility holding companies, consumer advocates say, and the country faces an energy and stock market debacle much like the one that led to the creation of the public utilities act. The law's roots go all the way back to the Great Depression and the stock market crash of 1929. The then-nascent electricity industry was largely owned by a small group of holding companies, which used their reliable receipts from selling electricity to invest in riskier ventures. When those ventures faltered, the holding companies imploded, and 53 electricity companies went bankrupt; the collapse helped deepen the Great Depression. Consolidation in the industry also allowed holding companies to manipulate the market and overcharge consumers for power. After an investigation and hearings, Congress approved the PUHCA regulations in 1935, imposing historic controls on energy holding companies. Now, however, energy industry spokesmen say the law is outdated and so onerous that investors are discouraged from putting money into electricity. "This is a fairly capital-intensive business. The repeal of PUHCA would serve to potentially encourage capital to flow back into the energy market," said Pete Sheffield, a spokesman for Duke Energy, which once employed Andrew Lundquist, the director of Cheney's energy task force, to lobby for the elimination of the law. The Clinton and Bush administrations have already weakened the regulations by allowing companies to be exempt from certain PUHCA rules. But eliminating the law entirely could have a catastrophic effect on both the financial markets and consumers, critics say. "It's the only thing between us and a cartel," said Lynn Hargis, a former staff attorney with the Federal Energy Regulatory Commission who now works for the watchdog group Public Citizen. Deleting PUHCA from the law books would put an estimated $1 trillion in energy assets in play, she said, presenting enormous implications for both the energy sector in particular and the financial markets as a whole. Deregulation, she predicted, would allow more episodes like the Enron scandal, because holding companies could move capital around and put the health of electricity providers at risk. Additional deregulation Lobbyists for energy interests succeeded in getting far more than financial deregulation, however. The current bill calls for deregulation of laws protecting air quality. One provision would ease rules on ozone, which produces smog. The language, which was not in either the original House or Senate bill, would not only lower the standards set in the Clean Air Act for ozone production, but would extend the time industry has to comply with the rules. The provision, added by the conference committee, would largely benefit oil refineries. Language was also inserted in the bill that exempts the oil and gas exploration industry from sections of the Clean Water Act; under the bill, such companies would not be penalized for contaminating public waterways. The provision would give oil and gas construction companies a "free pass" to avoid clean water laws, making them the only construction companies not subject to such regulations, said Representative Bob Filner, a California Democrat. Energy lobbyists also persuaded the Bush administration to weaken proposed rules on mercury, a toxin released in the air by coal-fired power plants. The proposed new rules would ease emissions limits and would give the power plants more time to comply, a combination environmentalists say will do little to protect people from mercury contamination in the water and in fish. The Bush administration's view of the mercury threat is far tamer than that of its predecessor. When former President Clinton's EPA issued a December 2000 statement announcing that reductions in mercury emissions would be required for the first time ever, the agency described mercury as a "harmful" substance that "has been associated with both neurological and developmental damage in humans. The developing fetus is the most sensitive to mercury's effects, which include damage to nervous system development." But the Bush administration's EPA has taken a more relaxed view, describing mercury on its website as a "naturally occurring element that is present throughout the environment." While mercury exposure should be "treated seriously," the site says, "health problems caused by mercury depend on how much has entered your body, how long you have been exposed to it, and how your body responds to the mercury." The energy interests and their supporters in Congress say the provisions come down to a matter of philosophy, not lobbying clout; industry spokesmen say too much regulation puts financial strains on companies and makes it harder for them to update their operations with more environmentally sensitive equipment. But those with access to Congress clearly did well in the package, according to the Globe's analysis of lobbying records, campaign contributions and the legislation. On the Hill, legislation as complicated as the energy bill tends to be written more by staff, who then may turn to people outside