the Medicaid program. Consequently, health care providers are not fully reimbursed for the services they provide to Medicaid patients. Because of lower reimbursement payments, one-third of physicians limit the number of Medicaid patients they see, and one-fourth of them refuse to accept any Medicaid patients. The federal government, through statutes and regulations, has enacted an increasing number of criteria for the states to follow in administering the Medicaid program. For example, from 1987 to 1992, the federal government imposed 30 mandates on states connected to eligibility, reimbursement, and services. The intent of these A sample mechanic’s lien ILLUSTRATION BY GGS CREATIVE RESOURCES. REPRODUCED BY PERMISSION OF GALE, A PART OF CENGAGE LEARNING. Mechanic’s Lien Claim of Lien (Mechanic’s Lien) California Civil Code §3084 Claimant, , (Address) hereby claims a mechanic’s lien as follows: Dated: (Print or Type Name/Title) VERIFICATION (Claimant) By: 1. Claimant’s demand, after deducting all just credits and offsets, is $ , plus interest at the rate of ____ % per annum from (date)___________________ 2. The name of the owner or reputed owner, if known, is: 3. Claimant furnished the following kinds of labor, services, equipment or materials: 4. Said labor, services, equipment or materials were performed or furnished at: 5. The name of the person by whom the Claimant was employed or to whom the Claimant furnished the labor, services, equipment or materials is: Dated: (Personal signature of person providing the verification) STATE OF CALIFORNIA COUNTY OF I, the undersigned, say: I am the _______________________________________ of the claimant of the foregoing mechanic’s lien; I have read said claim of mechanic’s lien and know the contents thereof; the same is true of my own knowledge. I declare under penalty of perjury that the foregoing is true and correct. Executed on ____________________ _, ____, at , California On before me, , (here insert name and title of the officer), personally appeared ___________________________________________, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature } } S.S. GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION 28 MEDICAID mandates was to reduce variations among the states and to create more consistency in the coverage to low-income persons. Under federal law, states cannot reduce other welfare benefits that people receive when they become eligible for Medicaid. State plans cannot impose a citizenship or residency requirement other than requiring that an applicant be a resident of the state. No age requirement exists, and everyone receiving welfare may apply for Medicaid. People who are “medically needy” because they are unable to cover costs for their medical care are also eligible, even if their incomes or resources exceed the level that would qualify them for welfare. Beginning in 1988, Medicaid was extended to the “working poor”— low-income persons who have jobs with no health coverage. When Medicaid began, persons who were eligible had the right to select their own doctors, hospitals, or other medical facilities. Because of skyrocketing medical expenditures, almost all states have received waivers from the federal government concerning the choice of physician. These states direct most of their Medicaid clients to private, MANAGED CARE programs. Managed care is a general term that refers to health plans that attempt to control the cost and quality of care by coordinating medical and other health-related services. The federal government has also granted waivers to states that prefer to pay for home and community care for elderly beneficiaries who otherwise would end up in nursing homes. This type of care is less expensive than nursing home care and allows state funds to be stretched further. The federal government reimburses states based mainly on their PER CAPITA inco me. States with high per capita incomes, such as New York and Illinois, receive 50 cents from the federal government for every dollar they spend on Medicaid. Poorer states receive more, with Mississippi receiving reimbursement of 76 percent. The average reimbursement level is 57 percent. Medicaid FRAUD has plagu ed the program. The size and complexity of the system, with each state administering Medicaid differently, create opportunity for health care providers and state employees to engage in abuse. It is estimated that 10 percent of Medicaid expenditures are paid on fraudulent claims by vendors. Relatively little fraud is attributable to individuals who provide false information to receive Medicaid benefits. Another problem for Medicaid has been the growing number of middle-class, elderly per- sons who divest their assets, usually to their children, to meet the Medicaid financial guide- lines and qualify for state-paid nursing home care. This practice resu lts in cases where the truly needy cannot find a bed in a nursing home. In addition, the divestiture of assets imposes additional financial pressures on a program that already has difficulty meeting the demands of the truly needy. If an individual or couple gives away or sells a resource at less than FAIR MARKET