THE TIANANMEN PAPERS
New York City
Edward Jay Epstein in "The 'Tiananmen Papers'" [Feb. 5] retails a story about 15,000 pages of secret Chinese documents being hand-copied even though I told him it is false, and he justifies doing so by mentioning two newspaper articles whose sources he hasn't checked. His other statements about how the material reached me, and how my colleagues and I verified it, are imaginary.
ANDREW J. NATHAN, co-editor
The Tiananmen Papers
New York City
I did, in fact, include in my article not only Andrew Nathan's assertion that reports in the Wall Street Journal and Associated Press concerning the number of pages of documents were erroneous but also his dubious claim that he and his co-editor were the only "authoritative sources on this question." I do not know how many authentic documents, if any at all, were ever copied anywhere. The problem that concerns me is not numbers but whether the provenance of what are purported to be transcripts of secret verbatim conversation of the leadership of China in 1989, which the publisher compares with the Pentagon Papers, is real or imaginary.
In the case of the Pentagon Papers, the New York Times, which published them, clearly established (1) the existence of authentic documents--the Secretary of Defense had commissioned them in the late 1960s, (2) the existence of a bona fide copy at the RAND Corporation and (3) that the copier of them, Daniel Ellsberg, had the necessary access and opportunity at RAND. In the case of The Tiananmen Papers, the publisher has not established (1) that any of the putative documents ever existed or that the Chinese leadership ever made verbatim transcripts of their secret conversations in 1989, (2) that any such documents were ever copied or (3) who transcribed the supposed documents. It has even kept secret the identity of the man who delivered to America electronic data, which is no more verifiable than an anonymous e-mail. Under such circumstances, how can one verify that copies of documents that one does not possess match original documents that one does not know ever existed?
EDWARD JAY EPSTEIN
HEALTH FOUNDATIONS SICKENED
Annette Fuentes and Rosemary Metzler Lavan's "No Health, No Wealth" [Dec. 18], critiquing the performance of several foundations created as a result of nonprofit organizations converting to for-profits, misrepresents the work of the California HealthCare Foundation. The foundation is characterized as providing a paltry sum to not-for-profit organizations. In fact, since 1998, we've made close to 600 grants to nonprofits totaling nearly $90 million. Representative of these grants are $1 million for breast cancer treatment for uninsured women in California, $2 million to augment the state's high-risk pool for uninsurable people and $4 million to subsidize coverage for undocumented children in Los Angeles, to name just a few.
The authors are dismissive of our investment in research into healthcare "market issues." The Nation itself, however, found one of our reports worth quoting in Simson Garfinkel's February 28, 2000, "Privacy and the New Technology." That report on problems with healthcare-website privacy policies brought about industrywide changes and prompted an investigation by the FCC. Foundation research, reports, workshops and conferences have helped keep privacy of healthcare information in front of policy-makers, the healthcare industry and the public, culminating in tough federal regulations announced by the Clinton Administration on December 20.
The foundation is severely criticized for making grants to for-profit organizations. Without the expertise available only from the private-sector, for-profit world, it would be impossible to do certain kinds of work, such as developing and pilot testing a web-based software application that will nearly eliminate time-consuming paperwork and cut the time it takes to enroll children in Medi-Cal and Healthy Families programs to as little as six minutes. We hope readers will visit our website (www.chcf.org), read our reports and decide for themselves whether "taxpayer money is being used against the taxpayers."
MARK D. SMITH, president and CEO
California HealthCare Foundation
I work for the Advisory Board and write for California Healthline, the online publication referred to in your article. The advisory board is not, as the article claims, an "organization of drug companies, hospitals and health plans." It is a healthcare research firm, committed primarily to conducting research that allows hospitals to improve their business practice. While it is a for-profit company, neither drug companies nor hospitals nor health plans have a role in running the company.
Woodland Hills, Calif.
"No Health, No Wealth" was decidedly one-sided and negative. The reporters ignored information about the nearly $700 million in grant funds our foundation provided over the past five years to California communities for programs ranging from health services for persons with HIV/AIDS and the homeless to new models of primary-care delivery for American Indians. Instead, the only example of our spending was the cost of a conference room table.
