the state closes Crownsville
Hospital Center, several nonprofit groups on hospital grounds will get a
reprieve from homelessness, at least for a little while.
Nelson J. Sabatini, state secretary of health and mental hygiene, told Anne
Arundel County lawmakers Friday that as long as the state owns the property,
the budget will include $90,000 a year for bare-bones maintenance of the
facility, allowing the county food bank and several treatment centers to
have no intention whatsoever in displacing anyone," Mr. Sabatini said.
General Assembly will have to decide through the budget process this year
whether to close the psychiatric hospital to save $6 million a year. The
assembly's annual session starts Wednesday.
addition to 200 patients and 500 employees, several nonprofit groups are based
on hospital grounds in exchange for minimal rent. They include the Anne
Arundel County Food & Resource Bank, the Second Genesis treatment program,
Hope House treatment program and a private school for troubled teens.
Other groups, like the Chrysalis House treatment center, a nursing home and a
church are linked into the hospital's utility system.
"The intention is we will maintain it and we won't displace any tenants," Mr.
eventually, the Department of Health and Mental Hygiene will give up the land
if the General Assembly endorses the closure. It will take about six months to
move patients to other state hospitals, and then the Department of General
Services can offer the land to other government agencies.
County Executive Janet S. Owens has her eye on the nearly 1,200 acre property,
but said she hasn't decided yet whether it would be in the county's best
interest to take over the land. About 500 undeveloped acres were supposed to
be put in an environmental preservation program, but that has been put on
After the meeting, Alvin Collins, Ms. Owens' chief of staff, said he's worried
the county might be stuck with big bills to modernize or demolish the
buildings scattered on the Crownsville campus.
Sabatini also outlined how the county would benefit from $5 million of the
savings that will be earmarked each year for "community mental health
Frances Phillips, county health officer, will head up a committee with health
officials from nearby counties to recommend how the money could best be spent.
But she already has some ideas, including starting up a round-the-clock
walk-in psychiatric center and adding beds at existing facilities.
said the goal would be to treat more psychiatric patients near their homes
instead of having them committed to the state hospitals.
we really focus on the community, we can do better," she said.
Published January 11, 2004, The Capital, Annapolis,
Norma Winchester, a part-time waitress at the Hilton hotel in Pikesville, had
health insurance until August. Then her hours were cut back, and she no longer
qualified for coverage from her employer.
who lives in Randallstown, checked out individual policies, making several
phone calls and using the Internet, but "they were all more than $100 a month
- not something I could afford." Making up for her lost hours at the hotel,
she takes child-care jobs through an agency, generally one or two days a week,
but that work doesn't provide insurance, either.
2004 could be a decisive year for people like Norma Winchester - the roughly
690,000 Marylanders who don't have health insurance.
group called Maryland Citizens' Health Initiative, chaired by Baltimore health
chief Dr. Peter L. Beilenson, has been working for several years to develop
and build support for a "health care for all" plan. More than 1,000 church,
labor, community and business groups have endorsed the effort.
group's plan was introduced in the legislature last year, but failed to
develop much traction. However, since then, key political leaders have been
talking about expanding coverage as rising health care costs and slow job
growth have increased the problems of the uninsured.
health initiative group says this is the year to pass a comprehensive plan. It
is expected to begin a stepped-up public campaign tomorrow to build support.
Most of the uninsured in the state are adults - 540,000 of them. Over the past
few years, the state has extended free or subsidized insurance to low- and
moderate-income children, including Winchester's
most of the uninsured, like Winchester,
work or live with someone who works. Only 4 percent of the uninsured adults in
Maryland live in a family with no working adult, according to a study released
recently by the Maryland Health Care Commission.
proposal by the Maryland Citizens' Health Initiative group seeks to expand
free coverage for low-income adults, subsidize coverage for those with
moderate incomes and require higher-income individuals to purchase coverage.
It would be financed in theory by an increase in tobacco taxes and a payroll
tax aimed at employers who do not offer health coverage to their workers.
Lawmakers, however, will also consider two other plans with less ambitious
sweep, at least in the short term, but with more certain political backing.
Nelson J. Sabatini, Maryland's
health secretary, says the Ehrlich administration agrees with the goal of
universal health coverage.
However, Sabatini says, the administration will concentrate on incremental
reforms this year, while looking to close the state's deficit. In the future,
he says, the administration will support a package of tax credits and tax
penalties to encourage individuals without health insurance to buy coverage.
John Adams Hurson, the Montgomery County Democrat who chairs the House Health
and Government Operations Committee, argues that the state can't currently
afford to buy or subsidize insurance for all who need it. Rather, he's looking
to shore up "safety net" programs, such as clinics that treat the uninsured.
While the uninsured can get primary treatment at clinics, a study last year in
Baltimore by the Open Society Institute - the public interest and charitable
group founded by billionaire George Soros - determined that the uninsured
often have trouble getting access to specialized care and related services
such as lab tests and prescriptions.
Norma Winchester says that if the state were to offer free or subsidized
coverage, "I'd love to try it."
Early last February, Carolyn Lamb, a 64-year-old office administrator at a
Bethesda school, phoned her husband. She had a headache and felt dizzy, she
told Charles Lamb. Could he come and drive her home?
was job stress, the Silver Spring couple reasoned. Then the
headaches worsened, and Lamb began getting lost in her own home. Within two
months, Carolyn Lamb was dead, believed to be the victim of a brain-wasting
illness known as Creutzfeldt-Jakob disease that affects one in a million
age and symptoms, doctors say, pointed to a strain that is related to -- but
not caused by -- eating beef from animals with bovine spongiform
encephalopathy, or mad-cow disease. No brain biopsy or autopsy was performed,
which would have confirmed the diagnosis. Even after the cause of his wife's
death was recorded with the Maryland Health Department, Charles Lamb said:
"Nobody contacted me. I was surprised."
Since the nation's first known case of mad cow disease was reported -- in a
Holstein in Washington state -- Carolyn Lamb's death has newly worried her
colleagues and friends. They wonder: Did Lamb die from the beef-related
illness after all? The odds against it are overwhelming, but the case points
to the difficulty in tracking an illness that until two weeks ago worried few
in this country.
need to look more closely at [patients] with atypical neurological disease" by
performing more diagnostic tests and autopsies, said Richard Johnson, a
physician who teaches neurology, microbiology and neuroscience at Johns
Hopkins University School of Medicine and its Bloomberg School of Public
Health. "That's a hard thing to get done. . . . But for public health, we
ought to be doing it."
Lamb was an energetic woman who owned a meeting and planning business in Olney
during the 1980s and was active in the town's Chamber of Commerce. After she
and her husband moved to Silver Spring three years ago, she joined the office
staff at the Harbor School, a private elementary school in Bethesda.
Lamb's headaches in February, her husband recalled, were soon followed by
other symptoms. In mid-February, when the region was coping with a blizzard
that stranded many people in their homes, Charles Lamb struggled to help his
wife. "She was so disoriented and confused, she'd get lost walking around the
dining room," he said.
Soon after, Carolyn Lamb went to Johns Hopkins, where doctors diagnosed
sporadic Creutzfeldt-Jakob disease. Like variant Creutzfeldt-Jakob, the strain
of the illness linked to mad cow, the sporadic form is a fatal illness
characterized by an abnormal protein, called a prion, that attacks and builds
up in brain tissue.
cause of sporadic Creutzfeldt-Jakob is unknown. It strikes suddenly, usually
in people older than 40, and kills within weeks or months. The mad cow-related
variant tends to affect people still in their twenties, has a years-long
incubation period and takes longer to progress.
There has been only one case of variant Creutzfeldt-Jakob found in the United
States -- that of a Florida woman who grew up in the United Kingdom, where a
mad-cow epidemic has caused 143 cases of the disease in humans since being
identified in 1996. By comparison, sporadic Creutzfeldt-Jakob has afflicted
586 people in the United States since 1997.
Lamb had never traveled outside the United States. The diagnosis was based on
her age, symptoms, the disease's speed and test results, her husband said. But
to be sure, doctors would have needed to test tissue from Lamb's brain, a
difficult surgery that her husband felt had little point. "They said all we
could do was to keep her comfortable, that it was just a matter of time," he
Carolyn Lamb died March 25. Charles Lamb did not want an autopsy, partly
because the disease can spread to people who have contact with victims'
nervous-system tissue. He said he was afraid that the disease would spread to
people in laboratories and the funeral home that handled his wife's body. He
said, however, that if he had known an autopsy could have helped further
research into prion diseases, "I probably would have said yes."
Prion disease researchers say their efforts to track and discover new strains
of the disease are hampered by a dramatic decline in the number of autopsies
in the United States. Nationwide, autopsies are conducted in five percent of
non-crime-related deaths, compared with 35 percent in the 1960s, according to
the prion disease committee at the Institute of Medicine of the National
Academies, which advises the federal government on public health issues.
congressionally chartered institute said that examining brain tissue is the
only sure way to pinpoint a prion disease. Yet "at least half of the estimated
total number of deaths caused by [prion diseases] in the U.S. are not
autopsied and confirmed by laboratory examination," a new report by the
Even at a research mecca such as Johns Hopkins, only about eight percent of
patients who die are autopsied, said Johnson, who serves on the committee. One
reason: Most health insurance plans won't pay for them.
"You're not going to know what you miss without autopsies," Johnson said. "I'm
concerned that there are other diseases like this out there."
March, a Harbor School newsletter announced Lamb's sudden death. Adding to the
shock and confusion was the rumor that Lamb had died of mad cow-related
illness, said Suzanne Clarke, a former Harbor School teacher.
"Everybody thought that's what it was," she said. When the Holstein in
Washington state was found to have mad-cow disease, Clarke said she grew more
worried. "To kill someone that quickly . . . we should know what this is," she
said. "If someone tried to connect some dots, they would be able to understand
would seem to be the logical thing to do."
Staff researcher Bobbye Pratt contributed to this report.
Urgency: Physicians are leaving the field because of what they see as a
malpractice insurance nightmare. The most extreme example of the situation is
James M. Kramon
Special To The Baltimore Sun
Sunday, January 11, 2004
THIS MONTH - Jan. 21 - more than 1,500 Maryland physicians are set to close
their offices, put on white coats and travel to Annapolis to impress state
legislators with the urgency of medical liability tort reform.
Although the emphasis of the physicians' arguments will concern economic
aspects of medical liability, the presentations are expected to address a
broad range of concerns.
Sharon M. Pusin, president of the Baltimore County Medical Association, makes
the urgency clear: "[Legislators] must be made aware that to do nothing is not
a viable option."
medical liability insurance crisis has reached a point where it is chasing
physicians out of medicine.
most extreme aspect of the situation concerns obstetricians/gynecologists. The
practice of obstetrics, preparation for and delivery of newborn babies, is a
malpractice nightmare. Not only does that practice pose the potential for
profound damage to a person that may last his or her life, but the statute of
limitations for instituting such a lawsuit against a physician (normally three
years) does not even begin to run until a child reaches the age of majority,
which is 18 in Maryland.
other words, a physician who delivers a baby is potentially liable for a
lawsuit - justified or unjustified - for 21 years from the time of delivery.
