Bush's Medicare Plans Hit Republican Flak - Selective Drug-Benefits Coverage Troubles Some Legislators Seeking Care Standards
CAL/AAEM News Service
pottsbri@yahoo.com
Sun, 16 Feb 2003 11:56:05 -0800 (PST)
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www.wsj.com
January 30, 2003
Bush's Medicare Plans Hit Republican Flak
Selective Drug-Benefits Coverage Troubles Some Legislators Seeking Care Standards
By JEANNE CUMMINGS, SARAH LUECK and BARBARA MARTINEZ
Staff Reporters of THE WALL STREET JOURNAL
It is one of the most politically ambitious proposals on President Bush's domestic to-do list: Dangle prescription-drug benefits as a lure to get senior citizens and Congress to accept changes to the Medicare health-insurance program.
But the plan is running into early resistance from Republicans -- even before basic details are released -- because it envisions offering the drug benefit only to seniors who agree to leave the traditional Medicare program for a newfangled private alternative.
As a result, President Bush is learning the political perils of trying to tinker with Medicare as its costs surge. And the early signs of trouble on what he hoped to make a centerpiece of his domestic agenda show how hard it may be for him to get Congress to embrace his post-November penchant for bold proposals.
The central question in the Medicare debate now is: Which of nearly 40 million elderly and disabled Medicare beneficiaries would be eligible for the government-subsidized prescription-drug benefits?
Administration officials have signaled they're considering requiring beneficiaries who want drug coverage to choose from a menu of private health plans. Those who chose to stay in the existing government-supervised, fee-for-service program wouldn't get drug coverage.
It isn't clear if Mr. Bush has signed off on that feature or if the administration sees it as a bargaining chip with Congress.
Sen. Charles Grassley, the Iowa Republican who heads the Senate Finance Committee, which writes Medicare legislation, tried to quash the idea before the ink on the plan dries. "All of our changes should be voluntary," he said in a statement Wednesday. "That means I won't draw lines on drug coverage. All seniors should have access to affordable prescription-drug coverage, regardless of the choice they make."
The administration's hope has been that a drug benefit would lure beneficiaries to sign up for privately run plans that compete with each other for the elderly -- thereby curbing the $250 billion-a-year program's rapidly rising costs. During the next decade, as the population ages and baby boomers enter the program, Medicare spending is expected to rise 7% every year if it is unchanged, the Congressional Budget Office estimates.
But some Republicans, particularly those who've voted for previous unsuccessful drug-benefit proposals, are uneasy. Among these legislators are Rep. Bill Thomas, chairman of the House Ways and Means Committee, which handles Medicare legislation in the House. Under his stewardship, the House has twice passed legislation that would provide such universal coverage. Both times the legislation died in the Senate.
Sen. Olympia Snowe, a moderate Republican from Maine who has been involved in the debate for years, also weighed in Wednesday. "I am concerned ... that the president's focus on ways to reform Medicare could hamper our efforts to pass comprehensive prescription coverage," she said.
Passage of a Medicare drug benefit could be a bonanza for drug makers, which support coverage that is part of an updated program. The industry has feared that just adding a drug benefit to the traditional Medicare program could lead to price controls. The upside for them is that a drug benefit would expand their market, as older people who now have little or no coverage filled more prescriptions.
Currently, only about 60% of Medicare's 40 million beneficiaries have drug coverage of any kind -- from the Medicaid program for the poor, from employer-provided insurance, from individually purchased insurance or from a Medicare option called from Medicare+Choice. That option was added five years ago but has proved limited and a disappointment.
Pressure to Curb Costs
With drug spending rising briskly, the pharmaceutical industry faces mounting pressure from insurers, lawmakers and consumers to restrain costs. Drug spending rose nearly 16% in 2001 -- faster than either hospital or physician services, according to federal data. Much of those costs are being borne by Medicare patients, who make up just 14% of the U.S. population but account for 43% of the nation's drug spending.
Some industry insiders worry that the White House desire for big changes to Medicare will make the effort too politically difficult to succeed. "There's a window here to get a benefit done.... There's concern this will blow the drug benefit," said one.
In Grand Rapids, Mich., Wednesday, President Bush echoed comments he made in his State of the Union address Monday calling for Medicare drug coverage and for more choices for seniors. Standing on a stage draped with a huge orange backdrop proclaiming "Strengthening Medicare," Mr. Bush urged Congress to modernize the 38-year-old program.