government to help them with legal language, said a Republican senator who asked not to be named. The specialists tend to be lobbyists, citizen advocates say, creating a situation where lobbyists have a heightened influence on lawmaking. Outside specialists, lobbyists or not, often have expertise that can be valuable. The trouble, some lobbyists and lawmakers say, is that the process tends to favor those who already have close connections to the White House, either by having held a previous job with the administration or attracting attention by raising money for the Bush-Cheney campaign. Energy industry lobbyists say it's not a matter of payback, but simply a situation where environmentalists are running up against an elected majority that happens to be unsympathetic to their interests. Environmentalists, they say, should be more flexible and recognize they are dealing with an administration that wants to increase energy production. "I think the environmental groups have marginalized themselves to the point where they don't get to have as much of an impact as they probably should," because they are so focused on attacking Bush, Maisano said. "They're not interested in policy. They're interested in getting the guy." Environmental lobbyists, for their part, said they bump up against a lot of closed doors when they try to lobby on the Hill. When they do get in to see sympathetic lawmakers, their views end up being suppressed by a Republican majority that wants to see more exploration and development of oil, gas, and nuclear power. "On the House side, it's positively Orwellian," said Marchant Wentworth, a lobbyist with the Union of Concerned Scientists. "Republican members have told me to my face that they're just not going to confront the chairman on an issue. I've never seen anything like it." This report was prepared with the assistance of Marc Shechtman of the Globe library and freelance research manager Maud S. Beelman and researchers Kevin Baron and Samiya Edwards. © Copyright 2004 The New York Times Company |
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| Boston.com CLOSED, FOR BUSINESS Medicare bill a study in D.C. spoils system By Christopher Rowland, Globe Staff | October 5, 2004 Last of three parts Republicans went to great lengths to make sure President George W. Bush won a Medicare prescription drug benefit for the elderly last year. Among their feats: bridging 200 miles of New England countryside with the stroke of a pen. Setting aside economic differences, not to mention mountains and rivers, the Bush administration plunked the University of Vermont teaching hospital in Burlington into the same federal wage district as metropolitan Boston. On a map, the move makes little sense. Politically, the rationale becomes clear. It resulted in a $23 million boost over three years for Vermont's largest health-care institution and helped firm up critical support for the Medicare bill from the state's independent senator, James Jeffords. "It defies belief that hospitals as far away from Boston as Burlington, Vt., can be part of the Boston area and be paid millions in Medicare payments," said Frank McGinty, executive vice president and treasurer of MaineHealth, a group of hospitals that tried and failed to do the same thing. The money for the hospital -- whose doctors and executives have been an important source of campaign funds for Jeffords -- was a portion of the tens of billions of dollars congressional leaders lavished on the health-care economy as part of last year's Medicare prescription benefit law. It is just one small example of how the Washington spoils system went into overdrive as Republicans and Democrats alike sought to build support for the bill while also taking care of their home states and special-interest groups that mounted an enormous lobbying drive. What once began as a proposal for $253 billion in drug coverage for seniors four years ago grew to a $400 billion grab bag for a broad spectrum of players in the health-care economy. The staggering costs rose yet another 33 percent when the Bush administration unveiled an estimate this year that it had kept quiet during the 2003 debate over Medicare: $534 billion. Congressional leaders rewarded university medical centers, publicly traded hospital companies, physicians, helicopter ambulance companies, hospice providers, nursing providers, dialysis clinics, insurance firms, and more. The bill benefited premier teaching hospitals from Boston to Houston. Doctors in Alaska got an extra $50 million. Cancer institutes with outreach programs for Native Americans got access to government loans they never have to pay back. The additions, which some supporters say were necessary to win support for the bill, help explain how such a massively expensive bill, contributing to record 17.4 percent Medicare premium increases this year, could provide a prescription drug benefit that is viewed as inadequate by many seniors. The actual costs of the bill are still being debated 10 months after its passage, triggering calls in some quarters of Congress to roll