Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.
CMPI Interviews Gov. Pataki
Social Networks
Please Follow the Drugwonks Blog on Facebook, Twitter and LinkedIn
Drugwonks
Drugwonks.com is the web log of the Center for Medicine in the Public Interest (CMPI), a forum offering rigorous and compelling research on the most critical issues affecting current drug policy.
The long-awaited and much anticipated draft guidance on REMS can be found here.
Also now available (and worth a careful read or two) is the FDA's strategic plan for risk communications. Here's the press release, along with a link to the complete document. FDA NEWS RELEASE
For Immediate Release: Sept.30, 2009
Media Inquiries: Christopher Kelly, 301-796-4676, christopher.kelly@fda.hhs.gov Consumer Inquiries: 888-INFO-FDA
FDA Issues Strategic Plan for Risk Communication Establishes framework for communicating with public about FDA-regulated products
The U.S. Food and Drug Administration today issued its Strategic Plan for Risk Communication, which outlines the agency’s efforts to disseminate more meaningful public health information. The plan also lays out a framework for the FDA to provide information about FDA-regulated products to health care professionals, patients and consumers in the form they need it and when they need it, and for how the agency oversees industry communications.
“We are committed to improving communications the public receives about the products we regulate,” said Commissioner of Food and Drugs Margaret A. Hamburg, M.D. “The FDA must communicate frequently and clearly about risks and benefits and inform patients and consumers about ways to minimize risk as they become increasingly involved in managing their health and well-being.”
The plan defines three key areas–FDA’s science base, its operational capacity and its policy and processes – in which strategic actions can help improve the FDA’s communication about the risks and benefits of regulated products. The plan also identifies over 70 specific actions for the FDA to take over the next five years, including 14 that the agency commits to accomplishing over the next year. They include:
Designing a series of surveys to assess the public’s understanding of, and satisfaction with, FDA communications about medical products
Producing a research agenda for public dissemination
Creating and maintaining a useful, easily accessible internal database of FDA and other relevant risk communication research
Developing an expert model to characterize tobacco-use related consumer decision-making and better understand the likely impact of FDA oversight of tobacco products
Developing a “library” of multi-media communications on safe food practices for general education purposes and for use with crisis communications concerning food contamination episodes
Posting pictures of FDA- regulated products affected by Class I or high-priority Class II recalls as part of recall notices/information
Developing detailed action plans at the agency and center levels for implementing and achieving the proposed action steps, including timelines, responsibilities and resource needs
The plan reflects the FDA’s belief that risk communications must be adapted to the needs of different audiences and should be evaluated to ensure effectiveness. The plan also focuses on improving two-way communication through enhanced partnerships with government and non-government organizations, and focuses on policies that affect areas of high public health impact.
Speaking of taxing “Cadillac” health plans, today’s New York Times reports that:
“The leading proposal in the Finance Committee would apply to family insurance plans that cost roughly $21,000 and up starting in 2013. For the sake of fairness, the threshold would vary based on geography and the average age of a company’s work force. In all, something like 10 percent of plans would be subject to the tax in 2013, according to the Center on Budget and Policy Priorities, a research group."
(The complete New York Times story can be found here.)
60% of the American public gets their health benefits through their jobs -- and they’re not “free.” According to the Kaiser Family Foundation, the average American worker with “employer-provided” healthcare pays about 41% of the cost.
So – will benefits be taxed before or after the 41%? Clearly the answer is – before.
And as everyone’s favorite economist, Robert Reich, opines, "According to the Congressional Budget Office, taxing all employee health benefits would yield a whopping $246 billion every year. Even limiting the tax to higher-income employees would go a long way to funding universal health care. Employer-provided health insurance is the biggest tax break in the whole federal income tax system.”
The AFL-CIO’s Gerald Shea, the union’s top healthcare lobbyist, sees the definition of “Cadillac” shifting with time, “People are going to see this as a huge middle-class tax hit.”
