Latest Drugwonks' Blog
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.
"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.
It may come as a surprise to many Americans to here that not only are all European health care systems not socialized but some are arguably less socialized and more market-based than the US and yet achieve universal coverage. The best example is Switzerland, which has dispensed with providing coverage through work, instead all Swiss purchase insurance directly from the companies. This means that consumers have freedom to pick whatever plan or company they want. Those who cannot afford to buy insurance are given subsidies to help them do so.
Further, since 2002, Switzerland allows insurance companies to be for-profit, unlike those in other European systems. Insurers operate on the canton (state) level, just as most US insurers do, and Switzerland tries to maintain robust competition between insurers over members by allowing them to offer difference prices or plans that cover different types of treatments.
As in the Netherlands, Swiss insurers must also make available a basic plan that is open to everyone, regardless of preexisting conditions or health risk, and the components are comprehensive and perpetually increasing. The price for this basic package is set based on location and age only. They are also forbidden from making money on this package. On all other plans, companies are allowed to discriminate based on age, risk, health status, etc. Rationing and waiting lists are nowhere in evidence.
This is possible in part because Switzerland mandates that everyone buy insurance and imposes stiff fines on those who do not comply. As a result, virtually 100 percent of the population has health coverage.
However, despite giving a lot of market freedom to companies and customers, Switzerland’s health care is not a total free market. Prices for services are negotiated between insurers and doctors/medical facilities but the government in each canton has to approve them. Drug prices are free – up to a ceiling.
Further, the Swiss system is expensive, if significantly cheaper than the US. Switzerland spent 11.3 percent of GDP on health care in 2006, ahead of every other country in Europe, and that percentage is rising much faster than in other countries, 2.4 percent vs. an OECD average of 1.5 percent. Premiums are costly too, and going up “twice as fast as costs.” Families spend approximately $680 per month or around $8,167 annually for four people on the basic plan. Keep in mind that this is all paid directly by consumers, the employer doesn’t contribute as in the US.
Prices for services are also high and paid on a fee for service basis. There is little payoff to doctors or hospitals for bringing them down, in fact they benefit from overuse of tests and procedures, exactly what the US has struggled with in its own system. In general, cost is the most common complaint among the Swiss about their health care. However, Switzerland is one of the few countries that is not currently facing urgent concerns about the financial sustainability of the system.
Switzerland has been conspicuously out of evidence recently but in the past politicians of both American political parties have seen it as a potential model, including a visit there in 2007 by Health and Human Services Secretary Michael Leavitt. Perhaps it is time to bring Switzerland back into the American debate so that we can understand the gamut of health care systems that exist elsewhere in the world and what they tell us about what works, what doesn’t, and the choices you make along the way.
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...
I bring this up again, because...
New tests may help spot early-stage Alzheimer's
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...
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.
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.
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.
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:
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."
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."
I suppose that goes for hospitals as well -- and doctors.
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."
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.
Americans hear a lot about the UK and Canada, so much that it sometimes seems like there aren’t any other countries out there. Sure, others pop up from time to time, often as mere entries on a list of nations that have single payer health care or, more ambiguously if more correctly, “national health care,” but real discussion of their ins and outs is thin.
However, given the broad agreement that uninsured Americans should be covered and the leeriness of many about letting government run health care, there is a lot we can learn from a country that has made use of both market competition and government regulation to produce a system where costs are under control, wait times and rationing are prevented, and coverage is universal: the Netherlands.
Presently, the Netherlands achieves universal coverage with a mandate that all resident buy health coverage. Those who don’t, receive a fine. To make sure everyone is financially able to participate, subsidies are given on a sliding scale up to a fairly high income threshold. Nonetheless, enforcement of the mandate has been limited and approximately 1.5 to 2 percent of people have not bought coverage.Another 1.5 percent joined an insurer but failed to pay their premiums.
The government sets the requirements for a basic (but quite comprehensive) health insurance package that is open too everyone, regardless of age, sex, or current health status. The companies can offer different types of further coverage on top of the basic plan and can take into account age and other variables on these packages. Competition is vital and insurers have come up with a variety of creative strategies to lure customers, reduce costs, and improve health. Premiums are also actually lower than anticipated, largely due to competition among insurers.
To compensate for the fact that the basic package is open to everyone at the same cost, insurers with more sick members get government funds to make up the cost difference. However, only 30 conditions are on the list used to pay out compensation, leaving some companies carrying increased costs and some patients with difficulty getting coverage above the basic plan.
Health coverage in the Netherlands is still mostly obtained through work. Each person pays an “income-related contribution,” 7.2 percent of income up to €31,200 for 2008, which is reimbursed by their workplace. On top of this, the Dutch pay a premium per adult (children are free) and taxes that are used to subsidize people who cannot afford health insurance on their own.
Health care is cheaper than in many countries, a basic package cost around €1,100 per adult in 2008 with a deductible of €150. Those willing to accept higher deductibles can get lower premiums. But one must beware that around 90 percent of people in the Netherlands opt to get further coverage so the actual typical cost is higher. Some companies also give higher reimbursement for in-network doctors than out-of-network ones.
Despite its successes, many doctors in the Netherlands dislike the new system. They feel that bureaucrats are watching over their shoulders and fear that there will be pressure to use cheaper treatments. Indeed, some insurers encourage the use of generics over brand name medication and given doctors bonuses for complying. Prices are set partially through negotiation between doctors and insurers but only about 20 percent of procedures are subject to such negotiation. Generic drug manufacturers have to accept a 40 percent price cut at the introduction of the new system.
A number of people in the US have seen the Netherlands as an interesting model for American health care and November 2007 from US Health and Human Services Secretary Michael Leavitt traveled there and spoke with a variety of people, from leaders to patients, about the health system there. The HHS said, however, that it “would not endorse a system like the Netherlands.”
As a warning, however, the system in the Netherlands is quite new; the law creating it was passed at the end of 2004 and was implemented only at the beginning of 2006. So while the news so far is largely good, we need to wait a while before more concrete conclusions can safely be drawn.
In all the tumult over healthcare reform, we haven’t heard that much about “drugs from
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
(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.
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.