Almost nowhere in the law, short of heinous criminal offenses for acts
resulting in death, does a statute of limitations exist nearly this long.
result of this situation is not surprising. Numerous OB/GYNs have, in recent
years, left the practice of medicine well before normal retirement age. Others
have expressly limited their practices to exclude obstetrics. It is
commonplace for contracts between OB/GYNs and hospitals to exclude matters
related to the delivery of babies. Parts of Maryland have been without
physicians practicing obstetrics for substantial periods of time and the
future looks worse: Only one graduate of the Class of 2003 at the two
Baltimore medical schools chose OB/GYN as a specialty.
legal profession bears a heavy part of the responsibility for what is
occurring. Lawyers, encouraged by the Supreme Court's approval of attorney
advertising, have, in recent years, had a field day with tort liability. Since
physicians have insurance and deep enough pockets to be interesting targets,
it is difficult for some lawyers to take their eyes off them.
absurdity of a lawsuit against a fast-food restaurant by a customer who spills
hot coffee on himself or against a phone booth manufacturer because a car
jumped a curb and ran through a phone booth injuring its occupant is obvious.
But the absurdity of many medical malpractice lawsuits is harder to see.
five years as general counsel for a Baltimore area hospital that had 185
physicians admitting patients, I saw dozens of malpractice lawsuits. Probably
more than half of them had no reasonable foundation, perhaps a third were
arguable (although I would not have been comfortable instituting many of
these), and a relatively small number were slam-dunk errors.
Some attorneys who institute large numbers of medical malpractice cases seem
to follow the notion that if you throw a lot of mud against a wall, some of it
Unfortunately - and for this I place the blame squarely on the legal
profession - there is little downside for an attorney who files an unjustified
medical malpractice lawsuit. Although recovery of defendants' costs is a
theoretical possibility (as distinguished from the English system where such
costs are routinely recovered), courts in this country almost never award
them. Other than the nominal requirement that a physician certify there is
liability - easily obtained - there is no limitation to filing such lawsuits
other than the good faith of attorneys.
threat of malpractice suits does not affect only careless physicians. The
specter of medical malpractice, particularly the knowledge that a physician
who has done nothing negligently can be sued at any time, utterly warps the
practice of medicine and erodes physician-patient relationships.
First, medical malpractice premiums, particularly in high-risk specialties,
are enormous. In recent years, such premiums have approached and occasionally
exceeded six-figure amounts. In addition, since such insurance is now all but
exclusively sold on what is known as a "claims made" basis, there is an
expensive insurance fee for what is known as a "tail" due at the conclusion of
a physician's practice. The economics of medical malpractice insurance are
untenable for many physicians, but they are not the worst result.
medical malpractice lawsuit, win or lose, is for many physicians the worst
experience of their lives. Every lawyer who has represented physicians in such
cases has had clients quit medicine, including some who have been found to
have no liability. Months and, not infrequently, years of obsession with a
lawsuit, dozens of phone calls and visits to one's lawyer, reviews of charts
and other documents, depositions, discussions with colleagues, constant
reminders of the lawsuit in other contexts, second-guessing, days of lost work
time, and sometimes a full-blown trial, are too much for many to endure.
Because physicians work in this environment every day, the practice of
"defensive medicine" has become commonplace. Any physician will tell you that
defensive medicine is lousy medicine, but the medical malpractice situation
leaves no choice.
Numerous physicians have told me that they spend upward of 50 percent, and in
some cases as much as 90 percent, of their time engaged in defensive-medicine
activities. A neurologist told me recently that more than half of the tests he
prescribes for patients would not be prescribed if he were not preoccupied
with liability concerns.
economic cost of such measures is extraordinary, and the disruption of
physician-patient relationships is immeasurable. When a physician is forced to
look at a patient as a source of potential liability, he cannot easily look at
that patient as someone he wishes to help in every possible way even if, as is
often the case, risks must be taken.
Some years ago it was thought that mandatory health claims arbitration was the
answer to this problem. But it was not. In most instances, a more complicated
legal system does little to discourage malpractice cases.
Medical liability tort reform must do two things. It must reduce potential
liability in ways that will not preclude a deserving claimant from achieving
reasonable success in a reasonable amount of time.
This can be done by shortening the statute of limitations in situations like
that of OB/GYNs, capping damages so that they are reasonable and within the
limits of insurance coverage, and curtailing attorneys' fees so there is not
an enormous windfall incentive - one large enough in fact to pay for primetime
television advertisements - to bringing lawsuits.
addition, something must be done to eliminate the shooting-fish-in-a-barrel
aspect of medical malpractice litigation. An attorney who brings an
unjustified malpractice suit against a physician, like anyone who recklessly
undertakes any form of action that portends harm to someone else, should be
answerable for doing that. The legal system is capable of distinguishing
arguable and inarguable cases. There is all the difference in the world
between a fairly arguable case - even if not successful - and an outright
Residents Applaud Fiscal Curbs but Worry About Schools
Craig Whitlock and Claudia Deane
Sunday, January 11, 2004; Page A01
Robert L. Ehrlich Jr., Maryland's first Republican governor in a generation,
has earned remarkably strong plaudits after his first year in office from
residents impressed as much by his personality as by his policies, according
to the latest Washington Post poll.
Marylanders gave Ehrlich especially high marks for such character traits as
honesty and also said they liked his efforts to restrain government spending
and promote economic growth. The statewide telephone poll of 1,000 residents
also found that almost six in 10 people favored his signature policy proposal:
legalizing slot-machine gambling at racetracks.
the same time, those surveyed were hard-pressed to identify any major
accomplishments by the governor, who watched most of his legislative agenda go
down to defeat last year in a General Assembly controlled by Democrats.
"he's what political scientists call an 'attractive candidate,' " said Donald
F. Norris, a professor of public policy at the University of Maryland
Baltimore County. "He just has one of those personalities that people like.
People may disagree with his policies, but he still seems like the kind of guy
who they can like."
With the assembly scheduled to convene Wednesday, more people listed education
as the biggest problem facing Maryland: Fifty-five percent of those surveyed
said they wanted Ehrlich and the legislature to make it their highest
similar percentage said they would be willing to accept tax increases, if
necessary, to deliver the state from its chronic budget problems and to pay
for a landmark $1.3 billion school-funding plan that a several legislators
have said is unaffordable.
the same vein, the poll, conducted last week, found that Marylanders are
overwhelmingly opposed to spending cuts in education and other programs in
order to solve the state's financial ills, something Ehrlich has threatened to
do if the assembly again rejects slot machines.
cannot afford to cut any funds that go to schools," said Jacqueline Rousseau,
49, a federal employee from Silver Spring who calls herself an independent.
"That's just not an option that's on the table, in my opinion. If we have to
pay more in taxes, none of us wants to do that, but it may be one of the only
options we have."
Already, there are deep divisions among Maryland lawmakers over whether
legalized gambling, higher taxes or spending cuts are the best way to close
the $700 million budget gap in next year's budget and solve the state's
long-term financial problems.
Unlike their counterparts in Virginia, who return to Richmond this week to
debate a detailed plan for restructuring the state's tax code, Maryland
lawmakers have no clear road map for the three-month session. Democrats say it
remains to be seen whether Ehrlich can capitalize on his personal popularity
to win legislative support for his agenda.
Although a majority of residents surveyed credited Ehrlich with improving the
quality of schools in the state, education was a weak point for the governor
compared with almost every other major issue. Relatively few people said they
wanted lawmakers to focus their energy on building roads or bringing slot
machines to Maryland, two of Ehrlich's most visible policies.
Unlike people nationwide, Marylanders generally view their state's economy as
strong, with 63 percent classifying it as "excellent" or "good." In
comparison, a nationwide poll conducted by The Post and ABC News in late
December found that 42 percent gave the U.S. economy the same ratings.
Maryland's optimism on the economy may help explain President Bush's strong
showing in last week's poll: a 55 percent job approval rating, which compared
favorably to the 40 percent of the state's vote he received in the 2000
Overall, Maryland residents are far more upbeat about conditions than they
were prior to Ehrlich taking office, with 57 percent saying the state is
headed in the right direction, compared with 42 percent in an October 2002
Post poll of likely voters.
Ehrlich narrowly defeated Lt. Gov. Kathleen Kennedy Townsend (D) with 52
percent of the vote to become the first Republican elected governor of
Maryland since Spiro T. Agnew in 1966. Since then, his popularity has
increased in a liberal-leaning state where registered Democrats outnumber
Republicans 2 to 1.
With 62 percent of Marylanders approving of the job he has done, Ehrlich is
held in much higher esteem than his Democratic predecessor, Parris N.
early 1995, as Glendening finished his first year battered by a pension
scandal and a fight over building stadiums, polls put his approval rating in
the mid-30s. That figure rose above 50 percent before his 1998 reelection but
plunged to 37 percent in the final months of his tenure, Post polls showed.
While Ehrlich predictably polled strongest among Republicans, 63 percent of
self-described independents and 50 percent of Democrats said he was doing a
good job. The governor even received a 54 percent approval rating from black
residents -- a bloc that voted heavily for Townsend even though Ehrlich's
running mate, Michael S. Steele, was African American.
the poll, his support was weakest in the economically struggling city of
Baltimore, a traditional Democratic stronghold. It was highest in a swath of
central Maryland, including the increasingly affluent suburbs of Anne Arundel,
Frederick, Howard and Baltimore counties, among others. Residents in Prince
George's and Montgomery mirrored the state figure of 62 percent.
Ehrlich appears to be cashing in on his charisma. Though he is a lawyer with
an Ivy League education, the governor stresses his roots as the son of a car
salesman from a blue-collar Baltimore suburb. He is a frequent guest on radio
talk shows, in which he presents himself as an average guy named Bob
predisposed to get along with anyone.
don't always agree with what he says, but he seems to me to be sincere," said
Olga Fosler, 66, a registered Democrat and clerical worker from Baltimore who
voted for Ehrlich in 2002. "He's not a razzle-dazzle speaker. He says, 'This
is the problem' or 'This is the circumstance,' and it seems to me that what he
says is the truth."
"They seem very human," Fosler added in describing the governor and his wife,
Kendel. "I can relate to them in that regard."
significant number of people who don't like the job Ehrlich is doing said they
can't help liking him personally. Among those who disapprove of his
performance, three in 10 still have a "favorable" view of him.
Ehrlich also outshines the two Democrats who are considered his chief rivals
for a second term: Baltimore Mayor Martin O'Malley and Montgomery County
Executive Douglas M. Duncan, neither of whom could match his name recognition
or favorability ratings.
Although the GOP has high hopes for building on Ehrlich's historic win in
2002, the survey suggests that Republicans have little chance of knocking off
incumbent Sen. Barbara A. Mikulski in November.
those surveyed, 65 percent said Mikulski deserved to be reelected. Her leading
competitor, state Sen. Edward J. Pipkin (R-Queen Anne's), is a virtual
unknown, with 87 percent reporting that they didn't know enough about him to
have an impression of him.
a telephone interview, Ehrlich attributed his high ratings to his persistence
in trying to fulfill his campaign promises. Among them: pledges to resist tax
increases, push for slots and build a long-planned highway between Montgomery
and Prince George's.
