Wow. Healthcare reform.
President-Elect Obama, in officially introducing Tom Daschle as his HHS Secretary-designate, said (in effect) "if not now, when?"
Okay, got that. But many questions remain unanswered, like ... how.
One item that will be at the core of the agenda (even though the administration won't explicitly call it by its real name) will be pharmaceutical price controls.
There will be three immediate bites at the price control apple:
The first is the revocation of the Non-Interference Clause. By so doing the government will be able to "negotiate" prices for Part D drugs. That's kind of like negotiating with your hands tied behind your back and a gun pointed at your head. There's also the potential for Uncle Sam to dictate that Part D prices be tied to prices in other countries -- a kind of Medicare reference price.
Bite #2 is importation. Even though such a program won't save any money (less than .1% of drug spending according to OMB) and is fraught with safety issues, it does present the opportunity to import de facto price controls. Would a Secretary Daschle provide Secretarial Certification? Do the ends justify the means?
Bite #3 is comparative effectiveness. Senator Baucus has this as an integral part of his package and it would be surprising if others (specifically Senator Kennedy) wouldn't do the same. While comparative effectiveness isn't, per se, a price control mechanism -- it's the HOV lane to that destination a la healthcare technology assessment and a NICE-like proposition.
(Senator Baucus' legislation -- at least the 2008 version -- says the work of this new AHRQ-based body couldn't be used for CMS reimbursement decisions. Sure. And if you believe that one, I've got a Senate seat to sell you.)
And it's important to note that all three of these "bites" can happen simultaneously, separately, before, during, or as part of a more comprehensive Administration-reform initiative.
Let threedom ring -- but remember for whom the bell tolls.
President-Elect Obama, in officially introducing Tom Daschle as his HHS Secretary-designate, said (in effect) "if not now, when?"
Okay, got that. But many questions remain unanswered, like ... how.
One item that will be at the core of the agenda (even though the administration won't explicitly call it by its real name) will be pharmaceutical price controls.
There will be three immediate bites at the price control apple:
The first is the revocation of the Non-Interference Clause. By so doing the government will be able to "negotiate" prices for Part D drugs. That's kind of like negotiating with your hands tied behind your back and a gun pointed at your head. There's also the potential for Uncle Sam to dictate that Part D prices be tied to prices in other countries -- a kind of Medicare reference price.
Bite #2 is importation. Even though such a program won't save any money (less than .1% of drug spending according to OMB) and is fraught with safety issues, it does present the opportunity to import de facto price controls. Would a Secretary Daschle provide Secretarial Certification? Do the ends justify the means?
Bite #3 is comparative effectiveness. Senator Baucus has this as an integral part of his package and it would be surprising if others (specifically Senator Kennedy) wouldn't do the same. While comparative effectiveness isn't, per se, a price control mechanism -- it's the HOV lane to that destination a la healthcare technology assessment and a NICE-like proposition.
(Senator Baucus' legislation -- at least the 2008 version -- says the work of this new AHRQ-based body couldn't be used for CMS reimbursement decisions. Sure. And if you believe that one, I've got a Senate seat to sell you.)
And it's important to note that all three of these "bites" can happen simultaneously, separately, before, during, or as part of a more comprehensive Administration-reform initiative.
Let threedom ring -- but remember for whom the bell tolls.