The New York Times agrees:
“ … the number of affected plans would grow over time. The Senate has been talking about having the threshold rise each year by the inflation rate plus one percentage point. Since medical spending has been rising much faster than inflation, more and more plans would probably cross the threshold in the years after 2013. Over the next decade, the Congressional Budget Office has estimated that the tax would pay as much as 25 percent of the cost of extending coverage to the uninsured.”
And so does Robert Reich. “So a sensible and politically feasible alternative is to limit tax-free employer-provided health benefits to workers whose incomes are under, say, $100,000 a year, and subject those with higher incomes to progressively higher taxes on them."
Reading Natasha Singer's article about the "safety" of Yaz and Yasmin -- two popular oral contraceptives I felt, as Yogi Berra would say, like it was deja vu all over again. Where or where did Ms. Singer find her muse about the risks of birth control, I wondered?
"...recently, the Yaz line’s image has been clouded by concerns from some researchers, health advocates and plaintiffs’ lawyers. They say that the drugs put women at higher risk for blood clots, strokes and other health problems than some other birth control pills do. Those critics, though, are up against a large European health study, sponsored by Bayer, the German pharmaceutical giant, that reported the opposite conclusion. The Bayer-financed study said that cardiovascular risks in women taking Bayer products were comparable to those taking an older formula of birth control pills."
Here's a blog from a law firm leading the litigation against Bayer, the company that makes Yaz:
"The risks associated with this popular birth control pill are severe; many women who took Yaz or Yasmin have died or been seriously injured because of the serious health risks associated with the drug. In fact, the FDA received over fifty reports of Yaz and Yasmin-related deaths between 2004 and 2008, most involving increased levels of potassium and occurring in women as young as 17 years old. Imagine how many went unreported! A growing number of lawsuits have been filed by or on behalf of these women, charging the drug manufacturer with inadequately warning them of the increased risks Yaz and Yasmin pose to those women who use the oral contraceptive.
While the public-at-large and many physicians may not recognize an adverse reaction to drospirenone, the health risks have been known for longer than many realize. In 2002, the British Medical Journal reported some practitioners’ concern about the drug as a result of 40 cases of venous thrombosis among women taking it. Also, in 2003, the Journal published a paper that detailed reports of thromboembolism deaths and injuries thought to be caused by Yaz and Yasmin.
The FDA has been reprimanding Yaz and Yasmin manufacturers for misleading and inadequate television advertising for the drug for quite some time."
Here's Singer again... stoking the fires, fanning the flames, leading the witness...
"The health questions and the lawsuits may rattle consumer confidence, but the warnings from federal health authorities about advertising and quality control raise larger questions about Bayer’s approach to complying with government rules, said Michael A. Santoro, an associate professor at the Rutgers Business School who has studied ethics in the pharmaceutical industry. "
False Claims Act anyone? That's the fulcrum which the trial lawyers use to leverage meager findings about safety into a conspiracy of silence and misrepresentation.
The potential for physicians to favor innovator biologics over follow-on biologics because of a reimbursement advantage would be eliminated under an amendment to health care reform legislation adopted by the Senate Finance Committee Sept. 23.
The amendment, offered by Sen. Charles Schumer, D-N.Y., says the goal is "to ensure that patients and the Medicare program utilize biosimilars appropriately" and "create parity between brand name biologics and biosimilars and save patients and Medicare money."
The basic problem the amendment is trying to solve is the fact that, under current law, each biological product must have a separate billing code for reimbursement by Medicare Part B. Since the reimbursement rate under Part B is the average sales price of the drug plus six percent, if a biosimilar were introduced at a lower price than the innovator, there would be no incentive for physicians to use the lower-priced drug, since the six percent administration payment would be higher for the innovator. As a result, there would be no downward pressure on prices.
To eliminate this disparity, the amendment would provide equal administration fees for both the innovator, or reference product, and the follow-on biologic. The description of the amendment says a biosimilar approved by FDA and assigned a separate billing code would be "reimbursed at the ASP of the biosimilar plus six percent of the ASP of the reference product."
