Representatives of TAKE BACK MEDICARE, an ad hoc group principally composed of members of Campaign for America’s Future, MoveOn.org, the Alliance for Retired Americans, and US Action, met with Cheryl Diehm, Congressman Mike Thompson’s District Representative, at 11 AM, 2/20/2004 in Rep Thompson’s office. The meeting was adjourned after approx 90 minutes of lively discussion.

Those present for this conference are:

Before proceeding on the Agenda, Walter Battaglia pointed out that many people desiring to attend this conference were not present. They had "volunteered" not to attend due to space limitations in Rep Thompson’s office. Many of those not present requested their names be included in the record. Those who did not attend, upon Walter Battaglia’s request, about 15 people, are:

In addition, several others were unable to attend due to scheduling conflicts, but were interested in this meeting and desired their names noted. Those 7 people are:

Finally, there were 8 people who initially indicated interest, but did not respond to further inquires (names withheld).

Altogether, some 40 TAKE BACK MEDICARE people signed up for this meeting, of whom 25 (62%) would have attended. About 18% had schedule conflicts, and 20% did not follow up their initial interest. [By usual standards, this is a very high response rate for meetings of this sort, even for political activists. America’s Future estimated 30-35%. I expected under 20%. - wlb]

Walter Battaglia (WLB) tediously outlined the nature of the problems with the MEDICARE REFORM law, which are listed in the pre-conference packet. The packet was distributed by e-mail and in print at this meeting. [Packet available on request. -wlb]

There are 2 areas that need immediate attention. The Federal government should allow re-importation of pharmaceuticals, and allow individuals to buy their prescriptions overseas (usually, from Canada and Mexico). The Federal government should negotiate drug prices with pharmaceutical companies, as provided in House bill HR3707.

Dave Henderson objected to WLB’s prioritization, and wanted to know Representative Thompson’s (MT) views. Cheryl Diehm stipulated that MT agreed with the views presented by TAKE BACK MEDICARE and WLB in the packet. There was no substantial disagreement among those present about the problems created by "Medicare Reform."

Margaret Watson asked about the 2-3 million people mentioned in TAKE BACK MEDICARE’s written presentation. WLB explained that as many as 1/3 of all seniors are at risk for losing employer-paid retirement health benefits on account of this law; that would be about 10-14 million people. That is why approx $80 billion or more was included in the law to subsidize employers: the subsidy is supposed to encourage employers not to drop coverage. 2-3 million is a very conservative estimate of those who would lose employer paid benefits.

Ms. Watson pointed out her situation is different: she has privately paid Medicare supplemental benefits with an HMO that covers prescription drugs. It appears this coverage would be dropped as a result of Medicare reform; the HMO would refer those insured to the new program. For Ms Watson, this creates a problem because the Medicare program may not cover her prescriptions, and the reimbursement rate is far lower than she now receives. This could result in an increase of more than $400/mo in her medical costs.

Ms Diehm said Ms Watson’s problem is confusing. Ms Diehm agreed to have the MT’s Washington-based Medicare expert research this problem. Ms Diehm will report results and follow up this matter.

Roger Russell brought up the issue of the uninsured (those who do not have any health insurance). Medicare reform does nothing for this group, and neither does the State of California. In fact, there are provisions of the new law which will limit, and even end, Medicaid programs. (In California, MediCAL = Medicaid.) Seniors getting prescription drug benefits from MediCAL will lose them. Meanwhile, the uninsured may have to pay higher brand name drug prices, because Medicare reform prohibits Federal negotiation with drug providers. Higher prices may result from an increase in total drug usage as a result of this law, which leads to price inflation.

Dave Henderson wanted to know what MT’s view of Medicare is; what is the Big Picture? What sort of program does MT envision, if he could set up anything he wanted? What would it include, and what not? How would it be funded?

Kay Matusek wanted to know, by comparison, what does MT think is realistic (feasible) for Medicare? What would a realistic program include, and what not? When would this happen? How would it be funded?

Ms Diehm pointed out she and MT agree with everything in the previous presentation and discussion of Medicare. However, MT does not have a "vision" statement of what Medicare should be at this time; it will have to be developed. Ms Diehm will forward our suggestion that MT develop such a comprehensive statement.

WLB noted that there are three tracks going on in this meeting: long-term solutions, revisions and administration of the law, and remediation. Dave Henderson’s request comes under long-term solutions; what should the program be? There was general (not universal) agreement health care should move in the direction of a single-payer plan, such as the Canadian system. There was also general agreement this was not likely to happen any time soon.

Ms Diehm, Roger Russell and Dave Henderson noted several times that a Democratic Congress and Executive would be far more amenable to the sort of Medicare program all of us want. This was a pitch to vote Democrat in the November, 2004 elections.

WLB annoyed everyone by steering the meeting away from "vote for me" enthusiasm, back to the grim issue at hand; this was a meeting about the new Medicare law. On the second track, revisions and administration, the question was put to Ms Diehm, ‘what could MT do about it?’

Ms Diehm made sure all of us had a copy of HR3707, introduced by Moore, Emerson, Davis, Burton, Emanuel and Wamp and of which MT is a co-sponsor. HR3707 amends the Social Security Act, Title XVIII, to authorize the Secretary of HHS to negotiate prescription drug prices for Medicare recipients. This would remove the prohibition placed in the Medicare Reform bill at the behest of the drug companies. Note, however, that authorizing the Secretary to do something is not the same thing as doing it.

WLB brought up several times that HHS Secretary, "Tommy" Thompson, has refused to sign an authorization allowing re-importation of prescription drugs. Re-importation is still possible under the new law, if the Secretary authorizes it. Secretary Thompson follows Clinton’s HHS Secretary in this, after heavy lobbying by the drug companies. Clearly, there is a problem in both parties on this issue. Elected and appointed officials are susceptible to lobbying efforts because the drug industry contributes millions to sympathetic officials.

