Latest Drugwonks' Blog
Two items of note (courtesy of the Pink Sheet) that are urgently important, but getting little attention.
1. Non-Interference
The House health care reform bill passed by the Energy and Commerce Committee directs HHS to negotiate drug prices directly with manufacturers for the Medicare Part D program, but it does not authorize HHS to establish a national formulary.
That leaves the provision vulnerable to being stripped out as the bill proceeds through Congress -on the basis that it may not reduce costs.
The Congressional Budget Office, in past estimates, has consistently concluded that savings generated from direct government price negotiation under Part D would be negligible unless HHS could bring some bargaining leverage to the table.
In a 2007 analysis, then CBO Director (now OMB Director) Peter Orszag wrote: "Negotiation is likely to be effective only if it is accompanied by some sort of pressure on drug manufacturers to secure price concessions."
Specifically, "the authority to establish a formulary, set prices administratively, or take regulatory actions against firms failing to offer price reductions could give the [HHS secretary] the ability to obtain significant discounts."
He added that "in the absence of such authority, the Secretary's ability to issue credible threats or take other actions in an effort to obtain significant discounts would be limited."
2. Comparative Effectiveness
Although it was not introduced during the House Energy and Commerce Committee's markup of the health care reform bill, an amendment prepared by Rep. Donna Christensen, D-V.I., that would create a public-private institute to oversee comparative effectiveness research activities remains in play and could be a part of the final package that is voted on by the House.
Christensen was given the go-ahead to introduce the amendment during the markup, but time constraints kept the amendment, which was filed with the committee, from being introduced for consideration. A staffer for Christensen said the representative has a commitment from Energy and Commerce Chairman Henry Waxman, D-Calif., to work on adding the amendment to the final House bill. The amendment would replace the current language in H.R. 3200 that places coordination of comparative effectiveness research activities within the Agency for Healthcare Research and Quality. The current language creates an independent CER commission to oversee the center, recommend research priorities and conduct stakeholder outreach.
According to a fact sheet on Christensen's amendment, it would create an independent public-private institute governed by a board of directors consisting of the HHS secretary, the directors of AHRQ and the National Institutes of Health, and 20 additional members appointed by GAO representing a broad range of stakeholders, including patients and consumers, physicians, public agencies (CMS and state and federal health programs), private payers, drug and device manufacturers, non-profit health research organizations, quality measurement/decision support organizations and organizations conducting minority health research.
The amendment, co-sponsored by fellow committee Democrat Jay Inslee,
Support for Obama's approach to health care has dropped in the polls, and the White House sought to address some oft-repeated claims.Among them: Will Medicare benefits be cut? Will government bureaucrats ration care? Will the elderly get progressively less care and then have euthanasia presented as an option?
Sebelius answered: No, no and no.
She said the administration wants to save money in Medicare by eliminating unnecessary procedures and hospital readmissions, among other things, but that there was no desire to eliminate needed benefits. She contended that insurance companies already ration care and that Obama wants to give doctors more control, not less.
As for the euthanasia claim: "Nothing could be less true ... that is just not part of the conversation," Sebelius said.
The rumor has become widespread and seems to stem from a provision in the House bill that would require Medicare to pay for direct consultations with health care professionals. Sebelius noted that no one would be required to use the benefit and said it would help many families. "
Notice any response from people that might have information -- cited and sourced (contra the Sebelius generalities) to the contrary?
Nada.
Nice work, Erica. Is this on top of your AP salary?
Read article here
Read it here
Let's be clear: there is nothing Nazi-like about any of the healthcare proposals. Just writing that, makes me sick. What is even sicker is how the LaRouche zombies are able to insinuate themselves into rallies, meetings, etc. without being called on it. Which explains how Borat got made I guess.
In any event, it is up to those people and organizations who are genuinely concerned about a government takeover of healthcare to express those opinions with passion, conviction and through democratic action. And at that same time it might behoove them to call out those who would use the Nazis plan to exterminate the Jews as a metaphor for healthcare reform as beyond the pale of civilized discourse.
KITTY PILGRIM, CNN CORRESPONDENT (voice-over): Go to a doctor in Britain, you won't have to pay when you leave. It's the same at the hospital. All health services are publicly funded by the National Health Service, funded by taxes. For that reason, a survey revealed only two percent of people in the U.K. who had a medical problem did not seek treatment because of costs. Peter Pitts (ph) of the Center for Medicine in the Public Interest, a nonpartisan research group, says the upside to the U.K. health system is universal coverage.
