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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.
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.
Hamburg's FDA Reorganization Merges Budget And Policy Functions
FDA Commissioner Margaret Hamburg is reorganizing her direct staff reports to streamline the development and tracking of the agency's budget.
As part of the proposed reorganization, the Office of Policy, Planning and Preparedness is being dissolved and a new Office of Policy, Planning and Budget will be created, housing the Office of Policy, the Office of Planning and a newly created office, the Office of Budget. It will be headed by an associate commissioner for budget. Currently, the budget functions are handled in the Office of Operations, which is being trimmed down and re-launched the Office of Administration.
The new structure will be accompanied by new faces at FDA. It may also involve departures: Randall Lutter, the current deputy commissioner for policy, planning and preparedness, and John Dyer, the chief operations officer are absent from the proposed organizational chart included in a memo outlining the proposed changes.
The departure of Lutter and Dyer would noteworthy because they are the last members of senior leadership team tapped by the Bush administration. Former Chief of Staff Susan Winckler departed June 19.
In the memo making the case for the new organization, Hamburg states, "Our program directors have been concerned for some time that we must be more successful in aligning our budget commitments with measurable outcomes."
"I intend to make the development and presentation of the agency's funding needs and performance goals among my highest personal priorities," Hamburg notes.
A focus on planning and budgeting has been one of the requests of congressional appropriators, and FDA's reorganization may help address the concerns of the purse string holders on Capitol Hill.
Appropriations and authorizing committees have expressed willing to provide FDA with more resources, and even as the agency's budget has gone up in recent years, the increases have been accompanied by comments that FDA needs a better plan for spending the funds.
Among the other features of the reorganization is a new deputy commissioner for foods, who will oversee the Center for Food Safety and Applied Nutrition and the Center for Veterinary Medicine. "There is no higher priority than assuring the public that we intend to make the food safety program at FDA successful," Hamburg said.
Former FDA Deputy Commissioner for Policy Michael Taylor is seen as the likely candidate for the post.
He is an experienced former FDA leader and recognized food safety expert. His resume includes posts as the administrator of the Food Safety and Inspection Services at the U.S. Department of Agriculture; vice president for public policy at Monsanto Corp.; and a senior fellow at Resources for the Future, where he focused on food safety. He is currently a research professor at George Washington University's Health Policy Department.
Also as part of the reorganization, the Office of Chief Scientist will be streamlined to focus on innovation and integrity issues, and a new Office of Special Medical Programs will be created. The proposal also adds an Office of External Affairs and elevates the agency's crises management functions.
Read more here
Rationing to save money without regard to health or value is dumb. Doing so without the consent of the doctor or patient and the use of population based information as Reinhardt has relentlessly proposed for a decade is inefficient and does not contain costs or improve improve health.
Further, Reinhardt stumbles en route his leap to logic, as do other single payer supporters, in assuming that administrative controls can tamp down costs. They do not and cannot. All they do -- take note Dr. Krugman -- is ration more completely and destroy innovation.
Then again, Reinhardt who believes America is NOT a democracy but an aristocracy, also believes in massive redistribution of income.
Which is why he continues to charge and take nicely sums from corporate and investor groups to talk about health care.
I wonder if Reinhardt will also pledge to enroll in Medicaid to help drive down health care costs and create social solidarity? Will Krugman?
More details to follow (on).
CMPI TO HOST HILL BRIEFING ON FOLLOW-ON BIOLOGICS WITH REP'S ESHOO AND ROGERS
Event Focused on Ensuring “Patient Safety” is Top Priority of Follow-on Biologic Legislation Being Debated on Capitol Hill
Grassley said his inquiry is part of his broader effort to establish transparency with regard to financial relationships between the pharmaceutical industry and medical professionals.
The text of the letter (sent to the American Journal of Medicine, the Annals of Internal Medicine, the Annual Review of Medicine, the Archives of Internal Medicine, Nature Medicine, PLoS Medicine, The Journal of the American Medical Association, and The New England Journal of Medicine) can be found here.
But inquiring minds want to know … who drafted the letter onto which Senator Grassley affixed his signature?
The bill states that "the [HHS] Secretary shall negotiate rates for the reimbursement of health care providers for benefits covered under a community health insurance option."
Direct negotiations? Some things to consider:
"It is not obvious that allowing the government to negotiate with pharmaceutical companies will lead to lower prices than those achieved by private drug plans. Private plans like Kaiser or United are able to negotiate deep discounts with pharmaceutical companies precisely because of the plans' ability to say no – the ability to include some drugs and to exclude others, allowing the market to judge the resulting formulary. On the other hand, when the government negotiates, its hands are tied because there are few drugs it can exclude without facing political backlash from doctors and the Medicare population, a very influential group of voters. Neither economic theory nor historical experience suggests government price negotiation will achieve lower drug prices. Congressional Democrats need to be careful in making the logical leap from market share to bargaining power. Empowering the government to negotiate with pharmaceutical companies is not necessarily equivalent to achieving lower drug prices. In fact, neither economic theory nor historical experience suggests that will be the outcome. Members should think carefully before jumping on the bandwagon – this promise may bring just the opposite of what was ordered."
