My erudite tones from the YourCall radio show on Monday–available streaming or in MP3 for download
POLITICS/TECH: Fame and fortune and everythingthat goes with it
Today, (Monday) I’ll be on local NPR in San Francisco talking about what the Democrats may (or more likely, may not) do about health care in the new Congress. It’s on the Your Call show on 91.7 KALW at 10am and yes it has the politics you’d expect of a San Francisco NPR station, so I’ll be the right winger on the show! You can tune in or listen here.
And on Tuesday I’ll be talking at the Northern California Chapter of HIMSS in San Ramon about the PHR. It’s a good line-up and I’ll be reporting back on the smell of sulphur!
POLICY/POLITICS/HEALTH PLANS: A Stark future for private health plans in Medicare?
Here’s the SF Chronicle on Pete Stark’s opinion about Medicare Advantage
Boiled down, Stark’s contention — based on a new Commonwealth Fund foundation study — is that the private firms are being paid 12.4 percent more per patient than government-run Medicare to provide the same level of services. In 2005, Medicare Advantage plans, originally created based on the contention that private industry could provide service for less than the government, were overpaid an average of $922 per enrollee, for a total cost to taxpayers of $5.2 billion.The payments “are not a mistake,” Stark charged. “Republicans are overpaying Medicare HMOs as part of a deliberate effort to shift beneficiaries into private plans. The Republicans’ ultimate goal is the privatization of Medicare, complete with a voucher system that leaves seniors to fend for themselves,” he added.The industry questioned the methodology of the study Stark used to make his charge and said that Medicare Advantage plans actually save money by injecting competition into the Medicare system, which covers about 43 million Americans. Figures from the America’s Health Insurance Plans trade group estimate that Medicare Advantage participants save on average $82 a month, compared to what they would pay in the traditional Medicare program. That comes to total savings of more than $6.8 billion annually, the group estimates.
And like the good politicians they are AHIP just changes the subject (See the release for a typical piece of Karen Ignagni’s tenuous relationship with the truth)..
Err, guys, it’s not whether the enrolled seniors are paying less in deductibles and co-pays that Stark is worried about. He knows that the private plans are cross-subsidizing those beneficiary costs (along with gym memberships et al) from the vast profits they’re making on them. It’s the taxpayer who’s paying more, as way too many GAO reports have shown (and now the somewhat more biased but no less true Commonwealth Fund report shows).
So the key question that the private plans need to be focusing on, especially as they are staring risk adjustment in the face anyway is, can they genuinely save money over the FFS on a non-risk selection basis by improving the efficiency and quality of the care they manage? Currently as the details of the report make clear, the risk adjustment has been hidden by an overall increase in the payments, and by the double inclusion of some other technical payments, such as the indirect amounts Medicare pays for medical education.
But surely that can’t last under any scenario. Logically in the high cost states like New York and Florida, making genuine savings over Medicare FFS—given the huge unnecessary care delivered and reported on by the Dartmouth crowd—must be achievable. Those savings should include decent profits for the private plans. They shouldn’t need extra payments to make it worth their while being in the market. If the private plans cannot prove that pretty damn quick, then they need to be prepared to get out—in a replay of the early 2000s. And Stark may want some of his (our!) money back!
POLICY/POLITICS/PHARMA: PhRMA sends the D out on the field
Even thought the White House will likely veto any change to Part D, the WSJ has started playing desperate defense on behalf of PhRMA.
Apparently if we impose government price controls, it’ll cripple R&D and no new drug will ever be developed. On the other hand, they also trot out the “fact” that Part D as constructed now means that the private sector has the ability to lower prices below those that the government could get. Of course we’ve heard all this before, and we all know who wrote Part D and in whose interests it was written.
But what I wonder is how can the WSJ’s Jane Zhang hold those two contradictory thoughts in her head without smoke coming out of her ears?
Meanwhile, here’s the NY Times on big Pharma’s attempts to buy its way out of the problem. It’ll certainly make some former Democratic staffers much richer!
POLITICS: I love hypocrisy
POLICY/POITICS: A Grim Anniversary
A Grim Anniversary: 20 years ago today possibly the worst single bill ever passed by the US Congress went into law. In the the hysteria over crack cocaine and the death of basketball star Len Bias (not from crack by the way), Tip O’Neill decided to get tough on drugs. In 3 days law left committees and was voted on with no one stopping to think.
The result is long long mandatory minimums for low level drug users and dealers—which far exceed those for murders and rapists— and massive costs for the taxpayer. The consequence has been the general corruption of our entire criminal justice system and civil liberties.
PHARMA/POLICY/POLITICS: More rational behavior from big Pharma
Exactly as happened in 2000, and 2002 a late surge of money is coming to help Republicans from the PACs of New Jersey’s finest.
According to a report published Wednesday in the Wall Street Journal, drug-industry dollars are helping to fuel the campaigns of Republican candidates like embattled incumbent Sen. Rick Santorum, R-Pa., who faces a tight race against Democratic challenger Bob Casey Jr., who calls the Part D program a “giveaway to Big Pharma.” The Santorum re-election bid has drawn $454,500 in contributions from pharmaceutical companies, WSJ said.Part D has drawn fire from Democrats in congressional races in part because it doesn’t permit the federal government to negotiate with drug companies on drug prices, and Democratic challengers have vowed to change that if elected, the report said.