PETER PITTS, CTR. FOR MEDICINE IN THE PUBLIC INTEREST: The NHS delivers healthcare today in the classic British tradition of muddling through. It’s mediocre care for everybody.
PILGRIM: The British government sets the budget and is charged with determining what will and will not be paid for. Critics point out that cutting-edge drug treatments for Alzheimer's, cancer and other severe conditions are often not included on a list of medicines that the government agency known as NICE will allow for reimbursement. Peter Pitts says it's a system that has real shortcomings.
PITTS: You can either accept a one size fits all health care system, which really doesn't fit anybody all that well, which is really terrific if you're not sick or very sick. But once you have cancer or advanced stages of lots of diseases and you really need cutting-edge medicine that system is really not equipped to provide it with excellence as ours is here.
PILGRIM: Now a 2007 study found that 57 percent of the people in the U.K. said the system really needed significant overhaul. Some in the U.K. have decided to opt out of the national health system and pay for private medical coverage. It is available. But anyone taking on private medical care has to opt out of the national health system, so a telling point is in the last decade some British companies are actually offering private health care as a recruitment perk for their employees.
Video posting of the complete segment shortly.
On a related and very timely note, the Times of London reports today that:
“Medical leaders have warned that shortages of doctors, nurses and other clinical staff are putting the NHS under unsustainable pressure as a generation of health workers enters retirement amid cutbacks in junior doctors’ working hours.
The number of vacancies for hospital doctors, dentists, nurses and midwives has risen for the first time in five years as trusts struggle to recruit and retain staff. New data from the NHS Information Centre revealed that more than one in twenty medical and dental posts were vacant at the end of March, in some cases for months at a time, while thousands of nursing and midwifery posts were also unfilled.
Of the total number of vacant posts, one in five — 5,500 jobs — had been left unfilled for three months or more, suggesting long-term problems with recruitment. Senior staff leaving the service and the reluctance of younger people to replace them were blamed for the shortfalls as total vacancy rates increased across most staff groups. Doctors’ leaders have also warned that the European Working Time Directive, which from this month limits junior doctors to a maximum 48-hour week, could create shortages, leaving trusts to rely on temporary or locum staff.”
The complete Times story can be found here.
These times demand the Times (of London).
CMPI's Peter Pitts on CNN's Lou Dobbs Tonight from Psyclone WMS on Vimeo.
More comments on this shortly.
FDA NEWS RELEASE
FDA Commissioner Sets Out Vision on Enforcement to Support Public Health
Commissioner of Food and Drugs Margaret A. Hamburg, M.D., today outlined her commitment “to prevent harm to the American people” through swift, aggressive, and effective enforcement of FDA laws and regulations.
“The FDA must be vigilant, the FDA must be strategic, the FDA must be quick, and the FDA must be visible,” Commissioner Hamburg told a group of industry representatives, attorneys, consumers, and others attending a speech sponsored by the Food and Drug Law Institute in Washington, D.C. “We must get the word out that the FDA is on the job.”
Commissioner Hamburg said that some FDA enforcement actions over the past several years “have been hampered by unreasonable delays” and “in some cases, serious violations have gone unaddressed for far too long.” She added that the pathways for enforcement actions “can be too long and arduous when the public’s health is in jeopardy.”
Commissioner Hamburg highlighted six initial steps designed to hone the effectiveness and timeliness of the FDA’s regulatory and enforcement system:
– Set post-inspection deadlines. The FDA will establish a clear timeline for regulated industry to respond to significant FDA inspection findings, generally giving no more than 15 days to respond to such findings before the agency issues a warning letter or takes other enforcement action.
– Take responsible steps to speed the warning letter process. The FDA will streamline the warning letter process by limiting review of warning letters by the Office of Chief Counsel to those that present significant legal issues.
– Work more closely with FDA’s regulatory partners. In some cases, such as with food safety issues, state, local, and international officials can act more quickly than the FDA. When public health is at risk, the agency will coordinate with its regulatory partners to take rapid action.
– Prioritize follow-up on warning letters and other enforcement actions. The FDA will work quickly to assess and follow up on corrective action taken by industry after a warning letter is issued or major product recall occurs.
