No Two Atypicals Are Typical

07/21/2009 04:02 PM |

Despite all the verbiage about using CER to find differences in response among subpopulations and to support personalized medicine, the CER industry consists of conducting/reviewing one size fits all trials to conclude that there is no difference between older and newer drugs...

Hence, this in Health Affairs...

Bethesda, MD -- Are drugs known as "second-generation antipsychotics" (SGAs) being overused and misused? What steps can be taken to make sure that medications are used correctly? Those questions are addressed in a trio of articles published today on the Health Affairs Web site.

Read article here

SGAs, also known as "atypical antipsychotics," have largely replaced older, less expensive first-generation (or typical) antipsychotics in the treatment of schizophrenia. SGAs are increasingly being used for a wide range of other clinical conditions as well.

The cost of SGAs is typically from ten to 100 times the cost of "first-generation" antipsychotics, and domestic U.S. sales of SGAs have reached $13 billion a year. However, based on recent research, some experts believe that the overall risk-benefit profiles of SGAs may be no better than those of some of the older and cheaper medications they have displaced, although important questions remain to be addressed through further research, and considerable variation exists in treatment response across individual antipsychotic drugs. While SGAs appear to cause fewer "extrapyramidal" side effects, including serious movement disorders, they bring increased risk of weight gain and blood-lipid abnormalities that may increase the risk of heart disease and diabetes.

 

Other researchers believe that SGAs can offer important new benefits for patients with schizophrenia and other serious mental conditions, but that the broadened use of these drugs for a more clinically diverse population of patients may have outstripped the evidence base for such use.

Examining The Use Of SGAs Among Youth and Elderly. In "Broadened Use of Atypical Antipsychotics: Safety, Effectiveness, and Policy Challenges" Stephen Crystal and coauthors document the increased use of SGAs on the two ends of the age spectrum, the nation’s youth and the elderly in nursing homes. When the researchers examined youth in seven state Medicaid programs, they found that 4.2 percent of enrollees ages 6-17 filled at least one prescription for an antipsychotic medication in 2004, up from 2.7 percent in 2001. Virtually all of the antipsychotics used were SGAs.

Read article here

Clinical indications approved by the Food and Drug Administration for antipsychotics in young people are limited to schizophrenia, behavioral symptoms in autism, Tourette’s disorder, and mixed or manic bipolar episodes. But in 2004, one-third of the youth in the seven Medicaid programs studied were being treated for attention deficit hyperactivity disorder without diagnostic codes for more-serious diagnoses such as schizophrenia, autism or bipolar disorder, according to Crystal, director of the Center for Education and Research on Mental Health Therapeutics in the Center for Pharmacotherapy at Rutgers University, and colleagues. Overall, almost three-quarters of Medicaid youth receiving antipsychotics were being treated only for conditions for which no FDA clinical indication existed. The results were similar among privately insured youth.

 

Likewise, among elderly nursing home residents, most use was for residents without an FDA diagnostic indication, and use increased from 1999 to 2006 despite new safety concerns including FDA warnings of increased mortality associated with use among elderly with dementia. Among nursing home residents in 2006, 27.6 percent were receiving antipsychotics, up from 20.2 percent in 1999.

Increasing Information To Ease Resistance To Practice Changes. In "Developing A Policy For Second-Generation Antipsychotic Drugs," Robert Rosenheck and Michael Sernyak report that many SGAs were prescribed for questionable reasons at one university-affiliated Veterans Affairs health center caring for veterans with serious mental illness. "The most frequent reasons given for prescribing SGAs … were greater efficacy, followed by patient preference and sedation/sleep, none of which is well-supported by current research. In contrast, prevention of neurological side effects – the reason for using SGAs with the strongest research support – was the least frequently cited reason for starting a new SGA," say Rosenheck, codirector of the New England Mental Illness Research, Education, and Clinical Center at the VA Connecticut Health Care System, and Sernyak, chief of the Mental Health Service at the VA Connecticut Health Care System.

