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SMonly 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.