back some provisions. "It became a feeding frenzy," said Robert M. Hayes, president of the Medicare Rights Center, a New York consumer group critical of the bill. GOP leaders added final details behind closed doors at a joint House-Senate conference committee, amid intense lobbying. A Globe analysis of federal lobbying disclosure reports found that drug companies, hospitals, doctors, nursing homes, HMOs, and other health care companies and trade associations spent $311 million lobbying Medicare and other bills in 2003. The disclosure reports do not make it possible to determine exactly how much money was spent lobbying directly on the Medicare bill, though it is clear most activity was focused on the measure, the prime health policy legislation of the year. As they deliberated, members of Congress occupying key committees gathered hundreds of thousands of dollars in health-care industry campaign contributions. "The Medicare program has now become a vast arena of special interest politics," said Robert E. Moffitt, a policy analyst at the conservative Heritage Foundation. "It has been transformed from a system where we were providing health coverage for seniors, into a system where there is a massive redistribution of income among health care providers." To date, most attention has focused on increased payments to Medicare HMOs worth up to $46 billion and new profits that pharmaceutical companies will get after the full drug benefit begins in 2006. Goldman Sachs Group Inc. said the bill would increase drug industry revenues by 9 percent, or $13 billion in the first full year, or more than $100 billion over eight years. A Boston University researcher who is a critic of the drug industry estimated new profits at $139 billion over eight years. For several years before 2003, the drug industry fought a Medicare prescription benefit because it feared government price controls. Drug executives dropped their opposition after congressional leaders agreed to a provision that specifically prohibits the agency that runs Medicare from negotiating drug prices, letting companies set prices in the private marketplace. Less attention has been focused on other aspects of the bill. For instance, the government agreed to pay about $71 billion in subsidies to discourage corporations from dropping senior citizens from existing private health plans and forcing them into Medicare. Hospitals across the country will receive billions in higher reimbursements for patients who are admitted to the hospital for everything from appendectomies to open-heart surgery. The White House defends the bill as a total revamping of Medicare, including the introduction of long-term, systemic changes that rely on private competition and other market forces that will make it efficient and affordable. "The president promised seniors not just a drug benefit, but a stronger, more modern Medicare system," said White House spokesman Trent Duffy. "A drug-only approach to Medicare would have added a costly benefit to a shaky Medicare foundation." Some advocates say the extra spending created cost gaps in the bill that Congress solved by taking money away from the benefits for America's elderly. In fact, congressional budgeters found $76 billion in savings as they reviewed Medicare programs. But eager to build support for the bill, leaders spent far more than that on programs that had little or nothing to do with getting drugs into the hands of seniors. "That's how it got through," said Valerie Cheh, a health economist at the independent firm Mathematica Policy Research Inc., in Princeton, N.J. "There's a little piece of everything in here for everybody." Here are some of those pieces, and how they were shaped: Corporate welfare Congressional sponsors said the $25 billion "rural package" of the Medicare bill was a much-needed lifeline for struggling hospitals and other providers in remote areas with small populations. But among the biggest winners were private, for-profit corporations that own chains of hospitals in both rural areas and small cities in the South and West -- especially Texas, Arkansas, Tennessee, and Florida. Chain hospitals in McAllen, Texas, a fast-growing area near the Mexican border, and Corpus Christi, with a population of more than 250,000, are eligible for money under the rural provision, according to the Texas Hospital Association. Stock analysts and the corporations themselves have estimated that Medicare-related revenue increases for several chains specializing in smaller communities -- Community Health Systems Inc., Health Management Associates Inc., and Triad Hospitals Inc. -- will be in the range of $8 million to $12 million a year for each corporation. The money boosts reimbursement for patient visits, including an adjustment to make payment rates the same as hospitals in big cities, where Medicare rates had been set higher to recognize the greater costs of labor and goods. "This isn't just a one-time, throw-money-at-them, catch-up," said Robert Mains, an analyst with Advest Group Inc., in Saratoga Springs, N.Y. "This is something they will