VALUE, the Social Security Administration must report such a transfer to the state Medicaid agency. A TRANSFER OF ASSETS may result in a period of ineligibility for certain Medicaid-covered nursing home services. In Wisconsin Department of Health and Family Service v. Blumer, 534 U.S. 473, 122 S. Ct. 962, 151 L. Ed. 2d 935 (2002), the U.S. Supreme Court upheld a Medicaid formula for determining Medicaid eligibility for a person needing nursing home care. More than 30 states developed Medicaid rules that used an income- first formula, while the remainder of the states Medicaid Recipients, 2005 SOURCE: Centers for Medicare & Medicaid Services, Medicaid Program Statistics, Medicaid Statistical Information S y stem (MSIS). Children 26,337,000 Adults 12,529,000 Children in foster care 875,000 Aged 65 and over 4,396,000 Blind/disabled 8,210,000 Other and unknown 5,296,000 ILLUSTRATION BY GGS CREATIVE RESOURCES. REPRODUCED BY PERMISSION OF GALE, A PART OF CENGAGE LEARNING. GALE ENCYCLOPEDIA OF AMERICAN LAW, 3 RD E DITION MEDICAID 29 used a resource-first formula to help determine eligibility for Medicaid assistance and the proper amount of income for the community spouse. The income-first rule generally calls upon the community spouse to count more of his or her assets toward his spouse’s nursing home care. The resource-first rule allows the spouse to keep more assets, in the belief that income from these assets will help to support the community spouse. The state of Wisconsin used the income- first formula. A married coupled challenged this formula, and the U.S. Supreme Court deter- mined that either formula could be used by a state without violating the Medicare Cata- strophic Coverage Act of 1988 (MCCA). The Court placed great emphasis on the fact that the HEALTH AND HUMAN SERVICES DEPARTMENT (HHS) had issued several statements in support of the income-first rule and noted that in late 2001 HHS had proposed a rule that would formalize this support. The seriousness of these fraudulent transfers led Congress in 1996 to make a person criminally liable who “knowingly and willfully disposes of assets (including by any transfer in trust) in order for an individual to become eligible for medical assistance” (42 U.S.C.A. § 1320a–7b[a]). A person conv icted of this offense may be fined $25,000 and imprisoned for five years. The Balanced Budget Act of 1997 provided a new opportunity for states to further expand health insurance coverage for children under Medicaid. The legis lation created a new State Children’s Health Insurance Program under Title XXI of the Social Security Act. Funding is available to states for this voluntary program. A state’s allotment may be used to expand Medicaid, to develop a new program or to expand an existing program to provide health insurance to uninsured children, or to imple- ment a combination of the two approaches. Up to 10 percent of a state’s allotment may be used for administrative costs, outreach, or other health care services for children. The new funds must be used to serve children below age 19 living in families with incomes at or below 200 percent of the federal poverty level. The increase in state and federal expendi- tures on Medicaid (more than $319 billion in 2007) and in federal mandates to states on administration of the program have led to calls for reform. Shortly after taking office in 2009, President BARACK OBAMA increased Medicaid payments to state governments as a part of an economic stimulus package and pressed law- makers to repair a health care system that he termed as broken. Among the proposals being considered by Congress in 2009 was a dramatic expansion and redefinition of the Medicaid program. The proposal would redefine who is eligible for benefits in an effort to achieve universal health coverage. Under the current Medicaid system, many low-income individuals who earn less than 200 percent of poverty are not eligible for benefits . The proposed reform would extend coverage to these individuals, an estimated 11 million, but at a substantial cost to the government. The nation’s governors op- posed the proposal, arguing that their budgets are already strained by the Medicaid’s increasing costs. Although the idea of health care reform was viewed by many as favorable, the type of reform and how it should be paid for remained subject to considerable debate. FURTHER READINGS Atlantic Publishing Company. 2008. The Complete Guide to Medicaid and Nursing Home Costs. Ocala, Fla.: Atlantic Publishing Group. Bishop, Harold M., and Amber Bollman. 2009. Medicare and Medicaid Benefits. Chicago: Wolters Kluwer-CCH. The Henry J. Kaiser Family Foundation. Medicaid/CHIP. Available online at www.statehealthfacts.org (accessed July 22, 2009). Koren, James Rufus. 2009. “Immigration Activists Seek Quicker Access to Medicaid.” San Bernardino County Sun. December 31. Tumulty, Karen. 