Read article here

Rosenheck and Sernyak suggest that the most appropriate policy would be "stepped therapy," in which patients would have to start on first-generation antipsychotics and would only be allowed to try the SGAs with the most risk of side effects if other drugs had failed to help them. However, this policy would be likely to meet resistance, the authors acknowledge. They suggest that "counter-detailing, with its emphasis on individualized education and direct feedback, may be crucial in garnering the understanding and needed support for successful implementation of meaningful practice change."


Notice, no measure of individual response or outcomes..

Whereas David Meltzer and co. note what happens when individual responses to individual drugs are counted...

The Need For More Comparative Effectiveness Research. In "Comparative Effectiveness Research for Antipsychotic Medications: How Much Is Enough?" David Meltzer and coauthors examine a high-profile study funded by the National Institutes of Health that has been used to argue for restricting coverage of SGAs. In 2006, a cost-effectiveness analysis based on this study – known as the Clinical Antipsychotic Trials of Intervention Effectiveness study, or CATIE – found that "treatment with perphenazine [a first-generation antipsychotic] was less costly than treatment with second-generation antipsychotics with no significant differences in measures of effectiveness." 

Read more here

However, there are a number of concerns about CATIE’s design that create "great uncertainty about the extent to which CATIE findings should be used to make coverage policy," write Meltzer, Director of the Center for Health and the Social Sciences at the University of Chicago, and colleagues. The authors present a model that they say indicates that additional comparative effective research involving SGAs would be of immense value – exceeding $300 billion – to those who have schizophrenia today and to those who will develop it over the next 20 years. The model also suggests that it would be worthwhile to perform studies of the effectiveness of SGAs with much larger sample sizes than CATIE, on the order of 8,300 patients in each treatment group as opposed to the 400 patients per group in CATIE. The model indicates that studies of cost-effectiveness should be even larger and would offer the greatest value.

Larger?  I don't think so.  I think spending money developing/testing predictive and biomarker based tools in observational settings would be a lot cheaper.  

What are people thinking? 

After the embargo lifts, you can read the article by Crystal and coauthors at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.5.w770

After the embargo lifts, you can read the article by Rosenheck and Sernyak at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.5.w782

After the embargo lifts, you can read the article by Meltzer and coauthors at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.5.w794

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The Three Urban Myths of Healthcare Reform

07/21/2009 12:04 PM |

When it comes to healthcare reform, as Aldous Huxley said, “Facts do not cease to exist because they are ignored.”

Three of the most common “urban myths” of American healthcare are that:

1. The lower life expectancy in the U.S. “proves” the total inadequacy of our system;
2. There are 47 million uninsured Americans — proving the inequity of our system; and
3. We spend “too much” on health care — proving the wastefulness of our system.

For the rest of the story, see this new op-ed, part of the Reuters’s “Great Debate” series on healthcare reform.

As the old saying goes, everything you read in the newspaper is true, except for those things you know about personally. Healthcare reform is too important (and too complicated) to permit reform by sound bite.


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Show me the money ... but how much?

07/21/2009 11:56 AM |

The AP reports that the FDA -- "which has struggled to fulfill its mission of regulating food, drugs, and other consumer goods that make up nearly a quarter of the US economy -- does not have the expertise to forecast its own budget needs," GAO officials say. "While many lawmakers and consumer advocates have long complained that the agency lacks the staff and equipment to accomplish its mission," according to the GAO, the FDA "doesn't even have 'the data to develop a complete and reliable estimate of the resources it needs.'" FDA officials said that "they are working to get a better picture of the agency's spending and how much additional funding it needs." Dr. Joshua Sharfstein, FDA deputy commissioner, said, "We have to be able to talk about the funds we need, and how we're using the money, with more detail than FDA has in the past." He noted that the agency is already "working to keep better track of how the agency uses its funding," saying, "We've actually been working on this since we started here, but it's a big agency and it's going to take some work to get to the level of detail people want."
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Incomplete Headline

07/20/2009 12:29 PM |

Front page, top of fold article in today's edition of the Wall Street Journal Marketplace section.  Headline reads, "Drug Makers Criticized for Co-Pay Subsidies."