Brand Pharma May Dodge A CBO Bullet
The committee adopted the amendment by unanimous voice vote, and brand pharma stalwarts Sens. Orrin Hatch, R-Utah, and Michael Enzi, R-Wyo., joined as co-sponsors.
Brands may be supportive of the idea of reimbursement parity for physicians because, if treated as the fix Medicare needs to accommodate FOBs, it would mean that brands avoided potentially much more consequential modifications to the program.
The Congressional Budget Office has previously suggested that there would be additional savings from follow-on biologics if they are put on equal footing with innovators in government health care programs, not just in terms of physician reimbursement, but product coding as well, which would mean that brands would be reimbursed at the FOB price.
In a December 2008 score of legislation options, CBO said that putting a biosimilar in the same reimbursement code as its brand-name counterpart would save the government $10.6 billion over 10 years, about 30 percent more than the $8.1 billion it would save if they were not in the same code.
Many observers believe that such a coding change would need to be made by statute, and that without it Medicare would never fully embrace FOBs. Indeed, while the Schumer amendment removes a disincentive to prescribing FOBs, it does not seem to create an incentive for their use either.
Neurologist David Alway has written an excellent piece explaining the logical fallacy in having government be the arbiter of allocating resources in the practice of medicine.
Dr. Alway concludes by boiling the entire debate down to two choices before us:
“There is a choice to be made. One road leads to greater individual rights, freedom, productivity, good doctor-patient relations, further advances in health care, and better lives. The other leads to statism, government control of the individual, falling levels of productivity, a lack of innovation in medicine, drone-like doctors and nurses, and ultimately, more death.”
For the sake of future Americans, let us hope and pray that we take the first road.
It turns out that the politically incorrect Bill Maher is reportedly unhappy with the Baucus bill.
That’s the good news.
The bad news?
Bill Maher’s opposition to the Baucus bill is not based on the sentiment that it goes too far; rather, Maher doesn’t believe it goes far enough.
Earlier this year, Maher wrote this Op-Ed in which he decries the entire notion of a profit-motive in the practice of medicine.
Now Maher makes some points worthy of discussion.
But he goes on to lament the higher costs of medical treatment today and wrongly attributes the medical inflation associated with such procedures to Capitalism.
Yes, there are many new medicines and medical procedures that cost money. But these drugs and treatments produce favorable medical outcomes, otherwise they would not be profitable.
However, Maher utterly fails to connect the dots between the increase of government’s role in health care and medical price inflation.
Evan Falchuk writes: “In 2007, federal, state and local governments paid for more than 46 cents of every health care dollar – more than $1 trillion. In fact, since 1980, the government has paid at least 40 cents of every dollar, and as early as 1960 – 5 years before Medicare – government paid a quarter of health care expenses. Government is a massive health care customer and has the impact one might expect such a big customer to have.”
With that level of government spending, is it any wonder why medical spending is so high?
Yet Bill Maher wants to cede total control of the health care sector to the government. A brilliant idea!
How about this?
I think entertainment should be free. There should be no profit-motive in comedy and entertainment. Bill Maher has a moral obligation to entertain people for free. We all have a right to happiness. Comedy and entertainment makes us happy. Obscene profits must not be made on the backs of people in desperate need of humor and entertainment. Therefore we can all expect Bill Maher to forfeit his salary from HBO from this point on.
Sound good? Well, it's about as logical as Bill Maher asserting we can maintain a quality medical system free of profit.
Maher continues by suggesting that the existence of a public fire department is somehow reason enough for us to adopt a government-run health care system:
“And if medicine is for profit, and war, and the news, and the penal system, my question is: what's wrong with firemen? Why don't they charge? They must be commies. Oh my God! That explains the red trucks!”
Repetition of trite sound-bites from Michael Moore’s Sicko may qualify as proof of intellectual profundity in Hollywood but here in the real world, Bill, you’re going to have to do better than that.
Health care is very personal – apparently a fact that escapes Bill Maher. The doctor-patient relationship is about the individual and each person’s specific medical needs.