– Be prepared to take immediate action in response to public health risks. To better protect the public health, the agency is prepared to act more quickly and aggressively to deal with significant public health concerns and violations. Such actions may occur before a formal warning letter is issued.
– Develop and implement a formal warning letter “close-out” process.” If the agency can determine that a firm has fully corrected violations raised in a warning letter the agency will issue an official “close-out” notice and post this information on the FDA Web site. This will be an important motivator for corrective action by manufacturers.
By taking these steps, Commissioner Hamburg said, the FDA will ensure that “violative inspection results are taken seriously, that warning letters and enforcement actions occur in a timely manner and that steps are taken to protect consumers in cases where immediate enforcement action is not possible.”
Wow. Busy day what with the front page article in the New York Times and some very savvy reporting in the Wall Street Journal. Who said August was going to be slow? Talk about a food fight at recess!
All that to say that the window seems to be somewhat open to actually discussing the … facts! I know, who would ever have thunk it.
Taking advantage of this new opportunity, I’ve penned a new op-ed on the Reuters “Great Debate” site. Here’s a taste:
“In SiCKO, Michael Moore portrayed the British National Health Service and the Canadian health system as particular exemplars of excellence. He backed it up with a lot of statistics, but statistics, as the saying goes, are like a bathing suit. What they show you is interesting, but what they conceal is essential.
And what SiCKO concealed was that systems such as those in the
Citizens of countries with government-run health care systems experience long wait times, a lack of access to certain treatments and, in many instances, substandard medical care. For example:
• The five-year survival rate for early diagnosed breast cancer patients in
• A typical Canadian seeking surgical or other therapeutic treatment had to wait 18.3 weeks in 2007, an all-time high, according to The Fraser Institute.
• The average wait time for bypass surgery in
• More than half of Canadian adults (56 percent) sought routine or ongoing care in 2005. Of these, one in six said they have trouble getting routine care.
• Eighty-five percent of doctors in Canada agree private insurance for health services already covered under Medicare would result in shorter wait times.
• Approximately 875,000 Canadians are on waiting lists for medical treatment.
If we’re going to look to other healthcare models for solutions, we must uncover and study their problems. Health care is too important to allow reform by sound bite. “Drugs from
The complete op-ed can be found here.
Here it is...
Well, ok...
So how about Obama vs. Obama. Is that fishy disinformation?
Here is the President's response -- captured in the clip provided by The Disinformation Czarina -- to a question posed by Jake Tapper about whether people will have to change plans or not:
"Well, all right- when I say if you have your plan and you like it, and your doctor has a plan- or you have a doctor and you like your doctor, that you don't have to change plans, what I'm saying is the government is not going to make you change plans under health reform. Now, are there going to be employers right now, assuming we don't do anything- let's say that we take the advice of some folks who are out there and say, "Oh, this is not the time to do health care. We can't afford it. It's too complicated. So, let's take our time," et cetera. So let's assume that nothing happened. I can guarantee you that there's the possibility for a whole lot of Americans out there that they're not going to end up having the same health care they have. Because what's going to happen is, as costs keep on going up, employers are going to start making decisions. We've got to raise premiums on our employees. In some cases, we can't provide health insurance at all. And so there are going to be a whole set of changes out there. That's exactly why health reform is so important."
Left unsaid in all this is whether the government will try to keep you from changing plans if you want (which happens in all bills) or using Medicaid as a dumping ground for people. And the President pretty cheery about the possibilities of a government run plan being lots cheaper than a private plans:
"So there are going to be some ground rules that are going to apply to all insurance companies. Because I think the American people understand that, too often, insurance companies have been spending more time thinking about how to take premiums and then avoid providing people coverage than they have been thinking about how can we make sure that insurance is there; health care is there when families need it. But, I'm confident that, if- you know, I take those advocates of the free market to heart when they say that, you know, the free market is innovative and is going to compete on service and is going to compete on, you know, their ability to deliver good care to families. And if that's the case, then this just becomes one more option. If it's not the case, then I think that that's something that the American people should know."
Is that because he knows government can set prices and low-ball private companies who are forced to charge young and healthy people higher premiums to subsidize sick and health people.
That's also in all the bills.
Is Obama vs the actual legislation fishy?
Want more? Go to www.handsoffmyhealth.org Get knee deep in disinformation. As Orwell said, “In a time of universal deceit, telling the truth becomes a revolutionary act.”