Then, when you read the article, you see that those doing the criticizing are ... insurance companies while those doing the praising are ... patients.

Why not a headline that reads, "Patients Praise Drug Makers for Co-Pay Subsidies."

I know -- man bites dog.
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Dean of all Lobbyists?

07/20/2009 11:00 AM |

Steve Usdin reports in BioCentury:

 

“In bending political opinion about biosimilars, BIO benefited from the services of prominent Democrats, most notably former Democratic National Committee chair and former Vermont Gov. Howard Dean, and perennial Democratic presidential campaign manager Joe Trippi, as well as well-placed lobbying firms. Trippi and Dean are not registered as lobbyists. Their activity, which supplemented the efforts of BIO’s in-house and external lobbyists, may not have met the legal criteria for requiring registration, but it was aimed at influencing the views and votes of members of Congress.”

 

“Dean, who represents the progressive, or more liberal, wing of the Democratic Party, surprised many on the political left by writing a commentary on biosimilars that was published in the July 8 issue of The Hill, a newspaper that is widely read on Capitol Hill. Dean repeated BIO’s talking points on biosimilars, contending that a “commonsense and fair approach, similar to the process and timeline currently in place for generic versions of chemical-based medicines, would allow the original developer of the biologic to protect the proprietary data used to develop the medicine for at least 12 years.” Dean, who attacked pharmaceutical company profits during his 2004 presidential campaign, wrote in the commentary that a “shorter exclusivity period would prematurely rob biotech innovators of their intellectual property and destroy incentives to develop new cure.” The Hill identified Dean as a physician, ‘former Vermont governor, Democratic National Committee chairman and presidential candidate,’ but did not mention any relationship with BIO.”

 

"In his e-mail to board members, Greenwood did not fail to include Dean in his praise. ‘Our team at BIO, the D.C. offices of our members, our consultants (now including former Vermont Governor and Democratic National Committee Chairman Howard Dean) did a magnificent job,’ he wrote. Dean told BioCentury last week that he provides ‘long-term and short-term strategic advice to BIO. I do not lobby.’ ”

 

In the same article Usdin also reports:

 

“Speaking at a briefing last week at the Center for Medicine in the Public Interest, Rep. Anna Eshoo (D-Calif.) said she plans to introduce a version of her Pathway for Biosimilars Act (H.R. 1548) as an amendment during Energy and Commerce Committee markup of its draft healthcare reform legislation.

The Eshoo amendment, which hasn’t been publicly released, “embodies the strengths of both H.R. 1548, as well as the recently passed Hatch/Enzi/Hagan Amendment at the HELP Senate Committee,” Greenwood noted in a July 16 letter of support for the Eshoo amendment.”

 

“The Eshoo amendment combines the 12-year exclusivity provisions passed by HELP last week “while also retaining the important provisions in H.R. 1548 aimed at avoiding patient and provider confusion over biosimilar products and ensuring patent disputes will be resolved prior to the expiry of data exclusivity.’ “

 

“Greenwood’s letter stated. H.R. 1548 requires that all biosimilars be assigned a unique international non-proprietary name (INN) rather than adopt the INN for the reference product as is the case for generic drugs. BIO has advocated for unique INNs, while biosimilars manufacturers oppose this as a barrier to interchangeability. Eshoo seems to have lined up enough support in the Energy and Commerce Committee to get the amendment passed — 23 of its 59 members are co-sponsors — if a vote is taken.”

 

CMPI (the public policy home of drugwonks.com) was proud to have sponsored that event (which also included comments by Representative Mike Rogers (R, MI), the Honorable Mike Ferguson, Former Vice-Chairman of the House Health Subcommittee (and a CMPI senior fellow), John F. Crowley, CEO, Amicus Therapeutics, Founder, CrowleyFamily5.com, and Dr. Geno Merli, Senior Vice President & Chief Medical Officer, Thomas Jefferson University, and Director, Jefferson Center for Vascular Diseases.