permanently have as a benefit," The idea of large corporations reaping profits from reimbursement provisions that were publicly billed as helping rural facilities struck some as incongruous. "When you have these big corporations running smaller hospitals, it is not necessarily money going into the rural community," said Lisa McGiffert, a health policy analyst with the Austin, Texas, office of the independent, nonprofit group Consumers Union. "It certainly isn't the picture that was painted to members of Congress when they were passing this bill. As often is the case, they pick a subject that is soft and sympathetic, and large corporations would not be sympathetic." Executives of some hospital chains contributed heavily to the campaigns of Republicans and Democrats, with a heavy tilt toward the GOP. Triad, based in Plano, Texas, for example, is the second-largest source of contributions to California Republican Bill Thomas, the powerful chairman of the House Ways and Means Committee and a key author of the Medicare bill. Triad has funneled $17,000 into Thomas's campaign fund in the 2003-2004 election cycle, most of it at a Dallas fund-raiser in March 2003, according to Federal Election Commission disclosures. Five Triad executives at the fund-raiser contributed $1,000 each, and the company gave Thomas another $10,000 from its political action committee. Among Triad executives who wrote a check was James D. Shelton, Triad's chairman and CEO. Triad and Shelton declined to comment. But Shelton gave an unusually blunt assessment of the motives behind his political campaign contributions during a conference call with Triad's stock analysts on Feb. 24, two months after Bush signed the Medicare bill. Asked by an analyst how the industry planned to fend off calls to cut back some of the Medicare increases for hospitals, Shelton said he planned to open his checkbook again. "First of all, I set a fund-raiser this last week for Blanche Lincoln in Arkansas," Shelton said during the conference call, referring to a Democratic member of the Senate Finance Committee. "We're continuing to be proactive in terms of a lot of the congressional delegations around the country." A spokeswoman for Thomas, Christin Tinsworth, said the contributions Triad and other health-care companies made had no bearing on the Medicare bill. Connections Another cosponsor of the Dallas fund-raiser for Representative Thomas was the Federation of American Hospitals, the lobbying arm of the nation's for-profit hospital chains. The federation's president, Charles N. "Chip" Kahn III, who contributed $2,000 to Thomas's campaign, is a former top member of Thomas's staff and one of dozens of Washington lobbyists who used to work for presidential administrations or Congress. The Federation of American Hospitals spent $2.78 million lobbying Congress in 2003, according to the Globe analysis. With Kahn's connections, the hospitals can make that money work more effectively. It's the type of "revolving-door" relationship that tilts the Capitol Hill equation in industry's favor, said Celia Wexler, vice president for advocacy at Common Cause, a national nonprofit lobbying group that focuses on government ethics. "He certainly has relationships on Capitol Hill and a level of expertise that would be very useful to the American Federation of Hospitals," she said. "We're not talking a level playing field here. The average member of the public does not have that kind of representation." Kahn also volunteers as a top fund-raiser for Bush's reelection campaign. He has "Ranger" status, which means he has rounded up more than $100,000 in "bundled" campaign contributions from individual political supporters for the president. He is one of 25 major Bush fund-raisers from the health-care sector, according to Public Citizen. In an interview, Kahn dismissed the suggestion that his former relationship with Thomas helped America's for-profit hospitals win more Medicare money. "He listens to me," Kahn said of Thomas, "but he listens to a lot of other people, too." Thomas's spokeswoman, Tinsworth, said Kahn's former relationship with the chairman does not affect policy. Securing bigger Medicare reimbursements under the banner of rural hospitals was not a tough sell, Kahn said. "Some of the members cared more about the rural hospital provisions than any other part of the bill," he said. A crucial supporter, Kahn said, was the chairman of the Senate Finance Committee, Charles Grassley, an Iowa Republican whose state was among the beneficiaries with about $151 million in rural hospital funding alone, according to data from the American Hospital Association. By merit of his powerful position, Grassley has received heavy campaign support from the health-care sector. He has collected $353,000 from insurance companies and executives, $333,000 from doctors and other health professionals, and $241,000 from the pharmaceutical and health products industries, according to disclosure reports compiled by the non-profit Center for Responsive Politics. In response to questions from the Globe, Grassley defended