"We've kept our word," he said. "In Maryland politics and national politics in
this era, you get extraordinary credit for keeping your word. Most
importantly, people understand I am following through on what I said and that
words do count. There's a consistency there."
Ehrlich remains popular despite last year's legislative session, when the
assembly bottled up most of his policy proposals. The House of Delegates
killed his slots bill, the Senate refused to confirm his candidate for
environmental secretary and neither chamber agreed to his legislation
toughening penalties for gun crimes.
Leading Democrats have lately been criticizing Ehrlich as a do-nothing,
Indeed, with one year under Ehrlich's belt as chief executive, the poll found
that 49 percent of people couldn't name a single major accomplishment by the
Duncan, who has tangled with Ehrlich on slots and other issues, said the
governor is popular primarily because he's still a novelty.
Voters "wanted a change in the last election, and that's what they got,"
Duncan said. "The challenge Ehrlich is going to have is showing people what he
stands for. Other than gambling and building the intercounty connector,
there's nothing really there."
Indeed, when it comes down to whom the public wants running the government,
Ehrlich doesn't have an advantage over the state's Democratic leadership.
When asked whom they trusted more to cope with the state's problems, those
surveyed sided with Democrats in the legislature over Ehrlich by 44 to 41
percent. The poll's overall results have a margin of sampling error of plus or
minus 3 percentage points.
Alan Gann, 64, an electrical engineer from Chevy Chase, said he voted for
Ehrlich in part because Maryland had been controlled by the Democrats for too
"He's a fresh face," said Gann, a registered Democrat. "I think the trouble
with being in a state where you have one party dominating state politics is
that you don't get enough fresh air in the process. So he certainly brings
Although Gann said he was willing to cut the governor "a little slack" while
he is learning the ropes, he added that he was reserving judgment on Ehrlich.
"I don't think he's been in long enough to say with certainty that he's done a
good job, or a bad job."
Director of Polling Richard Morin contributed to this report. Complete poll
results can be found at www.washingtonpost.com/metro.
Two-thirds of respondents would pay higher sales tax to improve education;
Half conditionally support slots; Ehrlich remains adamant in opposing new
Sunday, January 11, 2004
More than two-thirds of Maryland voters say they would be willing to pay an
additional penny sales tax for improving schools, despite the staunch anti-tax
stance being taken by Gov. Robert L. Ehrlich Jr., a new poll for The Sun
released today shows.
close the state's projected $736 million budget gap - an ever-higher priority
for those surveyed - a majority of voters oppose just putting programs on the
Instead, more than one-third say it should be accomplished only by raising
taxes; 20 percent say tax increases and program cutbacks must be done in
tandem to get the job done.
Half of Marylanders still support bringing slot machines to the state -
Ehrlich's biggest legislative priority, and failure a year ago - but more than
seven in 10 want them confined to specific locations such as racetracks or
Even if slot machines are approved, voters overwhelmingly said, they don't
want millions of the dollars raised to prop up the horse racing industry.
Maryland Poll, conducted for the newspaper and Sunspot.net by Bethesda-based
Potomac Inc., depicts some of the complex choices facing the General Assembly
as it convenes Wednesday for its annual 90-day legislative session.
just don't think people would be opposed to another one-cent tax," said
Frances Snyder, a retired Baltimore County bookkeeper. "I hate to see programs
cut, especially education and cleaning up the bay."
Budget issues, which have emerged as a top concern after barely showing up on
voters' radar just two years ago, remain the second-leading concern of state
residents, running close behind worries about the quality of public schools.
Taken together, nearly half of likely voters feel these are the biggest
problems facing the state, the ones people most want the governor and the
legislature to take up in the next three months.
Other issues such as crime, the economy and the environment trail far behind
in the single digits.
poll of 1,200 likely voters was conducted by telephone Jan. 2 though Monday.
It has a margin of error of plus or minus 2.8 percentage points.
"The overwhelming message from voters is that education and the budget are
dominant concerns, and everything else is pale in comparison," said Keith
Haller, president of the polling firm. "Of all the possible ways to increase
revenue at a time of a budget crisis, the sales tax is unquestionably the most
'Willing to sacrifice'
Ehrlich "has put his position in the sand," Haller added. "He's basically
saying no taxes whatever. You don't want to come across as incorrigible, as
insensitive when people are willing to sacrifice to deal with the budget
crisis to make sure education and other critical concerns are at least taken
the governor isn't budging from his opposition to the sales tax, a position
which he hasn't wavered from since his days on the campaign trail.
"That's the first number I've ever seen that would be that lopsided that would
favor a sales tax increase. It's the most regressive major tax we have,"
Ehrlich said last week. "It's not going to happen, is the bottom line."
Timothy Tarr, a 51-year-old Gaithersburg engineer, is a Republican who voted
for Ehrlich in 2002. He is not typically a proponent of higher taxes, but he
does want to see quality public schools in Maryland. He would like to see the
state's $1.3 billion landmark public schools reform initiative, known as the
Thornton Plan, put in place, a plan that some elected officials have warned is
in jeopardy without new dollars.
Republican governor wants to pay for it, in part, with slot machines and has
warned that the plan will have to be slashed without additional gambling
revenue. Democratic House Speaker Michael E. Busch said a one-penny sales tax
dedicated to the plan is a preferable source.
Many voters agree with Busch, according to the poll, and he said he is not
surprised at the results now that people have had a year to see "what's at
stake and have seen the alternatives."
concept even has a majority of support among Ehrlich's base: 52 percent of
Republicans surveyed support the penny tax, as do 56 percent of those who say
they plan to vote for Ehrlich if he runs for re-election in 2006.
Tarr, a supporter of slot machines and casinos in Maryland, said he still
thinks the sales tax might be the solution to the financial crunch facing
the end of the day, if there's no other way to do it, that's what we have to
do," Tarr said. "What are we if we're not an educated people? We can't go
through life selling each other hamburgers."
Marylanders, on average, each pay $873 in sales, alcohol, cigarette and other
levies, according to the state Department of Legislative Services. That's 40th
in the country. The U.S. average is $1,099 per person. The state's 5-cent
sales tax is a penny lower than most of its neighbors'.
William Cartwright, who works for Constellation Energy at the Calvert Cliffs
nuclear power plant, said in lean times, government should cut back from
"steak to hamburger," not go out and raise taxes.
his business, he has "found all sorts of interesting ways to save money and be
more efficient. I think there are tons of way to do that in government," the
50-year-old Solomons man said. "When a corporation has a bad year, everyone
has to tighten up their belts a little bit. I don't see the same out of
government. We've built in a lot of extras."
Snyder, the 76-year-old retiree, said she doesn't understand the hard-line
stance Ehrlich is taking against raising taxes, especially in the face of the
shortfall. "He's being really stubborn," she said.
Parkville resident Charles Hutton, a 36-year-old health care information
analyst, worries about budget cuts that could go too deep if some taxes aren't
cutting programs, it's costing a lot of jobs," he said. "In order for the
economy to get well, you need to have consumers. I'd rather have a multitude
of people pay taxes than see 10,000 people lose their jobs."
Paul E. Shurick, a spokesman for Ehrlich, said polling he has done shows a
different result, that people prefer program cuts over tax increases.
have seen other recent polls that provide a very different answer to that
question, and the governor hears every day from members of the public who
overwhelmingly ask the governor to oppose raising taxes," he said.
Maryland is still a fairly progressive state, the poll shows. Nearly six in 10
voters said they favor protecting the environment, even if it costs some jobs,
over bolstering the economy, even if it hurts the environment. And many
Republican voters, who are conservative on fiscal and tax issues, feel that
way about the environment.
More than half of voters said they support the death penalty, though less than
half would extend it to people convicted of crimes committed when they were
minors - a question prompted by the recent trial of Washington-area sniper Lee
Boyd Malvo, 17 at the time of the crimes, who was tried in Virginia because
Maryland doesn't execute minors. A jury recommended life in prison.
the question of civil unions for gay and lesbian couples, 50 percent of voters
said they oppose them and 40 percent favor them.
year into his term, meanwhile, Ehrlich's job approval remains quite high. A
year ago, 56 percent of voters predicted in the Sun's poll that the former
congressman would do a "good job," while 21 percent said they thought he would
do a "poor job."
Even with Glendening
This year, he still enjoys a 56 percent job approval rating, with 28 percent
approval numbers equal the highest that voters gave his predecessor, Parris N.
Glendening, over the last four years of his term in office.
looking beneath the surface, voters are not as supportive of the governor when
asked how he is doing more specifically. Asked how he is handling the budget
shortfall, for example, 50 percent have a negative opinion of Ehrlich. When
asked how he is "changing the tone in Annapolis," one of his campaign
promises, only 36 percent of voters have a positive view of how he is doing -
20 points lower than his overall job approval.
"Ehrlich has gotten through his first contentious year as governor with his
personal popularity intact," Haller said. "On the flip side, if he doesn't
effectively address the state budget or if his dealings with Annapolis come
asunder, there will be danger signs for his popularity going forward."
Looking ahead to 2006 - an eternity in political time - a hypothetical
gubernatorial match between Ehrlich and potential Democratic challenger
Baltimore Mayor Martin O'Malley is a statistical dead heat.
It's a tossup in the Baltimore region, with city voters behind O'Malley in a
big way and Baltimore County narrowly going for the homegrown Ehrlich. The
Washington region would go to O'Malley, the poll suggests. Montgomery County
Executive Douglas M. Duncan, who has also talked about a run for governor, is
10 points behind Ehrlich at this point if they were to go head-to-head.
Garrison Still, a 48-year-old electronics engineer from Bel Air, voted for
Ehrlich in the last election and would probably do so again. "He's very
smooth," Still said. "I can see some things he's doing right."
Sun staff writers Johnathon E. Briggs and David Nitkin contributed to this
Clashing interests imperil hopes for gambling bill
Sunday, January 11, 2004
Tavern owners want a chunk of the action. So does the state fair in Timonium.
Casino interests are sniffing around.
With the legalization of slot machines an unsolved riddle in Maryland, the
debate over expanded gambling has devolved into a battle royal among special
interests since the General Assembly last considered the issue.
lawmakers ready for a return to Annapolis this week, eyes remain fixed on
House Speaker Michael E. Busch, the leading critic of slots, who some believe
might be surreptitiously scuttling Gov. Robert L. Ehrlich Jr.'s top priority
by allowing competing forces to gnaw it to death.
Slots will once again be a dominant issue in the capital as 47 senators and
141 delegates convene Wednesday for the start of Maryland's 418th General
Assembly session. Lawmakers are hungry for a long-term financial solution for
the state's expensive commitments to public schools, health and other programs
that have created projected budget deficits for the foreseeable future.
there's little sign that such a solution will come easily, if at all.