 

Video of this event will be available shortly on www.cmpi.org

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Beware the Social Media Maginot Line

07/17/2009 04:40 PM |

The Internet is agnostic. It’s a library without a librarian. The Internet is agnostic to truth, accuracy, and spelling. So, when we talk about social media, it’s imperative to view it separate and apart from “the agnostic Internet.” Social media uses the Internet as its delivery mechanism and is anything but agnostic. The Internet is not social media – it is the playing field of social media.

If the Battle of Waterloo was won on the playing-fields of Eton, wither the battle of social media and healthcare? While everyone else is using social media as a healthcare communications blitzkrieg, or “lightening war,” regulated industry is digging in for a sitzkrieg, a “sitting war.”

This is not good news for pharma, physicians, or patients. Social media is driven in real time by facts (often wrong), statistics (regularly misunderstood), snake oil salesmen (wearing white coats), and just plain folks looking for information from a variety of sources – the most important being each other. Social media is the newest arrow in the quiver of social marketing, but it’s a discipline both misunderstood and frightening to those operating in the heavily regulated world of healthcare.

Pharma mustn’t feel safe behind a social media Maginot Line strategy.

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The AMA Pseudo-Endorsement

07/16/2009 11:59 PM |

Democrats are touting the fact that the AMA has signed on to their health care reform effort. But is the AMA really representing the views of its members, or are they playing a Washington game: currying favor with the Democrat majority, in the hopes that when negotiators decide who’ll pay for national health care, they’re not left holding the bill? Here’s one suggestion that the AMA leadership may be getting ahead of its rank and file:

Concerned that the American Medical Association has taken too tepid a position on Democratic healthcare reform plans, a coalition of state medical associations and specialty organizations is breaking from the country’s largest physicians’ group to mount its own push against the inclusion of a public insurance option in any overhaul bill.

Seventeen state medical associations and three specialty physicians’ groups planned a conference call late Wednesday to discuss a draft letter that would go much further than the AMA’s more measured responses to the public option.

The AMA has made clear it is not opposed to a public plan, but would resist a Medicare-like program that mandates physician participation and pays less than their costs..

The draft letter, written by members of the Medical Association of Georgia, says flatly that the physicians’ groups unequivocally oppose a government-administered insurance plan, as well as use of government-funded effectiveness tests, or “comparative effectiveness research,” to dictate which medical procedures should be eligible for coverage…

A Republican aide familiar with the coalition’s concerns said the physicians’ groups especially worry that AMA’s position on public option language in the House’s developing legislation has been “too squishy…”

“Physicians have been offered a seat at the table so long as we sit still with our hands folded in our laps and keep our mouths shut,” wrote John Black president of the South Carolina association, and Gary Delaney, the group’s chairman. “The muzzle that the Feds placed on us must be removed and the decibel level of our voices must be raised so that we are unmistakably heard.”

In addition to Georgia and South Carolina, state medical associations from New Jersey, Florida, Arkansas, Virginia and 10 other states and the District of Columbia planned to discuss the letter and consider signing it.

The Triological Society and the American Academy of Facial Plastic and Reconstructive Surgery were also invited to participate in Wednesday’s discussion, said a spokeswoman for the Georgia group.

Seventeen state associations are considering separating themselves from the national AMA to make clear that they oppose a government-run plan. That doesn’t completely devalue the AMA’s position, but it certainly makes you wonder what could have caused such a sudden and dramatic reversal. Given the threats Democrats have been leveling against groups that refuse to cooperate with their agenda, it would be no surprise if the AMA’s leadership simply calculated that it would be more dangerous to fight than to give in.

We’ll know in the next few days how many state associations are willing to buck their leadership and sign on to this letter. I wonder how much attention that will receive.

