Healthcare: Rubes Vs. Rulers

A side-by-side comparison of the leading comprehensive reform proposals from the Kaiser Family Foundation. On offer, in plain English, are the key provisions of the three health-care House bills (“Tri-Committee”), the two Senate bills, and President Obama’s own stated preferences.

Via Robert Bidinotto:

You can also tailor for yourself a document that will compare any or all of the plans – including plans by Republicans and individual congressmen – according to whatever criteria you select, by clicking here.

This site is updated frequently to reflect any changes in the pending legislation.

While rigging the healthcare market for the rubes, here’s what medicine is like for the rulers (or as Bidinotto puts it: “Here is why Congress refuses to participate in the same health-care plan it is about to impose on the rest of us”):

LITTLE KNOWN OFFICE ON CAPITOL HILL PROVIDES QUALITY MEDICAL CARE FOR LOW PRICE
By JAY SHAYLOR and MARK ABDELMALEK

Sept. 30, 2009—

This fall while members of Congress toil in the U.S. Capitol, working to decide how or even whether to reform the country’s health care system, one floor below them an elaborate Navy medical clinic — described by those who have seen it as something akin to a modern community hospital — will be standing by, on-call and ready to provide Congress with some of the country’s best and most efficient government-run health care.

Formally called the Office of the Attending Physician, the clinic — and at least six satellite offices it supports — bills its mission as one of emergency preparedness and public health. Each day, it stands ready to handle medical emergencies, biological attacks and the occasional fainting tourist visiting Capitol Hill.

Officially, the office acknowledges these types of services, including providing physicals to Capitol police officers and offering flu shots to congressional staffers. But what is rarely discussed outside the halls of Congress is the office’s other role — providing a wealth of primary care medical services to senators, representatives and Supreme Court justices.

Through interviews with former employees and members of Congress, as well as extensive document searches, ABC News has learned new details about the services offered by the Office of Attending Physician to members of Congress over the past few years, from regular visits by a consulting chiropractor to on-site physical therapy.

“A member walked in and was generally walked right back into a physician’s office. They get good care. They are not rushed. They are examined thoroughly,” said Eduardo Balbona, an internist in Jacksonville, Fla., who worked as a staff physician in the OAP from 1993 to 1995.

“You have time to spend to get to know your patients and think about them and really think about how you preserve their health going forward,” Balbona said. “We’re not there to put on Band-Aids. We were there to make sure that everything possible that could be done [is done] to preserve that member of Congress.”

Office of the Attending Physician Services

Services offered by the Office of the Attending Physician include physicals and routine examinations, on-site X-rays and lab work, physical therapy and referrals to medical specialists from military hospitals and private medical practices. According to congressional budget records, the office is staffed by at least four Navy doctors as well as at least a dozen medical and X-ray technicians, nurses and a pharmacist.

Sources said when specialists are needed, they are brought to the Capitol, often at no charge to members of Congress.

“If you had, for example, prostate cancer, you would go to one of the centers of excellence for the country, which would be Johns Hopkins. If you had coronary artery disease, we would engage specialists at the Cleveland Clinic. You would go to the best care in the country. And, for the most part, nobody asked what your insurance was,” Balbona said.

In addition to Balbona, several former staff members and private physicians who have consulted at the OAP as recently as last year agreed to talk to ABC News on background. They described a culture centered on meeting the needs and whims of members of Congress, with almost no concern for cost.

Members of Congress do not pay for the individual services they receive at the OAP, nor do they submit claims through their federal employee health insurance policies. Instead, members pay a flat, annual fee of $503 for all the care they receive. The rest of the cost of their care, sources said, is subsidized by taxpayers.

Last year, Congress appropriated more than $3 million to reimburse the Navy for staff salaries at the office. Next year’s budget allocates $3.8 million for the office, including more than half a million dollars to upgrade the Office’s radiology suite. Sources said additional money to operate the office is included in the Navy’s annual budget.

In 2008, 240 members paid the annual fee, though some sources say congressmen who didn’t pay the fee were rarely prevented from using OAP services.

Office of the Attending Physician Would Not Comment

The OAP refused to comment in detail for this story, and Rear Adm. Brian Monahan, the Attending Physician to Congress, did not return phone calls requesting an interview. When ABC News chief medical editor Dr. Timothy Johnson visited the office in person in September to speak with Monahan, he was asked to leave.

After Johnson’s visit, Kyle Anderson, a spokesman for the House Committee on Administration, which partially oversees the OAP, called ABC News and agreed to answer some general questions via e-mail. He refused to discuss the number of staff members who work at the OAP or the type of facilities the OAP makes available to members of Congress.