Ehrlich must, by law, submit a balanced budget by Jan. 21 that closes a $736
million gap between projected revenues and expenses. The $22 billion spending
plan will cut heavily into some state programs, with no new money from sales
or income tax increases - or from slots, which could take 18 months or longer
to start delivering proceeds to state coffers.
Future years of a school funding program known as the Thornton Plan aren't
possible without gambling, Ehrlich says, infusing the debate with tension.
has ruled out sales or income tax increases.
a first-year speaker, Busch single-handedly killed the governor's signature
slots-at-racetracks initiative last year, becoming a champion of gambling
opponents and a goat to others horrified that a delegate from Annapolis could
derail plans of a popular governor.
Over the summer, a House committee studied gambling, as Busch publicly
considered alternatives that he said would not unjustly enrich track owners
and would offer the best return for the state. That amounted to an invitation
for businesses that could benefit - from taverns to resorts that could house
the electronic gambling devices - and they have responded enthusiastically.
Opponents think the wider interest could sink the slots bill that the governor
says he intends to submit. Gambling forces will find it difficult to forge a
successful plan this year, said anti-slots lobbyist W. Minor Carter, because
of "greater fragmentation" among various interests.
"The casinos, the bar people - everybody's got their own proposal," Carter
Some Annapolis observers wonder whether the complications are the deliberate
creation of a speaker who wants to kill the bill again.
get all kinds of mixed messages from the House," said Democratic Sen. Patrick
J. Hogan of Montgomery County, vice chairman of the Budget and Taxation
Committee. "If it's by design, I don't understand what the endgame is."
Busch said he does not intend to use his full influence to defeat the proposal
this year. He prefers a sales tax increase to pay for public schools and
considers slots an unreliable income stream that preys on those least able to
mission is to bring some kind of conclusion to this issue," Busch said. "It's
clouded things for too long. I am not going to advocate for a bill, but I am
to going to let each legislator vote their conscience."
Ehrlich says he is able to compromise if Busch will. "If he wants to do a
deal, we can do it in an hour," Ehrlich said.
According to a poll conducted for The Sun, state voters are divided on where
slots should be. Thirty-nine percent favor confining them to racetracks, while
32 percent support specially built facilities away from urban areas, and 16
percent like tourist destinations such as the Inner Harbor.
a negotiation is ultimately successful, it will be a combination of every
option there," Ehrlich said.
Voices representing those options and others are clamoring to be heard.
Prince George's County, influential U.S. Rep. Albert R. Wynn is asking
lawmakers to band together to fight for community interests. He is advocating
casinos at the National Harbor project along the Potomac or at similar
point is that a major hotel complex with a concert hall and high-end
restaurants is much better than just throwing slots in a pre-fab barn
somewhere," Wynn said. "It doesn't create permanent jobs."
Fearing their business will be cannibalized, bar owners have drafted their own
plan. They want 5,000 slot machines at larger facilities and 5,000 divided
among taverns that already have Keno.
Such an expansion of gambling is repugnant to some, but Joseph A. Schwartz
III, the lobbyist for the Maryland State Licensed Beverage Association, calls
it practical and fair. "I want my client to come out a winner," he said. "I
either want my plan, or no plan."
Some fault Ehrlich for allowing confusion to reign. Critics say the governor
has not been willing to dig into the details of the debate. He wasted the
summer months in campaign mode, they say, traveling the state.
it didn't pass on the last day of the session, we should have worked on it the
day after that, and the day after that, and the day after that," said Senate
President Thomas V. Mike Miller, a slots supporter who has pledged to pass
Ehrlich's plan as his chamber did a year ago. "To solve the crisis, people
need to work around the clock. And that hasn't taken place this summer."
Ehrlich played down the need to work on slots, saying he has been waiting for
Busch to yield.
Miller's credibility on the slots debate has been clouded by an FBI
preliminary inquiry into $225,000 in donations received by a national
political organization that he oversees from a group headed by Pimlico and
Laurel track owner Joseph A. De Francis, a potential beneficiary of slots
last year, Maryland politics suffers from heightened partisanship. A
Republican governor and a Democratic-controlled legislature have yet to figure
out how to get along.
mood will be set early, when the Assembly attempts an override of
gubernatorial vetoes, which hasn't happened since 1989. Those votes will set a
bitterly partisan tone that could endure for 90 days.
much is expected of lawmakers. The second year of a four-year term is widely
considered the most productive: Newcomers have worked out their jitters, but
the next election is still three years off. "Traditionally, the closer you get
to an election, the harder it is in this environment to do any major things
that involve tax changes," said William S. Ratchford II, former head of the
state Department of Fiscal Services.
might be hard to tell, but slots won't be the only issue in Annapolis this
year. Lawmakers face important decisions in a variety of other areas.
After campaigning on a promise to end traffic gridlock, Ehrlich has identified
a $300 million yearly unmet need in transportation funding but has not
developed a plan to close it.
More than a month ago, a high-level commission headed by former Transportation
Secretary William K. Hellmann set the goal of raising $300 million a year to
replenish the depleted Transportation Trust Fund. But the panel punted on the
issue of how to raise the money, instead presenting Ehrlich with a "menu" of
options including increases in the gasoline tax and vehicle registration fees.
far, the governor has yet to announce a decision on what mix of
revenue-raisers - if any - he will propose. Some leading transportation
advocates are getting anxious.
package will emerge, and the administration will play a major role," Ehrlich
year after the Senate rejected Ehrlich's original nominee to head the
Department of the Environment - dealing the Republican administration its
first major defeat - the governor will bring forward acting Secretary Kendl P.
Philbrick has spent the past 10 months wooing both environmental activists and
Democratic lawmakers. Despite some lingering skepticism about his mostly
corporate background, he appears to have captured enough support to win
Philbrick will be helping the administration pass a $30 surcharge on the bills
of municipal water users to raise tens of millions of dollars to upgrade
sewage treatment plants and cut harmful nutrient pollution into the Chesapeake
administration is also pushing for changes to existing programs aimed at
reducing nutrient runoff from agriculture and encouraging cleanup and
redevelopment of polluted industrial sites called brownfields.
Social, justice issues
the aftermath of a Massachusetts Supreme Court ruling, lawmakers will consider
the legalization of gay marriage or civil unions in Maryland.
Abortion critics are pressing for more stringent restrictions on abortion
clinics, which they say should be subject to the same licensing requirements
as other outpatient surgery facilities.
bill sparked in part by the 2002 starvation and beating death of 15-year-old
Ciara Jobes by her court-appointed guardian would revise the law terminating
parental rights in cases of abuse and neglect.
Other measures will seek to ban the sale and possession of assault weapons and
alter the death penalty in Maryland by eliminating local differences in
Sun staff writers Greg Garland, Michael Dresser, Howard Libit and Kimberly A.C.
Wilson contributed to this article.
1990, when the federal government designed a surveillance system to detect mad
cow disease, scientists said the tests would find one case of the disease if
there were 45 infected cattle in the country.
Nineteen days ago, for the first time in this country, one case of mad cow
disease, or bovine spongiform encephalopathy (BSE), was spotted.
"Given that the United States has an adult cattle population of approximately
45 million, if we did have BSE in this country at the one-in-a-million level,
we could assume that we would have 45 infected animals," says a Department of
Agriculture Web site describing the surveillance program. But no one knows if
that is actually the case.
Still, the discovery of an infected Holstein cow in Washington state points
inexorably to the possibility that there are undetected cases in the U.S.
herd, which would have major political, economic and public health
Determining the exact number of infected animals will be difficult, perhaps
impossible. Unlike countries that test all slaughtered animals, the United
States tests a tiny fraction of the 45 million animals thought to be at risk
-- 20,526 tests were conducted last year -- leaving experts with more
questions than answers.
until the Wednesday before Christmas, we have not in this country felt that
getting those answers warranted the costs," said Barrett Slenning, an
associate professor in dairy production medicine at North Carolina State
University. "My guess is that is going to change quite quickly."
Epidemiologists and statisticians say the infected Holstein raises a flag that
could indicate there are two, 10 or even 90 infected animals in the United
Holstein might also be the only infected animal, but that would mean the tests
-- which sample fewer than one in 2,000 adult cattle -- spotted the only
needle in a very large haystack.
"This is a surveillance testing system," said W. Ron DeHaven, USDA deputy
administrator and chief veterinary officer, in a recent briefing. "It is not
intended to determine whether every animal that goes to slaughter has the
Different assumptions built into the surveillance program lead to different
answers as to how many animals might be currently infected, statisticians say.
example, the 20,526 tests conducted last year focused on visibly sick or
"downer" animals -- cattle too sick or old to walk. The surveillance program
assumes that if there were 45 infected animals, all would be among this
that is wrong and tested animals have the same risk of BSE as the rest of the
45 million adult cattle, finding a single case could imply that 90 animals in
all have mad cow disease in the United States, said Joshua Cohen, a senior
researcher at the Harvard Center for Risk Analysis, whose analysis of mad cow
disease government officials have repeatedly cited.
Even if most of the risk for mad cow disease is confined to downers -- which
were banned from the food supply Dec. 30 -- then it "seems likely that there
is at least one other animal with clinical BSE in the U.S," said Cohen, an
expert in applied mathematics and statistics.
the number of cattle at risk is even smaller -- say, only those downer cattle
imported from Canada before a 1997 safety ban on infected feed was instituted
-- then the number of infected animals in the United States "may be very small
indeed" said Cohen, explaining how different assumptions lead to different
answers. The 61/2-year-old infected Holstein was imported from a farm in
Alberta, the province where a Canadian beef cow was discovered to have mad cow
disease last May.
order to extrapolate how many animals might have disease, you would need to
make assumptions what their risk would be," Cohen said.
the untested animals had one-quarter the risk of the tested animals, "maybe
the total number of infected animals is 10 to 12," Cohen said. "This animal is
probably not the only one -- you wouldn't want to bet on it being the only
Government officials insist the nation's food supply is safe, because tissues
known to transmit the infection are kept out of the food supply. And they
believe that mad cow disease in the country is extremely rare. But scientists
agree that there are too many assumptions in the surveillance system to draw
one knows, for example, how many downer cattle entered the food supply in past
years; estimates hover around 200,000, meaning that only one in 10 was tested.
That is because, in 1990, when no one knew whether mad cow disease was in the
country, it was considered a waste of resources to test more.
the 45 hypothetical cases were evenly distributed among the 45 million adult
cattle, finding one case would have required 3 million annual tests, said
Victoria Bridges, a veterinary medical officer and epidemiologist with the
USDA in Fort Collins, Colo. So officials narrowed their search to visibly sick
and downer cattle.
That made the job easier.
you had 45 infected animals and all 45 are in that at-risk population, how
many samples do you have to take to find the disease?" Bridges said.
answer was about 12,500 tests. In recent years, USDA officials have conducted
more than that -- last year, it was 20,526. The larger number increases the
likelihood that disease will be spotted even if it occurs only at a low rate
but falls far short of a system that can actually count cases.
infected Holstein is a cautionary tale about the risks inherent in the
assumptions: If some animals with early stages of mad cow disease appear
healthy, they could escape detection.