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Reid: Between the Lines

07/16/2009 08:24 PM |

The Wall Street Journal reports that:

"Top Senate Democrats were critical Thursday of comments made by the director of the nonpartisan Congressional Budget Office that existing reform plans wouldn't curb federal spending on health care. CBO Director Douglas Elmendorf told lawmakers on the Senate Budget Committee earlier Thursday morning that legislation approved this week by a Senate panel wouldn't reduce the federal government's spending on health care. "And on the contrary, the legislation significantly expands the federal responsibility for health care costs," Mr. Elmendorf said. Mr. Elmendorf went on to say that there is widespread support among health analysts for taxing health care benefits as a way to reduce federal outgoings on health care. Taxing individuals' health care benefits is extremely unpopular among many Democratic lawmakers. Asked about the assessment, Senate Majority Leader Harry Reid (D., Nev.), quipped that Mr. Elmendorf should consider running for Congress."

Senator Reid, what do you mean by that remark?

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Trillion Dollar Baby

07/16/2009 11:26 AM |

That healthcare reform bill just released by Democratic House leaders calls for a public insurance option which would negotiate rates directly with providers, including drug firms.

It's in Subtitle B Section 224, which says: "The Secretary also has authority to negotiate prescription drug prices for the public option."

Direct negotiations? For some things to consider, see today’s edition of the Washington Examiner.

"Direct negotiations" means price controls. And price controls = choice controls.

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Don't fix the blame, fix the problem

07/15/2009 02:58 PM |

Pharmaceutical marketers are in a tough spot when it comes to social media. On the one hand, they understand the importance and opportunity of it. On the other, they are restrained and frustrated by a number of barriers, including actual and implied ones from the FDA, and self-imposed ones from the nabobs of “no” (aka MLR – medical legal review). Anti-depressants anyone?

Social media is a social movement, and using the excuse that pharma can’t engage because, “We’re different,” misses the point. Compliance issues are very important, but it’s precisely because of the “special differences” that pharmaceutical companies must engage actively and creatively in social media. And that difference is the responsibility of advancing the public health.

Don’t pin all the blame on MLR. They’re on board. As the head of one large pharma’s MLR department commented to me, “We have to talk to our customers where they are – and they are in social media.”

MLR looks at risk, but is marketing presenting the benefits? And what about the FDA?  The agency is certainly sending mixed messages. Yet, a senior Center for Drug Evaluation and Research (CDER) official said at the Drug Information Association (DIA) meeting last month: “The FDA does not want to stifle the use of social media.” Good news? We’ll see.

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Comparative Dyslexia

07/15/2009 12:49 AM |

This, in the preamble of section about the public plan in the House Dem bill....

"the Secretary’s primary responsibility is to create a low-cost plan without comprimising quality or access to care. "

So, not only do members not have to read the bill (per Mr. Hoyer) -- spelling no longer counts.

Perhaps the IOM should commission a study on the correlation between spelling errors and medical errors.
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Of Cuckoo Clocks and Market Health Care

07/14/2009 02:59 PM |

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Bend This!

07/14/2009 12:24 PM |

Peter Orzsag is more responsible than anyone for peddling the nonsense that comparative effectiveness research can save $700 billion over ten years and asserting that slowing health care costs are key to economic prosperity... 

I bring this up again, because...

New tests may help spot early-stage Alzheimer's

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By Julie Steenhuysen

CHICAGO (Reuters) - New tests assessing brain changes and body chemistry are showing promise at diagnosing Alzheimer's disease in its earliest stages, aiding the search for new drugs, researchers said on Tuesday.

In one study, Irish researchers found scans measuring brain volume and a combination of memory tests accurately identified nearly 95 percent of people who had progressed from mild cognitive impairment to early Alzheimer's disease.

In another study, U.S. researchers found that a type of brain scan that measures glucose combined with low scores on memory tests was a strong predictor of disease progression.

