This past week a mysterious thing happened: Former secretary of Health and Human Services – and former governor of Wisconsin - Tommy Thompson released a white paper giving his opinion on how to reform Medicaid. Beyond the mystery of its lack of originality and lack of useful data is a far greater mystery: Why would he think anyone would take him seriously? His performance as governor and secretary should have stripped him as every last shred of credibility.
Thompson is a political pigeon: He flies in, messes everything up and then flies away, leaving the cleanup to others. He may try to mimic songbirds, here to make our lives more pleasant, but don’t be fooled. Example: When the Bush administration offered states $12 billion in Medicaid dollars over a of couple of years if they promised to pay it back at the end of 10 years, Thompson was asked what happens in 10 years, when the droppings hit the fan, he reportedly chirped "I wont be in office then, so its not my problem."
Thompson has always been a pigeon, of course, but he spent so much time strutting around the country pretending to be otherwise that no one bothered to look at the mess he left as governor of Wisconsin. I wrote, 16 years ago, that "Thompson seems to be only about politics and his politics seem to be only about money. His values seem mostly negative and politically expedient. He seems to be an ill-tempered, vindictive fellow who speaks in an illiterate dialect from the side of his face." so I feel I’m in a position to share* with you a little about him.
Thompson was infamous for what became known as the Vanna White Veto – abusing his line-item veto power to veto all punctuation, all numbers and all words, and then to use the leftovers to create entirely new laws that were never dreamed of by the Legislature. When he took his arrogant use of power too far and began vetoing individual letters to make new words, and the state Supreme Court backed him up, the voters passed the Vanna White Amendment, prohibiting such absurdity.
He played accounting games during boom years and left the state with its lowest bond rating ever and a $3.5 billion deficit.
Under Thompson, 55.8 percent of Wisconsin’s black children, 48.8 percent of our Asian children and 33.7 percent of Hispanic children lived in poverty.
While paying the usual Republican lip service about cutting taxes, Thompson’s budgets raised taxes for most residents and cut taxes for the very richest.
In 2000, the black family income in Milwaukee was 23 percent lower than the national figure, and Milwaukee fell to 49th among the nation's 50 largest metro areas in racial disparities in income. In fact, Milwaukee's black male employment rate plummeted by 21 percentage points from 1970 to 2000 -- nearly double the 13 percentage point decline in the national employment rate during the Depression.
He ruled over a decade-plus of hundreds of millions of dollars in no-bid contracts going to companies with ties to Thompson fund-raisers. A study by a University of Michigan researcher found a strong connection between campaign donations by construction and road-building contractors and major state contracts awarded by Thompson's administration – and that there was an acceleration of large donations during state budget cycles and "exceptional levels" of donations just before and just after contracts were awarded. The study also found that the value of contracts awarded during the 1990s to contractors who contributed to Thompson's campaign averaged $20 million while the average value of contracts awarded to non-contributors was $870,000.
A tripod of conservation bodies, crafted by a citizen committee in 1967, was gutted by Thompson with a clause crafted in secrecy, with no public direction and buried in a massive budget bill. The move made natural resources an exclusive power of the governor and was meant to hasten the exploitation of those resources.
Thompson initiated the pro-voucher drive, moving toward privatization of education for all, to "help poor black parents have the same choices as we have." Those are the words he used with newspaper editors. Saner people argued that the voucher program was a way to achieve the goals of the white Southerners who resisted integration following Brown v. Board of Education: private, segregated, tax-supported schools.
Thompson tried to eliminate the personal care option for disabled residents, but was forced to back off when the TV cameras picked up the Capitol rotunda filled with angry people in wheel chairs. His administration audited and demanded millions in repayment of Medicaid funds from personal care providers based on "violations" of a provider manual that didn’t exist – often the "violations" occurred because providers followed the specific instructions of consultants the administration had hired to train them.
He neglected and abused the home health care** providers, on whom the elderly and disabled depend, so coldly that nearly half the home health care agencies closed their doors and 12,000 beneficiaries dropped from the home care rolls. A Milwaukee Journal Sentinel investigation produced a series of stories documenting both the financial ties of the nursing home industry to Thompson and the preferential treatment given to nursing homes by the Thompson administration.