Although government officials said the infected Holstein was a downer, Tom
Ellestad, a manager at Vern's Moses Lake Meats, where the cow was slaughtered
Dec. 9, said he remembered the animal standing, even walking. But even if
government records showing the Holstein was a downer are accurate, officials
insist the animal showed no clinical signs of disease.
Showing how difficult it is to visually identify mad cow disease, veterinary
officials confirmed after the Holstein was slaughtered that there was damage
in its pelvic canal -- consistent with a birthing injury it had suffered.
While tissues from the Holstein's brain were tested for mad cow disease,
officials assumed the animal was a downer because of the birthing injury and
saw no reasons to keep the meat out of the food supply.
weeks later, however, after the meat was shipped to several states and Guam,
the results came back positive for BSE, and officials ordered a recall "out of
an abundance of caution." By then, an unknown quantity had been consumed.
DeHaven said the surveillance system worked perfectly to answer the question
for which it was designed -- whether mad cow disease exists in the country.
a new tool will be required to find out how many animals are infected.
"Every statistical procedure is a special kind of screwdriver," said N.C.
State's Slenning. "It is designed to answer one particular question. If you
use it to drive nails, you can get something done, but it won't do a very good
job of it."
that Congress has enacted a Medicare prescription drug bill, Republicans and
Democrats -- and their allies -- are pursuing aggressive campaigns to mold
public opinion about whether the new law will help or hurt people who rely on
month after President Bush triumphantly signed the Medicare legislation, top
administration health officials are planning an advertising blitz and speaking
tours to promote the law during the election year. House Republicans have
produced marketing materials that lawmakers are handing out to their
Foes of the Medicare changes have mobilized with equal vigor. Democratic House
members convened five dozen town hall meetings around the country last month
to spread their objections to the law; their Senate counterparts are
scheduling dates when they plan to present particularly loud criticism.
Families USA, which opposed the legislation, is producing a film, to be
narrated by Walter Cronkite, that will be part of a Medicare road show the
consumer health lobby plans for the spring.
yesterday's Democratic weekly radio address, Wisconsin Gov. Jim Doyle said,
"Instead of using Medicare's enormous bargaining power to get the best
discounts for our seniors, American taxpayers and seniors will be forced to
foot the bill for greater drug company profits."
Such intense advocacy is commonplace when important bills are pending in
Congress. But lawmakers, scholars and policy analysts said they could not
recall any modern precedent for public relations efforts of this scale after a
major social policy has become law.
Those efforts attest to the stakes that both parties attach to Medicare for
the 2004 election, as they vie to own an issue that is of vital importance to
senior voters, a crucial voting bloc. The parties' eagerness is heightened by
polls showing that public opinion is divided over the issue -- and remains
another sense, the bitter aftermath is a perpetuation of the partisan passage
of the law. Medicare has long been identified as a Democratic issue. But this
time, it was the GOP that championed an unparalleled expansion of a vast
entitlement program, while most Democrats -- frozen out of any role in shaping
the bill's final form -- opposed it.
"There's a whole lot of political cross-dressing here," said Robert D.
Reischauer, president of the Urban Institute, a Washington-based nonpartisan
research organization. "It appears that the Republicans have stolen the
is very different when each party is trying to take a victory lap than when
you have one party throwing a lot of mud on the victors as they run around the
track," said Norman Ornstein, congressional scholar at the American Enterprise
Approved by Congress in late November, the Medicare law will produce the
largest expansion in the history of the program, which provides health
insurance to about 40 million seniors and disabled Americans. Starting in
2006, the government will subsidize drug coverage for any Medicare patient who
wants it. The law also contains steps intended to expand the role of private
health plans in caring for senior citizens. During the bill's long, heated
debate, the parties were polarized over whether the private-sector orientation
is a good idea and whether the government will give older Americans enough
help in paying for medicine.
Proponents and critics of the law seek to portray their plans as neutral
efforts to educate Medicare patients and health care professionals about the
way the 678-page law will change the program. But it is clear that the public
education is laced with ideology and politics.
Pollack, Families USA's executive director, said its film with Cronkite --
which his group wants to distribute to nearly every senior center in the
country -- and its impending road show are "not intended to be a diatribe. . .
. We are going to . . . explain to people what is in the legislation and how
it will affect them." Still, Pollack said, "We have little doubt how people
react to this stuff. . . . It will create a groundswell of people saying,
'This needs to be changed.' "
Doyle, for example, noted in the radio speech that the legislation does
"nothing for those under 65, who aren't eligible for Medicare but often face
exorbitant drug costs."
the other side of the issue, Bill Pierce, spokesman for Health and Human
Services Secretary Tommy G. Thompson, said the agency is organizing "a robust
campaign . . . the goal being to cut through the rhetoric with what we view as
straight facts and straight answers." HHS is beginning by mailing a letter and
brochure about the law to every Medicare recipient this month, and officials
want to place articles on newspaper editorial pages.
speaking tour by Thompson and other senior HHS administrators will include
several joint appearances with Republicans in Congress. And a recent White
House news release, announcing a routine step by the Treasury Department
toward creating Health Savings Accounts -- a controversial provision, favored
by conservatives, that will allow Americans to set aside money for medical
expenses in tax-free accounts -- began with the headline: "HSA's are good news
for all Americans."
House Republican Conference plans weekly polling to measure the impact of the
themes its members use to describe the law -- "to see what our strongest
message points are, where we need help," said a conference spokesman, Greg
Rep. Phil Gingrey (R-Ga.), a House freshman who is an
obstetrician-gynecologist, is holding town hall meetings on Medicare in all 17
counties in his district before Congress reconvenes Jan. 20. "I can't let this
get on the back burner," he said. His talking points are largely those the GOP
made during the congressional debate. Gingrey said he tells constituents the
law "is a godsend" for lower-income people on Medicare who will get the
largest drug subsidies and that the government will not force patients to
switch doctors or buy drug coverage. He also tells them that changes to the
program will help prevent it from running out of money.
Rep. Shelley Moore Capito (R-W.Va.), who has attended community forums and
made a public radio appearance during the past few weeks, said she encounters
frequent resistance and misconceptions. One elderly woman erroneously believed
that premiums for the drug coverage would automatically be subtracted from her
husband's Social Security check. "A lot of it, unfortunately, is dispelling
the rhetoric that's been put out on the negative side," Capito said.
Some Democrats acknowledge that they are actively sowing discontent. "Trying
to influence public opinion is certainly part of our aim," said Rep. Benjamin
L. Cardin (D-Md.), who has held meetings on Medicare in his suburban Baltimore
district in recent weeks. Cardin is planning to introduce legislation later
this month to change some of the law's most disputed features. .
Cardin and other Democrats want to fuel the kind of anger that erupted among
older Americans during the late 1980s after Congress added "catastrophic"
coverage to Medicare. That outcry prompted lawmakers to take the extraordinary
step of repealing the law the following year. "We want the same type of public
opinion to jell that brought about congressional action," he said. Cardin
predicted that Democrats' best opportunity to change the law will come in
2005, after the presidential election but before the drug benefits are to take
Senate Minority Leader Thomas A. Daschle (D-S.D.) plans to gauge -- and try to
shape -- public reaction at nine town hall meetings throughout his state
Sunday through Tuesday.
Senate Democrats have begun to coordinate with several liberal researchers who
are writing papers critiquing the law, and with advocacy groups. Former
representative Barbara B. Kennelly (D-Conn.), who is president of the National
Committee to Preserve Social Security and Medicare, said her staff has held
strategy sessions with aides to Sen. Edward M. Kennedy (Mass.), the Democrats'
harshest critic of the final bill. Kennelly is appearing across the country at
town hall meetings with congressional Democrats, and the organization is
convening its own "caucuses" in Iowa in the two weeks before the nation's
first presidential contest there to try to prime older voters there to
complain about the law.
MoveOn.org Voter Fund is spending $1.2 million on television advertising in
four presidential battleground states, saying Bush pulled "the rug out from
under Medicare." The Alliance for Retired Americans, a 3 million-member group
with ties to organized labor, is organizing grass-roots campaigns, starting in
four key states with large older populations. "It is our intention to make
this a major issue in the 2004 presidential campaign," said Edward F. Coyle,
the alliance's executive director.
Part of the rationale behind all this is evidence that public opinion about
the Medicare law is malleable -- and mixed. A Washington Post/ABC News survey
in mid-December found that one in five respondents had not made up their
minds. Of those expressing an opinion, those who disapproved outnumbered those
who approved, 42 percent to 37 percent.
Another poll, by the National Annenberg Election Survey, found even clearer
signs that opinion is up for grabs. When asked whether they supported the law,
about three in five respondents said they did -- at first. But after
supporters were read criticisms of the law, most of that support switched to
uncertainty. Conversely, some -- but not as many -- of the those who said they
opposed the law changed their minds after pollsters confronted them with
arguments for it.
"The party that wins the battle to define what was enabled will garner
substantial political benefits," said Thomas E. Mann, a senior fellow at the
Brookings Institution. "Democrats may begin with an advantage. That means the
White House will redouble its efforts at salesmanship."
2,000 people, the worried well, who come each year to Memorial
Sloan-Kettering's cancer prevention center will learn that many cancers can,
in fact, be prevented, and that it is up to them to have the appropriate
medical tests and to live right.
their $2,000 fee, most of which is paid by health insurance, they may be
steered to smoking cessation sessions, or watch a cooking demonstration and
hear a talk by a nutritionist. They will learn the early signs and symptoms of
cancer and they almost certainly will have a cancer screening test.
"There is a lot that can be done to prevent cancer and detect it early," said
Dr. Moshe Shike, the center's director. "We could probably cut cancer
mortality by 50 percent."
Stopping smoking can prevent many forms of cancer, and changes in diet and
weight loss also may have a marked effect. And while screening may find only
cancer that is already present, it can save lives by catching it early.
Cancer prevention has become a buzzword these days, with some medical centers,
like M. D. Anderson Cancer Center in Houston, planning entire buildings just
for prevention. Its center will open in about a year, big as eight and a half
even cancer experts who are participating in the new prevention efforts are
divided on what really can be done to prevent cancer, other than stopping
smoking. Looking at the same data on prevention, some experts say that for now
most efforts involve research that may or may not lead to clinical advances.
That is a problem emblematic of the fiercely competitive world of cancer
medicine, doctors say. Medical centers need to attract patients and federal
research money. And that means they need to be on the cutting edge of the
field. The National Institutes of Health requires medical centers that are
designated comprehensive cancer centers, and eligible for its grants and
contracts, to have a prevention component. The institute devoted $500 million,
or 12 percent of its budget, to cancer prevention and control.
But, some ask, how can an honest message be communicated to the public about
what can be done?
am concerned," said Dr. Donald Berry, a statistician at M. D. Anderson. "Most
of what this is about is research. I think we're really early on in the cancer
prevention area. Knowing what to do, knowing what the risk factors are and
knowing when to intervene and how to intervene � we're not there yet."
and others worry that many people greatly exaggerate their cancer risk and
have inflated expectations of what science can do to protect them.
created the fear that everything is carcinogenic," said Dr. Michael Gallo,
associate director for cancer prevention and control at the Cancer Institute
at the Robert Wood Johnson Medical School. At the same time, he added, medical
researchers "have convinced people that there is a magic bullet for
everything." The result, he said, "is self-defeating."