It must be nice to believe that Uncle Sam, MD can be the reincarnation of Marcus Welby. Similarly, it must be nice to believe that veganism is the answer to our national healthcare woes. And it must be nice to believe that a national healthcare system run by the government minus any free-market incentives isn’t socialism. Therefore, it must be nice to be Congressman Dennis Kucinich. He believes all of the above.
As already mentioned, (http://www.drugwonks.com/blog_post/show/6904) the former Boy Mayor and I spent the better part of an hour Saturday debating healthcare reform on Fox Business Channel. My favorite bit (and its right up front, so have look) was when he said that, just because the government would pay the bills and specify the treatments, doesn’t mean the government would be “in control.”
To which I replied (and with all due respect) that he was “living in fantasyland.”
The complete debate can be found here.
http://drugwonks.com/podcasts/peter-pitts-on-fox-business/
Kucinichcare. What a concept.
In the meantime, the gloves are off elsewhere too. Got this e-mail yesterday and it’s worth passing along:
FISHY CLAIMS
We Answer The White House's Call For "Disinformation" On Government-Run Health Care
THE WHITE HOUSE'S BLOG: "There is a lot of disinformation about health insurance reform out there, spa nning from control of personal finances to end of life care ... Since we can't keep track of all of them here at the White House, we're asking for your help. If you get an email or see something on the web about health insurance reform that seems fishy, send it to flag@whitehouse.gov." (
WE FOUND FISHY CLAIMS ABOUT KEEPING YOUR DOCTOR AND YOUR INSURANCE PLAN ...
"If you have insurance that you like, then you will be able to keep that insurance. If you've got a doctor that you like, you will be able to keep your doctor." http://tinyurl.com/mj5od2
"If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what." http://tinyurl.com/mzkrz9
AND FISHY CLAIMS ABOUT SO-CALLED "PUBLIC PLAN" AND CONSUMER CHOICE ...
"Now, the public plan I think is a important tool to discipline insurance companies. What we've said is, under our proposal, let's have a system the same way that federal employees do, same way that members of Congress do, where -- we call it an 'exchange,' or you can call it a 'marketplace' -- where essentially you've got a whole bunch of different plans." http://tinyurl.com/krmgqn
"That's why I've said that I think a public option would make sense. What that then does is, it gives people a choice ... You don't have to do anything. But if you don't have health insurance, then you have an option available to you." http://tinyurl.com/moq36h
AND A FISHY CLAIM ABOUT KEEPING HEALTH CARE COSTS DOWN ...
"What I've said is our top priority has to be to control costs... 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. It's going to have to control costs. It's going to have to be paid for." http://tinyurl.com/krmgqn
AND A FISHY CLAIM ABOUT TAXING MIDDLE CLASS
"And while they're [Congress] currently working through proposals to finance the remaining costs, I continue to insist that health care reform not be paid for on the backs of middle-class families." http://tinyurl.com/lkvgsp
So to help the surely inundated White House, we've already debunked these "fishy" statements at BarackObamaExperiment.com
Was anyone really ever wearing gloves in the first place? Hard to act polite when that "seat at the table" had a trap door beneath it.
Meanwhile, on the topic of when “cost” means “co-pay,” a new op-ed in today’s edition of Speaker Pelosi’s hometown newspaper, the San Francisco Chronicle. It begins as follows:
Higher co-pay, fewer prescriptions filled
Peter Pitts
“One of the major threats to patient health hasn't received nearly enough attention during the recent negotiations in
According to a recent study by Wolters Kluwer Health, fewer Americans are filling their drug prescriptions. In the fourth quarter of 2008,
Why? Drug prices. It's not that the cost of prescription drugs is rising - it's patients' out-of-pocket costs, or co-pays. One of the reasons for this is that insurance companies, reluctant to foot the bill for brand-name medications, have been refusing to cover more brand-name prescriptions.
In the fourth quarter of 2008, in fact, health insurers denied coverage for 10.8 percent of brand-name drugs - a jump of 21 percent from the first quarter of 2007.
And it's not because the medicines themselves are becoming more expensive. Between 1998 and 2003, prescription drug costs increased by $22.48 per person. Meanwhile during that same period, the average health insurance premium went up by $104.62 per person.”
For the rest of the story, see here.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/08/04/EDP0193SR1.DTL
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.