"I believe that seniors, if they're happy with the current Medicare system, should stay on the current Medicare system. That makes sense. If you like the way things are, you shouldn't change," he said. "However, Medicare must be more flexible. Medicare must include prescription drugs. Medicare must be available to seniors in a variety of forms."
Neither he nor aides who briefed reporters offered more than broad principles. A senior aide refused to say for sure whether the president's plan would or wouldn't offer drugs to those who remain in the current Medicare program. Reactions from Congress haven't changed the direction of the deliberations by a White House team working on Medicare, an aide insisted.
Mr. Bush's political calculus rests on two main tenets: First, adding a drug benefit to Medicare takes a big issue away from Democrats in 2004. Second, the drug benefit is the last, best carrot to get Congress to change the program in ways that could save money in decades ahead. The second goal complicates the first.
There are now two main categories of Medicare coverage. One is traditional fee for service, which provides maximum freedom in choosing doctors but offers no drug coverage and few preventive services. The other involves Medicare+Choice plans, mostly health-maintenance organizations and other managed-care plans, which cover about 13% of Medicare beneficiaries. Most of those people receive at least some drug coverage through Medicare+Choice.
In the years after that program's enactment in 1997, many private plans found it unprofitable and began dropping out. Those that remained scaled back benefits or increased co-pays, and some dropped the prescription-drug coverage.
A New Choice
Mr. Bush has been contemplating adding a third Medicare category. It would involve private health plans, including HMOs and preferred-provider organizations in which people can pay more to see a doctor who isn't included in a network -- and perhaps even a fee-for-service option.
This would differ from Medicare+Choice because the government, instead of paying plans through a complex formula set by law, would pay a portion of the premium, and the beneficiary the rest. Industry officials believe they would be able to offer a wider variety of plans with this program.
"What I heard [President Bush] says is: Let's keep old-fashioned Medicare, Medicare+Choice and something new," said Leonard Schaeffer, chief executive of WellPoint Health Networks Inc., a managed-care company. "That is a good idea. I think seniors will like that." But, he cautions, "the devil is in the details."
And in the politics. Democratic Sen. John Breaux of Louisiana, who supports overhauling Medicare, said the White House may have no option but to offer some drug coverage to those who remain in the traditional program while still offering an incentive for seniors to choose the new option. "You have to answer the argument that you're forcing people to go into a new program for prescription drugs," he said.
Sen. Breaux said some Senate Republicans "are not happy" because they've gotten only minimal details from the White House. "They haven't been communicating with those of us who are going to be involved," he said.
Similar complaints about the Bush proposal to make dividends tax-free have fueled criticism of that proposal. But since the White House hasn't said when -- or whether -- it will offer a detailed Medicare plan, it may yet have time to calm key Republicans.
AARP, the advocacy group for seniors, suggested that it might accept a more-generous drug benefit in the new Medicare program if some benefit was offered to those who remain in traditional Medicare.
In another complication for the administration Wednesday, a federal judge blocked a drug-discount-card program that was seen as a quick way to address public unease about drug costs. It would have let pharmacy-benefit managers and others offer a discount card for a one-time fee, carrying the government's seal of approval. The PBMs would then have negotiated for discounts on drugs for beneficiaries who signed up.
Groups representing pharmacies sued to block the card. Federal Judge Paul Friedman ruled Wednesday that the government didn't have authority to implement it. An appeal is likely.
-- Rhonda Rundle and Laurie McGinley contributed to this article.