M. D. Anderson, for example, more than 80 percent of the cancer prevention
center's budget is for research, which can range from basic laboratory work to
epidemiology to clinical trials testing ideas of how to prevent cancer, said
the center's director, Dr. Bernard Levin. Most people who come looking for
ways to protect themselves against cancer are steered to the center's smoking
cessation programs if they are smokers: a third of cancer patients there have
smoking-related cancers. They are also offered screening tests.
Such strategies are hardly revolutionary, Dr. Gallo said. "It's what we've
been doing for years. But it's sexy to be called the center for cancer
Otis Brawley, associate director for cancer control at the Winship Cancer
Center at Emory University, shared Dr. Gallo's view. "To be politically
correct as a cancer center you have to be interested in prevention," he said.
The government expects it and so do patients, he added. "It is like a lot of
things in medicine where we have implied success where actually there is very
everyone would agree. At Memorial Sloan-Kettering in New York, which offers
diet and nutrition counseling and even cooking classes, cancer screening,
genetic counseling and, of course, smoking cessation programs, the feeling is
that there are great opportunities.
"There is a lot that can be done to prevent cancer and detect it early," said
Dr. Shike, director of the cancer prevention and wellness program at Memorial
Sloan-Kettering. "My feeling is that the general public and the medical
profession don't take advantage of all the things we can do."
That depends on how you view the evidence and on what you mean by prevention,
said Dr. Barnett Kramer, director of the office of disease prevention at the
National Cancer Institute.
potential source of confusion, he said, is that cancer prevention centers
include screening. But screening, with a few exceptions like colon cancer and
cervical screening that find and remove precancerous growths, looks for cancer
that is already present. That may or may not save lives, Dr. Kramer said,
depending on whether the treatment is effective and whether the cancer would
have been deadly if it had been left alone, undetected.
all cancers will spread and kill, and sometimes the outcome is the same
whether a cancer is found earlier or later. But with screening, doctors treat
any tumors they find because they cannot tell which are worrisome and which
the end, screening, far from preventing cancer, actually leads to more cancer
patients, Dr. Kramer noted, by finding both those whose cancers would have
been deadly and those whose cancers would never have been a problem because
they would have remained small and never spread, or would even have
"People often talk about mammograms to prevent breast cancer when what it's
done is to increase, not decrease, the incidence of breast cancer," Dr. Kramer
Many people decide to take their chances with screening, reasoning that they
would rather be treated for a cancer that would not have killed them than to
miss being treated for a cancer that could be lethal. But it is not easy to
know if screening helps or harms over all, Dr. Kramer said, adding that it
requires large controlled trials. Such studies, he noted, have not yet been
completed for some popular tests, like the P.S.A. test for prostate cancer and
spiral CT tests for lung cancer.
for genetic screening to see who is susceptible to cancer, that is still in
its infancy, Dr. Berry said. There are a couple of genes that predispose to
breast cancer and a couple that predispose to colorectal cancer. "Not much is
known beyond that," he said. And other than taking tamoxifen to prevent breast
cancer or having one's breasts, ovaries or colon removed to prevent cancers in
those organs, what does someone do who is genetically susceptible? Another
research question, Dr. Berry said.
When it comes to other prevention strategies, like diet, Dr. Kramer said, "it
gets a lot trickier." He urges caution in jumping to conclusions that specific
foods, or diets, or even weight loss will be protective. Researchers often
find associations between diets and cancer risk, but that does not mean that a
particular diet or food caused or prevented cancer, he said. The history of
research in this area has been sobering.
example, study after study found that people whose diets were high in beta
carotene had a lower incidence of lung cancer. But in studies in which smokers
and former smokers took beta carotene supplements, it turned out that the
vitamin actually increased lung cancer risk and lung cancer deaths. Studies
found associations between high-fiber diets and reduced incidence of colon
cancer. But a large study that randomly assigned some subjects to high-fiber
diets found no reduction in cancer or in polyps, the growths that can precede
Memorial Sloan-Kettering, Dr. Shike said, patients are taught how to eat
healthy diets and even go over their diets food by food with a nutritionist
and a computer program, but are not told that diets are a panacea. "We are not
saying you can prevent cancer with a healthy diet, but we say a healthy diet
and a healthy weight are part of a healthy lifestyle, which can help lower
Berry has a different view of cancer prevention centers. For now, while
research continues, perhaps their greatest value to healthy people is not so
much in giving them ways to prevent cancer but in showing them that their
fears of getting cancer may be exaggerated and that if they do develop cancer,
it usually is not because they did something wrong.
"The person in the street greatly exaggerates their risk of cancer," Dr. Berry
said. One thing a cancer prevention center can do, he said, is let people know
their real risk and the real effect of measures that many think will give them
cancer, or protect them from it.
can be letting them know that changing their lifestyle may change their risks,
but not by much," Dr. Berry said. "We can be letting them know that while
hormone therapy may increase the risk of breast cancer, it does not increase
MEMBERS OF THE Maryland General Assembly departed Annapolis last spring like
errant 9-year-olds, their most pressing homework left incomplete. As the
state's political leaders gather again this Wednesday for the start of another
90-day session, they have a chance to atone, to mend old wounds, confront
tough issues, end partisan bickering and find common ground.
why does that seem so unlikely?
Alas, Gov. Robert L. Ehrlich Jr. and House Speaker Michael E. Busch remain in
a depressingly familiar strait - the same deadlock over slot machines and the
state's $1.8 billion budget deficit that they were stuck in last April. Mr.
Busch doesn't want to expand gambling, but he might budge if the governor
agrees to raise taxes. Mr. Ehrlich likes slot machines, but he won't go near a
broad increase in taxes, particularly Mr. Busch's favorite budget-balancer - a
penny more on the sales tax.
clash looms as the spinning black hole of Annapolis. No issue of fiscal
consequence can move through the legislature unless this conflict is resolved.
And as if this crisis doesn't seem dire enough, be reminded: At stake in the
non-debate is the state's ambitious schools initiative - the five-year, $1.3
billion Thornton Commission plan to boost public education statewide.
Some legislators grumble that Thornton is the deficit, and there is some truth
to that. When approved by lawmakers in 2002, the plan lacked financing. It
still does. Mr. Ehrlich has once again tied Thornton to slots. His message: If
slots aren't acceptable, then Thornton gets scaled back after this year.
Others in Annapolis, fearful of the looming budgetary train wreck, have even
suggested recently that Thornton be deferred, stretched out or delayed no
matter what happens to slots. Neither approach is particularly responsible.
Annapolis, it is said that the first two years of any new administration are
its most important. Now is the only chance for a newly elected governor to be
bold. His political clout is at its height and voters at their most forgiving
(since the next election is two years away). Last year was a painful lesson.
This year may be the state's best hope.
With so much at stake, voters should rightly expect that Mr. Ehrlich, Mr.
Busch and Senate President Thomas V. Mike Miller would have locked themselves
in a room by now, vowing not to emerge until they've found a way out of this
mess. Maybe even the beginnings of a compromise. But that has not happened
yet. By all accounts, the state's most powerful leaders are barely on speaking
terms. How depressing. How irresponsible. How ... familiar.
even in this gloom, there is a flicker of hope. The Thornton funds haven't
been cut - yet. The administration believes its most pressing problem - next
year's $700 million chunk of the deficit - can be bridged through budget cuts
and modest new sources of revenue (with neither a major tax hike nor money
from slots as part of that plan). That's not a long-term solution, of course.
But there also are signs that Mr. Ehrlich will be better prepared for this
session than last. His agenda is more ambitious, his State House team a bit
more experienced, the economic outlook less bleak.
That's a start. What we need now is for both sides to demonstrate a
willingness to compromise. Mr. Ehrlich needs to stop being absolute about
slots and taxes. Democrats need to hold their wagging tongues, offer new
approaches (rejecting the advice of party hacks who'd rather they sandbag the
governor), and then find a solution that they, and the governor, can endorse.
Experience tells us that the State House pot will have to boil a while before
that could happen. Everyone will get steamed and the rhetoric will fly. But
ultimately, the politicians should be graded not on what gets said but on what
gets accomplished: The coming 90 days are the best indicator yet of who
deserves favor - or a quick dismissal in 2006.
LAST WEEK in Annapolis, as we reported, there was some interesting discussion
of the state's continuing fiscal crunch, and some bold - if sometimes
impractical - proposals for easing it.
trouble is, the forum at St. John's College, co-sponsored by the Calvert
Institute and Maryland Business for Responsive Government, wasn't a gathering
of elected officials. In fact, none of the state's 188 legislators showed up
at the symposium, held two blocks from the State House.
legislators will be here this week to start their own 90-day symposium, and it
will be vastly entertaining. There will be maneuvering and egos and games of
beat-the-deadline and who's-up-and-who's-down. There will be cameo appearances
by all sorts of issues, relevant and irrelevant.
at the bottom of it all will be the basic dilemma discussed, if not resolved,
at the symposium:
Even with the economy accelerating, the state is still in a fiscal hole of
about $700 million. It is also committed to a huge increase in educational
funding - the Thornton plan. Gov. Robert Ehrlich is committed to not raising
sales or income taxes (although it seems to be a different matter with other
taxes and fees).
governor thinks he can fill much of the gap by legalizing slot machines,
although so far he hasn't come up with a convincing plan for doing so. Indeed
he spent much of last year saying he wouldn't even try, before changing his
mind last month. The speaker of the House and other state political leaders
remain opposed to slots.
short, something has to give. What will it be?
course, we don't know what will happen. But we do sense an impending political
disaster. Mr. Ehrlich, a bright and dynamic politician with the chance to
permanently change Maryland's unhealthy tilt toward one-party government,
remains convinced that slot machines are the state's path to solvency.
Quite apart from the social damage involved - sufficient reason to reject
slots - what sense does it make to tie school spending, of all crucial
priorities, to something as mercurial and unsteady as gambling revenue? What
sort of legacy is that for a fiscal conservative? With time ticking away on
Mr. Ehrlich's chances to reach a bipartisan consensus with the General
Assembly - the closer he gets to the next election, the harder it will be -
does he really want to expend effort and credibility on this?
the way, we're not endorsing the notions discussed at last week's symposium.
We're not as convinced as some of the participants that the state has run out
of fat to cut and has no alternative to higher taxes. Some of the ideas - a
tollbooth at the Wilson Bridge, anyone? - were hilariously impractical. But
will the governor and the General Assembly do better? That, you might say, is
the $700 million question.
Published January 11, 2004, The Capital, Annapolis, Md.
THREE OF the state's most experienced and highly regarded students of
government finance offered their views on how to deal with Maryland's deficit
during a sparsely attended forum last week at St. John's College in Annapolis.
For the most part, they left politics out of their equations.
Call it fiscal tennis without a net, but it was a scintillating exchange
days later, on the campus of the General Assembly, the net was up -- way up.
