Tag: Policy/Politics

POLICY/POLITICS: Congress acts in health care emergency

Last week a young Florida child sank into a coma. Due to recent cutbacks, he
wasn’t eligible for the state CHIP program and with no health insurance and
precious little money available from her job at Wal-mart, his mother had skipped
on taking him to the ER until it was too late. With a sudden realization that
American health care was in crisis, late last Saturday night Congress passed a
bill completely changing the nation’s health care system. President Bush flew in
from yet another vacation to sign the new law, saying that the health care
system ought to preserve the culture of life. Evangelical religious groups
picketed Congress holding banners denouncing the impact of the lack of health
insurance and the high cost of health care for poor and middle class Americans.
Self-appointed moral values spokesmen denounced the nation’s courts for doing
nothing to improve the infant mortality rate, claiming that it was below that of
Cuba. Finally, all the cable news channels turned their networks over 24 hours a
day to covering the crisis. Even though there were bitterly opposing sides in the dispute and polls seemed
to show that most Americans didn’t agree with Congress or the President, the
politicians insisted that the moral imperatives made their action necessary. Sage editorials in the major newspapers explained that the Florida
tragedy had at least had the virtue of having families in the nation discuss
whether or not they wanted access to health insurance. Sadly the young boy died unaware that his fate had transformed a nation.

PHARMA/POLICY: The NY Times misses the point on medicinal marijuana

The New York Times has a very dumb article about medical marijuana called Medicinal Marijuana on Trial, which suggests that medical marijuana hasn’t been properly proved by clinical trials.

Well leaving aside that plenty of drugs have been approved by the FDA which have had less than full trials, there are three points not made in the article.

1st: Medical marijuana has been broadly favored by an Institute of Medicine report, and the Federal government has been sending it out for years to a very few patients.

2nd: There have been no major trials in the US, and precious few elsewhere, precisely because the DEA has stopped it for purely political reasons. So this article, which shows modest benefits from the few studies that have been done, but irrelevantly claims that this is outweighed by the impact on teenagers who smoke vast quantities of marijuana for no medical purpose. So we deny sick people medicine because of the actions of other people.  Well in that case, we shouldn’t allow Percocet for people coming out of surgery, because some people are heroin addicts.  Illogical rubbish and the NY Times should know better.

3rd: Most importantly, like Ginko, vitamins, fish oil and God knows how many other "cures", sick people take medical marijuana because they think it makes them feel better and healthier.  Making people feel better is the point of medical care. Rightly or wrongly people should be allowed to have what they believe to be medicine.  And despite some 75% of the country being in favor of allowing medical marijuana, it’s purely political grandstanding by extremist (and predominantly family values Christian) groups–being used as a front for the vast amount of money that the taxpayer has to pour into law enforcement–that has opposed sick people getting what they believe to be medicine.  Shameful.

POLICY/POLITICS: Arnie, what a screw-up and what a disappointment

It’s incredible what a useless governor Arnie has been. Here was a guy from way outside the political establishment who had the chance to really change politics in California, so what has he done?

  1. He ran non-stop adverts all through the recall campaign saying that he would cut the state deficit by having a "full audit" (or in Arnie-speak "Foorl Ordit".  He then increased the deficit by canceling the $4bn increase to the car tax, and when, surprise, surprise, the Foorl Ordit didn’t miraculously find $15bn of waste to get rid of he simply borrowed the money by changing the law and issuing bonds.  Some budget hawk, eh.
  2. He ran as an outsider and used at least some of his own money in the campaign. But after  he won he paid his own account back from new political contributions — those are called bribes in less polite society — which came from not "special interests" like the ones from whom that Grey Davis guy used to get his cash from.  Oh no — Arnie’s money came from "powerful interests".  And who might they be?  Well apart from the Spanos real estate family that owns most of central California, it also includes a lot of money from big pharma after Arnie vetoed a bill trying to legalize Canadian imports into California.  No pay-off there
  3. And while we’re on the pay-off theme, several of us felt that the most despicable part of the Gray Davis regime was its ownership by the appalling prison guards union.  This is a state where a prison guard earns way, way more than a teacher, and where the CCOA (California Correctional Officers Association) in vehement on insisting that instead of spending money on education now instead of prisons later, we spend on prisons now and prisons later.  So a funny thing happens just before the Nov 2004 election. Arnie takes the prison guards cash, just like Davis did, and then comes out against the modest reform of the worst injustices of the 3-Strikes measure, turning it from a moderate winner to a very close loser — and costing the taxpayer a boatload more in the future.
  4. And to confirm his total moral bankruptcy, instead of standing as a decent Republican alternative to the clowns running the nation in DC, he decides to emulate them. While the Bush Administration has been putting out fake news stories and become a laughing stock along the way, now Arnie has decided to copy it.  What does this mean? Yes, you and I the taxpayer are paying for fake news propaganda to oppose the nurse staffing law which was passed with a fair measure of popular support, and was recently reaffirmed by a state judge.  And of course some dumb TV stations have been running the stories, which look like real news (in as much as "real news" is ever seen on local TV station news — I suspect the people who watch that stuff get the "news" they deserve.