Write to Jeanne Cummings at jeanne.cummings@wsj.com, Sarah Lueck at sarah.lueck@wsj.com and Barbara Martinez at barbara.martinez@wsj.com
Updated January 30, 2003 3:54 a.m. EST
Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC Irvine
MD/MBA candidate
pottsbri@yahoo.com
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT face="Times New Roman" size=3>January 30, 2003</FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Bush's Medicare Plans </FONT></FONT><FONT size=3><FONT face="Times New Roman">Hit Republican Flak<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Selective Drug-Benefits Coverage Troubles </FONT></FONT><FONT size=3><FONT face="Times New Roman">Some Legislators Seeking Care Standards</FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">By JEANNE CUMMINGS, SARAH LUECK and BARBARA <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /><st1:City><st1:place>MARTINEZ</st1:place></st1:City> <o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Staff Reporters of THE <st1:Street><st1:address>WALL STREET</st1:address></st1:Street> JOURNAL<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">It is one of the most politically ambitious proposals on President Bush's domestic to-do list: Dangle prescription-drug benefits as a lure to get senior citizens and Congress to accept changes to the Medicare health-insurance program.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">But the plan is running into early resistance from Republicans -- even before basic details are released -- because it envisions offering the drug benefit only to seniors who agree to leave the traditional Medicare program for a newfangled private alternative.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">As a result, President Bush is learning the political perils of trying to tinker with Medicare as its costs surge. And the early signs of trouble on what he hoped to make a centerpiece of his domestic agenda show how hard it may be for him to get Congress to embrace his post-November penchant for bold proposals.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">The central question in the Medicare debate now is: Which of nearly 40 million elderly and disabled Medicare beneficiaries would be eligible for the government-subsidized prescription-drug benefits?<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Administration officials have signaled they're considering requiring beneficiaries who want drug coverage to choose from a menu of private health plans. Those who chose to stay in the existing government-supervised, fee-for-service program wouldn't get drug coverage.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">It isn't clear if Mr. Bush has signed off on that feature or if the administration sees it as a bargaining chip with Congress.<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Sen. Charles Grassley, the Iowa Republican who heads the Senate Finance Committee, which writes Medicare legislation, tried to quash the idea before the ink on the plan dries. "All of our changes should be voluntary," he said in a statement Wednesday. "That means I won't draw lines on drug coverage. All seniors should have access to affordable prescription-drug coverage, regardless of the choice they make."<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">The administration's hope has been that a drug benefit would lure beneficiaries to sign up for privately run plans that compete with each other for the elderly -- thereby curbing the $250 billion-a-year program's rapidly rising costs. During the next decade, as the population ages and baby boomers enter the program, Medicare spending is expected to rise 7% every year if it is unchanged, the Congressional Budget Office estimates.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">But some Republicans, particularly those who've voted for previous unsuccessful drug-benefit proposals, are uneasy. Among these legislators are Rep. Bill Thomas, chairman of the <st1:Street><st1:address>House Ways</st1:address></st1:Street> and Means Committee, which handles Medicare legislation in the House. Under his stewardship, the House has twice passed legislation that would provide such universal coverage. Both times the legislation died in the Senate.<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Sen. Olympia Snowe, a moderate Republican from <st1:State><st1:place>Maine</st1:place></st1:State> who has been involved in the debate for years, also weighed in Wednesday. "I am concerned ... that the president's focus on ways to reform Medicare could hamper our efforts to pass comprehensive prescription coverage," she said.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Passage of a Medicare drug benefit could be a bonanza for drug makers, which support coverage that is part of an updated program. The industry has feared that just adding a drug benefit to the traditional Medicare program could lead to price controls. The upside for them is that a drug benefit would expand their market, as older people who now have little or no coverage filled more prescriptions.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman"><SPAN style="mso-spacerun: yes"> </SPAN><o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Currently, only about 60% of Medicare's 40 million beneficiaries have drug coverage of any kind -- from the Medicaid program for the poor, from employer-provided insurance, from individually purchased insurance or from a Medicare option called from Medicare+Choice. That option was added five years ago but has proved limited and a disappointment.<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Pressure to Curb Costs<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">With drug spending rising briskly, the pharmaceutical industry faces mounting pressure from insurers, lawmakers and consumers to restrain costs. Drug spending rose nearly 16% in 2001 -- faster than either hospital or physician services, according to federal data. Much of those costs are being borne by Medicare patients, who make up just 14% of the <st1:country-region><st1:place>U.S.</st1:place></st1:country-region> population but account for 43% of the nation's drug spending.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Some industry insiders worry that the White House desire for big changes to Medicare will make the effort too politically difficult to succeed. "There's a window here to get a benefit done.... There's concern this will blow the drug benefit," said one.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">In <st1:place><st1:City>Grand Rapids</st1:City>, <st1:State>Mich.