Though the first presidential debate was all about foreign policy, healthcare was the battle cry on the streets of Washington, as numerous groups denounced the Bush administration's policies as negligent at best and destructive at worst and an insurance group rallied to defend the president and the new Medicare law.
From children's advocates to senior citizens, a wide array of organizations said the administration had failed to carry out promises made during the past four years.
On Capitol Hill last week, roughly 100 seniors attended a pro-Medicare rally organized by America's Health Insurance Plans, an industry lobbying group. The assembled seniors voiced support for Medicare Advantage plans, which were one of the law's major benefactors.
But the anti-Bush activity was much hotter. At a news conference organized by Vote Kids-a nonpartisan group focused on children's issues-pediatricians issued an open letter criticizing recent tax cuts and budget policies leading to cuts in Medicaid and the State Children's Health Insurance Program.
Speakers also ripped into President Bush and Congress for not acting more swiftly to make sure states can keep $1.1 billion in unspent SCHIP funds that will instead return to the general treasury. According to the speakers, 27 million children went without insurance at some point during 2002-03.
"The words `leave no child behind' ring hollow when so many children are left without," said Joel Alpert, a professor of pediatrics and public health at the Boston University School of Medicine and former president of the American Academy of Pediatricians.
HHS Spokesman Bill Pierce disputes the claims, saying that under Bush childhood vaccination rates reached an all-time high, as did the number of children enrolled in SCHIP. "These aren't America's pediatricians," Pierce says. "These are Democratic pediatricians for John Kerry."
Meanwhile, hundreds of elderly Americans gathered across the street from the White House to protest Bush's Medicare policies and the prescription drug bill he signed into law last year. Those attending the rally, sponsored by the Alliance for Retired Americans, waved sock-covered arms in the air as they chanted anti-Bush rhetoric and heard from a host of Democrats and labor officials critical of the current administration.
"It's time to vote this anti-senior president out of office and put his socks on the road," said Richard Trumka, secretary and treasurer of the AFL-CIO. "He's not going to sock it to us one more day after Nov. 2."
Four trillion dollars is enough money to pay off more than half the nation's total public debt. It is also 10 times the amount Congress allotted for a Medicare prescription drug benefit over 10 years. Even in Washington that's major money.
For that reason, lobbyists and many hospital officials were stunned recently when a rumor published by the Premier hospital alliance stated the federal government could save $4 trillion over 10 years if it revoked not-for-profit hospitals' tax-exempt status.
The House Ways and Means Committee is examining the tax-exempt sector, including hospitals, to determine what they do to earn their favorable treatment from the federal government.
The item published in Premier's Outlook, an electronic newsletter, cited "(Capitol) Hill sources" as saying that Ways and Means is "proceeding with its effort to rein in not-for-profits, especially the healthcare sector."
According to Premier's sources, the Congressional Budget Office and White House Office of Management and Budget estimated how much revenue would be generated by revoking hospitals' tax exemptions. The annual figure: $400 billion annually, or $4 trillion over 10 years.
Not the case, say the offices. No such estimates have been conducted, or even requested by Ways and Means, according to the two budget offices. A Ways and Means spokeswoman says the tax-exempt inquiry is proceeding, but that it is inaccurate and premature to assume hospitals will be targeted. Many analysts and lobbyists said the $4 trillion estimate is astronomically high, but Ways and Means data show not-for-profit hospitals spent $337 billion in 2001. Taxes on that over 10 years would be far from $4 trillion but still would be serious money.
Acting at HHS
Even seasoned Beltway healthcare players are finding it difficult to keep track of the lineup changes at HHS' inspector general's office.
In the latest switch, Acting Inspector General Dan Levinson, who will not be confirmed by the Senate this year because of a shortened congressional calendar and the elections, named Deputy Counsel Larry Goldman to the post of acting principal deputy inspector general, the No. 2 post in the inspector general's office. Government sources and healthcare lawyers applauded Levinson's decision, which he made because of the temporal nature of his title and the importance of having a well-regarded insider fill the post and maintain stability among the agency's 1,500 employees. Levinson reasoned that the current deputy inspectors general should remain in their positions until a permanent inspector general is named.
Goldman replaces Dara Corrigan, who left her post as acting principal deputy inspector general Oct. 1. She was not offered the top post in the office despite a solid track record that drew praise from colleagues, other federal agencies and Capitol Hill. Corrigan had taken over the duties but not the title of former Inspector General Janet Rehnquist.
Since the post is only an acting one, Goldman-who as deputy counsel reported to Lewis Morris, chief counsel to the inspector general-will now supervise his boss, who remains Morris, at least until a permanent principal deputy inspector general is named by a confirmed HHS inspector general, likely to take place next year, sources say.