The findings, presented at an Alzheimer's Association meeting in Vienna, Austria, are some of the first from a five-year, $60 million study aimed at identifying brain changes that signal the advance of Alzheimer's disease.

"The idea is if there could be biological markers identified that tracked what was going on in the brain, this would give you a better idea of whether a drug was having a biological effect," Neil Buckholtz, who heads the U.S. National Institute on Aging's Alzheimer's Disease Neuroimaging Initiative, or ADNI, said in a telephone interview.

The study, which is funded with U.S. government and industry funds, involves more than 800 people looking at brain structure and biological changes such as in spinal fluids that could signal disease progression.

Despite decades of research, doctors still have few effective treatments for Alzheimer's disease, a mind-robbing form of dementia that affects more than 26 million people globally and is expected to reach 100 million by 2050.

CHEAPER TRIALS

Only an autopsy revealing the disease's hallmark plaques and tangles in the brain can offer a definitive Alzheimer's diagnosis. Short of that, doctors use neurological and memory tests. Because they are subjective, drug companies must run large, costly trials to show their drugs work.

Biomarkers may lead to cheaper trials, Buckholtz said...."

Newer tests.  Earlier intervention.  More drugs that are targeted.. More costs upfront.  People living longer, healthier lives. 

Not good in the Orszagian Universe...

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Jim who?

07/14/2009 11:21 AM |

BioCentury reports:

 

“Proponents of six separate bills seeking to create a pathway for approval of biosimilars are trying to line up enough support to prevail in a vote that could come as early as Friday in the Senate Health, Education, Pensions and Labor (HELP) Committee. The bills have been introduced as amendments to healthcare reform legislation.

 

The Biotechnology Industry Organization is strongly backing an amendment introduced on Thursday by Sens. Kay Hagan (D-N.C.), Michael Enzi (R-Wyo.) and Orrin Hatch (R-Utah) that would provide 12 years of exclusivity for pioneer biologics. BIO is opposing an amendment introduced on Tuesday by committee Chairman Sen. Edward Kennedy (D-Mass.), arguing that the amendment's nine year period of guaranteed exclusivity is too short. BIO also opposes language that seeks to limit exclusivity to a "major new substance" that would exclude many biologics, as well as the amendment's limited exclusivity for products approved before enactment of the legislation.

 

Sen. Sherrod Brown (D-Ohio) has introduced two biosimilars amendments, which would provide for seven and nine years of exclusivity. Two other pending amendments, filed by Sens. Barbara Mikulski (D-Md.) and John McCain (R-Ariz.), would provide 10 years of basic exclusivity. If the HELP Committee fails to agree on one of the amendments, it may send healthcare reform to the Senate floor without biosimilars provisions. This could put the creation of a biosimilars pathway in the hands of the House of Representatives.”

 

On a related note, it seems that BIO needs to hire a new publicist for Jim Greenwood.  In her Wall Street Journal article, reporter Alicia Mundy refers to him simply as an “industry lobbyist.” I guess the fact that he’s the president of BIO and a former United States Congressman isn’t relevant.  It’s also interesting that she describes the Kennedy bill as a “victory” for biotech. 

 

Ms. Mundy should probably put Steve Usdin on speed dial.

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No-Part Harmony

07/13/2009 11:37 AM |

It’s not surprising that physicians serving in Congress are as conflicted as their peers outside the Beltway when it comes to how best to achieve healthcare reform (“For Doctors, Little Harmony on Health Care,” New York Times, July 12, 2009). 

What is surprising is how ignorant some physician/representatives are when it comes to existing options for their patients/constituents who are without health insurance.  Representative Steve Kagen (D, WI) is upset that a patient cannot afford the medicines he prescribes, but seems ignorant or unwilling to recommend the many patient assistance programs available to those who earn too much to receive government assistance but too little to afford private insurance.  Such programs are valuable options, providing free or low cost medicines to millions of Americans. The Partnership for Prescription Assistance (toll-free, 1-888-4PPANOW; www.pparx.org) is a single point of access to the more than 475 patient assistance programs, which include more than 180 programs offered by the pharmaceutical industry. 

