Latest Drugwonks' Blog
In his State of the Union address, the President implored Congress not to "walk away" from healthcare reform. With Scott Brown's victory in Massachusetts, and growing skepticism among Americans, passage of a "comprehensive" healthcare bill is looking less and less likely every day.
And for good reason. The House and Senate versions of healthcare reform are nearly 2,000 pages long. Some of the most expensive provisions in the bills are effectively unfunded and will indeed exacerbate our federal fiscal catastrophe.
The most egregious example of this reckless spending is the infamous "Doc Fix" provision, which determines how and how much the government will reimburse physicians for services provided to patients on Medicare and Medicaid. This provision is only a one-year patch -- with the cost offset by taxes and reduced spending elsewhere. What about the other nine years? That, it seems, is the purview of S.1776 and, according to a recent New York Times piece, "Congressional Democrats have no plans to offset the cost of S. 1776, which is why they are eager to keep it separate from the broader health care legislation and avoid breaking the president's promise."
Remember President Obama's promise? "I will not sign a plan that adds one dime to our deficits -- either now or in the future. Period." Well, it seems that many in Congress are looking at the "period" and seeing an ellipsis. The Times continues, "Congressional Democrats insist that fixing the doctor payment formula should not count toward the cost of the big health care legislation, because it is a problem they inherited." Unlike the problem of the uninsured? Unlike the problem of preexisting conditions? Unlike the problem of the donut hole? Unlike the problem of (FILL IN THE BLANK)? And from whom exactly did they inherit the problem? LBJ? Sounds like a total ellipsis of the sum.
Honestly -- a healthcare bill that doesn't include Medicare payments to physicians? As my kids would say: "Word." And to quote Representative Charlie Rangel, supporters of the pending legislation "have a serious problem." The Quinnipiac poll has only 34% of respondents approving the bill. Americans smell something fishy. And they're right. Americans are wondering just how healthcare reform is going to impact them. And now that the voting public is paying attention, they don't like what they see. Because what they're seeing is whose going to pay.
The most high profile debate is about the 40% excise tax on "Cadillac" health plans. But consider just two of the ways Democrats are suggesting the public "pay" for healthcare reform:
• 2.35% increase in Medicare payroll tax on incomes over $200,000 for individuals and $250,000 for couples.
• $471 billion in cuts to Medicaid.
You're not hearing a lot about either of these because they tax the middle class and gut healthcare options for senior citizens. Not core Democratic Party talking points. You're not hearing about it is because Democratic lawmakers are horse trading behind closed doors. And in case you've forgotten, during the presidential campaign candidate Obama pledged that any negotiations on healthcare legislation would be broadcast on C-SPAN, "so the American people can see what the choices are," and "not conducted behind closed doors." "Such public negotiations," he said, were "the antidote" to "overcoming the special interests and the lobbyists who… will resist anything that we try to do." To quote another American media icon, Madonna -- "Not." Americans aren't stupid -- and Americans are paying attention.
Can history repeat itself? When it comes to healthcare reform, let’s hope so.
The parallels are striking. A young, charismatic president. A “special address to Congress.” A time of national uncertainty.
Barack Obama on healthcare reform? No. John Kennedy on the space race. On May 25th, 1961, JFK intoned:
“Let it be clear--and this is a judgment which the Members of the Congress must finally make--let it be clear that I am asking the Congress and the country to accept a firm commitment to a new course of action--a course which will last for many years and carry very heavy costs”
Sound familiar?
“I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the Moon and returning him safely to the Earth.”
And we did it. Even though the science and the engineering didn’t exist and the costs seemed prohibitive. We did it.
Can we do it again? Can we reform our healthcare system “before this decade is out? – even though it will certainly “last for many years and carry very heavy costs.” Do we have the national fortitude?
Yes we can. If we learn nothing from the current stalemate, it’s that healthcare reform is not going to emerge, fully formed from the head of Zeus (or Nancy Pelosi or Harry Reid or Peter Orszag – or Barack Obama).
