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Correspondence-Robert Rubin Chronological File
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I
Sanford C. Bernstein & Co., Inc.
Investment Research and Management
Kenneth S. Abramowitz
Health Care Analyst
November 10, 1994
Mr. Robert Rubin
Assistant to the President
Jen
On Economic Policy
FYI
The White House
1600 Pennsylvania Avenue, N.W.
Smat
Washington, D.C. 20500
Dear Robert:
As a health care analyst with 17 years of experience with a research and
money management firm in New York, I thought you might be interested in
knowing that I will be giving a speech in Washington D.C. on December
15 at 8:00-9:00 a.m. at the Washington Sheraton Hotel. I will be speaking
to 150 health care industry executives with an update of the changes going
on in the marketplace and in Washington relative to health care reform. I
will also be presenting my hypothetical compromise solution, which may
be of some use to you, should Congress wish to reconsider health care
legislation in 1995.
Should you or one of your staff members wish to attend this speech, please
let me know. If you are unable to attend, but would like to discuss some of
my ideas, I will have some free time that day and would be pleased to meet
with you to discuss some of these issues.
Sincerely,
Kan alrowell,
767 Fifth Avenue, New York, New York 10153-0185
212/486-5800
Managing Benefit Costs: What Approach
Should Employers Use?
A Conference Highlighting
"Outcomes Management"
Keynote Speaker
Health Care Analyst
E43861
Sanford C. Bernstein and Co., Inc.
FACULTY
Henry Blissenbach, Pharm.D.
President
Diversified Pharmaceutical Services
Wayne N. Burton, M.D.
Vice President, Corporate Medical Director
MARK YOUR CALENDAR!
The First National Bank of Chicago
Patrick J. Casey, J.D.
Executive Director
Health Action Council of Northeast Ohio
Mark H. Glasser, M.D.
WHO SHOULD ATTEND?
Chief, Departments of Obstetrics
Fortune 1.000 corporate benefits and human resource
and Gynecology
executives, benefit consultants, and other decision-
Kaiser Permanente Medical Center
makers responsible for the delivery and planning 01
corporate health care
Christopher J. Mathews
Principle
Learn the new approach to managing benefit costs by
Williams, Thacher, and Rand
focusing on the outcome of treatment. You will hear
employers and consultants describe how they are using
Ron McDaniel, M.D., M.B.A.
outcomes management to purchase better care at
Assistant Director, Departments of
better prices. Case studies. panel discussions.
Outcomes Research and Epidemiology
presentations, and an open forum for your questions
Abbott Laboratories
will enable vou to take home innovative ideas to help
lower your health care costs without relinquishing
Dwight N. McNeill
health care quality
Healthcare Information Manager
GTE Corporation
TUITION
Sean Sullivan
This conference is being offered at no charge through
President and CEO
this invitation. This complimentary tuition covers all
National Business Coalition on Health
sessions. course materials. welcome reception. and
additional meals
To register, or for more information, please call
Discovery International at (800) 338-4721, ext. 4605.
This conterence is sponsored by Tap Pharmaceuticals Inc. and Abbott Laboratories
Hypothetical Compromise Solution
Year 2000
Issue
Potential Compromise
Budget Impact
1. Excise Taxes
Materially raise taxes on cigarettes, liquor, cholesterol and fat
$25B
2. Tax Cap
Set high employer and employee tax cap of $8,000 per family in an urban
$15B
state and $6,000 in a rural state; grow the cap level 0% for 5 years and then
at CPI thereafter
3. Tax Reform
Fully tax all not-for-profit insurance carriers and HMOs, partially tax not-for-
$15B
profit hospitals and fully tax their PHO's
4. Medicare
Set means tax at very high level, largely eliminating the $3,000 annual
$8B
subsidy for the top 10% of the beneficiaries; grow Part B payments 5%
annually for HMO members, but 10% annually for non-HMO members
5. Veterans Administration
Close 90% of VA hospitals by not rebuilding over 30 years
$2B
6. Small Group Reform
Impose adjusted community rating for employers with less than 50 lives;
--
disallow pre-existing exemptions; do not try to mandate a guaranteed benefit
package, except for Federally-qualified HMOs
7. Alliances
Encourage voluntary, multiple alliances that cannot exclude competing
-
plans. Wait 3 years before considering making into monopolies or
mandatory for employers with fewer than 50 employees
8. Employer Mandate
Raise minimum wage from $4.25 to $4.50 and funnel the incremental $0.25
-
into catastrophic insurance; funnel all future minimum wages increases into
health insurance
9. Individual Mandate
Mandate all employees making over $4.50 per hour to buy at least $500 of
-
tax deductible, catastrophic health insurance that the employer must offer;