the inclusion of expensive hospital provisions in the drug benefit. The "rural package," Grassley said in an e-mail message, was paid for with savings squeezed from other areas of the Medicare program. "The rural provisions were crucial for improving beneficiaries' access to physician and hospital services," he said, "because if seniors can't see the doctor, then a prescription drug benefit is of little value." Leverage Some of the most intense infighting focused on $900 million that was dropped into the bill in the final weeks of debate for hospitals that claim they are disadvantaged by regional wage differences -- the provision that helped the University of Vermont's hospital. Hospital executives in lower-paying areas wanted more money from Medicare, saying they needed the money to retain staff by paying better hourly wages. The Bush administration used the broadly worded congressional guidelines accompanying the $900 million to write a complex set of specifications for hospitals to win a higher wage classification, using geography, population, and income data. When the dust settled and an obscure board in the Department of Health and Human Services issued the list of 121 recipients, many were hospitals in states and districts represented by key Republicans. Among them were two hospitals in the Texas district of Republican Majority Leader Tom DeLay, a member of the conference committee on the Medicare bill. Ten hospitals in Connecticut, home of US Representative Nancy Johnson, another Republican member of the conference committee, also benefited. Pennsylvania, represented by Arlen Specter, a moderate Republican who had crusaded for health care money, had 13 institutions in the victory column. Charles Robbins, a Specter spokesman, said Specter "is always interested in improving hospitals." Johnson's office and DeLay's office did not respond to requests for comment. Also represented were hospitals in a handful of states represented by key Senate Democrats, including Max Baucus of Montana, ranking member on the Finance Committee, and Kent Conrad of North Dakota. Their support, along with that of Vermont's Jeffords, was key to the Medicare bill's passage. Nine Democrats and Jeffords gave the Medicare bill its 54 to 44 margin. In New England, the regulations resulted in about $7.8 million a year for three years for the University of Vermont's Fletcher Allen Health Care medical center, in Burlington -- money the hospital says it can use to pay its workers better, a hospital spokesman said. To squeeze UVM under the umbrella for the benefits, Jeffords, the lone Senate independent and a key supporter of the Medicare legislation, fought to get Burlington, Vt. in the same wage district as Boston and Worcester, according to his staff. It was a renewal of an earlier Medicare provision that benefited the Burlington hospital but was due to expire, the staff said. Jeffords, in a statement responding to the Globe's questions, said he worked to put Fletcher Allen and other hospitals like it "on a level playing field with their urban counterparts." "I voted for this bill knowing it was not a perfect bill, but after so many years, we could no longer afford to keep talking about a perfect bill while letting a good bill slip from our grasp," he said. About 150 hospitals thought they qualified for the higher reimbursements but were frozen out when the money was distributed by the administration. McGinty, the Maine hospital official, thought Maine's hospitals would get $70 million over three years but learned otherwise just before the list was released. "We really don't understand what happened," McGinty said. "We are mystified." Conrad, the North Dakota senator, confirmed in a telephone interview that he and other Senate Democrats negotiated details with the Bush administration on how the hospital wage money would be distributed. He said he was personally given assurances that hospitals in North Dakota would benefit in a telephone call with the Health and Human Services Secretary Tommy Thompson, who was contacting members of Congress to build support for the bill. There was no specific quid-pro-quo in exchange for his vote, Conrad said. But Thompson's assurance, he said, "was certainly a factor" in his support of the bill. In all, nine North Dakota hospitals appeared on the list of 121 hospitals across the country. A spokesman for Thompson, Bill Pierce, said the department did negotiate with members of Congress to set up the detailed specifications for which hospitals would qualify. He said Thompson or other Health and Human Services officials did not get involved with the work of the independent board that awarded the money, called the Medicare Geographic Classification Review Board. "We didn't know those decisions until they were released," Pierce said. Some people said the process looked like it favored certain institutions. "When you look at the distribution of the money, it looks like the regulations were set up to favor some hospitals," said John Thorpe, a Texas health-care consultant who hopped a jet to the Baltimore offices