Dr. Kagen, the other physicians in Congress and every member of Congress should be aware of private sector healthcare access success programs before opting for a government-run public option.
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Change You Can Laugh At

07/10/2009 08:51 PM |

Obama invoked Lincoln and read Roosevelt as he prepared to become president and provide the American people an image to shape our vision of his leadership... Here, given the recent roilings of the health care debate, are graphic scenes of yesteryear that may be a more appropriate metaphor:


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Blue Dog Day Afternoon

07/10/2009 04:15 PM |

Conservative House Dems rebel on health care bill

By ERICA WERNER
Associated Press

WASHINGTON -- Conservative Democrats in the House rebelled against their party leaders Thursday, raising concerns about the cost of President Barack Obama's health care overhaul and seeking to put the brakes on legislation. The fiscally conservative Blue Dog Coalition planned to present a letter to House Democratic leaders asking for more time, members of the group told The Associated Press.

Democratic Rep. Mike Ross of Arkansas said that if the Democrats' liberal legislative plan came to the floor as proposed, an "overwhelming majority" of his group would oppose it. The Blue Dogs claim 52 members, so that could endanger the bill.

The move comes just as House Democratic leaders are trying to finalize the proposed legislation and unveil it Friday. Committees plan to vote next week and House leaders want to pass a bill before the August recess.

"We've just got a lot of questions and the top of the list would be how to pay for it," said Rep. Marion Berry, D-Ark.

Pushing to complete a comprehensive health care overhaul plan, House Democrats focused on an income tax surcharge on the highest-paid wage earners to help subsidize insurance for the 50 million people who lack it.

As discussed in the tax-writing House Ways and Means Committee, the surtax would apply to individuals with adjusted gross income of more than $200,000 and couples over $250,000, according to officials involved in the discussion. Most spoke on condition of anonymity because the talks were private.

Rep. Shelley Berkley, D-Nev., a member of the panel, said the panel is looking at a surtax of around 3.5 percent on income above those amounts. Other members suggested it would be closer to 3 percent.

In addition, key lawmakers are expected to call for a tax or fee equal to a percentage of a worker's salary on employers who do not offer health benefits.

Ways and Means Chairman Charles Rangel, D-N.Y., has said his committee needs to come up with $600 billion in new taxes to deliver on Obama's goal of sweeping changes to the nation's health care system to bring down costs and cover the 50 million uninsured. Hundreds of billions of dollars more would come from cuts to Medicare and Medicaid to pay for legislation expected to cost around $1 trillion over 10 years.

Lawmakers cautioned that no final decisions have been made. Smaller tax options remained possibilities, depending on the overall cost of the legislation, including a tax on sugared soft drinks and ending a tax break that drug companies receive for advertising.

In the Senate, Democrats edged away from their goal of passing health care legislation by early August amid heightening partisan controversy over tax increases and a proposed new government role in providing insurance to consumers.

Sen. Chuck Schumer, D-N.Y., told the AP he believes the "ultimate goal" is to have a bill by the end of the year that is signed into law by the president.

Separately, Republicans who met Wednesday with Senate Majority Leader Harry Reid, D-Nev., said he indicated he was willing to allow more time before legislation is brought to the floor.

Failure to meet the August goal would be a setback - but not necessarily a fatal one - for Obama's attempt to achieve comprehensive health care legislation this year. A group of Democratic and Republican senators led by Finance Committee Chairman Max Baucus, D-Mont., is still trying to work out a bipartisan deal.

But the Finance Committee work appeared to have suffered a setback when Reid relayed concerns to Baucus about the compromise taking shape. Finance's proposal was expected to omit a new government insurance option to compete with private insurers - something Republicans oppose but most Democrats favor. A leading contender to pay for the measure was a new tax on employee health benefits, which Obama campaigned against and many Democrats oppose.