James C. "Chip" DiPaula Jr., Gov. Robert L. Ehrlich Jr.'s estimable budget
secretary, said increased education funding hinges on passing a slot machine
gambling bill. There will be no other sufficiently large revenue source, he
said -- no sales or income tax increase. It was not a new warning.
Immediately, House Speaker Michael E. Busch declared again that gambling is
the wrong way to pay for a public service as fundamental as education. The
people and their representatives should assume that responsibility -- not
slough it off on gamblers. He suggested a penny increase in the sales tax.
Nothing new there, either.
Thus did the speaker and the governor redraw lines that have divided them over
the last year or so. Neither man doubts the resolve of the other by now. But
change is not unimaginable as the 2004 legislative session begins Wednesday.
What worries many in Annapolis these days is also not new: The opposing sides
don't talk much with each other. What you have is a kind of rolling stalemate
in which two of the government's power centers haven't found a way to
Senate President Thomas V. Mike Miller Jr., a Democrat, has sided with the
governor in this debate, judging apparently that Mr. Ehrlich is right
politically: people don't want to pay more taxes. Mr. Miller also is on the
side of those Democrats who believe slots, even when operating at full bore,
won't produce enough money to pay down the deficit and maintain other state
services. In that event, the Republican governor would be driving Maryland
into the ditch. Democrats could ride in to save the day with a tax increase
that would hardly be felt. It's a dreary scenario.
there a politically feasible alternative? Maybe not in this new day of
partisan, campaign promise-driven politics. But maybe reason will prevail.
Busch signals he's ready to relent on slots -- but only if compromise includes
the governor's agreement to sign a tax bill. His apparent thinking: If you
simply grant the gambling venture, you lose leverage for a tax increase.
Better to stand firm, deny the slots revenue and let government go into the
ditch in time for people to see the results before they vote for governor in
2006. You can have your doomsday now or you can have it later.
you ask, what role might wise advice and the public interest play in such an
St. John's College, a starting point was quickly identified by the experts:
William S. Ratchford II, former fiscal adviser to the Assembly; Robert R.
Neall, former county executive and former state senator; and Nancy K. Kopp,
state treasurer, were joined by George W. Liebmann of the Calvert Institute
for Policy Research and James T. Brady, a businessman, Ehrlich administration
adviser and former secretary of economic development.
Their thought? Maryland's tax structure is outdated, unfair and inefficient at
a time when maximum efficiency is needed. An update would produce more
revenue. The mere mention of the "T-word," even if followed by the word study,
sends tremors through the political strategist's soul. This conclusion is not
new, either. But politics always get in the way.
you studying the system so you can reduce taxes? Well, of course not. But you
might be trying to align the tax structure with the economy as we know it.
Fiscal leaders have been saying for some time that a service economy demands
taxes on services: from those provided by lawn services to those you're
supposed to get from lawyers and car repair shops. Yes, each of these groups
will squeal. Retail merchants don't want an increase in the sales tax. People
with lots of money don't want even a temporary surcharge on the income tax.
dear. What to do. Pass slots and pray? Raise the sales tax? Increase fees
because the fee word doesn't begin with T? Watch it all heading for the ditch?
None or all or some of the above?
Look carefully at the options, select one and then sell it like political
leaders ought to do.
C. Fraser Smith is news director for WYPR-FM. His column appears Sundays.
Maryland's chronic budget problems continue, but the state's finances are no
longer a victim of the economy. Instead, the budget is being held hostage by
political absolutists on both the spending and tax side who seem incapable of
result? Maryland's key economic indicators appear stronger than those of most
states, but its budget deficit continues to be larger than those of most
Maryland's unemployment rate is the seventh-lowest in the nation, and the
state also ranks seventh in job growth. Its housing market is the
fifth-strongest in the nation, and Marylanders' personal income is far above
the national average. The state's economic indicators grow stronger every day.
a strong economy doesn't necessarily translate into a strong budget. Just a
year ago, 31 states faced budget gaps totaling $17.5 billion. Most of these
states have eliminated their deficits, but not Maryland. Today, Maryland is
one of fewer than a dozen states still reporting significant budget gaps, with
a deficit standing at $715 million.
Maryland deficit is a political condition, not an economic one. Anyone
doubting this proposition need only recall April 4, 2002, the date that the
Maryland General Assembly finalized the final phase of a $600 million income
tax cut while enacting the six-year, $1.3 billion Thornton education funding
commitment. Neither action was affordable. Neither was responsible. Reverse
the two decisions, and Maryland's $715 million deficit turns into a $250
course, no one expects the income tax cut to be reversed or Thornton to be
repealed. But Maryland needs to significantly modify both its education
spending and its tax policies it if wants to preserve its triple-A bond rating
and attain fiscal recovery.
this requires compromise, the enemy of the absolutism reigning in Annapolis.
the spending side, the absolutists demand funding Thornton's full cost of $1.3
billion. This number was developed on the basis of a consultant's complex
report that cited the figure as the price of "educational adequacy" throughout
the state, with an additional $80 million beyond the consultant's
recommendations thrown in to pacify Montgomery County.
thirst for additional dollars for education from kindergarten through 12th
grade is unquenchable. In these circles, the Thornton spending recommendations
have achieved an infallibility usually reserved for papal pronouncements.
Responsible efforts to impose fiscal integrity on Thornton's massive cash call
are usually met with a one-word threat: litigation.
Fortunately, this is a hollow threat. The notion that the state's educational
finance system is unconstitutional unless the legislature appropriates an
additional $1.3 billion is ludicrous. The Maryland Court of Appeals rejected a
more ambitious challenge 20 years ago, and education aid today is larger by
$2.2 billion annually.
course, missing from this debate is accountability. Few are asking what
improvements occurred as a result of the $2.2 billion increase in educational
spending. Last week it was announced that 60 percent of the state's high
school seniors failed the English I competency exams. A promised
administration task force to study school performance has not yet
the other end of the philosophical spectrum are the "no-tax" absolutists.
These legislators oppose raising state tax rates by even a penny, regardless
of Maryland's fiscal condition. This translates into great 30-second TV ads,
but it is terrible public policy.
policy, like a budget, is dynamic. Throughout history, the legislature has
modified the tax structure to meet the demands of the economy. When the retail
economy emerged, it adopted a sales tax. When expressways and subways were
needed, transportation taxes were levied.
today the absolutists want the state's tax structure to be carved in stone.
This means, for instance, that, without new revenue, the state's
transportation program will become functionally insolvent in two years. And
the state's capacity to benefit from technology growth will be limited by its
'50s-style sales tax structure.
Many legislators have a healthy fear of both the no-tax absolutists and the
Thornton absolutists. Some try to satisfy both by supporting Thornton and
opposing new taxes to pay for it. This has created political gridlock.
Paralysis, though, has a way of making its own policy. For instance, by
insisting on funding Thornton without new taxes, the state is essentially
financing K-12 education by cutting higher education; 18 percent tuition
increases at state colleges and universities are to make up for the more than
$100 million in cuts. This represents a large transfer of support from higher
education to primary and secondary schools.
the transportation side, Maryland is facing a $300 million annual funding gap,
and yet it borrowed $300 million from the transportation trust fund to pay
general-fund operating expenses. By doing nothing, Maryland has sacrificed its
highway program -- now ranked 47th in the nation -- to general fund spending
and rising mass transit costs.
same dynamic is at work in health care, with Medicaid costs rising $212
million this year and eroding the state's capacity to provide other critical
preventive health care programs.
is these dynamics, not deliberate decisions by the state's elected leaders,
that will drive the budget. Despite its economic recovery, Maryland will not
have a budget recovery without political leadership.
Compromise requires courage and hard work. By comparison, absolutism is easy.
Whether Maryland has leaders who will stand up to absolutism and demonstrate
leadership remains to be seen.
The writer is a lawyer and former Democratic member of the Maryland General
Assembly. His e-mail address is firstname.lastname@example.org.
POLITICIANS CONTINUE their misguided -- and dangerous -- attempts to
circumvent federal law in order to bring large quantities of prescription
drugs into the United States from Canada.
the latest episode, Illinois Gov. Rod R. Blagojevich asked U.S. authorities
Dec. 22 to waive current laws and designate his state for the nation's first
"federally approved drug importation program."
Mr. Blagojevich, along with other advocates of reimportation in Congress and
the states, is being disastrously short-sighted as well as economically
obtuse. The most likely effects of reimportation would be fewer high-quality
drugs for Canadian citizens, more risk of counterfeit or contaminated drugs
for Americans and reduced incentives for pharmaceutical companies to spend
billions of dollars a year to find new medicines.
other words, if the reimporters are successful, their efforts will lead to
more illness and more deaths.
Blagojevich and his allies have the problem exactly backward. Instead of
focusing on re-importation, they should be pushing Canada and other countries
to liberate their health care systems -- to end subsidies and restrictions and
open their markets.
Canadians spend less on drugs for two reasons: First, they are poorer than
U.S. citizens, so demand is lower, and second -- and more important -- their
government imposes price controls on drugs and, through its monopoly health
care system, restricts and delays the availability of new medicines.
Canada is not alone. Similar government monopolies, with power over
price-setting and availability, prevail in Europe, Australia and elsewhere.
Almost certainly, these countries are violating World Trade Organization rules
by erecting barriers to the free flow of U.S. exports at market prices and by
blackmailing the companies into offering them drugs at lower prices in order
to avoid losing patent rights. That's bad enough, but now American politicians
such as Mr. Blagojevich want to import this destructive system to the United
with the proper safety precautions, pharmaceuticals flowed freely across
borders, as they should, then prices to consumers in countries with similar
levels of income -- and, thus, demand -- would be nearly the same, just as a
digital camera costs roughly the same in Toronto, Rome and Chicago.
U.S. policy-makers should focus attention not on the fact that Americans pay
more for drugs, but on the fact that Canadians pay less because they are
freeloading on Americans. U.S. consumers provide the funds necessary for
pharmaceutical firms -- nearly all of them now U.S.-based -- to make the
investment in research to develop new drugs. But the rest of the world
benefits from those drugs.
This is the outrage, and it is reassuring that rather than playing demagogues,
as has Mr. Blagojevich, top U.S. officials are speaking out responsibly and
example, House Speaker Dennis Hastert stated Dec. 11: "It is wrong that our
friends in Canada use threats to steal the patents of American drug companies
in order to negotiate lower prices, and their price control regime is unfair
to American consumers. Americans shouldn't be forced to subsidize health care
for the rest of the world. By getting fairer pricing in Canada, American
consumers will get fairer prices for their prescription drugs."
Hastert's strong statement reflects action taken by the House and Senate in
their conference agreement on the Medicare bill last year. The pact calls for
a study by the Commerce Department that will identify "countries that use
price controls or other such practices with respect to the pharmaceutical
trade" and then estimates the "additional price to U.S. consumers because of
such price controls" and the impact of "fair pricing, innovation, generic
competition and research and development."
agreement also directs the U.S. trade representative and other officials to
analyze whether trade negotiations "present an opportunity to address these
price controls" and other restrictive practices. This study, due in mid-year,
will shine a spotlight on the real problem: nationalized health systems,
directed by overweening bureaucrats with no interest in the process of
developing life-saving drugs.