Rather healthcare reform must be a thoughtful, iterative process. That’s not as sexy a political soundbite as “universal coverage” or “drug importation” – but it is reality. And those who ignore reality do so at their own peril. Hello Massachusetts.
In 1961, nobody in that joint session of Congress disagreed that we should put a man on the moon. Nobody shouted “liar” when the president presented his goals along with a detailed budgetary request – a behemoth $531 million in fiscal 1962 and an estimated $7-9 billion more over the next five years.
And there lies the biggest asymmetry between JFK’s challenge and President Obama’s September 9, 2009 Joint Session speech on healthcare reform – personal ownership and a detailed plan. Kennedy’s remarks followed a thorough investigation by an appointed Space Council chaired by Vice President Lyndon Johnson.
Just as with the issue of putting a man on the moon, healthcare reform is as much about vision as it is about engineering. In 1961 the pledge was made before the mechanics existed to make it happen. But that’s what challenges are all about. Reach. Stretch. Delta.
Similarly with healthcare reform, the promise must be made – all Americans must have access to quality and affordable healthcare. Healthcare reform is no different. The challenge is big and many of the tools are nascent (i.e., molecular diagnostics).
And, like the space race, the solution must be “elegant engineering” – a term that could hardly be applied to the current legislative packages passed by the House and Senate. Legislative sausage didn’t put a man on the moon. Neither will it deliver long-term healthcare reform.
Putting a man on the moon wasn’t about “good guys” (Democrats) wanting it and “bad guys” (Republicans) in opposition. And that’s not the case with healthcare reform either. The cynical politics of healthcare reform must end. All the more reason not to think about Scott Brown as the 41st vote against healthcare reform, but rather the first vote towards a new, more thoughtful approach.
Ezra (Moment of the Mind) Klein:
That said, many are hoping that the State of the Union was the start, not the end, of Obama's renewed sales pitch. As I write, the president is in Tampa, making many of the same arguments, in much the same way, as he did last night. He sounds like he did on the campaign. He has more events scheduled in the next few weeks. It was a good beginning, say some on the Hill, but that's not enough.
http://voices.washingtonpost.com/ezra-klein/2010/01/what_obama_did_and_didnt_say_o.html
Jonathan Cohn (giving it the " we just need to explain it more and better excuse")
Fortunately, Obama seems to grasp this too. He acknowledged, explicitly and with a sense of humor, his administration's failure to explain the plan--and noted that few people understand exactly what it would do. He also reminded people, in simple terms, of the reasons he took up the challenge. He talked about people suffering because they had no insurance or their insurance was inadequate--and he talked about the economic importance of controlling health care costs.
http://www.tnr.com/blogs/the-treatment
And my favorite from Senator Baucus
“We’re not going to put it down,” Baucus said. “We’re moving expeditiously. And expeditiously means quickly, solidly, thoughtfully.”
http://news.yahoo.com/s/politico/32191
Rosner's Domain: The why-Haiti-but-not-Gaza nonsense
While Israel is making an effort to save life in Haiti, the never-happy-with-Israel crowd is trying this new line of over-sophisticated counter-intuitive argument: Haiti is easy, but what about Gaza.
Here's Derfner saying: "the Haiti side of Israel that makes the Gaza side so inexpressibly tragic. And more and more, the Haiti part of the national character has been dwarfed by the Gaza part". Here's the Electronic Intifada criticizing the media for its positive spin of this humanitarian effort: "A few media outlets have pointed out the discrepancies in Zionist self-congratulation". And the estimable NYT showing very little understanding of Israel's true feelings by claiming that "Israelis have been watching with a range of emotions, as if the Haitian relief effort were a Rorschach test through which the nation examines itself. The left has complained that there is no reason to travel thousands of miles to help those in need - Gaza is an hour away".
"Range of emotions" meaning what? that 99% support the effort and 1% complaining about Gaza? That 99% feel proud about this humanitarian effort and 1% feel the need to politicize even the simplest act of compassion and demonstrate, yet again, that they've lost their collective minds?