Pelosi made clear Thursday that whatever the Senate comes up with, the House bill will have a public plan and will not tax benefits.

"We will not be taxing benefits, health care benefits in any legislation that comes from the House," Pelosi said. "And it will have, coming out of the House, a public option," she said. "The only debate on that is what it will be called: a patient option, public option. Write in your suggestions."
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From Middle Ground to Middle Finger

07/09/2009 11:22 AM |

Wither healthcare reform when one host extends a hand and the other the finger?

House Energy and Commerce Chairman Henry Waxman (D, CA) said this morning that the $80 billion deal reached last month by PhRMA with Senate Finance Chairman Max Baucus does not have House support and is losing the White House's backing. "The White House is not bound. They told us they're not bound to that agreement," Waxman said at a National Journal breakfast. "We're certainly not bound by that agreement."

I suppose that goes for hospitals as well -- and doctors.

And what about Teddy?

In response to a question from Senator Gregg in the HELP hearing, CBO Director Douglas Elmendorf just expressed strong skepticism that the Kennedy/Dodd bill would bend the cost curve for health care.  In fact, quite the opposite.  Elmendorf said, “This bill will add substantially to the long-term spending burden for health care on the Federal government.”

This appears to pose a significant problem since President Obama said in his most recent press conference,  “And I've said very clearly: If any bill arrives from Congress that is not controlling costs, that's not a bill I can support.”

No laughing matter.

House majority leader Steny Hoyer (D, MD) said Tuesday that the healthcare reform bill now pending in Congress would garner very few votes if lawmakers actually had to read the entire bill before voting on it.

"If every member pledged to not vote for it if they hadn't read it in its entirely, I think we would have very few votes."

Mr. Hoyer was responding to a question on whether he supported a pledge that asks members of the Congress to read the entire bill before voting on it and also make the full text of the bill available to the public for 72 hours before a vote.

In fact, Hoyer found the idea of the pledge humorous, laughing as he responded to the question. “I’m laughing because I don’t know how long this bill is going to be, but it’s going to be a very long bill,” he said.

Cliff Notes.  Not acceptable in high school.  Not acceptable in Congress.  Not acceptable for healthcare reform.

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An Experimental New System

07/08/2009 03:06 PM |

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Canadian Re

07/08/2009 11:47 AM |

In all the tumult over healthcare reform, we haven’t heard that much about “drugs from Canada.”  There are clearly bigger fish to fry. And (not to go metaphor-crazy) those in the frying pan know just what I mean.

Witness PhRMA panjandrum Billy Tauzin, who, according to a report in today’s edition of the Wall Street Journal told a White House meeting Tuesday that “if the larger health-care bill passes, the cost savings will be big enough to make reimportation unnecessary.”

A White House official confirmed the meeting took place and said, "As a political matter there may be less pressure" to pursue reimportation after a health bill passes.

(Meanwhile, Bernie Sanders -- the Senator from Ben & Jerry's -- disagrees with "any move to drop the importation idea."  Yawn.) 

Two things.

First, it’s amazing that this issue is even being mentioned. Why? Because, according to the Congressional Budget Office, importing drugs would lower costs by less than 1% -- decimal dust when you compare it to the $80 billion “deal.” And that’s not even factoring in the significant safety questions.

Second, there is no such thing as “reimportation.” The various schemes under discussion (most recently Senator McCain’s amendment that got voted down in committee the other day) call for the importation of drugs from a variety of nations around the globe – including Canada.  This isn’t about getting “the same drugs” as our neighbors to the North.  The drugs that would be imported aren’t even legal for sale in Canada. The only reason to “pursue” is for pharma-bashing politics.

(It should also be noted that on-patent medicines represent about 8% of our national healthcare expense.  The rhetoric may be great for headline-seeking pols, but is trivial when it comes to lowering health care costs.)

There is no such thing as “reimportation” and no financial incentive for importation.  But the most important issue of all is safety. And that should be what stops this absurd notion from going even one step forward.

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