2009. “Medicaid and the States.” Time. (July 21). CROSS REFERENCES Health Care Law; Health Insurance MEDICAL EXAMINER A public official charged with investigating all sudden, suspicious, unexplained, or unnatural deaths within the area of his or her appointed jurisdiction. A medical examiner differs from a CORONER in that a medical examiner is a physician. Medical examiners have replaced coroners in most states and jurisdictions. Medical examiners determine such things as the positive identification of a corpse, the time of death, whether death occurred at the location where the corpse was found, and the manner and cause of death. They conduct autopsies and other medical tests to determine any or all of GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION 30 MEDICAL EXAMINER the details of death. They often work in conjunction with a legal team, such as a state prosecutor’s office, and will testify at trial as to their findings and determinations. In that regard, a medical examiner’s testimony is that of an expert witness, subject to cross-examina- tion by counsel or refutation by the testimony of other expert witnesses. MEDICAL MALPRACTICE Improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other HEALTH CARE professional. NEGLIGENCE is the predominant theory of liability concerning allegations of medical mal- practice, making this type of litigation part of TORT LAW. Since the 1970s, medical MALPRACTICE has been a controversial social issue. Physicians have complained about the large number of malpractice suits and have urged legal reforms to curb large damage awards, whereas tort attorneys have argued that negligence suits are an effective way of compensating victims of negligence and of policing the medical profession. A person who alleges negligent medical malpractice must prove four elements: (1) a duty of care was owed by the physician; (2) the physician violated the applicable standard of care; (3) the person suffered a compensable injury; and (4) the injury was caused in fact and proximately caused by the substandard conduct. The burden of proving these elements is on the plaintiff in a malpractice lawsuit. Physicians, as professionals, owe a duty of care to those who seek their treatment. This element is rarely an issue in malpractice litigation, because once a doctor agrees to treat a patient, he or she has a professional duty to provide competent care. More important is that the plaintiff must show some actual, compen- sable injury that is the result of the alleged negligent care. Proof of injury can include the physical effects of the treatment performed by the physician, but it can also include emotional effects. The amount of compensation at issue is usually a highly contested part of the litigation. Causation may also be a vigorously litigated issue because a physician may allege that the injuries were caused by physical factors unrelat- ed to the allegedly negligent medical treatment. For example, assume that a physician is sued for the negligent prescription of a drug to a patient with coronary artery disease and that the patient died of a heart attack. The plaintiff’s estate cannot recover damages for the heart attack unless there is sufficient proof to show that the medication was a contributing cause. The critical element is standard of care, which is concerned with the type of medical care that a physician is expected to provide. Until the 1960s the standard of care was traditionally regarded as the customary or usual practice of members of the profession. This standard was referred to as the “locality rule,” because it recognized the custom within a particular geographic area. This rule was criti- cized for its potential to protect a low standard of care as long as the local medical co mmunity embraced it. The locality rule also was seen as a disincentive for the medical community to adopt better practices. Most states have modified the locality rule to includ e both an evaluation of the customary practices of local physicians and an examination of national medical standards. Physicians are called to testify as expert witnesses by both sides in medical malpractice trials because the jury is not familiar with the intricacies of medicine. Standards established by medical specialty organizations, such as the American College of Obstetricians and Gynecologists, are often used by these expert witnesses to address the alleged negligent actions of a physician who practices in that specialty. Nonconforman ce to these stan- dards is evidence of negligence, whereas con- formance supports a finding of due care. Other rules govern the standard of care evaluation. A few states apply the “respectable minority rule” in evaluating a physician’s conduct. This rule holds that a physician is not negligent merely by electing to pursue one of several recognized courses of treatment. Some states use the “error in judgment rule.” This principle exempts a physic ian from liability if the malpractice is based on the physician’s error in judgment in choosing among different methods of treatment or in diagnosing a condition. Medical malpractice litigation began to increase in the 1960s. Tort lawyers were able to break the traditional “conspiracy of silence” that discouraged physicians from testifying about the negligence of colleagues or serving as expert witnesses. By the 1970s physicians alleged that malpractice claims were interfering GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION MEDICAL MALPRACTICE 31 with their medical practices, with insurance companies either refusing to write malpractice policies for them or charging inflated premiums. Over the years, physicians and health care providers argued that malpractice claims were also driving up the cost of health care. They contended that jury verdicts in the millions of dollars had to be passed on to the consumer in the form of higher insurance premiums and physician fees. In addition, man y physicians were forced to practice “defensive medicine” to guard against malpractice claims. Defensive medicine refers to the conducting of additional tests and procedures that are not medically necessary but that would assist in defeating a negligence claim. In response to rising malpractice suits, many states pushed for “tort reform” measures. Such measures limit the amount of damages a patient can recover for noneconomic losses, such as pain and suffering, and PUNITIVE DAMAGES.Forexam- ple, in 1975, California enacted the Medical Injury Compensation Reform Act, which limits recovery of noneconomic damages at $250,000 and restricts the amount of fees that may be recovered by lawyers. Several other states adopted similar measures based on the California model. The medical community, however, contin- ued to fight for widespread tort reform amon g the states, and at the national level. They cited insurance increases in the late 1990 s and early 2000s, which put further pressure on doctors’ and hospitals’ earnings—earnings that had been shrinking under MANAGED CARE. Some areas of medicine were particularly hard hit. In New York and Florida, for example, obstetricians, gynecologists, and surgeons—the doctors who are sued the most frequently—pay more than $100,000 per year for $1 million in coverage. In 2003 President GEORGE W. BUSH addressed the medical community’s concerns by endor- sing legislation that would place a $250,000 cap on noneconomic damages at the national level. According to Bush, who spoke before an AMERICAN MEDICAL ASSOCIATION (AMA) advocacy conference, “There are too many frivolous lawsuits against good doctors, and the patients are paying the price.” The president cited the fact that the federal government suffers losses of $28 million per year as a result of liability insurance and defensive medicine practices. Critics who contest tort-reform laws argue that medical malpractice awards account for only one percent of the total yearly NATIONAL HEALTH CARE expenditures. They also claim that such reforms protect insurance companies and physicians, and not the patients. Trial attorneys point the finger at the insurance companies. They claim that insurers keep prices artificially low while competing for market share and new revenue. When the economy is sluggish and the market is slow, they increase premiums because they are no longer able to use STOCK MARKET gains to subsidize low rates. Proponents of reform continue to maintain, however, that a federal cap will ultimately result in lower medical costs and greater medical access for the general population. FURTHER READINGS Finkelstein, Joel B. March 17, 2003. “Bush to AMA: Tort Reform a Must.” American Medical News. Available online at http://www.ama-assn.org/amednews/2003/03/ 17/gvl10317.htm; website home page: http://www. ama-assn.org (accessed August 13, 2009). Loiacono, Kristin. 2003. “A Good Fight in the House Over Medical Malpractice ‘Reform’.” Trial 11. Sloan, Frank A., and Lindsey M. Chepke. 2008. Medical Malpractice. Boston: MIT Press. CROSS REFERENCES Health Care Law; Managed Care; Patients’ Rights; Physi- cians and Surgeons. MEDICARE Medicare is a federal ly funded system of health and hospital insurance for persons aged 65 and older and for disabled persons. The Medicare program provides basic health care benefits to recipients of SOCIAL SECURITY and is funded through the Social Security Trust Fund. President HARRY S. TRUMAN first proposed a medical care program for the aged during the late 1940s, but Medicare was not enacted until 1965, as one of President Lyndon B. Johnson’s Great Society programs (42 U.S.C.A. §§ 1395 et seq.). Medicare went into effect in 1966 and was first administered by the Social Security Ad- ministration. In 1977, the Medicare program was transferred to the newly created Health Care Financing Administration (HCFA). The HCFA is concerned with the development of policies, programs, procedures, and guidance regarding Medicare recipients, the providers of services, such as hospitals, nursing homes, and GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION 32 MEDICARE physicians, and other organizations that are closely related to the Medicare program. Unlike other federal programs, Medicare is not supported by a large, federal organizational hierarchy. The federal government enters into contracts with private insurance companies for the processing of Medicare claims. Health care providers must meet state and local licensing laws and standards set by the HCFA in order to qualify for Medicare payments for their services. Eligibility for Medicare does not depend on income. Almost everyone aged 65 and