</st1:State></st1:place>, Wednesday, President Bush echoed comments he made in his State of the Union address Monday calling for Medicare drug coverage and for more choices for seniors. Standing on a stage draped with a huge orange backdrop proclaiming "Strengthening Medicare," Mr. Bush urged Congress to modernize the 38-year-old program.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">"I believe that seniors, if they're happy with the current Medicare system, should stay on the current Medicare system. That makes sense. If you like the way things are, you shouldn't change," he said. "However, Medicare must be more flexible. Medicare must include prescription drugs. Medicare must be available to seniors in a variety of forms."<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Neither he nor aides who briefed reporters offered more than broad principles. A senior aide refused to say for sure whether the president's plan would or wouldn't offer drugs to those who remain in the current Medicare program. Reactions from Congress haven't changed the direction of the deliberations by a White House team working on Medicare, an aide insisted.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Mr. Bush's political calculus rests on two main tenets: First, adding a drug benefit to Medicare takes a big issue away from Democrats in 2004. Second, the drug benefit is the last, best carrot to get Congress to change the program in ways that could save money in decades ahead. The second goal complicates the first.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">There are now two main categories of Medicare coverage. One is traditional fee for service, which provides maximum freedom in choosing doctors but offers no drug coverage and few preventive services. The other involves Medicare+Choice plans, mostly health-maintenance organizations and other managed-care plans, which cover about 13% of Medicare beneficiaries. Most of those people receive at least some drug coverage through Medicare+Choice.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt">
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">In the years after that program's enactment in 1997, many private plans found it unprofitable and began dropping out. Those that remained scaled back benefits or increased co-pays, and some dropped the prescription-drug coverage.<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">A New Choice<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Mr. Bush has been contemplating adding a third Medicare category. It would involve private health plans, including HMOs and preferred-provider organizations in which people can pay more to see a doctor who isn't included in a network -- and perhaps even a fee-for-service option.<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">This would differ from Medicare+Choice because the government, instead of paying plans through a complex formula set by law, would pay a portion of the premium, and the beneficiary the rest. Industry officials believe they would be able to offer a wider variety of plans with this program.<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">"What I heard [President Bush] says is: Let's keep old-fashioned Medicare, Medicare+Choice and something new," said Leonard Schaeffer, chief executive of WellPoint Health Networks Inc., a managed-care company. "That is a good idea. I think seniors will like that." But, he cautions, "the devil is in the details."<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">And in the politics. Democratic Sen. John Breaux of <st1:State><st1:place>Louisiana</st1:place></st1:State>, who supports overhauling Medicare, said the White House may have no option but to offer some drug coverage to those who remain in the traditional program while still offering an incentive for seniors to choose the new option. "You have to answer the argument that you're forcing people to go into a new program for prescription drugs," he said.<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Sen. Breaux said some Senate Republicans "are not happy" because they've gotten only minimal details from the White House. "They haven't been communicating with those of us who are going to be involved," he said.<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Similar complaints about the Bush proposal to make dividends tax-free have fueled criticism of that proposal. But since the White House hasn't said when -- or whether -- it will offer a detailed Medicare plan, it may yet have time to calm key Republicans.<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">AARP, the advocacy group for seniors, suggested that it might accept a more-generous drug benefit in the new Medicare program if some benefit was offered to those who remain in traditional Medicare.<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">In another complication for the administration Wednesday, a federal judge blocked a drug-discount-card program that was seen as a quick way to address public unease about drug costs. It would have let pharmacy-benefit managers and others offer a discount card for a one-time fee, carrying the government's seal of approval. The PBMs would then have negotiated for discounts on drugs for beneficiaries who signed up.<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Groups representing pharmacies sued to block the card. Federal Judge Paul Friedman ruled Wednesday that the government didn't have authority to implement it. An appeal is likely.<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">-- Rhonda Rundle and Laurie McGinley contributed to this article.<o:p></o:p></FONT></FONT></P>
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<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Write to Jeanne Cummings at jeanne.cummings@wsj.com, Sarah Lueck at sarah.lueck@wsj.com and Barbara Martinez at barbara.martinez@wsj.com<o:p></o:p></FONT></FONT></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><o:p><FONT face="Times New Roman" size=3> </FONT></o:p></P>
<P class=MsoNormal style="MARGIN: 0in 0in 0pt"><FONT size=3><FONT face="Times New Roman">Updated <st1:date Month="1" Day="30" Year="2003">January 30, 2003</st1:date> <st1:time Hour="3" Minute="54">3:54 a.m. EST</st1:time></FONT></FONT></P><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
<a href="http://rd.yahoo.com/O=1/I=brandr/vday03/text/flow/*http://shopping.yahoo.com
/shop?d=browse&id=20146735">Yahoo! Shopping</a> - Send Flowers for Valentine's Day
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