raise the mandate by $500 annually (50% financed by employer) until it is
sufficient to join a Federally qualified HMO within 10 years. Employers
providing insurance must maintain current contribution to health benefits for
5 years
10. Individual/Employer
Cut taxes $100-500 annually for employees below 200% of poverty level to
$(35B)
Subsidies
cover the cost of the individual mandate for those without health insurance;
raise the subsidy (voucher) as the individual mandate rises; allow individuals
to deduct 100% of the cost of a health plan up to the cap level
11. Medicare Drug Benefit
Raise Medicare payments to HMOs from 95% to 100% of average costs to
-
pay for drug benefit
12. Workers Compensation
Integrate group health and workers compensation
:
13. Malpractice Reform
Cap award for pain and suffering; encourage alternative dispute resolution
-
mechanisms and set time limits; force losing plaintiff to pay 25% of court
costs of the winner
14. Illicit Drugs
Set-up needle exchange programs; test the dispensing of illicit drugs under
-
physician control, as in the UK
15. Federal Laws
Pass Federal pre-emption of state "any willing provider" and other anti-
I
managed care laws; only slightly relax anti-trust laws
16. Long-Term Care Benefit
Double allowable IRA contributions; raise the $40,000 threshold for tax
$(15B)
deductibility to $60,000. Raise Medicare payments to HMOs 2.5% to cover
the cost of a modest benefit.
17. Medicaid Reform
Mandate entry into an HMO, but allow choice of at least 2-5 HMOs
$(10B)
18. Unemployed Individuals
Raise unemployment compensation by $500 annually to cover catastrophic
$(5B)
insurance
$0B
Kenneth S. Abramowitz
Health Care Analyst
Sanford C. Bernstein & Co.
(212) 756-4590
Called
UNIVERSITY OF MIAMI
CORAL GABLES, FLORIDA 33124-8087
SCHOOL OF LAW
P.O. BOX 248087
October 17, 1994
Ocopy to track
2
Robert E. Rubin
to Jen Klein:
Assistant to the President
National Economic Council
Second Floor - West Wing
for response.
The White House
Washington, D.C. 20500
TY
Smat.
Dear Bob:
I enjoyed your talk at our reunion dinner last Saturday and the chance to visit with
you briefly.
(
I am writing at Alan Jacobson's suggestion to let you know that I very interested in
working with this administration on health policy issues continuing the work I did for the
White House Health Care Task Force. In 1993, I took a leave from Cardozo School of
Law, where I teach courses in law and medicine and health care regulation, to accept a
fellowship at the Federal Judicial Center. While I was there, the Administrative Conference
of the United States recommended me to the Governance and Legal Audit working groups of
the Task Force, to work on health policy questions as well as issues of federalism, separation
of powers, preemption and administrative law raised by the Clinton plan. I found the
experience fascinating both substantively and procedurally and would like very much to
continue my involvement with this administration's effort to bring about meaningful changes
in our health care system.
Although we have attended several of the same reunions, I don't think we have
actually recapped the last thirty years something even more difficult to do in a paragraph.
In brief, after a stint with Covington and Burling, I spent part of my time raising four
children and part practicing public interest law, litigating cases involving health and mental
health care issues. After completing a post-doctoral year in the Department of Health Policy
and Management at Johns Hopkins School of Public Health in 1987, I taught health law
courses at Yale and Virginia law schools as an adjunct, and accepted a tenure track position
at Cardozo Law School when Monroe was dean, commuting from Washington while my
children finished high school. I am currently visiting at the University of Miami Law School
A private, independent, international university
An equal opportunity/affirmative action employer
where I will finish up in May.
I would appreciate very much your letting me know if I could be useful to the Clinton
health care reform effort on either a consulting basis during the academic year or full time
basis in the spring. I will be in Washington at the end of this month if you think it would be
helpful for me to meet with you or your staff, and of course, I could arrange to come at any
other convenient time.
Thanks very much for thinking about this.
Sincerely yours,
magic
Margaret G.Farrell
O. (305) 284-2830
h. (305) 662-7538
MARGARET G. FARRELL
1994
Business Address:
1994-95
Permanent address
University of Miami
Cardozo Law School
School of Law
55 Fifth Avenue
1311 Miller Dr.
New York, N. Y. 10003
Miami, Florida 33124
(212) 790-0200
(305) 284-2930
Home Address:
1994-95
Permanent address
7480 SW 64th Street
4719 Cumberland Ave.
Miami, FL. 33143
Chevy Chase, MD 20815
(305) 662-7538
(301) 654-8638
Education:
B.A., Cornell University, 1961. Phi Beta Kappa.