Thompson's administration was infamous for playing fast and loose with statistics about health and social services. It doctored internal reports to portray pet programs as successful when the evidence said otherwise, used misleading data to defend programs, and blasted the messenger any time outside agencies presented proof of the dishonesty. Perhaps the ugliest example was when, in trying to limit a welfare family’s grant so that it wouldn’t grow with a new birth, his administration more than doubled the number of actual new births in such families per year.
Thompson's administration was also infamous for disregarding truth whenever it wanted to crush a program. Having strong financial ties with the nursing home industry, Thompson treated home health care as the enemy. One his closest officials told a room full of home care nurses - caring, educated women so devoted to their mission that they work for far less than they should and endure far more than they should - that they were all crooks and were going to be put out of business. Another official told a Senate hearing that "dozens" of home care providers had been jailed for Medicaid fraud; the truth was, according to the state Department of Justice, no licensed home care provider had ever been jailed in Wisconsin. His administration developed a system of legalized extortion in which state auditors would make outrageous demands for repayment of Medicaid funds – without evidence of fraud and often without even an audit – and then offer not to press legal action if the home care provider agreed to pay a far lesser amount without a court fight.
Thompson opposed welfare programs allowing poor parents to get a college education, saying he didn't want welfare to be a "college scholarship program" for poor people.
Thompson, against the advice of his secretary of corrections and most prison wardens in Wisconsin, decided to build a Supermax prison. He sent a team around the country to visit other so-called super-maximum facilities to make sure Wisconsin's would be the worst of the worst for inmates. He succeeded. Some inmates there have been held in solitary for two years without ever seeing daylight – violating the minimal standards of the Geneva Conventions? It was tremendous and unnecessaery expensive (Wisconsin now spends more on its prison than on its university system), as well as a tribute to cruel and unusual punishment.
Thompson built a state human services department that was paralyzed by its own weight, loss of credibility and belligerent nature (within itself and toward its partners), then found a new roost in a similar federal tree.
Thompson's main program, Wisconsin Works, or W-2, basically eliminated Aid to Families with Dependant Children (AFDC), replacing it with a draconian system that forces virtually all recipients to work, regardless of their circumstances. Thousands of mothers on AFDC, many of them with severe obstacles to working, never transferred over to the new system. For those able to find jobs - many of them at temp agencies - the average wage is just over $7. For those unable to "succeed" under the new rules, there is no more safety net. The results have been devastating. Homelessness has skyrocketed, as has the number of children taken into the state's foster care system. In the first year of W-2, the black infant mortality rate in Milwaukee city shot up an incredible 37 percent. Far from being a program to reduce poverty, W-2 creates a low-wage, captive work force that means super-profits for private businesses. It opens wider the door to massive privatization of government services and it helps to obliterate the concept that the government has any inherent obligation to "promote the general welfare."
Why were all the records relating to two of the most controversial issues in Thompson's 14 years as governor destroyed? The records that would explain the deal with the Milwaukee Brewers baseball franchise to build what is now Miller Park, and his pardons, are now toilet paper. Accident? Sure. As one political opponent quipped: And Lee Harvey Oswald acted alone.
Wisconsin’s taxpayers voted, by nearly a 2-1 margin, "no" to spending $400 million on a new stadium. Thompson, with help from the Milwaukee Journal Sentinel, rammed the stadium deal down the taxpayers throats – but never signed the one document that might keep the Brewers in Wisconsin. The Brewers’ lawyers never asked for a signed copy? And the Journal Sentinel, having hired lobbyists to push through the deal, never asked? Yep. Lee Harvey was one lonely guy.
Thompson created an under-funded, bloated bureaucracy to prop up a handful of poorly designed pilot program as a pretense of helping the 10,000 disabled and elderly who were on waiting lists for community-based care, and then flew out of town. When he left, 9,000 remained on the waiting list.
As secretary of HHS, Thompson remained true to form.
Not quite up to the job?
Thompson frequently appeared to lack the intellect suitable to the task of his position at HHS. He has long suffered from the sort of malapropism that has made President Bush the butt of countless jokes, but it cost him a great deal of credibility when, during the anthrax attacks, – among many other mistakes – he referred to anthrax as a "poison." Anthrax is an acute infectious disease.