The Fire Department serves a community, a town, or city. The analogy is ludicrous on its face but that doesn’t stop the simple-minded from repeating it endlessly in arguing for government seizure of the health care sector.
Indeed, most of us exercise individual responsibility by keeping one or more fire extinguishers in our homes because to rely on the fire department to reach your place in time during an emergency would be taking a huge risk with one’s life.
Not to mention, there are private companies such as Rural/Metro Corporation which specialize in fire protection services and many volunteer fire departments serving communities across the country.
Does Maher mention all the volunteers, physicians, and charities dedicated to providing medical care to poor Americans every year free of charge? Of course not.
Suffice it to say, Bill Maher’s time would be better spent speaking to real physicians who work diligently every day to treat and care for patients and less time at his HBO studio if he has any interest in understanding our health care system.
"People have unique needs. I take Lipitor, they put me on the generic, Zocor, my cholesterol went up. They put me back on Lipitor, my cholesterol went down."
You mean that all statins aren't the same? That different people respond to different drugs in different ways. That generic substitution can have ... unintended consequences? Holy cow! And who is the mysterious "they" the Senator refers to? Probably not his Uncle Sam.
(PS, "Zocor" is not the "generic." Simvastatin is the generic. Not the same thing. But that's another story for another time.)
And at the top of the list should be the growing and worrisome EU/US medtech gap.
FDA NEWS RELEASE
For Immediate Release: Sept. 23, 2009
Media Inquiries: Karen Riley, 301-796-4674, karen.riley@fda.hhs.gov Consumer Inquiries: 888-INFO-FDA
FDA: Institute of Medicine to Study Premarket Clearance Process for Medical Devices
The U.S. Food and Drug Administration today announced that it has commissioned the Institute of Medicine (IOM) to study the premarket notification program used to review and clear certain medical devices marketed in the United States.
The IOM study will examine the premarket notification program, also called the 510(k) process, for medical devices. While the IOM study is underway, the FDA’s Center for Devices and Radiological Health (CDRH) will convene its own internal working group to evaluate and improve the consistency of FDA decision making in the 510(k) process.
“Good government conducts periodic reviews and evaluations of its programs,” said Jeffrey Shuren, M.D., acting director of CDRH. “Our working group and the IOM’s independent evaluation will help us determine how the 510(k) process can be improved to better support FDA’s mission to protect and promote the public health.”
The 510(k) process was established under the Medical Device Amendments of 1976 with two goals:
* Make safe and effective devices available to consumers * Promote innovation in the medical device industry.
During the past three decades, technology and the medical device industry have changed dramatically, making it an appropriate time for CDRH to review the adequacy of the premarket notification program in meeting these two goals.
Established by the National Academy of Sciences, the IOM provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.
As part of the study, the IOM will convene a committee to answer two principal questions:
* Does the current 510(k) process optimally protect patients and promote innovation in support of public health? * If not, what legislative, regulatory, or administrative changes are recommended to achieve the goals of the 510(k) process?
The $1.3 million IOM review is slated for completion in 2011, and is one of six priorities Dr. Shuren has outlined for CDRH. Others include:
* Creating an internal task force on the use of science in regulatory decision-making * Developing an effective compliance strategy * Optimally integrating premarket and postmarket information * Increasing transparency in decision-making * Establishing clear procedures to resolve differences of opinion.
The IOM will hold two public workshops during the next nine months as part of its review, and will publish a final report in March 2011 containing its conclusions and recommendations.
The FDA classifies medical devices into three categories according to their level of risk. Class III devices represent the highest level of risk and generally require premarket approval to support their safety and effectiveness before they may be marketed. Class III devices include heart valves and intraocular lenses.
Class I and Class II devices pose lower risks and include devices such as adhesive bandages and wheelchairs. Most Class II devices and some Class I devices can be marketed after submission of premarket notifications—also called 510(k) applications—that support their substantial equivalence to legally marketed devices that do not require premarket approval.