WLB also brought up that the new Medicare law makes it a criminal activity to import drugs without authorization. This means individuals could be arrested for buying drugs in Canada and Mexico that they bring back to the United States. The law makes no exemption for personal use; whereas the old law was not clear about this matter . FTC has already cracked down on several Internet pharmacies that were buying drugs from Canada for resale; some of those are now out of business. This problem could be resolved by Sec. Thompson’s authorization.

Ms Diehm said there is discussion among the Democratic Members concerning a bill to encourage re-importation. There is a difficulty in that the present law allows it, but does not require it. Congress would have to decide how re-importation would be authorized, a task now delegated to the HHS Secretary. Ms Diehm also pointed out several times that another party controls the House and the Executive, so MT is not in a position to control or influence policy.

Ms Diehm will advise MT that his constituents want a greater commitment from him on Medicare issues.

Dr Sarah Martin (Kaiser Permanente) thought non-profit direct medical services (e.g., MD office visits) should be encouraged or required. Most of those present agreed with that notion, or the notion that medical care generally should be non-profit. Large amounts of medical care money are going into administration, CEO salaries and profits, not health care. Non-profit health care organizations are a well-established answer to those problems.

Dr Martin also said the government should negotiate prices for the Medicare prescription drug program.

Roger Russell wants more action on the uninsured. Should Medicare be extended to the uninsured? Most of those present agreed tying health care to employment was "insane," as medical care is something everyone needs. Medical care is not workmen’s compensation. WLB noted that he had received a letter from State Senator Machado to the effect that the State was prevented from doing anything about any of this by Federal law or regulation. WLB will follow this up with Ms Diehm.

Gene Grant said the Medicare law prevents recipients from paying (privately) for secondary insurance to defray the cost of surgery and other doctor’s services. He has undergone medical procedures costing up to $30,000, sometimes as many as 8-10 times annually. Medicare and most HMOs pay only 80%, leaving as much as $6,000 patient liability for each procedure. Gene now has better insurance than what is offered under Medicare, including prescription coverage. He doesn’t want to lose his insurance, as is likely to happen under the new Medicare law. [This is similar to Ms Watson’s difficulties. - wlb] Gene thinks people should be allowed to buy secondary insurance which covers costs not included in the primary insurance, just as we have now, or have the option of leaving things as they are. He is worried the new Medicare law will eventually bankrupt many of us.

Jose Hernandez attended the meeting on behalf of the college. He pointed out that students would like to help with solutions to seniors’ problems, and they need help with medical care, too. However, they don’t know how they can help. So, we should not forget about the students.

Kay Matusek (KM), Candace Kuss and others wanted concrete suggestions about what to do. KM suggested that, since HR3707 is only a House bill, everyone urge our Senators to introduce a companion bill in the Senate. KM felt people should contact their relatives and friends in other States and urge them to do the same thing. She felt that we should lobby the House and Senate to allow Federal negotiation of drug prices covered by Medicare.

KM noted that "Tommy" Thompson has not authorized re-importation of pharmaceuticals. We should lobby the House and Senate to make re-importation a law which does not allow Administrative discretion.

There was general agreement on the foregoing proposals. Ms Diehm agreed we should write and lobby our Senators. (There were also Take Back Medicare meetings with Senators Boxer and Feinstein Friday morning. - wlb) She agreed the Senators should consider complementary legislation to HR 3707 and to implement re-importation.

Ms Diehm noted that the vote on the Medicare reform bill was very close in the House, and forced to the desired conclusion by the House leadership. Now, the costs of that bill have escalated, and even more Republicans are worried about it. So, there is some possibility Congress could be urged into amending the present law. Ms Diehm agreed there is nothing preventing us from urging friends and relatives in other States to lobby their representatives. She pointed out lobbying efforts may be particularly effective in certain "swing" States, or in those States where Congressional elections are closely contested.

So, it is important that our representatives see us as an organized and immediately visible presence. The fact is that those who are not gone are not soon forgotten.

We also need to bring to light those cases of people adversely affected by the new Medicare law. The Congressman may be able to assist in obtaining remedies for the afflicted.

Ms Diehm and WLB agreed on following up about having another Medicare meeting. This would be a public meeting in a larger hall. The purpose of such a meeting would be (1) to disseminate MT’s vision of Medicare, (2) to uncover any new general and individual Medicare problems, (3) to discover new ways to resolve the many Medicare problems caused by the recent legislation.

WLB also notes that the Medicare program is poorly understood. It requires an expert to interpret it, and MT has access to one of those. One thing that is desperately needed is a booklet that explains just what Medicare "reform" does or does not do. Individuals need to know how they will be affected. A larger meeting is likely to turn up more unexpected consequences, like that of Ms. Watson, which require research. We need to be concerned with the immediate effects of the program, regardless of who gets elected next November.

WLB notes the prescription drug program begins operation in 2006, but the rest of this new law’s provisions are in effect NOW. That includes employer, HMO and drug company subsidies, and the crackdown on Canadian drugs.

WLB notes there must things MT can do in remediation of the problems. This is an urgent problem which will affect large numbers of people in the 1^st CD. For example, MT could push for oversight hearings regarding HHS and FDA. Ms Diehm pointed out that Democrats don’t control the government. Nonetheless, WLB feels MT should be more proactive about Medicare, a Federal program.

WLB will also be following up on whether Federal regulations prevent the States from doing something about the uninsured. Are the States free to solve this problem?

Respectfully submitted,

Walter L. Battaglia

Chair and Secretary, pro tempore

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