Thompson didn’t do much better when he tried to talk about the West Nile virus at the Wisconsin State Fair in 2002. "We haven't had any attacks as of anybody receiving West Nile virus or encephalopoulus," Thompson said.
In interviews and appearances, Thompson confessed that he knew little about science when he became the nation's top health official. "I just dwelved into it," he said.
"Can you imagine the hemopathetic blood cell being started here?" he said in a speech praising research on finding the hematopoietic, or blood stem cell. He later referred to them as "those pathetic stem cells.... Embryonic stem cells has the potential of really changing the direction of medicine," Thompson said. "To be able to grow part of a heart, or even a heart, to be able to rejuvenate the nerve impulses, the neutrons (neurons), into a Parkinson-diseased person."
He also said, "There's three nerve lines: the ectoderm, the entoderm and the mesoderm. And they're pluripotent, and that means they can subdivide into any one of these three layers. And when they can do that, the potential for replication is mind-boggling."
Thompson confounded medical experts with his baseless confidence in making erroneous statements regarding SARS. He was quoted as telling reporters in Brussels that: "I am not confident at all ... I do not think SARS is going to go away. Even though it may level off now, it could come back in the fall, and then you can, I think, anticipate that you will have deaths in all the continents."
While it is quite possible that SARS is seasonal, or that China will not be able to eradicate it, there are no data suggesting that either is true – just fears. As WHO spokespeople trying to clean up the damage were quoted as saying: "We have only seen SARS for a couple of months and it is too early to know if it will establish a seasonal pattern," Maria Cheng said. "There is no evidence to tell one way or the other." Dr. David Heymann, said, "The general public's perception of the risk has been much greater than the actual risk, despite clear guidance. Governments have not done a good job in educating the general public about this disease."
We might forgive him for not knowing science, but because he’s a lawyer we might have expected him to understand the law. The American Lawyer, published in January 2002, said, "in October, when people started dying from anthrax infections and the strongest available antibiotic disappeared from pharmacy shelves, Thompson twisted the arm of that medicine's owner, Bayer AG. He might disregard the company's patent, he said, if the company didn't drop its price. Bayer did, and Thompson promptly went before a national gathering of 6,000 public health administrators to crow about his toughness at the bargaining table. The boast was an appropriately shallow finale to his week-long display of bureaucratic mumbo jumbo, during which he and his staff made at least five misleading or false statements about his powers to break patents in times of crisis."
Rotting from top down?
It seems some Thompson’s employees had similar issues. During his term, a GAO study found only 4 percent of questions posed by providers about Medicare policy and billing were answered accurately by Medicare call centers. As one long-time federal employee wrote: "Thompson's stewardship of HHS, at least the part I know about (CDC, NIH, NIOSH), has been catastrophic. Morale and effectiveness have never been lower in those agencies in my forty years in the profession."
Lining the pockets of his own golden parachute:
Thompson spent much of his time in DC delivering favors to insurance, pharmaceutical and other health care corporations. Then, preparing for his time to take wing again, he eluded federal rules that bar top officials from actively seeking jobs while they are in office by hiring two attorneys to sift through private sector job offers.
Cronyism:
In so doing, Thompson followed in the footsteps of his former top Medicare official, Thomas Scully, who, after he helped write the new Medicare law, resigned to become a lobbyist for major drug companies, including Abbott Laboratories, Aventis and Caremark Rx. Those companies are affected by the new Medicare law he helped write and promote. Two members of Congress wrote to Thompson that for seven months, members of Congress who counted on Scully for information did not know he was actively looking for employment with firms "that have significant interests in the issues at stake." They said Thompson’s waiver gave Scully "free rein" to negotiate with firms directly effected by his decisions as CMS administrator. "It is not intended," they wrote "that high-ranking government officials be actively trolling for work in the very industry they are being entrusted to regulate and oversee on behalf of the public."
Scully had also retaliated against an outspoken University of Wisconsin think-tank director by canceling a $1.6 million federal research grant on the same day Medicare staff had approved it, after becoming miffed that one of the director (who had studied nursing home quality for 20 years under four administrations, three of them Republican) questioned how Medicare compares nursing homes. Sen. Charles Grassley, R-Iowa, told Thompson Scully's actions were "unacceptable."