Devices that present a new intended use or include new technology that presents new questions of safety or effectiveness may not be found substantially equivalent and require premarket approval.
My Grandmother Out-Tweets Your Biotech By DAVID WASHBURN
Wednesday, Sept. 23, 2009 | Very few industries are as willing to take risks on new technologies as the biotech industry. Companies will spend millions, and even billions, developing a drug that has a chance to cure a cancer or a device that could change the face of heart surgery.
Yet when it comes to social media, the industry has proven to be risk adverse. In fact, your grandmother is probably more likely to be active on Twitter or Facebook these days than a pharmaceutical, medical device or contract research company.
"What we've got is the social media Maginot Line," said Peter Pitts, director of global health care for the public relations firm Porter Novelli, referring to the French army's strategy of fortifying its borders during World War II.
"If they avoid social media they are safe. But what is happening is that important discussions about the medications and how they affect patients are happening minus the participation of companies," Pitts said after a panel discussion hosted Wednesday by Biocom, the local biotech industry association.
The FDA has scheduled a two-day public meeting in November to solicit views regarding how it should deal with social media. Among other things, the agency wants to discuss how companies will fulfill their fair balance obligations in social media, how they will deal with inaccurate information posted about their products as well as adverse event reporting.
The meeting, Pitts said, is an acknowledgement by FDA officials that the agency is "behind the curve," and needs to address the issue. FDA officials involved in the planning of the meeting could not be reached for comment today.
Pitts and others hope a larger embrace of social media emerges from the FDA meetings, and that the industry realizes that it is "irresponsible not to use social media." They raised the issue of benefits that a drug may have that are not officially recognized by the FDA.
Say, for example, that a clinical trial shows that a drug has an effectiveness against a certain type of cancer tumor that was not thought possible when the drug was submitted for FDA approval, and therefore isn't on the FDA label for the drug.
"If they choose not to share that information in the best way possible -- which is social media -- is that the ethical and moral thing to do?" Pitts said.
An even more vexing issue facing both the companies and the regulators is how they deal with adverse event reporting. Suppose, Pitts said, that someone taking a cancer drug develops numbness in their fingers, and then writes about it in a blog or on a Facebook wall.
"This is an opportunity in real time to understand adverse reporting issues," Pitts said.
"Rather than avoid it from a legal and regulatory standpoint, they should pursue it from a public health perspective. That, however, is a very contentious proposition."
On Fox News Newt explains why Congress refuses to make the same 365 choices available to members of Congress as part of health care reform: "Because it doesn't increase the control government has over health care."
Which is also one reason why insurance under the health care proposals are 3 times more expensive than are available in the marketplace.
The other reason: legislation is nothing but a huge subsidy to large corporations, most union benefits and the liberal imagination. Heaven forbid, people choose health plans with higher deductibles, lower premiums, less coverage than the micromanagers want us to have.
On a related note: Here's President Obama's OMB director on what is really happening to health care costs:
"On the consumer side, and despite media portrayals to the contrary, the share of health care expenditures paid out of pocket, which is the relevant factor for evaluating the degree to which consumers are faced with cost sharing, has plummeted over the past few decades, from about 33% in 1975 to 15% today. All available evidence suggests that lower cost sharing increases health care spending overall. The result is that collectively we all pay a higher burden, although the evidence is somewhat mixed on the precise magnitude of the effect."
Rather than allowing people to choose plans that allow for cost sharing and accumulate cash (especially important for people who are chronically ill) and include health insurance premiums to lock in rates and pay for one time costs Orszag endorses the current solution: using an expert panel to determine what doctors should do and how much they should get paid for it:
"The real traction, though, will come from building the results of that research into financial incentives for providers. In other words, if we move from a “fee-for-service” to a “fee-for-value” system, where higher-value care is awarded with stronger financial incentives and low- or negative-value health care is penalized with smaller incentives or perhaps even penalties, the effects would be maximized."
