Following a familiar pattern of blaming any unfavorable health care story on the recently passed health care law, the Senate Republican Communications Center has seized on an AP story about the consolidation of prescription drug plans to try and convince seniors that they won’t be able to keep the coverage they have. The AP article reports on “a new analysis by a leading private research firm estimates that more than 3 million beneficiaries will see their current drug plan eliminated as Medicare tries to winnow down duplicative and confusing coverage, in order to offer consumers more meaningful choices. Instead of 40 or more plans in each state, beneficiaries would pick from 30 or so.” Without missing a beat, the Senate GOP issues this release:

This really represents one of the most transparent and shameless attempts to scare seniors about health care in the post reform era. Consolidating Part D plans have nothing at all to do with Obama’s law and is actually a continuation of a Bush administration effort to ensure that seniors have meaningful choices of prescription coverage.

When Part D became law in 2003, lawmakers feared that seniors would not have enough prescription drug choices and established government back up plans that would go into effect in case private insurers failed to materialize. But private insurers did participate, offering some 1,400 plans nationally in the first several years and up to 1,800 plans in 2007. Insurers began offering a multitude of plans with an array of different co pays and deductibles in the hopes of attracting the largest possible market share. CMS officials in the Bush administration and senior advocacy groups like AARP, however, felt that seniors would become overwhelmed by the plethora of choice and began to set guidelines for how many plans a single issuer could offer. Several 100 plans, for instance, had fewer than 500 people enrolled in them and seniors themselves felt unable to compare all the choices adequately.

Beginning in 2005, CMS used its regulatory authority to narrow the number of plans a single sponsor could offer, eventually instituting a rule that any given sponsor could only offer three plans per region. The Obama administration has continued with this approach. In April, it published regulations saying that sponsors would have to demonstrate meaningful differences among plans and that plans with very low enrollments should be discouraged. The final list of plans to be offered for 2011 is still pending, but some don’t expect a great deal of coverage disruption. In fact, consolidation could proceed relatively smoothly, with insurers simply transferring policyholders to a different basic policy.

The larger point here is that all this has nothing at all to do with the health care law or Obama’s promise that you can keep the policy you have. The GOP press release relies on the party’s pre-reform tactics of literally lying to America’s senior citizens to discourage them from voting for Democrats.

Ben Smith observes that the GOP strategy of running against the health care bill (you know, suing the federal government or trying to pass nullification measures on the states) isn’t reaping in the kind of dividends that Minority Leader John Boehner (R-OH) had predicted:

This March, two attorneys general took the lead in lawsuits challenging the constitutionality of the health care overhaul: South Carolina’s Henry McMaster and Florida’s Bill McCollum. Another, Michigan’s Mike Cox, soon signed on.

The lawsuits made them national leaders on the central national issue, and seemed tailor-made for Republican primaries. But all three lost those primaries, as CNN’s Peter Hamby noted of the first two last night.

McMaster lost to Nikki Haley, whose reform message trumped his series of ads touting his health care fight. Cox, who also put his health care suit on air, lost to a wealthy businessman who ran on a non-ideological platform under the slogan, “one tough nerd.” McCollum lost to Rick Scott, and there the message may not be as clear — Scott was also a leading national foe of the health care bill.

Indeed, it’s hard to argue that opposition to the health care law sank the ship, but it is likely that a heavy repeal message — one that focused on the dangers of reform sometime after 2014 — moved the conversation away from more immediate economic concerns and on to some ill defined, yet to be determined, cost increases down the road. In this sense, the anti-health reform AGs would have probably been better off following the national party’s advise to Democrats throughout the last year and a half: stop and focus on jobs and the economy.

We’re also seeing some indication that the repeal message just isn’t selling right now. State lawmakers are having a great deal of difficulty in passing legislation to invalidate different parts of the measure, Republicans can’t convince their entire caucus to sign the various repeal petitions, and public support for the law is growing as the early reforms come out.

Republican Gubernatorial Candidate Rick Scott

In his victory speech last night, Rick Scott, the 57 year old former health care executive and founder of the health care attack group Conservatives For Patients Rights, assured Republicans that the “party will come together” after a particularly bruising primary challenge against Florida Attorney General Bill McCollum. Scott entered the race in April and proceeded to spend approximately $50 million of his estimated $218 million fortune on a negative campaign that sought to deflect attention from his past business controversies and smear McCollum as a product of the establishment.

That outlandish sum, however, is not nearly as shocking as how Scott came to acquire it, as the chief executive of one of the largest and most controversial for-profit hospital chains in the country, Columbia/HCA.

In 1987, Scott, a mergers and acquisitions lawyer who “had cut his teen on deals involving radio stations, fast food businesses, and oil and gas companies before focusing in on the money to be made by acquiring hospitals,” didn’t enter the health care business for the sake of improving the quality of care, but rather wanted to “do for hospitals … what McDonald’s has done in the food business” and “what Wal-Mart has done in the retailing business.” The goal, as Maggie Mahar explains in Money Driven Medicine, “was to combine volume with low cost.” This quote is demonstrative: “Do we have an obligation to provide health care for everybody? Where do we draw the line? Is any fast-food restaurant obligated to feed everyone who shows up?” he asked.

Indeed, through an aggressive strategy of rapid acquisitions and consolidation, Scott turned Columbia/HCA into one of the largest health care companies in the world. Forbes magazine noted Scott ruthlessly bought “hospitals by the bucketful and promised to squeeze blood from each one.” HCA/Columbia executives saw health care as any other commodity. “This industry’s not any different than an airline industry or a ball bearing industry,” said David T. Vandewater, Columbia’s chief operating officer. “You run at 40 percent of capacity or at 60 percent of capacity you’re not getting the maximum value out of your assets.”

Under Scott’s leadership, Columbia/HCA plead guilty to a massive array of fraud charges – which resulted in a fraud settlement of $1.7 billion dollars, the largest in U.S history. Columbia/HCA systematically defrauded taxpayers, charging Medicare $15,000 for Tiffany pitchers and other luxury goods, “exaggerating the seriousness of the illnesses they were treating,” and engineering a program where doctors were granted partnerships in hospitals as a kickback for referring patients. In 1997, “disaster struck in the form of an FBI raid.” In July of that year, “federal agents swarmed Columbia/HCA hospitlas and offices in five states. Within weeks, three executives were indicted on charges of Medicare fraud, and the board had ousted Scott.” Scott left in disgrace, but not before walking away with “a $9.88 million severance package, along with 10 million shares of stock worth up to $300 million at the time.”

During Scott’s tenure at Columbia/HCA, his cost cutting methods threatened patient care and safety:

- Susan Marks, a technician at one of Scott’s hospitals, was forced to monitor 72 heart monitors by herself. Marks explained, “I have to. I’ve been told you either do it, or there’s the door.” [ABC News, 9/26/97]

- Scott downsized nursing staffs, created conditions where “babies were attended as infrequently as every three hours. Once, the only nurse caring for seven ill infants was so busy she failed to hear an alarm when a baby stopped breathing. A parent dashed to the baby and stimulated breathing, the state report said.” [New York Times, 5/11/97]

- Hospital workers in Florida complained, “gloves come in only one size, and rip easily.” In addition, California employees protested “filthy conditions,” and being “stretched to the limit” as Scott’s company slashed “the ratio of nurses to patients.” [Money Driven Medicine, pg. 119]

In 2001, Scott would return to health care and the ‘McDonalds model,’ with a chain of urgent care clinics all over Florida. And as Tristam Korten explained in this two part series for Salon, it quickly replicated many of Columbia/HCA’s favorite business practices.