Republican Rep. Philip M. Crane of Illinois, who chairs the Ways and Means
Trade Subcommittee, as well as all the top Republicans on that panel, signed a
letter in November encouraging Trade Representative Robert B. Zoellick to
"address Australian price controls as part of the U.S.-Australia free trade
Australian government's Pharmaceutical Benefits Scheme covers 96 percent of
all drugs. It thus has the power of what economists call a "monopsony" -- in
effect, a single purchaser of a product. The PBS regularly delays or denies
access to U.S. pharmaceuticals and sets unreasonably low prices.
This is how Australians, like Canadians and many Europeans, act as free
riders. They get the benefits of pharmaceutical innovations while Americans
pay for the research. This must end -- but it won't happen through
can happen, however, through tough trade negotiations. We need to force other
countries to live up to their treaty obligations and stop subsidizing and
restricting the flow of pharmaceuticals and controlling their prices. When
that happens, a true free market will prevail worldwide, and Americans will be
James K. Glassman is a fellow at the American Enterprise Institute.
"What good is happiness? It can't buy money." -- Henny Youngman
Social hypochondria is the national disease of the most successful nation. By
most indexes, life has improved beyond the dreams of even very recent
generations. Yet many Americans, impervious to abundant data and personal
experiences, insist that progress is a chimera.
Gregg Easterbrook's impressive new book, "The Progress Paradox: How Life Gets
Better While People Feel Worse," explains this perversity. Easterbrook, a
Washington journalist and fellow of the Brookings Institution, assaults
readers with good news.
American life expectancy has dramatically increased in a century, from 47 to
77 years. Our great-great-grandparents all knew someone who died of some
disease we never fear; as recently as 1952, polio killed 3,300 Americans. Our
largest public health problems arise from unlimited supplies of affordable
typical American has twice the purchasing power his mother or father had in
1960. A third of America's families own at least three cars. In 2001 Americans
spent $25 billion -- more than North Korea's GDP -- on recreational
Factor out immigration -- a huge benefit to the immigrants -- and statistical
evidence of widening income inequality disappears. The statistic that
household incomes are only moderately higher than 25 years ago is misleading:
Households today average fewer people, so real dollar incomes in middle-class
households are about 50 percent higher today. Since 1970 the number of cars
has increased 68 percent and the number of miles driven has increased even
more, yet smog has declined by a third and traffic fatalities have declined
from 52,627 to 42,815 last year. In 2003 we spent much wealth on things
unavailable in 1953 -- a cleaner environment, reduced mortality through new
medical marvels ($5.2 billion a year just for artificial knees, which did not
exist a generation ago), the ability to fly anywhere or talk to anyone
anywhere. The incidence of heart disease, stroke and cancer, when adjusted for
population growth, is declining.
rate of child poverty is down in a decade. America soon will be the first
society in which a majority of adults are college graduates.
so it goes. But Easterbrook says that such is today's "discontinuity between
prosperity and happiness," the "surge of national good news" scares people,
vexes the news media and does not even nudge up measurements of happiness.
Easterbrook's explanations include:
"The tyranny of the small picture." The preference for bad news produces a
focus on smaller remaining problems after larger ones are ameliorated. Ersatz
bad news serves the fundraising of "gloom interest groups." It also inflates
the self-importance of elites, who lose status when society is functioning
well. Media elites, especially, have a stake in "headline-amplified anxiety."
"Evolution has conditioned us to believe the worst." In Darwinian natural
selection, pessimism, wariness, suspicion and discontent may be survival
traits. Perhaps our relaxed and cheerful progenitors were eaten by
saber-toothed tigers. Only the anxiety-prone gene pool prospered.
"Catalogue-induced anxiety" and "the revenge of the plastic" both cause
material abundance to increase unhappiness. The more we can order and charge,
the more we are aware of what we do not possess. The "modern tyranny of
choice" causes consumers perpetual restlessness and regret.
The "latest model syndrome" abets the "tyranny of the unnecessary," which
leads to the "10-hammer syndrome." We have piled up mountains of marginally
improved stuff, in the chaos of which we cannot find any of our nine hammers,
so we buy a 10th, and the pile grows higher. Thus does the victor belong to
The cultivation -- even celebration -- of victimhood by intellectuals, tort
lawyers, politicians and the media is both cause and effect of today's culture
Easterbrook, while arguing that happiness should be let off its leash, is far
from complacent. He is scandalized by corporate corruption and poverty in the
midst of so much abundance. And he has many commonsensical thoughts on how to
redress the imbalance many people feel between their abundance of material
things and the scarcity of meaning that they feel in their lives. The gist of
his advice is that we should pull up our socks, spiritually, and make meaning
by doing good while living well.
book arrives as the nation enters an election year, when the opposition, like
all parties out of power, will try to sow despondency by pointing to lead
linings on all silver clouds. His timely warning is that Americans are
becoming colorblind, if only to the color silver.
THERE are a couple of questions that few people seem to be asking about the
limited Medicare prescription drug law that goes into effect in 2006:
What impact will it have on pharmaceutical companies' programs that offer free
drugs to low-income people, including those on Medicare?
does the law prohibit beneficiaries from buying private insurance to cover the
considerable gaps in coverage?
drug companies themselves are struggling with the first question, as is their
trade group in Washington, the Pharmaceutical Research and Manufacturers of
America. But one thing is clear: if the companies do not change their
requirements by 2006, thousands of older low-income Americans will lose access
to free or nearly free drugs. That's because participants in the programs
generally must not have any drug coverage or access to it. Of course, they
will have access to drug coverage in 2006 - although with coverage gaps that
could cost thousands of dollars a year.
free-drug programs are crucial for many recipients. The income limits are not
that strict: in some cases, people earning up to $50,000 a year can qualify.
The drugs are commonly dispensed through doctors or via discount cards;
patients usually have to requalify regularly and apply separately to each
company that makes the drugs they need.
Nancy Pekarek, a spokeswoman for GlaxoSmithKline, said her company had made no
decisions yet about its free-drug program. "We have to see what this new
Medicare bill is really saying and how it will play out, or be amended," she
said one possible option was for GlaxoSmithKline to change its requirements
and allow free drugs to be offered to low-income people when they encounter
gaps in the new benefit. One gap is the so-called doughnut hole, under which
coverage stops after a person spends $2,250 in a given year, and does not pick
up again until drug expenses reach $5,100. That means an outlay of $2,850, not
to mention premiums, deductible and co-payments.
"We've had this program in place for a long time, recognizing there are people
who fall between the cracks in the system and need some assistance," Ms.
Pekarek added. "My guess is there will still be people falling between the
cracks after 2006."
Rick Luftglass, director of United States philanthropy at Pfizer, said changes
in Pfizer's program were "up in the air and hard to answer at this point."
Pfizer provided free or nearly free drugs through various programs to 1.7
million patients of all ages in 2002. To get free Pfizer drugs through a
doctor, a patient must have an income of less than $16,000, or $24,000 for a
couple. Pfizer also offers a discount card for low-income Medicare patients
that gives them a 30-day prescription of a Pfizer drug for $15. The new
Medicare law includes a discount card, to be available this spring, for
discounts of 10 to 25 percent. What this will mean for the Pfizer card is
unclear. "We have made no decisions," said Mariann Caprino, a spokeswoman for
Robert M. Hayes, president of the Medicare Rights Center, a nonprofit group
based in New York that helps people handle Medicare and Medicare H.M.O.
problems, said he was concerned that "the drug companies may decide to end
their discount cards because of the Medicare discount card."
MOST of the drug companies explain their free drug programs on their Web
sites. In addition, the Pharmaceutical Research and Manufacturers of America
Web site (www.phrma.org), provides information on all the programs offered by
prohibition against buying private insurance, meanwhile, will hit
middle-income people the hardest. "Many people will be forced to put out their
own money, even if they want to buy insurance," Mr. Hayes said.
report accompanying the final Medicare bill when it was passed last year said
the insurance prohibition was to keep beneficiaries from becoming "insensitive
to costs." Well, if your mother needs a prescription, her "sensitivity" is not
going to lessen her need, but the cost may lessen her ability to buy it. And
why shouldn't she be allowed to buy private insurance to help if she wants to?
By that logic, should we prohibit auto insurance to make people sensitive to
high repair costs?
Some administration and Congressional officials argue that older Americans
would consume less health care if they had to pay more for it, so the
government would save money. Maybe, but what are the health consequences?
Deane Beebe, a spokeswoman for the Medicare Rights Center, said: "The whole
concept is based on the idea that people will use too much medication if they
have coverage. We're really troubled by that."
Hayes added, "There is something very unrealistic about politicians who think
that people will rush off to take prescription medication they don't need."
law, however, allows states to cover the gaps and deductibles for low-income
people as long as no federal money is used.
the policy argument is that you want people to actually spend money to enjoy a
benefit, but the bill is inconsistent in allowing states but not insurance
companies to step in," Mr. Hayes said. "But this will vary widely from state
to state. It's a crazy quilt."
added: "This insurance prohibition will hit a broad swath of the middle class.
It will hurt more people than it will help."
Hayes said he believed that the prohibition might be eliminated before 2006,
partly because of pressure from insurance companies that want to sell the
lot of people who voted for this bill," he said, "had no clue about this
Fred Brock is an editor at The Times. His column on the approach and arrival
of retirement appears the second Sunday of each month. E-mail:
son has been having chelation therapy for over two years after being diagnosed
with five learning disabilities. He has already released over 1,400 micrograms
of various heavy metals, including mercury.
attended a "Defeat Autism Now" spring conference and heard Dr. Stephanie Cave
speak on thimerosal poisoning and safe vaccinations. Presently, the medical
community has been treating only the end result of a catastrophic toxic insult
at the beginning of the physical and neurological development of children.
These children are suffering from serious physical health conditions.
attempted to contact the governor's office; Sen. Barbara Mikulski, D-Md.; area
health departments; the Environmental Protection Agency and the Food and Drug
Only the FDA replied. When asked what was being done to address this problem,
it stated that there was no proof that the traces of heavy metals came from
thimerosal. I replied, "It's not traces, it's thousands!"
Introducing a toxin at the beginning of life convinces the body that a toxin
is a nutrient. Consequently, the body absorbs environmental toxins as well.
medical community should do the appropriate testing to diagnose the
devastating health conditions that exist in these children. Currently,
Maryland has the third-highest rate of autism in our country.
first vaccine with thimerosal came out in the 1930s. I believe Dr. Leo Kanner,
who documented this disorder in the 1940s, was really diagnosing three rare,
but different, disorders that can have similar symptoms.
a list of vaccines containing thimerosal, go to www.autism-mercury.com. Look
for the latest report, soon to be released by Tulane and Wake Forest
universities, based on Dr. Andrew Wakefield's research, on
ELAINE F. DOW
Published January 11, 2004, The Capital, Annapolis, Md.