All of which is at the heart of the Baucus bill and every other piece of legislation. Well since CER has been implemented elsewhere and costs have gone up, what has been the result on patients? Dr. Orszag let's it slip:
"... if all one did was, say, reduce payment rates under Medicare and Medicaid, and then tried to perpetuate that over time without a slowing of overall health care cost growth, the result would probably be that fewer doctors would accept Medicare and Medicaid patients, creating an access problem that would be inconsistent with the underlying premise and public understanding of these programs."
If you have not heard or read FDA commissioner's speech on regulatory science -- namely the Critical Path to promote personalized medicine in product review and post market management -- you should. It lays out vibrant vision of how the FDA can continue to adapt to and encourage companies to adopt genomics, biomarkers and other 21st century tools to make products safer and more effective.
We may disagree with the Obama vision of health care but we also share his commissoner's vision of how to sustain medical innovation.
According to Senate leadership aides, Senate Majority Leader Reid may bring a bill to the Senate floor in the next two weeks that would allow the importation of prescription drugs from Canada.
Wonder if Senator Reid has discussed this act of pharmaceutical imperialism with our neighbors to the North. Last conversation I had with Canadian officials left no doubt they are very concerned with how such an action would impact their domestic medicines supply.
And is this bill about drugs from Canada or drugs through Canada?
“Exempting Class I devices does not address the arbitrary nature of this tax. It will still cover scores of consumer products and medical devices used by millions of Americans every day. For instance, contact lenses and solution and battery powered breast pumps for nursing mothers will still be taxed.”
And, in a further feat of legislative legerdemain, maxi pads are not taxed, while scented maxi pads are.
Time to get out and dust off your Part 15 mojo for the November 12-13 "Promotion of Food and Drug Administration-Regulated Medical Products Using the Internet and Social Media Tools" meeting.
It's about time.
According to the announcement:
"... FDA recognizes that the Internet possesses certain unique technological features and that some online tools that may be used for promotion offer novel presentation and content features. Another emerging issue involves the reporting of adverse event data because such information may initially be revealed using social media platforms in the context of Internet promotion for FDA-regulated medical products."
Writing in the Chicago-Sun Times Jesse Jackson claims that government healthcare is a proven success.
He starts off by saying of the VA, “Despite its many faults, it is very popular, as virtually any veteran will tell you.”
How many veterans do you suppose Jesse Jackson knows? Enough for him to assert that “virtually any veteran” will tell us that the VA is paradise on earth?
He goes on to list a litany of gratuitously partisan – not to mention fallacious - arguments in favor of the president’s health care overhaul.
Jackson then makes the following claims regarding the insurance reforms proposed:
“They can't refuse you insurance if you are already sick. They can't cut off your insurance if you get sick. They can't discriminate against women in health-care rates. These are big deals. And insurance companies have been ready to accept them so long as they could continue to ratchet up rates on millions of new customers. That's why they hate the public option so much. It would derail their gravy train.”
Scott Harrington argues in the Wall Street Journal that policy rescissions aren’t as widespread a problem as some would have us believe.
Equally absurd is the notion that discriminatory pricing is somehow “unfair” in the area of insurance. The potential medical risks are different for men compared to women. And, of course, insurance premiums are based on risks.
Several factors account for the price disparity in premiums for males and females:
1. Well, for one, males and females have different bodies, thus different reproductive systems.
2. Generally speaking, women tend to visit the doctor more often than men for check-ups and tests.
3. High use of oral contraceptives.
The good news is that women generally pay less for auto insurance, as young males are more likely to be reckless and irresponsible drivers.
On the issue of life insurance, males also tend to pay more than women.
And, if that’s not enough, you still have ladies’ night at bars and clubs, ladies!
You see, discriminatory pricing is all around us. It’s a function of that beautiful thing called a free market.
We need less commentators reducing the health care debate to this sort of childish thinking and more focused on advancing the best ideas for reform.
Reverend Jackson would be wise to focus on other issues and leave health care policy to the experts.