The Gallup Organization sued Scully in a lawsuit that alleged he tried to bully a Gallup official who was looking into alleged collusion over the patient satisfaction surveys between Medicare and a Nebraska survey firm.
Thompson also appointed Stewart Simonson as assistant secretary for public health emergency preparedness, whose only qualifications were that he’d been Thompson’s staff lawyer when he was governor, and a top dog at Amtrak when Thompson was its board chair. During a time when the nation has heightened concerns over flu vaccine shortages, the threat of pandemic flu and bio-terrorism, Simonson’s appointment is just this side of criminal.
Playing politics with our health:
Under Thompson many potential nominees for federal scientific advisory posts were questioned about their political views and even whether they had voted for Bush. The most transparent manipulation occurred in 2002 when the CDC Advisory Committee on Childhood Lead Poisoning was to consider narrowing the criterion of lead poisoning, so that sources of poisoning that were formerly banned became permissible. A panel of new nominees for the advisory committee was proposed by the CDC and, for the first time in the history of the committee, nominees were rejected by the direct intervention of the secretary of health and human services, Tommy Thompson, who replaced them with five persons who were previously known to oppose tightening the standard. Two of the five had financial ties with the lead industry.
In Thompson’s world, expertise and truth counts for nothing when arrayed against political and economic clout. Under Thompson, HHS stripped government websites of inconvenient facts about birth control and sex ed. An Agriculture Department official's warning about the meat-inspection system was ignored. And EPA enforcement chiefs resigned after the agency abandoned its suits against major polluters. A CMS official with realistic cost estimates for the prescription-drug bill was threatened with dismissal.
Thompson decided to prohibit HHS scientists from participating in UN meetings unless he approved them. "No one knows better than HHS who the experts are and who can provide the most up-to-date and expert advice," HHS spokesman Tony Jewell said. "The World Health Organization does not know the best people to talk to, but HHS knows." In short: Tommy Thompson thought himself the best man to decide which group of scientists another group of scientists should talk to (apparently from his ability to "dwelve" into science).
Thompson’s actions appeared to be motivated by an embarrassing moment with a WHO panel declared formaldehyde a known carcinogen, based its decision on studies that Bush administration political appointees in the EPA had rejected as inconclusive. Voting members of the panel included scientists from the National Cancer Institute and the National Institute for Occupational Safety and Health who had been authors of the studies.
In one revealing case, Thompson intervened at the precise moment that the CDC's Advisory Committee on Childhood Lead Poisoning Prevention was set to consider once again lowering acceptable blood-lead levels in response to new scientific evidence. The administration rejected nominee Bruce Lanphear and dumped panel member Michael Weitzman, both of whom previously advocated lowering the legal limit. Instead, Thompson appointed William Banner--who had testified on behalf of lead companies in poison-related litigation--and Joyce Tsuji, who had worked for a consulting firm whose clients include a lead smelter. (She later withdrew.) Banner and another appointee, Sergio Piomelli, were first contacted about serving on the committee not by a member of the administration but by lead-industry representatives who appeared to be recruiting favorable committee members with the blessing of HHS officials.
Undermining justice:
Under Thompson the administrative law judges, who decide disputes between Medicare and its patients, were brought under Thompson’s control where they faced a pay-for-performance system that would could create at least the perception, if not the reality, that judges are more interested in meeting the expectations of the person evaluating their performance -- to obtain a pay raise -- than in reaching an impartial decision on disputes. Such a fear became reality in 1983, when a federal district court found that Social Security officials had engaged in acts of "dubious legality" and put improper pressure on the judges to deny benefits to people with disabilities. The practices stopped only after a lawsuit was filed.
The anthrax attacks:
Thompson's completely bungled the anthrax scare, and not just because he didn’t know what anthrax is. He stumbled and tripped repeatedly, just when he could have been a reassuring presence for the nation. First, he downplayed the danger, then he assured the public that a mere $1.5 billion would be enough to upgrade the nation's dilapidated public-health system. He falsely told America that the first anthrax victim might have contracted anthrax by drinking stream water, something health experts and science reporters immediately knew to be false, given the symptoms he displayed.