of the Medicare administration to hand-deliver a successful application for a hospital in Wichita Falls, in the district of Republican US Representative Mac Thornberry. The hospital will get $2.2 million over three years. "It's gotten so political it's hard to tell who's on first," Thorpe said. The losers win, anyway Even senators who ended up opposing the Medicare bill worked to include money for their districts. Prominent among them were Massachusetts Senators John F. Kerry and Edward M. Kennedy, who lobbyists said were instrumental in giving a financial lift to Boston's prestigious teaching hospitals. Nationally, teaching hospitals secured $400 million in bigger medical education payments over five years to help train young doctors. Of the total increase, Massachusetts hospitals will receive $22.5 million. To help secure the Massachusetts share, the Coalition of Boston Teaching Hospitals paid $260,000 to a team of lobbyists that included Christopher R. O'Neill, the son of the late House Speaker Thomas P. "Tip" O'Neill Jr. The Boston hospitals worked closely with the Association of American Medical Colleges, which reported $580,000 in lobbying expenses. Kennedy and Kerry defended the provision as critical to the future of medical education. "Considering the overall size of the bill, there was broad, bipartisan support for helping academic health centers," said Andy Davis, a Kerry spokesman. Getting that bipartisan support took some work. A big hurdle, according to lobbyists who worked on the issue, was to convince Representative Thomas, the Republican House Ways and Means chairman, to support the measure. Many of the nation's teaching hospitals are situated in Democratic strongholds like Massachusetts, New York, and Illinois. For them, they key was to identify the few major teaching hospitals in Republican states, such as Texas, that also would benefit from the higher reimbursement rates and get their CEOs to pressure their lawmakers. The Methodist Hospital in Houston and the University of Texas Medical Branch in Galveston were among the Texas hospitals that contacted the office of GOP Texas Senator Kay Bailey Hutchison, who in turn went to bat for the institutions in a Senate floor speech, Hutchison's office confirmed. The teaching hospitals also had to convince the Bush administration to give them the additional money. Dr. Peter Slavin, CEO of Massachusetts General Hospital, and Ellen Zane, now the chief executive of Tufts-New England Medical Center, who at the time was president of Partners Community Healthcare Inc., the physician's network associated with MGH and Brigham & Women's, visited the White House in July 2003 and met with Bush's health-care adviser, Douglas Badger. They brought along executives from teaching hospitals in swing states in the presidential election, Pennsylvania and Ohio. Among their key points: Hospitals had been hit hard by cuts in funding in 1997, and the money needed to be restored. To set up the White House meeting, Zane called an acquaintance whom she had met while serving on the Stonehill College board of trustees, Bush Chief of Staff Andrew Card. The meeting occurred within days after the phone call, Zane said. "We were constantly putting the pressure on everywhere we could," said Dick Knapp, executive vice president for the Association of American Medical Colleges, who coordinated the lobbying effort. "Once CEOs get engaged with their senators, it gets there." Details Lawmakers secured a plethora of smaller expenditures for pet programs, local reimbursement increases, and home-state demonstrations. Democrat Harry Reid of Nevada, who voted against the bill, pushed for and won a $200 million construction loan program for cancer institutes that will benefit an institute that is being built in Las Vegas, a spokeswoman confirmed. The loans will be forgiven for institutes with Native American outreach programs, such as the one at the planned Nevada facility. The Reid spokeswoman, speaking on condition of anonymity, said the Nevada institute is not alone. In all, 10 to 12 other cancer institutes around the country will qualify for forgiven loans under the Native American provision. Alaska doctors, thanks to that state's powerful Republican senator, Ted Stevens, will receive a 50 percent increase in their reimbursement rates, worth about $53 million for the first two years. Brian Gavitt, an aide to Alaska's other Republican senator, Lisa Murkowski, suggested Alaska's delegation was able to wrest the money for their doctors because the expected close vote gave them leverage to make financial demands on Congressional leaders. "They were counting votes, and the Alaska delegation was pretty set on it," he said. A $100 million pilot program for placing computerized patient records systems in doctors' offices emerged in the bill. It said the demonstrations should be set up in four states, and that "one shall be in a state with a medical school with a Department of Geriatrics that manages rural outreach sites and is capable of managing patients with multiple chronic conditions, one of which is