Facing the powers that be

Lobbyists, entrenched forces in congress and self-interested friends will try to stymie Clinton's efforts. A look at four key arenas of combat.     

The Medicare secondary payor provisions: possible rewards and pitfalls

A 1990 report prepared by the Office of Inspector General estimated that as much as $1 billion is lost to the Medicare program annually because (i) secondary payor situations are not detected and (ii) insurance companies often do not pay when they are required to be the primary payors. Office of Inspector General, No. A-09-98-00151, April 1990, Medicare and Medicaid Guide (CCH) [symbol: see text] 39,112, at 25,649. In order to better enforce the MSP provisions, suggestions have been made at the Congressional level to impose sanctions against providers who demonstrate a pattern of inappropriate billing practices such as double billing, repeated failures to screen beneficiaries for other insurance coverage, and the repeated submission to Medicare of bills that should be submitted to another payor. (See the Subcommittee Report on erroneous payments under the MSP program, supra.) Although authority for such sanctions has yet to be adopted, given the fiscal problems currently plaguing the federal government, providers can expect increased enforcement of the MSP provisions as a means of reducing Medicare costs, and should review their screening and billing practices accordingly.     

The New Right and family politics

Political concern for the family has historically been intermittent; the present context is that there are considerable consequences for individuals, families, and personal life. Socioeconomic and cultural changes brought the rise of the New Right; The Thatcher (UK) and Reagan (US) administrations were committed to strengthening the traditional family. The emergence of the family as a social problem and the political agenda are discussed. The costs of liberalism were felt in a recessionary economy. The US political agenda of Carter to hold a White House Conference on the American Family never materialized. Reagan used the restoration of the traditional American family as a way to get the economy back on its feet. Moral crusaders and the new evangelical Christian movement merged with the political right; the "Gang of Four" (Republican Party right) politicians involved morally conservative communities normally outside the political area into the New Right. Grass roots organizations were mobilized on the Right. The British situation is explained; differences existed in that there were no antiabortion and moral lobby groups tied to the Right although their influence was felt. Pressure group politics is relatively novel to Britain. The Moral Majority in the US and right wing pressure groups on the Tory government are but 1 part of the New Right; it is characterized as populist, proclaiming the Radical Conservatism of Adam Smith and Edmund Burke. The approach in this article is to show the complex interactions of theory, biography, and public opinion in the practical politics of the New Right. Policy outcomes are not predictable because of ideological differences in New Right attitudes toward the family. The attitudes of the moral order and the family is exemplified in the work of Roger Scruton's neoconservative stand on social order, Robert Nozick's Kantian proposition that human beings are ends with natural inviolable rights of individual freedom, Hayak and Friedman's efficacy of the market in guarantees of freedom, and Ferdinand Mount's concern for family based in humanist, secular, and anticollectivist thought. Thatcher and Reagan both incorporated the ideological contradictions of the aforementioned positions. The failure of the New Right in implementing policy is explained. The greatest obstacle was the major demographic, economic, social, and cultural shifts which impacted on the role of women. The camp was divided. Economic policies did not strengthen the traditional family. It is likely that the family will remain as a political pressure point.