older is entitled to Medicare coverage. Disabled persons under age 65 may receive Medicare benefits after they have been collecting Social Security or railroad disability payments for at least two years. Workers do not have to retire at age 65 in order to be protected by Medicare. People who have not worked long enough under Social Security to receive retirement benefits may enroll in the plan by paying a monthly premium. For those individuals who are not covered under Social Security and who are too poor to pay the monthly pre mium, MEDICAID, the state and federal program for low-income persons, is available. Medicare is divided into a hospital insur- ance program and a supplementary medical insurance program. The Medicare hospital insurance plan is funded through Social Security payroll taxes. It covers reasonable and medically necessary treatment in a hospital or skilled nursing home, meals, regular nursing-care services, and the cost of necessary special care. Medicare also pays for home health services and hospice care for terminally ill patients. The hospital insurance program extends coverage based on benefit periods. An episode of illness is termed a benefit period and starts when the patient enters the hospital or nursing home facility and ends 60 days after the patient has been discharged from the facility. A new benefit period starts with the next hospital stay, and there is no limit to the number of benefit periods that a person can have. In any benefit period, Medicare will pay the cost of hospitali- zation for up to 90 days. The patient must pay a one-time dedu ctible fee for the first 60 days in a benefit period and an additional daily fee called a co-payment for hospital care for the following 30 days. Apart from these payments, Medicare covers the full cost of hospital care. Medicare also pays for the first 20 days of care in a skilled nursing home and for expenses exceeding a daily minimum amount for the next 80 days when certain conditions show that Medicare Enrollment, 1970 to 2008 20.5 25 28.5 31.1 34.2 37.5 39.6 45.3 0 5 10 15 20 25 30 35 40 45 50 1970 1975 1980 1985 1990 1995 2000 2008 Year Enrollment (in millions) SOURCE: Centers for Medicare & Medicaid Services, Medicare Enrollment Reports. ILLUSTRATION BY GGS CREATIVE RESOURCES. REPRODUCED BY PERMISSION OF GALE, A PART OF CENGAGE LEARNING. GALE ENCYCLOPEDIA OF AMERICAN LAW, 3 RD E DITION MEDICARE 33 such care is necessary. Payment also may be made for up to 100 home-health visits provided by a home-health agency for up to 12 months after the patient ’s discharge from a hospital or nursing home, provided that certain conditions apply. Medicare’s supplementary medical insur- ance program is financed by monthly insurance premiums paid by people who sign up for coverage, combined with money contributed by the federal government. The government con- tributes the major portion of the cost of the program, which is funded out of general tax revenues. Persons who enroll pay small, annual, deductible fees for any medical costs incurred above that amount during the year, and also a regular monthly premium. Once the deductible has been paid, Medicare pays 80 percent for any bills incurred for physicians’ and surgeons’ services, diagnostic and laboratory tests, and other services. Doctors are not required to accept Medicare patients, but almost all do. Payments may not be made for routine physical checkups, drugs and medicines, eyeglasses, hearing aids, dentures, or orthopedic shoes. Medicare bases its 80 percent payment for medical expenses on what is considered to be a reasonable charge for each kind of service. The reasonable charge is an amount that is deter- mined by the in surance organizations that process Medicare claims for the federal govern- ment, based on the customary charge for that service in that part of the country. Medicare payments may be sent directly to the doctor or provider of the service or to the patient. In 1994, 93 percent of all charges to Medicare patients for covered physician services were billed directly to the insurance systems rather than to the patients themselves. Thus, few patients need to be reimbursed for payments that they had made directly to the physician or another provider of services. Under either method, the patient receives a notice after the doctor or provider files a medical insurance claim. The notice details the medical service and explains the expenses that are covered by Medicare and are approved; how much of the charge is credited toward the annual deductible amount; and how much Medicare has paid. A person who disagrees with the decision on the claim may ask the insurance company to review the decision. A formal hearing may be held on claims that, if paid, would total at least $100. Cases that involve $1,000 or more can eventu- ally be appealed to a federal court. The financial future of Medicare has been a hotly debated issue since the 1980s. In 2008 Medicare covered nearly 45 million peop le. The number of people eligible for Medicare will continue to rise as the post-World War II baby boom generation begins to retire. Other factors have had an impact on the financial future