The emergence of conversion foundations brings the real potential to change health systems. No matter the size of our assets, no single foundation will make sustainable sweeping change in the healthcare arena. However, working together, as health foundations have begun to do in California, we can leverage our assets to begin to bring systematic change toward improving the health of the underserved. The article ignored the tremendous progress that has already been made and, most important, the significant lessons learned in reforming healthcare in California, for the sake of sensationalism.
STEWART KWOH, ESQ.
ROBERT K. ROSS, MD
The California Endowment
Annette Fuentes and Rosemary Metzler Lavan rightly report on the egregious activity that has characterized some of the new conversion foundations recently established using the charitable assets of healthcare institutions that abandon their nonprofit missions. It is very troubling.
Fortunately, not all conversion foundations are plagued by the problems cited. Many of these new philanthropies are playing critical roles in supporting important healthcare projects, including funding community clinics, underwriting immunizations and health screenings and extending services to underserved communities. Increasingly, consumer advocates are organizing their communities to prevent the kind of abuse profiled in the article. Since 1996 the Community Health Assets Project, a partnership between Consumers Union and Community Catalyst, has worked to provide technical assistance and legal-advocacy services on conversion issues to community groups and public officials nationwide.
In Building Strong Foundations, we recommend that conversion foundations dedicate their assets to the mission of the converting nonprofit through a planning process that involves community involvement. Conversion foundation boards should not include members from the former nonprofit or the purchaser and should reflect the diversity of the community. There should be strict limits on terms of service and strong conflict-of-interest policies for board members and an organizational structure that is transparent and publicly accountable.
In communities where citizens insist on public involvement in their conversion foundations, the resulting philanthropic organization is much more responsive to local needs. Consumers and public officials who've intervened in Blue Cross and Blue Shield transactions in Maine, Kentucky, Kansas and Missouri have won important structural guarantees on governance, bylaws, mission and community participation on boards and in grantmaking decisions. With proper citizen input, these charitable assets can be preserved in publicly accountable foundations to help serve unmet healthcare needs far into the future.
New York City
Mark Smith is a whiner. He would have criticized any article that did not laud him and the California HealthCare Foundation. Indeed, his public relations person contacted this magazine after I interviewed Smith to complain that I had "an agenda." That's the same criticism Smith leveled against consumer watchdog Jaime Court, who questioned the foundation's funding of for-profit, market-oriented healthcare entities and research with public charitable assets. As California for-profit health plans prepared to eject thousands of elderly Medicare patients last year because they weren't making enough money off them, Smith's foundation issued a report declaring that everything would be OK because only a few thousand Medicare enrollees would be left without any alternative health plan. Of course, there is an epidemic of for-profit HMOs dumping Medicare patients across the country--and there is nothing OK about it. Smith should get CHCF's priorities straight.
John Kastellec is a nit-picker. The Advisory Board Company is a multimillion-dollar concern that does custom research on the healthcare marketplace for its 2,500 members, including pharmaceutical companies like Pfizer and Eli Lilly, a dozen Blue Cross/Blue Shield plans, hospitals and others who pay hefty membership fees. For the California HealthCare Foundation to give the Advisory Board more than $700,000 of Californians' money is not charity. It's corporate welfare.
Stewart Kwoh and Robert Ross are predictable. Their defense of the California Endowment's missteps, misspending and floundering first years is to hype the millions in good grants they've made. I wish I had a dollar for every source who refused to speak on the record on the endowment and its troubles because they didn't want to spoil chances of getting grants or because they're part of the philanthropic-industrial complex, to borrow from Eisenhower.
Harry Snyder and Robert Restuccia are right. Unfortunately, the rosy picture of community involvement they paint has been the exception rather than the rule, despite Consumers Union's efforts over the years. But the fight for "good" conversion foundations is a red herring. The healthcare system is in a state of emergency because consumers and people like Mark Smith bow to the inevitability of for-profit, market-driven healthcare that leaves 43 million Americans uninsured and countless millions scrambling for basic care. Universal healthcare anyone?