Bush's First 100 Days -- A Healthy Start?

From the WebMD Archives

April 27, 2001 (Washington) -- The Bush administration says that during its first 100 days, "significant strides" have been made in keeping the president's campaign pledge to improve U.S. healthcare quality. However, no one would dispute that there's still a lot that needs to be done.

"Solid B, I would say. No real reason to say that expectations haven't been met," Robert Reischauer, PhD, former director of the Congressional Budget Office and now head of the Urban Institute, tells WebMD. But then, Bush's primary domestic initiative has been to cut taxes, not remodel the nation's healthcare system. So Reischauer says the president has set the bar relatively low.

Healthcare economist Uwe Reinhardt, PhD, of Princeton University, comes to a similar conclusion about the president's performance. "They really have not come forth with a written, coherent program of their initiatives. What you've seen is worth a B, but that's like from the homework and midterm. You don't really have the final exam to give the student a solid grade," Reinhardt tells WebMD.

In a release put out by the Department of Health and Human Services, officials cite a number of healthcare initiatives under way, ranging from strengthening Medicare to protecting patient access to -- and privacy of -- medical records. Ultimately, in that area, the president simply allowed regulations developed by the Clinton administration to take effect.

"Patients didn't know that [their records] weren't protected. So this was an issue waiting to happen," says Reischauer. But Bob Helms of the American Enterprise Institute gives the President a B+ for getting his agenda out there.

"It's amazing that they were able to get this much of it done. ... I don't give them an A+, because they should have been further along in getting their own people at HHS," Helms tells WebMD.

Not surprisingly, Democrats say there's a healthy dose of exaggeration in George W. Bush's health claims.

"[The President] decided to reject a Medicare prescription drug program that covers all seniors who want it, and that even some in his own party consider a top priority. He decided to stop the bipartisan Patients' Bill of Rights that would really help patients and take power away from HMOs," says House Minority Richard Gephardt (D-Mo.) in a statement.

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In fact, the six-page HHS release doesn't mention a word about the debate over whether patients in health plans should have legislated guarantees, including the right to sue their HMOs for denial of treatment. Although Bush is on record as being in favor of patients' rights, he's opposed to a proposal authored by Sen. John McCain (R-Ariz.).

McCain, who was Bush's main rival for the Republican presidential nomination, wants to set a higher ceiling for liability claims than the President does. Still, many Republicans, as well as Democrats, are backing the McCain reforms.

What Bush has proposed is an "Immediate Helping Hand" program for poor seniors to help them buy prescription drugs. The $46-billion dollar plan would be administered by the states as a stopgap until more comprehensive Medicare reforms are passed. For that, Bush is suggesting a 10-year, $153-billion overhaul that would revamp the system to make it more competitive with the private marketplace.

Even so, Reischauer says the transition will be difficult. "In a way, we've promised more than we can deliver, and one aspect of the promise is the extent to which low-income people would be subsidized. ... It's expensive is what it is. If you ask me, what you get is a pretty chintzy benefit," he says.

Also during his first 100 days, Bush also unveiled a proposal to provide tax credits to help low-income people buy insurance. The benefit would be $1,000 for individuals and $2,000 for couples, which the administration says would cover 6 million more people. But Reinhardt argues more needs to be done to assist the 40-million-plus Americans who still have no coverage.

In fact, Reinhardt says the Bush administration, like it or not, will have to expand existing entitlement programs.

"They will hate to do this, but eventually Republicans always do things they hate. After all, who put in administered prices, which is really a Soviet-style kind of price determination? Reagan, with the Medicare fee schedule," says Reinhardt.

So far the Bush team has not committed itself to the controversial issue of federal funding for fetal stem cell research. The technology offers hope for treating dozens of chronic diseases but requires the use of tissue derived from human embryos.

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"There's a lot of conservative Republicans who have family members with diseases [that would use] treatments that could be discovered using stem cells," says Reischauer.

Both Reischauer and Reinhardt agree that judgement must wait until the Bush healthcare team is in place. That includes Tom Scully, the nominee to head the much maligned Health Care Financing Administration -- in effect the government's administrator for Medicare and Medicaid.

In addition, Mark McClellan, MD, PhD, a highly regarded Stanford University economist, is advising the White House on Medicare and related issues. McClellan is the former CEO of the Federation of American Hospitals.

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