Politics & Government
Consolidated health-care market drives up costs
Fourth District GOP congressional hopeful Goldstein says system has become dependent on 'market share'
By Scott Benjamin
GREENWICH – If you go to buy a Zegna suit at Richards of Greenwich, or walk the sidewalks near Total Mortgage Arena in Bridgeport, or the farms in Oxford or the corporate headquarters in Shelton, Michael Goldstein says voters are concerned about soaring health care costs.
Goldstein – an eye doctor and an attorney – is in a three-way race for the Republican nomination in the Fourth Congressional District. It is the second time he has sought the seat, which the GOP once dominated before U.S. Rep. Jim Himes, who lives in the Cos Cob section of Greenwich, helped turn it into a solid Democratic district following his initial victory 16 years ago – when John Sterling was still shouting “El Captain” as Derek Jeter slugged a homer.
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Goldstein said that according to figures discussed at the Greenwich Representative Town Meeting, a body that he serves on, the typical family there spends $39,000 a year on their health care insurance plan.
So, if George W. Bush signed the Medicare reform package with the prescription drug coverage for non-hospitalized senior citizens in 2003, which updated Lyndon Johnson’s program of 1965 . . . If Barack Obama approved the Affordable Care Act in 2010 – something that had been discussed since Harry Truman’s administration in 1945. . . If Joe Biden signed legislation in 2022 to cap out-of-pocket costs for insulin for senior citizens and saved money on 47 drugs covered by Medicare, which the Democrats had been clamoring for since at least the 2006 midterms . . . Then why are health care costs still soaring?
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“A lot of it has been related to regulation and health care consolidation. We have seen the disappearance of private practitioners,” commented Goldstein, a longtime Greenwich resident.
He insisted that the anti-trust laws need to be reformed.
“[It has resulted from] The mergers and acquisitions of community-based hospitals and private practices,” Goldstein explained in an interview with Patch.com. “[There also have been] Venture capital acquisitions of practices.”
“Everything in health care is related to market share,” remarked Goldstein, who served as president for the New York County Medical Society for two terms. “A large hospital system gets paid more from an insurance company than individual practitioners for doing exactly the same thing. As health care systems consolidate, prices go up.”
Surgeon Larry Lazor of West Hartford, who was the Republican candidate in the First Congressional District in 2022, added, “As groups consolidate, you’re going to have less free-standing individual practices. It becomes very hard to do it now with the requirements of electronic health records and negotiating with insurance companies. It is very hard for a solo practitioner to exist now.”
Goldstein said that the increased “regulatory compliance” has forced physicians to spend “20 hours a week putting data into a computer instead of treating patients.”
He estimates that deregulation could trim $1 trillion a year nationally in health care costs.
Lazor said American health care costs are “50 percent beyond” that in the “most expensive European country.”
In a phone interview with Patch.com, he said the U.S. should adopt a value-based system in which if, for example, someone has diabetes they are not doing repeat visits to their physician, and instead a nurse visits their home, confirms that they can take the steps toward addressing the condition that will provide the “most cost-effective care.”
“As long as we have a fee-for-service, doctors get paid more for the more they do,” Lazor explained. “So, the incentives are not great. The incentives are bill, bill, bill, because you make more, more money. If you’re only making a certain amount [under value-based health care], then you’re going to do it more cost-effectively.”
Regarding the Republican nomination, Goldstein said he is “optimistic” about winning the convention on Monday, May 20 at Fairfield Ludlowe High School, where he will face Bob MacGuffie of Fairfield, a longtime member of the Tea Party who has aggressively criticized Himes’ voting record, and Daniel Miressi of Norwalk, who was the GOP nominee in the 25th state Senate District two years ago.
Goldstein said that his campaign is far ahead of where it was two years ago at this time when he failed to secure enough convention delegates to automatically force a primary and then collected more than 2,400 valid petition signatures to get on the GOP ballot that August. He ultimately lost to former Darien First Selectwoman Jayme Stevenson – 60 to 40 percent - in the primary.
His son, Jonathan, an attorney, is again managing his campaign.
It has been a productive association.
“However, it is sometimes hard to be told what to do by your son,” Goldstein said with a smile.
Combined, Republicans Lowell Weicker, Stewart McKinney and Chris Shays captured every election from 1968 through 2006. Himes narrowly defeated Shays in 2008 and in recent elections has been garnering about 60 percent of the ballots.
Ken Dixon of CT Hearst has recently stated that Himes reported $2 million on hand for his reelection campaign through the first fund-raising quarter of 2024. MacGuffie had $73,426 on hand; Goldstein reported $8,760; Miressi had $42.21 raised. Also challenging Himes is Independent Jaden Joseph Skudlarek of Fairfield, who reported no money.