Stanford Business School's Alain Enthoven and Kyna Fong
"Both the non-partisan Congressional Budget Office and Medicare actuaries have said they doubt the government could negotiate lower costs than the private sector. The theory behind Part D is that market forces and competition among drug plans, overseen by government, can achieve better results than a government-run program. The multitude of plans allows seniors to pick one that best meets their needs. Government price negotiation could leave people without drugs that manufacturers decide aren't sufficiently profitable under the plan. Medicare recipients account for half of all drug prescriptions. With that kind of clout, government might try to dictate prices, not just negotiate them. This could leave people without drugs that manufacturers decide aren't sufficiently profitable under the plan. The VA plan illustrates the point. It offers 1,300 drugs, compared with 4,300 available under Part D, prompting more than one-third of retired veterans to enroll in Medicare drug plans."
"Our View On Medicare Part D: Put Brakes On Drug Plan 'Fix,'" USA Today, 11/13/06
The bottom line here is that Part D is a tremendous success – due in no small part to the Non-Interference Clause. Consider:
* The projected cost for Medicare Part D is $117 billion lower over the next decade than experts estimated just last summer. This means that over the 10-year period from 2008 to 2017, the estimated $915 billion cost of Part D fell to $798 billion.
Why? Marketplace competition.
* And, according to a study published in the Annals of Internal Medicine, the Medicare drug benefit led to a 17 percent decrease in out-of-pocket expenses, or $9 a month, for seniors who enrolled in the new Medicare Part D benefit in 2006, the first full year prescription coverage became available in the federal health insurance program for the elderly and disabled.
* And the savings amounted to an extra 14 days of medicine for those who signed up, or a 19 percent increase in prescription usage.
Can Part D be made even better? Absolutely. But this is good news worth sharing -- and not because it helps any particular partisan political agenda but because it means that more Americans -- tens of millions of more Americans -- are getting access to the medicines (largely chronic medicines) that will help them live healthier lives. And this, in no small measure, significantly reduces more drastic medical interventions -- which in turn reduces our overall national health care spending.
We shouldn’t interfere with success.
By revoking the Non-Interference clause, Uncle Sam will be able to "negotiate" prices for Part D drugs. That's kind of like negotiating with your hands tied behind your back and a gun pointed at your head. There's also the potential for Uncle to dictate that Part D prices be tied to prices in other countries -- a kind of Medicare reference price.
“Direct negotiations” means price controls. And price controls = choice controls.
The HELP committee will resume markup of the health reform bill on July 7th.
For the best recap, have a look at what Tobin Harshaw wrote in the New York Times' “Opinionater” column:
“It was a bit like planning the dream wedding only to have a hurricane rip away the chapel roof as you make your way down the aisle.”
He also offers useful links to what other reformacenti had to say:
Jeff Poor of the Business and Media Institute gives a “thoughtful, respectful and probing” analysis:
“Call this a teachable moment, but even with ABC’s best-laid plans to kickstart the debate about health care reform and not allow the “Prescription for America” special to become an “infomercial,” as many have complained – the president spent more than twice as much time as his questioners vaguely answering or not answering the questions asked of him. But the network consistently presented the event as part of the need to fix a “broken system.” When asked, every one of the 164 hand-picked audience members said they felt that health care needed to be changed.”
And further …
“While Obama had to field some difficult questions — from the audience and ABC — he faced no Republican critics of his proposals. The network also allowed him to dominate the program with long-winded and vague answers. Out of the 75 minutes the network dedicated over the two programs (commercials excluded), the president managed to take 60 percent of that time: 45 minutes to give 19 vague responses – not exactly the “dialogue” advertised by ABC …”
Scarecrow at FireDogLake’s Oxdown Gazette, however, thinks the network lured the president into a devilish trap:
“For its part, ABC insisted on having Charles Gibson and Diane Sawyer, instead of informed, qualified health care experts, guide the conversation. That was a mistake, but not the worst of ABC’s offensive conduct. Sawyer’s main contribution was to introduce her own uninformed biases/opinions in framing issues and introducing questioners. Gibson’s primary role was to reveal his own misconceptions and then literally read talking points from a Republican letter — an obvious ransom extracted after days of Republican whining about giving the President air time on a critical public issue.”
And as far as trading "Good Morning America" for "Healthcare at Night" ...
“Gibson’s other role was to interrupt the President every few minutes to announce a commercial break. The all too frequent commercial interruptions served as an apt metaphor for how private commercial interests demand our attention and extract their profits while limiting our ability to discuss critical public policy issues.”
Harshaw’s full column can be found here.