Major: Government.
Yale Law School, 1961-1963. Member of the Yale Law Journal. Sixth in a class
of 167.
J.D., University of Chicago Law School, 1964. Order of the Coif. Third in a
class of 128, Cum Laude.
Post Doctoral Fellow, Johns Hopkins University, School of Hygiene and Public
Health, Department of Health Policy and Management, 1985-1986.
Employment:
Visiting Associate Professor, University of Miami School of Law, Miami, FL.
33124. 1994-95.
Associate Professor of Law
Benjamin N. Cardozo School of Law, New York, N.Y.
1988 to present.
Associate in the Department of Health Policy and Management, School of
Hygiene and Public Health, Johns Hopkins University, 1992 to present.
Federal Judicial Fellow, The Federal Judicial Center, Washington, D.C. 1992 -
1993
Visiting Lecturer Yale Law School 1986, University of Virginia Law School 1987,
American University Law School 1993; Visiting Professor, George Washington
University Law School, 1987-1988.
Partner, Ennis, Friedman, Bersoff & Ewing, 1981-1986. Washington, D.C.
Senior Litigation Attorney, Mental Health Law Project, Washington, D.C., 1977-
1981.
Legislative Assistant to Senator Abraham Ribicoff 1973.
Attorney, Neighborhood Legal Services Corp., Washington, D.C., 1969-1971.
Attorney, The Appellate Division, United Charities Legal Services Program,
Chicago, III. 1966-1968.
Associate, Covington and Burling, Washington, D.C., 1964-1966.
Courses Taught:
Health Care Regulation
Law and Medicine
Insurance
Bioethics
Contracts
Regulated Industries
Selected Publications:
"Coping with Scientific Evidence," Emory Law Journal (forthcoming 1994).
"The Need for a Process Theory for the Resolution of Health Care Disputes,"
Journal of Law and Health, (forthcoming 1994).
"Daubert V. Merrell Dow Pharmaceuticals, Inc.: Epistemiology and Legal
Process," 15 Cardozo Law Review 2183 (1994).
"Revisiting Roe V. Wade: Substance and Process in the Abortion Debate," 68
Indiana Law Journal 883 (1993).
"Doing Unto Others: A Proposal for Participatory Justice in Social Security's
Representative Payee Program," 53 University of Pittsburgh Law Review 883
(1992).
"Administrative Paternalism: Social Security's Representative Payment Program
and Two Models of Justice," 14 Cardozo Law Review 283 (1992).
"The Social Security Administration's Representative Payee Program: Problems
in Administrative Paternalism," Administrative Conference of the United States.
Reports and Recommendations (1991).
"Reregulation in the Health Care Industry: Filling in the Gaps," Biolaw
University Publications of America (1989).
"Legal and Ethical Issues in the Regulation of Health Care," BioLaw University
Publications of America (1987).
"Health Planning and Deinstitutionalization: Advocacy In the Administrative
Process", 31 Stanford Law Review 679 (1979).
Other Activities:
Member, White House Health Care Task Force, Working Group on Governance
and Legal Audit Committee, 1993.
Conference Consultant, Administrative Conference of the United States, 1989-
1991.
Member, Committee on Legal Ethics, D.C. Bar Association, 1983-1986.
Member, United States Judicial Conference for the District of Columbia Circuit,
1980, 1982-1988.
Executive Committee, Yale Law School Association. 1984-1987 (ex-officio
member.)
Delegate, Association of Yale Alumni, Yale University,1984-1987.
Member: Health Law Forum, American Bar Association; The Health Services
Research Association; The American Society for Law, Medicine and Ethics.
Admissions:
United States Supreme Court.
United States Court of Appeals for the District of Columbia Circuit.
United States District Court, District of Columbia.
District of Columbia Court of Appeals.
Superior Court of the District of Columbia.
EXECUTIVE OFFICE OF THE PRESIDENT
07-Nov-1994 09:36am
TO:
Jennifer L. Klein
FROM:
Sylvia M. Mathews
Economic and Domestic Policy
SUBJECT:
Margaret Farrell
Did I send you the letter that BR received from Margaret Farrell?
This is someone that Rubin thinks pretty highly of and wants to
make sure that even if we don't want/aren't able to utilize her
that we treat her well. If you do not have the letter, please let
me know and I will get a copy to you.
Thanks.