of Medicare. The quality of medical care has increased life expectancies. Nearly three years have been added to lif e expectancies since Medicare was created. Mod- ern medicine is likely to continue this trend, which means that Medicare will be taking care of people for longer. Another factor is the increased cost of medical care itself, which takes more resources out of the system. Medicare’s hospital insurance is financed by a payroll tax of 2.9 percent, divided equally between employers and workers. The money is placed in a trust fund and is invested in U.S. Treasury securities. A surplus accumulated during the 1980s and early 1990s, but the program’s outlays are projected to rise more rapidly than the future payroll-tax revenues. Changing the financing of Medicare has proved difficult. In 1988 Congress passed legislation to expand Medicare to cover the health care costs associated with catastrophic illnesses. The new coverage was to be financed by a surtax on the incomes of taxpayers over the age of 65. Elderly citizens and organizations such as the AMERICAN ASSOCIATION OF RETIRED PERSONS vigorously protested the tax. In the face of this opposition, Congress repealed the law in 1989. In Fischer v. United States, 529 U.S. 667 S. Ct. 1780, 146 L. Ed. 2d 707 (2000), the U.S. Supreme Court addressed the issue of criminal aspects with respect to payment of Medicare benefits to an institution. Fischer, while presi- dent and part owner of Quality Medical Consultants (QMC), negotiated a $1.2 million loan to QMC from West Volusia Hospital Authority (WVHA), a municipal agency that is responsible for operating two Florida hospitals, both of which participate in the federal Medicare program. In 1993, WHVA received between $10 and $15 million in Medicare funds. After a 1994 audit of WHVA raised questions about the QMC loan, the petitioner was indicted for violations of the federa l BRIBERY GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION 34 MEDICARE statute, including defrauding an organization that receives benefits under a federal assistance program. A jury convicted him on all counts, and the district court sentenced him to prison, imposed a term of supervised release, and ordered the payment of restitution. On appeal, the petitioner argued that the government had failed to prove WHVA, as the organization affected by his wrongdoing. The U.S. Court of Appeals for the Eleventh Circuit rejected his argument and affirmed his conviction. In 2003 President GEORGE W. BUSH signed into law the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA), Pub. L. No. 108-173, 117 Stat. 2066, bringing people with Medicare more choices in health care coverage and better health care benefits. The 2003 act preserved and strength- ened the Medicare program by adding impor- tant new prescription drug and preventive benefits and providing extra assistance to people with low incomes. Despite the increase in benefits, the act still allowed seniors the ability to choose their own doctors, hospitals, and pharmacies. One of the major changes in the 2003 act was the Drug Discount Cards, which began in 2004. Medicare-Approved Drug Discount Cards helped seniors save on prescription drugs. Medicare contracts with private companies offered new drug discount cards as a temporary measure, until a Medicare prescription drug benefit began in 2006. In 2006 a prescription drug benefit called Medicare Part D was implemented. Parti cipants must affirmatively enroll in the program by selecting one of the Part D plans offered by private companies. All Medicare beneficiaries are entitled to drug coverage under Part D, regardless of income, and no physical examina- tions are required. Medicare recipients can receive prescription drug coverage either through a stand alone plan (PDP), which offers only drug coverage, or a Medicare Advantage Plan (MA-PD), which covers both medical services and prescription drugs. The 2003 act also provided for improved preventive benefits and Health Savings Accounts for all Americans, which function just like an INDIVIDUAL RETIREMENT ACCOUNT (IRA). Using the Health Savings Accounts, Americans are able to set aside money to be used on healthcare each year, tax free. Shortly after he was sworn in as president of the United States in 2009, BARACK OBAMA launched a campaign focused on decreasing Medicare spending. He characterized Medicare spending as the root problem of a nationwide health care crisis and called upon Congress to reach a solution that would place Medicare payment authority under the auspices of a separate entity, rather than in the hands of politicians. Proposals considered by Congress on the issue of payment reform faced strong criticism that they fail to adequately address the sharp growth of Medicare and the correspond- ing expenses. Medicare spending currently accounts for 5 percent of the gross domestic product, and it is predicted to account for 20 percent of the gross domestic product in the next 40 years. Although a consensus exists that a change to the current Medicare system is needed, just how and what that change should be remained the subject of continuing debate. For the latest information on Medicare, visit the Medicare Web site at www.medicare.gov. FURTHER READINGS Bishop, Harold M., and Amber Bollman. 