There’s more fun stuff from including a fun video of protesters getting thrown out of an Arnie fundraiser.

PHARMA/POLICY: Was Plan B Crawford’s ‘Plan B’ for Commissioner?

Ex-FDAer Robert Steeves has this fascinating look at how Lester Crawford made it to the FDA Commissioner’s office despite being largely responsible for the FDA’s lack of activity and failed response to the COX-2 acopalypse. This is a re-print from FDAweb, which I would encourage you to  subscribe to (although it’s not cheap so it’s probably best if someone else is picking up the tab!)  Thanks to FDA Web publisher Jim Dickinson for permission.  As you might suspect with this Administration, it looks like political payoffs have triumphed over scientific integrity and commonsense

Looks like the true story of Lester
’s apparent triumph over conventional wisdom may be seeping out —
the only way most delicate information can get out of FDA. And it looks like a
good, old fashioned, political payoff. There are just too many “firsts” and too
many Plan B’s here to ignore.

Consider the emerging scenario as

In 2002, the White House considers Crawford for commissioner
and backs off for reasons never explained. Perhaps someone discovers that in
1985 the House Committee on Government Operations unanimously found that
then-CVM director Crawford “actually fostered the illegal marketing of
unapproved drugs,” failed to discourage the illegal use of drugs that tainted
the milk supply, failed to remove drugs from the market that had been proven
unsafe and approved drugs that his staff members suspected were carcinogenic.
Significantly, the committee found Crawford had disbanded an independent drug
safety group for humans within his Center because, as he then stated, “it is now
our job to approve drugs.” Internal reports warned that this move would
undermine safety concerns, hearings found.

Apparently concluding that Crawford could not be confirmed as FDA
commissioner in 2002, the White House instead names him deputy commissioner,
which many assume means de facto commissioner because popular wisdom is, and I
agree, that no nominee will be put up for confirmation to the top job. It makes
good sense — Senator Edward Kennedy,
the ranking Democrat on the Senate HELP Committee, has been threatening to
vigorously oppose any candidate with prior industry ties, and so placing
Crawford in a post not requiring confirmation avoids that obstacle without
changing substance. Anyway, FDA has no raging controversies and there are more
important issues facing the White House.

But FDA constituencies begin a steady drumbeat for a “permanent” FDA commissioner and
along comes Mark McClellan, a
physician with a business degree too, already serving in a presidentially
appointed and confirmed post, and he zips through the confirmation process but
sticks around for only 10 months before moving off to the Center for Medicare
and Medicaid Services. So, back to “Plan B” (leave Crawford as deputy and make
him the acting commissioner again.

Fast-forward to 2004 and the White House is looking at the potential of a
tough reelection race for the president, and there is unrest among the religious
and conservative base that Bush is not being sufficiently sensitive to their
concerns. Just when he needs least, Barr Laboratories provokes the
conservative/religious base with an NDA for an over-the-counter alleged
instant-abortion “morning after” pill, Plan B.

The nCDER review staff’s recommendation is favorable, the advisory committee agrees
23 to 4 and the decision gets kicked up a notch. CDER director Steven Galson “consults” with the Office of the Commissioner, FDA’s command center for political inputs. Why does
he do this, if as everyone later insists, the decision on Plan B is “purely
scientific” with no political considerations? He comes away from the
consultation and decides not to approve Plan B, saving the day for the White
House, intentionally or not.