While the concept of science-based companies backing Rick Santorum (the one who took his stillborn child home to meet his kids, and thinks that the earth is 6,000 years old) may be odd, it’s completely rational. Essentially now that there is a Medicare drug benefit, eventually price controls will be introduced. It’s in Pharma’s interest to delay that day as long as possible. Anyone can see that including big Pharma, who as Joe Paduda reminds us have seen profits rise with their volume now that Part D has cut in
However, it therefore exposes the whole McClellan/Ignagni line about how the private market in Medicare Part D has lowered drug costs more than direct negotiations would have done for the lie it is. After all, if Part D as written is so much worse for big Pharma than government negotiations/price controls, why would they be fighting so hard to protect it?
POLITICS: Beyond belief!
I used to have a joke game called the “who’s Denny Hastert” game. Essentially none of my college educated friends in San Francisco and Silicon Valley knew who he was despite the fact that he was Speaker of the House of Representatives, and third in line to the Presidency. I played the game one Christmas (I think it was 2001) at a friend’s house where there were a dozen people, including VCs, managers of big companies, etc, etc. None of them knew (although one guy thought that a San Francisco woman was speaker of the House, and he might be right in a few weeks!). I thought then the country was screwed in terms of basic civic literacy (don’t forget I’m a damn immigrant!)
But this is a little more serious. Can You Tell a Sunni From a Shiite? Apparently not if you’re a senior member of Congress with an intelligence responsibility or the guy in the FBI responsible for counter-terrorism. My mind absolutely boggles.
PHARMA/POLICY: McLellan leaves offices with partisan and incorrect remarks about Part D
Someone should tell Mark McClellan that he was generally respected by everyone and that now that he doesn’t work for the White House there’s no need to become a Republican shill. But that’s what he’s doing by saying that Medicare drug costs are going down. There are two basic porkies in the statement. The first is that the cost he’s comparing it to is the inflated projection that was come up with well after the MMA was passed–not what Congress was told it was going to be. (I’ve written about how that number changed plenty before, but suffice it to say if you change it up enough and then it comes in lower, that’s not "savings"). If his optimism is correct, we’re back near the original projection, which was still way more than a proper drug benefit should have cost, and was based on more people being covered.
Second, claiming that premiums for seniors in Part D have gone down is not true, as Pete Stark’s office pointed out. Premiums have gone down on average only if you count Medicare HMO/Advantage premiums with those for Part D standalone plans. Medicare Part D standalone premiums have in many cases gone up. Joining a Medicare HMO is a much different thing than adding a Part D standalone plan–just ask anyone who was kicked out of their Medicare HMO in the late 1990s. And of course the HMOs were given a huge subsidy in the MMA legislation separate from the drug coverage part of the legislation, and that’s the money that they are using to reduce their premiums. And we’ve seen this movie before too, including the part when the subsidy is reduced and the private HMOs give up. Just ask anyone who was kicked out of their Medicare HMO in the late 1990s
By the way, you can tell what McClellan is saying here is a lie because Karen Ignagni agrees with him! No need to bother actually researching it, she’s that good a barometer of avoiding the truth! Here’s her quote, if you care:
"There’s no doubt that Medicare is providing valuable benefits for
seniors, and costs are far less than what was expected at the time
legislation passed" creating the new drug benefit, Ignagni says.
Finally, where did Medicare Part D really fall down on the job? It was in failing to enroll low income seniors who would actually have benefited from it. That’s because it was a confusing "market-driven" voluntary program, not a compulsory extension of traditional Medicare. And are low income seniors able to make sensible "market-driven" choices? Apparently not!
NEW YORK, Oct. 13 (UPI) — U.S. seniors with low incomes or no
prescription coverage are less likely to use generic cardiovascular
drugs than more affluent seniors, a study finds. Researchers at
the Mount Sinai School of Medicine in New York say that seniors with
low incomes or no prescription coverage were less likely to use generic
cardiovascular drugs than more affluent seniors and those with
prescription-drug coverage.The study, published in The American
Journal of Managed Care, is the first nationally representative study
that examines the association of income and prescription drug coverage
with generic medication use by Medicare beneficiaries, according to
lead author Dr. Alex D. Federman. Federman and colleagues
examined generic cardiovascular drug use in a nationally representative
sample of elderly Medicare beneficiaries with hypertension. The
findings showed that older patients with cardiovascular diseases often
used costly brand name drugs when equivalent but lower cost generic
versions are available. "The patients that we were concerned
about are low-income and underinsured seniors," said Federman. "Our
findings show this group in-particular are missing opportunities to
save money on prescription drugs without sacrificing quality of care."
But if we had put all seniors into a guaranteed drug benefit program that ensured that they got the best pricing on all drugs (a la VA) and actively managed them so that they were given generics where relevant, then both they and the taxpayer would have been better off. And don’t even start me on the subject of how much the whole benefit would have cost the taxpayer if it had been designed sensibly rather than by PhRMA and AHIP.
I just hope that now he’s out of the Administration McClellan can go back to realizing that there are many shades of gray.
POLITICS/PHARMA: Bush Aides Called Evangelicals ‘Nuts’
Apparently Karl Rove and friends think that the religious right is nuts
A new book by a former White House official says that President Bush’s top political advisors privately ridiculed evangelical supporters as "nuts" and "goofy" while embracing them in public and using their votes to help win elections. The former official also writes that the White House office of faith-based initiatives, which Bush promoted as a nonpolitical effort to support religious social-service organizations, was told to host pre-election events designed to mobilize religious voters who would most likely favor Republican candidates. The assertions by David Kuo, a top official in the faith-based initiatives program, have rattled Republican strategists already struggling to persuade evangelical voters to turn out this fall for the GOP.
I can’t say that I disagree with them. But if the sophisticated Bushie’s are merely using the religious right to win elections and otherwise ignore them when they govern—as many on the religious right have said—why did they have to give them control over the FDA and other allegedly “neutral” agencies that regulate science in the process?