2009. Medicare and Medicaid Benefits. Chicago: Wolters Kluwer-CCH. CCH Health Law Editorial. 2009. Medicare Explained. Chicago: Wolters Kluwer-CCH. Channick, Susan Adler. 2003. “The Ongoing Debate over Medicare: Understanding the Philosophical and Policy Divides.” Journal of Health Law 36 (winter), pp. 59–106. Golding, Elliot. 2009. “Medicare Part D: Rights without Remedies, Bars to Relief, and Miles of Red Tape.” George Washington Law Review. 77 (June). Mayes, Rick, and Robert A. Berenson. 2008. Medicare Prospective Payment and the Shaping of U.S. Health Care. Baltimore, Md.: Johns Hopkins University Press. Murray, Shailagh. 2009. “Obama Eyes the Purse Strings for Medicare.” Washington Post. (July 16). www.medicare.gov Tanenbaum, Sandra J. 2009. “Pay for Performance in Medicare: Evidendiary Irony and the Politics of Value.” Journal of Health Politics, Policy and Law 34 (October). CROSS REFE RENCES Elder Law; Health Care Law; Health Insurance; Managed Care; Phy sicians and Surgeons; Senior Citizens v MEESE, EDWIN, III Edwin Meese III is an attorney, a law professor, and an author who served as a close and trusted adviser to President RONALD REAGAN, joining Reagan’s gubernatorial staff in 1967 and eventually rising to the position of U.S. attorney general during the Reagan administration. MEESE, EDWIN, III 35 GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION Meese was born on December 2, 1931, in Oakland, California. After graduating from high school in his hometown, Meese received his undergraduate degree from Yale University in 1953 and his law degree from the University of California School of Law at Berkeley in 1958. Upon graduating from UC Berkeley, Meese worked as a deputy district attorney for Alameda County, California, until 1967. Meese prosecuted felony cases while maintaining a private practice on nights and weekends, focusing on CIVIL LAW. During this service, he drew the attention of Republican Senator Donald Grunsky, who later recommended Meese to governor-elect Ronald Reagan. In 1967, Meese joined then-California gov- ernor Ronald Reagan’s staff as secretary of legal affairs. In 1969, Meese became executive assis- tant to the governor, and in the following year he was made chief of staff. As Reagan’s chief of staff, Meese was instrumental in the decision to crack down on student protesters at People’s Park in Berkeley, California, on May 15, 1969. Meese was widely criticized for escalating offi- cial response to the People’s Park protest, during which law enforcement officers killed one protestor and seriously injured hundreds of others, many of whom were bystanders. Meese advised Reagan to declare a state of emergency in Berkeley, contrary to the recommendation of the Berkeley City Council, which led to a two- week occupation of the city by NATIONAL GUARD troops. Meese’s role in quelling the riots at UC Berkeley has been identified by critics and supporters as an example of a conservative law-enforcement philosophy in action. After Reagan left office, Meese worked in business and law, serving as vice president for administration of Rohr Industries in Chula Vista, California, and reentering PRIVATE LAW practice. In 1977 he founded the Center for Criminal Justice Policy and Management at the University of San Diego, serving as the center’s director and also as a law professor at USD until 1981. During that same time, he held the Edwin Meese III. ROBYN BECK/AFP/GETTY IMAGES Edwin Meese III 1931– ▼▼ ▼▼ ❖ ◆ ◆ 1939–45 World War II 1931 Born, Oakland, Calif. 1950–53 Korean War 1961–73 Vietnam War ◆ ◆ ◆◆ ◆ ◆ ◆ 1953 Graduated from Yale University 1958 Earned J.D. from University of California Law School; began working as deputy district attorney for Alameda County, California 1967–68 Served as secretary of legal affairs for Calif. Gov. Ronald Reagan 1969–74 Served as Gov. Reagan’s executive assistant and chief of staff 1977 Became director of Center for Criminal Justice and law professor at UC San Diego 1981–85 Served as counselor to President Reagan 1985–88 Served as U.S. attorney general 1987 Wedtech scandal first surfaced; Iran- Contra report released 1992 Wrote and published With Reagan: The Inside Story 2002 Defending the American Homeland published 1995 Appointed Ronald Reagan Distinguished Fellow in Public Policy at the Heritage Foundation 2000 Served as transition adviser to President George W. Bush 1997 Appointed distinguished visiting fellow at Hoover Institution, Stanford University ◆ ◆ 2006 Appointed to Iraq Study Group 2005 Received Heritage Foundation’s Luce Award 1925 2000 1975 1950 36 MEESE, EDWIN, III GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION position of vice chair of California’s ORGANIZED CRIME Control Commission and was activ ely involved with the California Bar Association’s CRIMINAL LAW section. Meese joined Reagan’s presidential cam - paign in 1980 as Reagan’s chief of staff, in charge of day-to-day campaign operations, and as his senior issues adviser. After the election Meese orchestrated Reagan’s