As is the case of the other four congressional districts in Connecticut, the Fourth District is diverse. The difference is the diversity comes from 17 municipalities – the fewest of any of the congressional districts in the state. In comparison, the Second District, which stretches through most of Eastern Connecticut, has 63 municipalities.
In the Fourth District, four of the municipalities rank in the top nine in population in Connecticut – Bridgeport, first; Stamford, second, Norwalk, sixth; and Greenwich, ninth.
Stamford and Greenwich make up the largest population bloc in the state among municipalities that border each other.
Said Goldstein, “Almost 10 percent of the state’s income tax revenue comes from Greenwich,” which has some of the most expensive neighborhoods in the United States and a raft of hedge fund offices.
He said the town has added population since the pandemic.
“A lot of families that have moved into Cos Cob and other parts of Greenwich have found that this area is a lot more appealing to younger families,” Goldstein remarked.
In less than 20 years, Stamford has moved past Waterbury, then Hartford, and then New Haven in population.
Goldstein said that Stamford, which has four Fortune 500 companies, has attracted families and also continues to capture young professionals who used to live in the East Village or Chelsea but now have a downtown apartment and go to the Pre-Game Weekly Open Mic at the New York Comedy Club on Tresser Boulevard.
He added that he has been impressed with the corporate growth in Shelton, a middle-class suburb, which is noted for having the headquarters for Bic.
On another topic, Goldstein said he endorses the recent comments by Donald Trump, the former president and apparent Republican presidential nominee, on abortion rights.
CNN has reported that Trump said, “My view is now that we have abortion where everyone wanted it from a legal standpoint, the states will determine by vote or legislation, or perhaps both. And whatever they decide must be the law of the land. In this case, the law of the state.”
In a 2022 interview with Patch.com, Goldstein said that the U.S. Supreme Court’s 6-3 vote in support of the Dobbs v. Jackson decision on abortion is “returning power to the people” by putting it “in legislative bodies.”
On a separate subject, a Wall Street Journal editorial of April 9 stated, “Washington continues to spend like deficits and debt don’t matter and the politicians would rather you don’t know. . . The six-month interest payments of $440 billion [for the first six months of Fiscal 2024] exceeded the $412 billion in outlays for defense.”
There hasn’t been a balanced federal budget in nearly 23 years.
“I think a balanced budget is something that needs to happen,” Goldstein commented.
Former state Sen. George Logan of Meriden, who was the Republican nominee in the Fifth Congressional District in 2022 and is favored to again win the GOP nod in May, has called for a commission to address deficit reduction.
Said Goldstein, “I think it is a good idea.”
However, in 2010 Congress failed to approve a commission and, instead, Democratic former President Barack Obama established the Alan Simpson-Erskine Bowles Commission through executive order. It didn’t meet its threshold of a supermajority of 14 of the 18 members agreeing to the recommendations so they could be considered by Congress.
According to Wikipedia, some Democrats objected to reductions in social programs and some Republicans balked at tax increases.
Despite that lack of success more than a decade ago, Goldstein said that a commission still should be created if there is “potential” for “solving a problem.”
Goldstein commented that the success would depend on how a commission is “structured.”
On another fiscal topic, Bloomberg Chief Washington Correspondent Saleha Monsin wrote in her recent book, “Paper Soldiers,” that Steve Mnuchin, who was Treasury Secretary to Trump, said at the Davos Economic Forum in 2019 that, “A weak dollar is good for the U.S. as it relates to trade and opportunities.”
The U.S. has advocated a strong dollar policy for decades.
“I’m not so much in love with that idea [of a weaker dollar],” Goldstein remarked. “A weaker dollar may negatively impact people on fixed incomes or retirees who are living on pensions. It also would require the federal government to pay higher amounts of money for Social Security and higher amounts of inflation-based pensions and higher amounts of inflation-based wages to government employees. So, I think there are a lot of down sides to a weaker dollar.”
Resources:
Interview with Michael Goldstein, Patch.com, Monday, April 15, 2024.
Phone interview with Larry Lazor, Patch.com, Wednesday, April 24, 2024.
“Paper Soldiers,” Saleha Monsin, Portfolio, 2024.
https://en.wikipedia.org/wiki/National_Commission_on_Fiscal_Responsibility_and_Reform.
https://www.cnn.com/2024/04/08/politics/donald-trump-abortion-2024/index.html
https://patch.com/connecticut/brookfield/primary-hand-stevenson-wary-democratic-spending
https://stamford.newyorkcomedyclub.com/
https://georgewbush-whitehouse.archives.gov/infocus/bushrecord/factsheets/healthcare.html
https://obamawhitehouse.archives.gov/healthreform/healthcare-overview
https://www.trumanlibrary.gov/education/presidential-inquiries/challenge-national-healthcare
https://www.archives.gov/milestone-documents/medicare-and-medicaid-act