Even worse, during the first weeks of the largest bio-terror attack in our history, when the need for accurate information was highest, Thompson gagged government experts and made himself the spokesman. After the attacks, reporters could not get their calls returned, and veteran press officers and government experts were forbidden from speaking with them.
Medicaid waivers:
Under Thompson, states were allowed to make vast changes in Medicaid but were not held accountable for the quality of care they provided to poor elderly and disabled people. Investigators from the General Accounting Office (GAO) said Thompson had "not fully complied with the statutory and regulatory requirements" to monitor the quality of care under such waivers. Thompson also played personal political games with the waivers by denying those requested by his long-time nemesis and successor as governor of Wisconsin, Jim Doyle (D), despite the fact that the waivers were meant to expand on initiatives Thompson had made as governor and built on principles Thompson had touted.
Where waivers were granted, their effect was grossly overstated. The Kaiser Foundation found that the waivers led to a net gain in coverage of roughly 200,000 people previously not eligible for Medicaid, SCHIP or state-funded coverage just when Thompson told a Senate Finance Committee hearing that: "I've been able to use the waiver process for 2.5 million Americans who've been able to get health insurance that wouldn't have it now."
The vaccine debacle:
When 3,000 Americans were killed by attack in 2001, our federal government put almost everything it had into responding to the tragedy; when 12 times that many Americans were killed by the flu in 2002, our federal government put almost nothing it had into responding to the tragedy. When the flu vaccine shortage of 2004 threatened more than 60,000 Americans lives, and the best Thompson and his crew had to offer was to tell people how to sneeze and cough. The gross negligence that has led to this grotesque calamity demanded accountability –none was found.
More than 1,000 pages of documents obtained by Rep. Henry Waxman (D-CA) revealed, in striking detail, "that despite being aware of major problems at the [Chiron] vaccine manufacturing facility as early as June 2003, [the Food and Drug Administration under Thompson] missed repeated opportunities to correct them." (The Chiron facility was located in Liverpool, England, but Chiron is a California company whose operations are regulated by the FDA.) Sixteen months later, British regulators shuttered the facility because of contamination problems and the U.S. was left with a massive flu vaccine shortage. The incident draws focus to bipartisan concerns about the impact of the administration's personal and financial ties to the drug industry.
Sen. Charles Grassley (R-IA) said, "The kind of mismanagement we've seen this year by the Food and Drug Administration demands tough scrutiny. One of my concerns is that the FDA has a relationship with drug companies that is too cozy. That's exactly the opposite of what it should be. The health and safety of the public must the FDA's first and only concern."
The flu vaccine shortage wasn’t the only problem. In the preceding two years, the U.S. had run out of vaccines eight times for illnesses such as diphtheria, tetanus, chicken pox and measles. Even before the vaccine shortage, health departments reported at least 49 instances in which shortages forced them to ration vaccines.
Drug reimportation:
Thompson refused to certify the safety of Canadian drugs, effectively preventing widespread reimportation to the United States. Thompson's reticence has been a boon to the pharmaceutical industry which rakes in huge profits from high-priced U.S. prescriptions – but a blow to average Americans, especially seniors, who could save as much as 72 percent off the price of the most common medications.
Drug safety:
Thompson, who oversaw the FDA, presided over irresponsibly lax regulation of prescription medications. According to Jerry Avorn, a Harvard University drug safety expert, "the FDA has been asleep at the switch in its regulatory function." Most famously, Thompson allowed Vioxx to stay on the market for years after public studies provided evidence "strong enough to initiate discussion of whether the drug should be recalled," unnecessarily exposing thousands of people to an increased risk of heart attack or stroke.
The uninsured:
Under Thompson's watch, 5 million more people became uninsured, driving the total up to 45 million, but that's not the way Thompson saw it. Thompson said, "Even if you don't have health insurance, you are still taken care of in America. That certainly could be defined as universal coverage." According to the Institute of Medicine, "18,000 unnecessary deaths occur each year because of lack of health insurance." Further, the "United States loses the equivalent of $65 billion to $130 billion annually as a result of the poor health and early deaths of uninsured adults."