To soften the blow for Barr, Galson suggests more “scientific” studies on the
“complex” question of how to assure that girls under 16 (not previously studied)
might handle Plan B and how to prevent them buying it if were available OTC.
Nobody but the religious far-right buys this subterfuge and political flak from
liberals gets into high gear as the election nears.

Meanwhile, the Vioxx withdrawal, the winter flu vaccine debacle,
whistleblower David Graham, and
associated pressures turn up even more heat on the White House for putting in a
permanent commissioner. Assessments on who the White House will nominate
universally discount him because he’s been the one in charge when the
controversies exploded, and because he has been passed over by the White House
before as being too provocative to the Kennedy crowd — notwithstanding the loyal
endorsement of his original champion, then HHS secretary and White House ally Tommy Thompson, or the rapidly
deteriorating situation at FDA under his management.

Wrong!!! Conventional wisdom forgets the “Plan B” political chit still
outstanding. When the president and the White House needed a “signal event” to
shore up the conservative base in the election campaign, who took the risk of
standing against the CDER drug review staff and the advisory committee’s
provocative recommendation — the first FDA head to do so that I can recall — and
save the day with the conservative base?
This is the scenario that is in the air. All the pieces make sense now and only if you
use all of these pieces. You do not have to have the political insights of a Karl Rove to put this together, but he might be a key witness in getting to the bottom of this.
When chairman Mike Enzi
reconvenes his Senate HELP Committee this week to examine the “unique and
confidential complexities” of Plan B, it ought be an open hearing, with sworn

What can be so secret about these machinations? To the extent that
there might be some trade secrets to protect, Barr CEO and chairman Bruce L. Downey — whose company surely has little to thank the Bush Administration for in this episode, given the profits lost by Plan B’s much-delayed launch — might waive any objections or
assertion of confidentiality, to permit the questions and explanations to be in
an open forum, especially if the witnesses risk perjury for false or misleading
statements. Mr. Downey has shown himself to be an innovative leader in the past
and he, too, might want to have this issue put to rest.
Is Plan B Crawford’s own “Plan B” route to the post that he lost in 2002 and that
conventional wisdom was sure he would otherwise have been denied? The Bush White
House values nothing higher than this kind of loyalty.

Neither science nor common sense can suggest any better explanation for this series of

POLICY/POLITICS: A despair at the lack of new ideas

A long time THCB friend and contributor is back from the big NMHCC show.  He was not impressed at what he heard:

Just got back from NMHCC in DC last night. I was
shocked – shocked! – at the paucity of any kind of original thought at the
conference.  There were a couple of interesting collaborations between payers
and providers (e.g. BCBS of Delaware providing access to its MeDecision database
to allow them to print patient history reports in Christiana Health System’s
ER), but nothing especially compelling or breakthrough to discuss.  No
substanative discussions (beyond CDHP) about the 45 million uninsured (at least
that I heard) or the millions more that will be with the looming Medicaid

HHS Sec’y Leavitt outlined 12 strategies for Medicaid
(I wandered off during number 8, I think: his diatribe about how big a problem
lawyers cause helping seniors who are above the poverty level give their assets to
their kids so that they can qualify for Medicaid coverage of LTC).  His
mandate is clearly to eviscerate Medicaid as we know it… I’m all for progress
(i.e. a better Medicaid that covers more people at fewer cost with less waste,
fraud and abuse and chronic disease) but not for removing a vital safety net for
the indigent and working poor (especially children)…

POLICY/POLITICS: Faith-based health care as the solution for the health insurance crisis

New contributor Susan Mucha has some interesting and amusing takes on the views of the  Republican voting core on the health insurance question:

Excellent thoughts on this topic. I share your frustration on shopping for health insurance–my "association plan" is $6500 a year with a $5000 deductible and it goes up about $1000 a year (I’ve never made a claim). Unfortunately as a member of the middle class, if I had a need for emergency medical care and didn’t insure myself, the hospital would take my
house and savings after presenting the bill, so I choose to pay for a noncompetitive "group" insurance policy rather than play roulette with my retirement. Individual insurance wanted to indefinitely exclude my gastro-intestinal tract (family history of hiatal hernia plus had a screening colonscopy/endoscopy about four years ago–no further treatment but a black mark on my health screening questionnaire).