transition into the White House. Meese was appointed counselor to the President and served as a member of both the Cabinet and the NATIONAL SECURITY COUNCIL from 1981 to 1988. As counselor, Meese became an important adviser on domestic policy. Meese and Reagan shared a common agenda on legal topics—they both sought to make ABORTION illegal and to restrict criminal defendants’ rights, and they were also in agreement on the issues of AFFIRMATIVE ACTION and judicial activism. Meese helped to reshape the federal judiciary by advising the president on the appointments for more than half the federal judgeships. In 1984 Reagan nominated Meese to be U.S. attorney general. Meese encountered fierce opposition from Senate Democrats, who ques- tioned his commitment to CIVIL RIGHTS and his personal ethics. Charges concerning Meese’s personal finances contributed to a 13-month delay in his confirmation, but the Senate eventually confirmed Meese, who became attor- ney general in March 1985. As attorney general, Meese served as chair of the Domestic Policy Council and the National Drug Policy Board, which coordinated with Nancy Reagan’s "Just Say No" national anti-drug campaign. He also sought to introduce tough policies against PORNOGRAPHY, establishing the Commission on Pornography, also known as the Meese Commission, in the spring of 1985. The commission issued a controversial two- volume report in 1986 that state d that there was a causal link between violent pornography and aggressive behavior toward women. The report also claimed that nonviolent, sexually explicit material contributed to sexual violence, a conclu- sion that many social scientists challenged. The report broke new ground in its exploration of the problem of CHILD PORNOGRAPHY. In 1987 Meese came under scrutiny for his role in the IRAN-CONTRA scandal, which involved a 1985 arms-for-hostages deal with Iran. The key issue in that scandal, which involved presidential aides Oliver L. North and John M. Poindexter, as well as other administration officials, was whether President Reagan had been aware of these activ ities in 1985. Meese announced on November 24, 1986, that the president had not known about the deal. A congressional Iran-Contra committee is- sued its report in November 1987. It stated that Meese had failed to give the president sound legal advice. The report suggested that Meese had not fully investigated the scandal and that he might have participated in a cover-up. In addition, the committee determined that he had failed to take appropriate steps to prevent North and Poin- dexter from destroying critical evidence. INDEPEN- DENT COUNSEL Lawrence Walsh, who investigated Iran-Contra, issued a report in 1993 that stated that Meese had made a false statement when he said that Reagan had not known about the 1985 deal. Walsh did not seek a criminal charge against Meese because he did not have a key piece of evidence—the notes of former defense secretary Caspar W. Weinberger—until 1991. While Iran-Contra plagued Meese, a more serious problem arose, known as the Wedtech scandal. The scandal began in February 1987 and grew to involve other highly placed members of the Reagan administration, as well as govern- ment officials in New York, where the Wedtech Corporation was located. In the early 1980s, the Wedtech Corporation sought DEFENSE DEPARTMENT contracts. The company hired E. Robert Wallach, Meese’s former law school classmate and personal attorney, to lobby the government on its behalf. In 1982 Meese helped Wedtech, at Wallach’s urging, to get a special hearing on a $32 million Army engine contract, which the Army considered Wedtech unqualified to per- form. Soon after the meeting, the contract was awarded to Wedtech, and one of Meese’stop deputies went to work for the corporation. A federal criminal investigation unraveled a string of illegal conduct that led to the conviction of Wallach and other public officials. Independent Counsel James C. McKay investigated the Wedtech contract and other allegations of misconduct by Meese. In July 1988, he issued his report, which did not call for the filing of any criminal charges against Meese. Following the release of McKay ’s 830-page report, Meese announced his resignation, effec- tive at the end of August 1988. Meese claimed that the report vindicated his actions. MEESE, EDWIN, III 37 CONSTITUTIONAL INTERPRETATION IS NOT THE BUSINESS OF THE COURT ONLY, BUT ALSO PROPERLY THE BUSINESS OF ALL BRANCHES OF GOVERNMENT . —ED MEESE GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION . any or all of GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION 30 MEDICAL EXAMINER the details of death. They often work in conjunction with a legal team, such as a state prosecutor’s office, and. Heritage Foundation’s Luce Award 1925 2000 1 975 1950 36 MEESE, EDWIN, III GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION position of vice chair of California’s ORGANIZED CRIME Control Commission. Reports. ILLUSTRATION BY GGS CREATIVE RESOURCES. REPRODUCED BY PERMISSION OF GALE, A PART OF CENGAGE LEARNING. GALE ENCYCLOPEDIA OF AMERICAN LAW, 3 RD E DITION MEDICARE 33 such care is necessary. Payment