Two-chin Tommy as Two-faced Tommy:
Those of us who have known Thompson for decades have enjoyed the rich irony of his lecturing the nation on the dangers of being overweight. During his years in Wisconsin, he was such a poor physical specimen – dumpy, overweight and ashen gray - that even people who intensely disliked him feared for his health. The derisive nickname of Two-chin Tommy followed him for years, but there was an uglier irony that wasn’t so funny.
Behind the scenes, while Thompson urged us to watch our diets, Thompson’s HHS responded to concerns about sugars, beverages, processed foods, and restaurants by casting doubt on the link between obesity and addictions to soft drinks and fast food. When the World Health Organization issued a report embracing these linkages, for example, HHS officials sent a 28-page memo to Geneva attacking the report.
The Medicare reform fiasco:
Announcing his resignation from HHS, Thompson said he was most proud of marshalling the administration's Medicare scheme into law (later, he say it was the new law was passed over his objections – so which was it?). Countless pages can, have and will be written about all that’s wrong with this "Medicare deform" bill, but we can touch on some of the lowlights.
Lotta love for Big Pharma... The Medicare bill was also Thompson’s biggest gift to the insurance and pharmaceutical industry. The law prohibited Medicare from reducing costs by negotiating bulk rates on prescription drugs. That prohibition, by one estimate, is worth $139 billion to the drug industry over eight years. Corporations offering drug discount cards under the law were allowed to change their prices every week, while seniors were locked into a particular card each calendar year. The bill also included $46 billion in subsidies to the insurance industry and $16 billion for a new tax shelter for wealthy older Americans.
Robert E. Moffitt, a policy analyst at the conservative Heritage Foundation. "It (Medicare) has been transformed from a system where we were providing health coverage for seniors, into a system where there is a massive redistribution of income among health care providers."
Illegal spending for propaganda... The GAO found that Thompson had violated two federal laws in its publicity campaign to promote the administration’s changes to Medicare. HHS spent $9.5 million to air the now infamous television ad in which one of Thompson’s employees pretended to be a news reporter interviewing Thompson.
Lying to Congress... Thompson’s agency under-reported the estimated cost of the Medicare reform by more than $150 billion, and Thompson’s appointee, Tom Scully, threatened to fire the chief Medicare actuary if he revealed to Congress the true cost. Investigators determined that the data was illegally from Congress, and that Scully’s threat to fire the actuary was in violation of an explicit provision of federal appropriations law. Accordingly, they said, federal money could not be used to pay Scully's salary after he began making the threats to the actuary in May 2003.
When asked about this, Thompson lamely replied, "I may have been derelict in allowing my administrator, Tom Scully, to have more control over it than I should have... And maybe he micro-managed the actuary and the actuary services too much..." Threatening to strip a man of his livelihood to keep him from telling a $150 billion truth is "micro-managing"? Only in Thompson’s twisted mind.
Buying Congress... Setting aside economic differences, not to mention mountains and rivers, the Bush administration crossed 200 miles of New England countryside with the stroke of a pen and plunked the University of Vermont teaching hospital in Burlington into the same federal wage district as metropolitan Boston. On a map, the move makes little sense. Politically, the rationale becomes clear. It resulted in a $23 million boost over three years for Vermont's largest health care institution and helped firm up critical support for the Medicare bill from the state's independent senator, James Jeffords. The money for the hospital - whose doctors and executives have been an important source of campaign funds for Jeffords - was a portion of the tens of billions of dollars congressional leaders lavished on the health care economy as part of the law.
If this – believe it or not – abbreviated list of Thompson’s pigeon droppings isn’t enough to persuade you that Tommy’s opinion isn’t worth a loaf of bread crumbs, try this: He hosted a fund-raiser for the disgraced, corrupt and felony-indicted Tom Delay. Was this sympathy for the devil motivated by poor judgment or weak moral fiber? It doesn’t matter, because either way it marks him as a man worthy of our indifference, if not disdain. One of his pals told the Associated Press that the fund-raiser was "Just Tommy being Tommy." Exactly.
* Much of what's presented here is gathered from numerous sources and is not my original work.
** I am executive director of the Wisconsin Homecare Organization, the state trade association for providers of in-home health care.