I have some humor to share with you. A member of
our local Republican Women’s group called me last night to see why I wasn’t
re-joining–I’ve refused the last two years because of my frustration on
Administration policies related to health care (the Democrats don’t have better
answers because the insurance lobby feeds both sides too well). I told her that
I felt that the Administration was out of touch on this issue and until I saw
some evidence of it being given attention I wasn’t going to re-join. She shared
with me that she was currently uninsured because her husband was self-employed
and couldn’t find affordable health insurance. She says she "prays to God
every day that she won’t get sick." So, I guess Republican women are starting a
new "faith-based" initiative to address the health insurance issue. Personally I
think the HSA isn’t much better than praying to God to stay well. I’m not
worried about a $5K hospital bill. I’m worried about $100K hospital bill and
because no one knows how much procedures cost, it is impossible to understand
what you are buying in a hospital emergency situation.We definitely need to fix the problem and the report you’ve posted has excellent suggestions. There are a lot of us out here that are willing to pay
for reasonable health coverage insurance and a little better regulation of
insurance industry policies would go a long way in incentivizing continued
individual health cost responsibility. I see more and more people "praying to
God" instead of paying insurance premiums and ultimately we taxpayers are
covering those bets.

I actually think that this is a screaming big deal, and that the social conservatives without access to health insurance are the "swing voters" who will eventually vote for rather than against their economic interests, and vote for a national health insurance program.  How long they’ll stay with faith-based insurance, I don’t know.

POLICY: Medicaid muddles on

Today’s story about California hospitals suing Medi-cal comes on the heels of a
week of meetings between state governors and the Bush administration about
Medicaid. Medicaid has long been a dog’s breakfast of American health policy
with all types of programs thrown together. It’s a health insurer for the very
poor, it’s a long-term care plan for some of the elderly, it’s a subsidy program
for large inner city hospitals (the DiSH program), and it even pays Medicare
Part B premiums for those "dual eligibles" too poor to afford them. In addition,
in many states the CHIP program for near-poor children is rolled into Medicaid
too. Furthermore, many states use what are now called by HHS secretary Leavitt
"accounting gimmicks" to get more of their program on the Feds’ tab.

The problem is that all these programs tend to be underfunded anyway, and in
a time of state and federal budget squeezes, they come severely under fire.
Taking even another $6 billion per year out of the program, as the
Administration proposes, feels to the states like getting blood out of an
already over-squeezed stone–even if the GAO says its only $5bn a year. A rational system would somehow fold Medicaid into
some type of universal insurance system. But we are not getting that any time
soon, and right now many poor Americans and their safety net providers rely on
Medicaid to keep them from toppling into the abyss. So expect the politics of
desperation to play out in that sector over the next few months.

This is not going to be a fun time to be either a Medicaid recipient, or worse someone who would like to be.  And that includes a lot of young and poor children.  It’s also not going to be fun to be a safety-net provider who relies on Medicaid as one of their better payers.

POLICY: Disappointing Presidential silence about illicit drugs reveals bankrupt policy ideas

Not that anyone can be in the least surprised, but it’s clear from the tapes secretly recorded by one of his henchmen that in 1999 Bush privately admitted to both taking marijuana and cocaine in his period of "youthful indiscretion". There’s been a surprising lack of comment about this other than this one article in the Chicago Tribune called the Disappointing presidential silence about illicit drugs. The incredible hypocrisy in which Bush feels that his drug use was a "wild, youthful indiscretion" but that any current drug use by a young person is a seriously punishable offense leads to two terrible consequences for society.

First, Bush has presided over an Administration which has dramatically gone after anyone who remotely disagrees with it on the drug issue, including medical marijuana advocates and pain doctors, with the full force of draconian drug laws. It has also left more than 33,000 young people unable to attend college because of the heinous HEA amendment than bans anyone with a drug offense of any kind getting a Federal loan.  Let’s not forget that has this law been in place in the 1970s that number ought to have included Bush and former Eli Lilly exec, and current Indiana governor Mitch Daniels who was convicted of low level drug dealing at Princeton. The hypocrisy and lack of contrition from those holding this position is unspeakable.