dementia." Arkansas is the only state that fits that description. The provision was tailor-made for Democratic Arkansas Senator Blanche Lincoln, a member of the Senate Finance Committee whose support was crucial to the Medicare bill's passage. Other states in line to receive money under the computerization provision are California, Massachusetts, and Utah. Lincoln declined to comment on the program, a spokesman said. Back-room deals Key members of Congress negotiated details of the Medicare Prescription Drug Improvement and Modernization Act of 2003 -- as the 415-page bill was called -- behind closed doors in the joint House-Senate conference committee. The committee operated like the proverbial back room, with heavy-hitting members of Congress determining who got what. Republicans, led by Thomas from the House and Grassley from the Senate, controlled the proceedings. In its first weeks of deliberations in August and September of 2003, Republicans and Democrats on the committee agreed on many provisions, including creation of a Medicare drug discount card in 2004 to give seniors cheaper prescriptions until full drug coverage begins in 2006. But they sharply disagreed on critical provisions, including whether to permit Americans to import prescriptions from abroad and to what extent private insurance companies should be encouraged to compete with the government to cover Medicare recipients. As disagreement grew, the Republicans barred five of the seven Democratic conferees from the room, including all three House Democrats who had been named to the panel, and two senators, Minority Leader Tom Daschle of South Dakota and Jay Rockefeller of West Virginia. That left the lineup on the committee 10 Republicans and two Democrats. It also cleared the way for negotiations on one of the most costly and controversial provisions of the Medicare bill: more money for private health plans. The vast majority of Medicare business is "fee-for-service," in which providers like hospitals and physicians are reimbursed by the government for treatments. The Bush administration wanted to encourage greater participation by HMOs and preferred-provider organizations, or PPOs, based on the conviction that private enterprise and competition would drive down costs. To make that happen, insurance lobbyists insisted, their reimbursement rates would have to be increased. At the old Medicare HMO rates, the industry claimed, insurance companies could not make programs attractive enough for doctors or patients to participate. To emphasize their message, health insurance companies and lobbying organizations (now combined under the name America's Health Insurance Plans) spent $27.8 million lobbying Congress in 2003, according to the Globe's analysis. They hired lawyers and flew insurance industry executives to Washington to meet with members of Congress and their staffs. One part of the effort was a trip by a delegation of health insurance executives from Massachusetts, who met with Kennedy: Charles D. Baker, CEO of Harvard Pilgrim Health Care Inc.; Nancy L. Learning, CEO of Tufts Associated Health Plans Inc.; and Fallon Community Health Plan CEO Eric H. Schultz. "It was mostly around spending levels and reimbursement," Baker said. Baker said he also participated in a second trip to Washington with insurance executives, providing background information to large groups of reporters and government officials, including a briefing at the White House. Learning said the additional money was important to provide lower premiums for the elderly and higher reimbursements for doctors. Karen Ignagni, president of America's Health Insurance Plans, declined to describe details of the association's lobbying effort, other than to say CEOs of major health plans from around the country met "one-on-one" with congressional staff and key decision-makers. In the end, the conference committee gave a big boost to Medicare rates for insurance plans in 2004 and beyond, by an amount now estimated by the administration to be worth $34 billion over 10 years. Republicans also added a $12 billion fund for the administration to offer additional incentives to attract insurance companies to Medicare in regions where they otherwise would show no interest. Republicans called it at "stabilization fund." Democrats led by Kennedy branded it a "slush fund." The Republican efforts to enhance Medicare rates for insurance plans have come at great cost. The Bush administration has identified the extra money for private health plans as accounting for 23 percent of the difference between the original $400 billion estimate on the bill and the $534 billion price tag that was revealed this year. Closed-door deals by the conference committee, Ignani said in a telephone interview, should not shock anyone. "All the major issues are settled not necessarily in the open forums, but by leaders in conference committee, when they get together and decide what they are going to do," Ignagni said. "It's pretty standard operating procedure for the Congress." |

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