Requests by ABC News to tour the facility were also denied due to “security sensitivities.”

Anderson said members of Congress are treated by specialists from military hospitals who visit the OAP at no charge. Congressmen are also eligible for free out-patient care at military facilities in the Washington, D.C., area, including Walter Reed Army Medical Center and Bethesda Naval Medical Center.

However, Anderson said, “individual health insurance is required for members to see local health professionals.”

Rep. Kagen Refused Health Care Benefits

Rep. Steve Kagen of Wisconsin — one of 15 medical doctors in Congress — is the only member of either the House or Senate who has no health insurance coverage. Kagen, a Democrat and advocate for health care reform, said he turned down the plan he was offered through the Federal Employee Health Benefits Program.

“I said, ‘I’ll tell you what. I respectfully decline. Until you can make the same offer to everyone that I have the honor of representing, I just don’t think it’s fair,” Kagen said he told the congressional staffer who reviewed the plan with him in 2006.

But while Kagen has touted in campaign advertisements and news interviews that he has no health insurance coverage, he has openly admitted he used OAP services. In January, for example, he paid more than $4,000 out of pocket for outpatient arthroscopic knee surgery. After the procedure, he said, he used the attending physician’s office and staff to assist him with physical therapy.

“It’s one of the, quote, benefits of being in Congress,” Kagen said. “They have physicians and nurses that will see you on the spot, on the beck and call.”

Kagen said he believed the office was no different than the on-site medical clinics at major corporations. “It’s kind of like being at a very large employer, where you have an on-site nurse or an on-site doctor, an on-site capability to get your immunizations or your blood pressure checked.”

Those who have worked at the OAP, however, said the services are far more advanced than what is available at most companies. One former staff member, who asked not to be named, described the OAP as “the best health care on the planet.”

Primary Care

Members of Congress interviewed for this story say they believe the model of ready primary care services offered by the OAP should be expanded nationwide, though few discussed the logistics of how those services could be offered.

Republican Rep. Lee Terry of Nebraska says he does not use the OAP and was unaware of the types of services it offers. “I don’t participate,” Terry said. “But I know there’s an option that you could use them as your, in essence, family practitioner while you’re here.”

Terry is introducing a bill to expand another health care model used by Congress — the Federal Employee Health Benefits Program — to all Americans. The FEHBP is an insurance exchange that allows federal employees to choose health insurance from several options.

Asked if the model of primary care services provided by the OAP should also be included in his legislation, Terry said, “I think that’s a fair question. … [All Americans] should have that, because, frankly, having a physician you can call or contact actually helps drive down costs.”

Yearly Fee

One aspect of the office’s operations which remains unclear is just how the annual $503 fee is determined.

Until 1992, OAP services were free to members of Congress. But after former Sen. Harris Wofford of Pennsylvania angered members by introducing a bill to make Congress members pay market rate prices for using the OAP, a compromise was reached.

Instead of charging for each service, Wofford said, members of the House and Senate agreed to hire independent consultants to determine the average value of the services offered and to use that amount to determine an annual fee.

“We thought of the pricing much like an HMO,” Wofford said of the compromise pricing model. “The attending physician at the time told me he had no interest in handling insurance or billing for each service available.”

But Wofford said the House and Senate committees tasked with determining the fee each insisted on hiring their own consultants, leading to a split pricing system. According to press accounts from 1992, the Senate set the fee at $520; the House fee was set at $263 for the same care. At some point, sources say, the separate rates were scrapped and replaced with the single fee, now set at $503.

The Office of the Attending Physician refused to comment on the fee or why it has not changed significantly in 17 years, despite rampant inflation in all other areas of health care costs.

Anderson refused repeated requests for the Committee on House Administration to provide details of how the rate is determined or who determines it. “Members pay an annual fee determined by an independent actuary for use of the OAP services,” Anderson responded each time he was asked about the pricing model.

Defending the Office

While many former staff members told ABC News they believe the services of the Office of the Attending Physician were often abused by some members of Congress, others, including Balbona, said the office serves a necessary role protecting the legislative branch of the federal government. Balbona said he agreed to talk to ABC News to defend the O.A.P.

“They provide members an accessible, professional place to get services. The alternative would be members going throughout Washington, DC, interrupting their service to our country,” Balbona said. “It’s not a political perk. Much like a medic who’s in combat, it’s not a perk for those soldiers. It’s part of the mission.”

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