I thought I was hearing things this morning when I watched this video of President Obama speaking to college students at the University of Maryland yesterday and he said this:
“We are the only nation on Earth that leaves millions of people without health insurance.”
Wow. I’ll let the absurdity of that statement speak for itself.
Now, for a politician who advocates big government, college students probably represent the optimal target audience. Many are still living with their parents, receiving government loans or other entitlements, and have yet to face the realities of life. In other words, they’re heavily insulated from the costs of big government due to their minimal experience in life.
There is another point President Obama made in his concluding remarks that needs some clarification.
“Health care is about more than the details of a policy. It’s about what kind of country you want to be. Young people, it's about what kind of country you want to be. We are the only nation on Earth that leaves millions of people without health insurance. We spend more than any country on Earth, and we're not any healthier for it. So this is about what kind of country you want your children to grow up in.”
When the president says we are not any healthier for our higher level of spending on health care, will somebody please ask him what exactly he means by that?
Aside from that, this debate is very much about what kind of country we want our children to grow up in.
Medicare is on an unsustainable financial path. Not too far into the future, there will be only two workers for every Social Security recipient.
And now the geniuses in Washington want to turn even more control of the health sector over to the government. Make no mistake about it, the quality of our medical care will undoubtedly diminish. The overall quality of life, standard of living and opportunities for many of the young people in attendance at the University of Maryland will diminish.
Over at State House Call, Greg Scandlen explains the irony of young Americans’ support for President Obama’s health care agenda:
Oddly, the key population to be hit with the effect of mandatory coverage are young adults, which are also the biggest supporters of Obama and health reform generally. The recent Census Bureau survey notes that 28.6% of young adults from 18 to 24 years old are uninsured, as are 26.5% of those from 25 to 34. That is double the rate of those of age 45 to 64.
Many of these people are in very good health, so don't feel a strong need for coverage, but in the proposals before Congress, they will not be allowed to benefit from their good health and will pay the same premium as people who are very sick.
These young people often have other priorities for their money. They are looking for a mate or starting a family. They are setting up their household from scratch and need to buy furniture, or save for the down payment on their first house. They are getting rid of the beat-up Toyota they used in college and buying a decent car to get to their new jobs. They are buying clothing that is suitable for the workplace.
Scandlen concludes:
Man, if this thing passes, these folks are in for a rude awakening. But, I guess growing up involves a whole series of disillusionments. This will be just one of many for the new generation.
Opposition to Health Care Plan Hits New High of 56%
Friday, September 18, 2009
Fifty-six percent (56%) of voters nationwide now oppose the health care reform proposed by President Obama and congressional Democrats. That’s the highest level of opposition yet measured and includes 44% who are Strongly Opposed.
Just 43% now favor the proposal, including 24% who Strongly Favor it.
But the overall picture remains one of stability. While the numbers have bounced a bit following nationally televised appearances by the president to promote the plan, opposition has generally stayed above 50% since early July. Support has been in the low to mid 40s.
The number who Strongly Oppose the plan has remained above 40% and the Strongly Favor totals have been in the mid-20s. This suggests public opinion is hardening when it comes to the plan that is currently working its way through Congress.
However, now just 48% say that health care reform plan is at least somewhat likely to pass this year, a figure that has been trending down in recent days. That figure includes 17% who say passage is Very Likely.
Rasmussen Reports has been tracking support for the health care plan on a daily basis since the president's speech to Congress last week intended to revitalize the troubled initiative.
RUMBLINGS ABOUT A BLUE DOG BETRAYAL.... Rep. Bill Cassidy (R) of Louisiana told a conservative talk-show host this morning that Blue Dogs Democrats have been quietly reaching out to conservative Republicans about a GOP-friendly health care reform plan.
"I'm having Democrats come to me, to speak to me as to what House Republicans are putting up," Cassidy told a conservative news radio program. "And when I mention our patient-centered plan...they want to have more conversations regarding that."
Cassidy was referencing the bill H.R. 3400, introduced by some House GOP lawmakers as an alternative to the bill favored by most Democrats.