Anyway. Since this the why-Haiti-but-not-Gaza nonsense is gaining traction, maybe some reminders are necessary. Here we go:
1. Because Haitians never bombed Israeli towns.
2. Because the government of Haiti never declared that it wanted Israel to be eliminated.
3. Because no Haitian suicide bomber was caught trying to reach an Israel bus stop of cafe.
4. Because while Gazans' suffering should not be belittled, I don't remember any report claiming that 100,000 Gazans are dead because of Israeli blockade. Not even the Goldstone report.
5. Because it's easier sending rescue workers and doctors in uniform into a place in which Israelis in uniform are well received.
6. Because no Israeli soldier is being kept hostage in Haiti, and there's no standing Haitian demand for the release of hundreds of terrorists from Israeli jails.
7. Because Haiti had no way of stopping the earth-quake and the government of Gaza can easily make life better for its people by changing course.
If you're smarter than a fifth grader, I'm sure you can add many more such points. If you're smarter than a fifth grader you know that sometimes being too-smart is being stupid.Christina Romer, a senior economic adviser to the president, predicted in October that the tax would encourage "both employers and employees to be more watchful health care consumers." But research released last week by Mercer, an employee benefits consulting firm, showed that in addition to considering lower-cost plans, two-thirds of companies polled said they would also raise health care costs for workers through higher co-pays and deductibles, regardless of whether the employee is a CEO or a line worker at a factory.
"America did too much of this and that's why their medical costs have grown," said Masaharu Nakajima, a surgeon and former director of the Health Bureau at the Ministry of Health, Labor and Welfare.
Since Japan enacted universal health insurance in the early 1960s, the emphasis has been on a minimum standard of care for all. People must pay a monthly health-insurance fee, and large companies pay also. Coverage decisions, doctors' pay, and other rules are set by the central government.
Japanese doctors complain that they have no time to spend with patients. The experience of seeing a doctor is summarized as "a three-hour wait for a three-minute visit."
"Healthcare is a great driver for the economy. It's the biggest employer, and medicine--not "health insurance"--is a product that people want to consume, sometimes desperately, ravenously. And not just Americans, but people around the world. So if that's not an economic engine, what is? Isn't that what we want?
But the argument has to be made. And alas, since, 98 percent of the discussion over healthcare has been over controlling costs--that is, shrinking the healthcare sector, perhaps provoking a recession in one of the few vibrant sectors of the economy--then it's little wonder that the country doesn't think of healthcare and medicine as an economic driver.
Serious Medicine Strategy has always been an economic strategy--now is the time to make that case."
seriousmedicinestrategy.blogspot.com/2010/01/democrats-slam-brakes-on-health-care.html
First, it is a movie that parents and kids (13 and up in my opinion) can and should see together. It demonstrates the power of love and the determination parents have, even under the most dire circumstances, to provide children with hope and happiness each moment of their life. It shows that you can go up against and use the system to make a difference and that the "system" will invest in that risk and reward it. However the movie shows that making a miracle involves going against the grain, which is why meaningful change or advances take time. And the movie does the best job of explaining the interesection of capital, science, passion and faith the constitutes the process of biomedical innovation. A thoughtful, impactful movie about biotech and drug development? Extraordinary Measures is that and more because it ties the process of innovation to the ultimate purpose and people who benefit.
Second, the movie itself is the culmination of a process that has created a family of relatives, friends, supporters around the Crowleys. I was fortunate to have attended a post-movie reception that Geeta Anand, the gifted and gracious author of The Cure held in NYC yesterday. The group that gathered (including the Crowleys) -- including people involved in the movie, Geeta's literary agent (and mine) Joelle Delbourgo, former associates, etc. shared not only in the success of her book but in the spirit the book, the movie and the release of both have created: A sense that while anything may not be possible, nothing great happens without passionate intensity, friendship and cooperation and support of those you love. Such is the recurring source of hope.
Seeing the movie and reading The Cure will allow you to share in that experience. Few movies have been made to convey such a message. You read more about Extraodinary Measures and The Cure at the link below.
http://www.thecurebook.com/
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.