Second and much more seriously, the ridiculous head-in-the-sand antics of the government (and this includes both Republican and Democratic Administrations and Congresses over the last 30 years — although the Republicans are clearly worse) on drugs means that the appalling social and health impacts of drug abuse are essentially allowed to go unchecked, leaving the taxpayer and the health system to deal with them. There are some very interesting models in harm reduction, and drug maintenance programs that have enabled addicts in Switzerland, the UK, Germany and now Canada to live relatively normal lives at little cost to the taxpayer and with minimal impact on society — as opposed to the huge amount of crime and personal cost seen in the unregulated activities of addicts here. But no one in the US will even discuss these models.  Instead
we allow the war on drugs to continue to fill the coffers of law enforcement departments and criminals and dictators across the world, and force taxpayers and health care workers to keep paying for it.  That no fuss is made about the fact that the current President essentially admitted to drug use in his twenties, shows how we’ve accepted this appalling situation as being only too normal.

POLITICS: Do you remember Social Security on the campaign trail?

No you probably don’t.  And this is why.

While Social Security reform/privitization/dismantlement has become the biggest policy issue of the 2nd term, now that the word is out and people understand what the Administration’s goal is, the impact is hitting the President’s poll numbers hard.:

"Adults were evenly divided on Bush’s job performance in January, but now 54 percent disapprove and 45 percent approve. The number who think the country is headed down the wrong track increased from 51 percent to 58 percent in the past month."

Of course the real conspiracy theorists amongst us might have felt that they knew messing with social security was always going to be very tough, but that raising the issue, particularly with the vast shortfall it would leave in the budget, would allow or even force Congress to be more active in cutting other areas.

Or it might be just that there are enough honest conservatives left who cannot countenace a Medicare bill that busts the budget so badly. It’s a pity that there don’t seem to be enough as perturbed about the huge and unmentioned scandal of war profiteering, even as Bush asks for another $80bn a year for Iraq’s reconstruction–an amount that could eliminate uninsurance here at home.

POLICY/POLITICS: Leavitt lays out his Medicaid stall and changes his tune

Not two weeks ago Mike Leavitt had no idea what to do about Medicaid. And he certainly had no idea at all about any possibility of a move to block grants. No siree, not a clue, not a whiff of an idea. And he told the Senate committee that fawned all over him while confirming him as HHS secretary that he just didn’t know what the Administration might possibly do about those block grant things.

Well, to paraphrase a certain British prime minister (prize if you know which one), ten days is a long time in politics. Yesterday Leavitt laid out his ideas for the future of Medicaid:

Leavitt called Tuesday for sweeping changes in Medicaid that would cut payments for prescription drugs and give states new power to reduce or reconfigure benefits for millions of low-income people. Leavitt said that Medicaid could save $4.5 billion over the next 10 years if it restricted the ability of elderly people to gain Medicaid coverage of long-term care by transferring assets to their children.

Finally, he said, the federal government could save $40 billion in the next decade if it cracked down on "accounting gimmicks" that he said were used by states to shift costs to the federal treasury. The Government Accountability Office, an investigative arm of Congress, said last week that such moves by the states "generate excessive federal matching payments" and "cost the federal government several billions of dollars each year."

And how exactly might they put a stop to those "accounting gimmicks"? How about if they gave the states freedom to do whatever they liked to their own Medicaid programs and just gave them a big lump sum. But of course they can’t call it a block grant. How about just calling it a "big ol’ pile of cash" and hope that none of those irritating governor fellows notice that the pile will be a little (or, in some states, a lot) smaller than the one they ended up with in previous years by using those "accounting gimmicks." Yup that sounds like a good, and highly original, idea.

Meanwhile, I just hope no one at PhRMA was listening when Leavitt said that Medicaid could save money by paying less for drugs. I’m sure that wasn’t the thinking behind all those campaign contributions. Still I’m sure that the naive man from Utah will soon be taught the ways of Washington on that score!


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