"Some of my Democratic colleagues are approaching me now, saying we are not going to vote for H.R. 3200, can we talk about some of our ideas," Cassidy explained. "I'm very encouraged by this."
This isn't the first time this has come up, but it's gone almost entirely overlooked, in part because it seems hard to believe.
Last week, The Hill had a report, citing "GOP sources," claiming that Rep. Mike Ross (D-Ark.), the leading Blue Dog on health care policy, has been "keeping a back channel open" to Rep. Charles Boustany (R-La.) about a possible reform deal. The sources said Ross and Boustany have "secretively ... been in talks for weeks."
And as far back as July, Boustany claimed that Blue Dogs and conservative Republicans were having "conversations" about a center-right compromise that would effectively reject everything Democrats had proposed.
At this point, the only people talking about this publicly seem to be conservative Republicans. Whether there's anything to this is entirely unclear. Maybe this has to do with a negotiating ploy. It might even be little more than a psych-out.
But if Cassidy's comments this morning were accurate, Blue Dogs could be part of a rather massive betrayal. If the conservative Democrats decide, en masse, that they'll support a conservative Republican approach to reform -- premised on the notion that American families already have too much insurance -- but not a Democratic package, the consequences would be devastating.
Ceci Connolly's piece on the marvels of the Baucus bill captures the complete disengagement of the political process and parasite class involved in health care reform from the essential fabric of representative government. As long as "stakeholders" are numb and happy, all is well. Screw the people who will be forced to pay more money for a small number of health plan choices that are more expensive yet demonstrate no greater benefit than less costly forms of coverage, accept cuts in Medicare and Medicaid without regard to individual need.
It seems that since Obama became President, Washington has become more detached from public sentiment... Ceci just channels the delusion such disregard is not only acceptable but essential to being politically effective...
My favorite quote about liberalism is from Lionel Trilling: (“We must be aware of the dangers which lie in our most generous wishes. Some paradox of our nature leads us, when once we have made our fellow men the objects of our enlightened interest, to go on to make them the objects of our pity, then of our wisdom, ultimately of our coercion.”)
Thus stands the clueless observation of Drew Altman who maintains that by such time in the future the annual cost of health care will be $30k a year: For the worker share of the premium alone, the average amount paid by families increased from $1,543 in 1999 to $3,354 in 2008.
But that's according to the Book of Kaiser which believes that all health care coverage should include all the benefits and first dollar amounts that the Kaiser Foundation social engineers deem ok. Which is why the Baucus bill eliminates choice of any coverage other than the most expensive Kaiser model
Meanwhile, consumer expenditure data shows that Americans on average spent $945 a year on health insurance premiums in 1999 or two percent of the average pretax income. In 2007 the average was $1545 a person or a whopping 3 percent of pretax income. In both cases, that amount was less than what a person spent, on average, for dining out or entertainment.
Drew tells us that... the average cost of a family health insurance policy in 2009: $13,375....premiums in 2019 will average a whopping $30,803, a very scary number.
Let's set aside the mythical nature of that number, how it reflects pretax wage increases on the one hand and a one size fits all benefit package replete with mandated services on the other. Let's set aside the fact that the average yearly family premium in the individual health market with a $2000 deductible with the same benefits Drew drools for is $4500. SOURCE: eHealth, Inc.
Instead, let's focus on Drew's solution for making the scary number go away:
"One obvious implication is that we need to get more serious about reaching agreement on ways to slow the rate of increase in health care costs. But consensus on measures that would put a real dent in the health cost trajectory has been hard to achieve. Even simple first steps, such as comparative effectiveness research to collect data on what works and what does not in medical practice, have proven controversial, requiring language in draft legislation disavowing that they will ever be linked to payment."
Poor Drew. America lacks the will to require government to ration care explicitly. But he should take heart that much of Congress has bought into to the element of the liberal vision: a one size fits all, overpriced health plan that will be hard to pay for and three times as expensive as what most of us would choose if we actually had the choice.
.jpg)
