Okay, so yesterday I brought you the tale of one Leonard Lance, a GOP House member from New Jersey who got called out by his local paper for supporting repeal of the Affordable Act even while he enjoys a very generous health insurance plan that's paid for by New Jersey's taxpayers. Now the story has taken an amusing new turn.
What's funny about Lance's saga is that his state-level insurance might never have come to light if his staff hadn't loudly protested when Blue America PAC, a liberal group, started running ads demanding that he forego the health plan enjoyed by members of Congress. As I noted here yesterday, Lance's staff got the ad pulled after they insisted that he was not taking that insurance.
That, in turn, was what led the Courier-Post to do the digging necessary to ferret out his state insurance. In short: If Lance's staff had just kept quiet about the initial ad, and hadn't declared that he was foregoing the federal-level insurance, the whole thing would have blown over and disappeared.
But now that his state plan has come to light, Blue America PAC is up with another radio ad lampooning Lance all over again:
The ad, which parodies a New Jersey reality TV show, recaps the entire saga, with a narrator concluding in a pronounced Jersey accent:
"This guy deserves his own reality show: New Jersey's biggest hypocrite."
This is the sort of tale that has viral potential and can get out of control very quickly. Something tells me this isn't the last we're going to hear about this Lance fellow.
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Beating a dead horse?
Posted by: mark_in_austin | February 15, 2011 3:41 PM | Report abuse
Whistling past the grave yard of Obama's budget release and subsequent press conference.
Going off topic here.
Mark, you were wrong this morning when you said you can't get people to take entitlement reform seriously. A lot of us take it very seriously. Medicare and Medicaid suffer from the same dilemma we all suffer from, the high cost of health care. There's a big difference between cutting benefits or using vouchers and bringing the cost down by taking on the big HIC big three, insurance, pharmaceuticals and hospitals. Here's a little something in the Obama budget that addresses pharmaceuticals. It's not nearly enough but if it squeaks through it may give us all courage to tackle more of the same. The pay for delay, something you may know about as a lawyer, is especially egregious IMO.
""Big pharmaceutical companies could face increased competition from generic drugmakers under two proposals put forth by the Obama administration on Monday despite earlier savings extracted from drugmakers as part of last year's healthcare law.
President Barack Obama, as part of his 2012 budget proposal, called for cutting the number of years drugmakers could exclusively market brand-name biologic drugs to 7 years from 12.
He also set his sights on ending controversial "pay-for-delay" deals that affect traditional, chemical drugs by giving the U.S. Federal Trade Commission power to block them. Under such pacts, brand-name and generic drugmakers settle patent challenges with payoffs that delay lower-cost rivals from reaching the market.""
Posted by: lmsinca | February 15, 2011 3:51 PM | Report abuse
Once again, the liberals rush off to solve the symptoms instead of curing the disease.
In this case lmsinca is touting a massive interference in the market that the left hopes will lower drug costs. After all those nasty pharmacy companies in the same moral and ethical league and insurance companies and hospitals, right? If there were a god of ignorance I'm convinced it would look like Dennis Kuchinich or someother moonbeam liberal.
If the life of a patent is reduced from 12 years to seven the ROI for the investment in a given molecule will change dramatically. This will mean that the developer must recoup the initial investment in a shorter time frame. that could mean, inter alia, that initial price of the drug will skyrocket. Wait, don't liberals love it when prices sky rocket? O no that is just for mundane unimportant things like electricity and gasoline.
so we'll face a situation where a new drug may not make it to market because the cost at launch will be so high that no one will buy it. Ever wonder what the first doses of penicillin must have cost?
Further drugs aimed at specific clinical issues that are focused on a relatively small group of patients will not make it to market either, for the same reason. A drug that could extend the life of a few people, but at a significant expense because of the limited time for patent exclusivity won't see the light of day.
the liberals will respond by claiming that government sponsorship of basic research will offset these market loses. The problem with that is simple: then the kids in DC decide which maladies get fundage. That never works out. Here's an example: today in america more people die of MRSA than of AIDS. Which disease is getting the attention? According to Kaiser, the 2010 budget contained 2.8 billion for AIDS research. I can find no reference to any funding for MRSA research. In fact there are zero new drugs in the pipeline to handle MRSA and it is going to explode as an issue for us. So much for government intervention.
I understand the desire to reduce healthcare costs. But the left keeps ignoring the workable solutions, just as lmsinca did. It seems to this observer that the left is more interested in punishing successful businesses than is solving problems.
This Op-Ed by Gerson is really on the mark, IMO, regarding the stupidity of cutting aid programs by the GOP- http://www.washingtonpost.com/wp-dyn/content/article/2011/02/14/AR2011021404500.html
Posted by: ChuckinDenton | February 15, 2011 4:17 PM | Report abuse
lmsinca, it's good to know these things are in the budget. I hope they end up in the final product. As imperfect as the healthcare bill was, I always thought its funding for pilot projects to test ways to bring down healthcare costs and make delivery systems more efficient was a promising part of it.
Posted by: AllButCertain | February 15, 2011 4:21 PM | Report abuse
Mr chuck in denton is proving something I predicted a while ago. Every nickel spent by the gummint has a breathless champion that will predict dire consequences if the fundage halts.
Every nickle. Whatever it is that gerson is talking about is no different from all the other vastly important expenditures that will be threatened in the coming weeks.
CATO has started a "slasher" blog wherein people can share stories from the media about how "slashing" so and so will mean that we're all going to die after living short, brutish, nasty and cold lives.
I hardly think so. some things aren't going to be funded. The only way to reduce the amount we spend is to reduce the amount we spend.
Imsinca -- those two provisions are expected to save about $8.5 billion over 10 years. While welcome, Medicare Part A alone will spend $203 billion next year. Total Medicare for next year: $548 billion.
Stuff like pay-for-delay, if it even survives the budget process, won't address the structural problems facing entitlements, which starts with their "such sums as necessary" nature.
See p. 59 for the line items on the 2 drug provisions.
http://www.hhs.gov/about/FY2012budget/fy2012bib.pdf
Posted by: NoVAHockey | February 15, 2011 4:28 PM | Report abuse
I've heard your argument before but not everyone agrees including the FTC.
Posted by: lmsinca | February 15, 2011 4:38 PM | Report abuse
then there is this:
He also set his sights on ending controversial "pay-for-delay" deals...
What is controversial about these? Are they in any way illegal? Or are they controversial simply because you don't like them?
"pilot projects to test ways to bring down healthcare costs and make delivery systems more efficient"
There is nothing new in the ACA, there are more mandates for everything that already exists. We don't need any more pilot projects that work fine and then get eliminated. These have been going on for years, medical home/integrated delivery models, FQHCs, in home delivery systems...we all ready know how to bring down health costs and make delivery systems more efficient. We just don't want to.
Which argument is that? Are you saying that it is not valid? Based on what?
Did you actually read Gerson? I don't know why I'm going to waste keystrokes on this, but, what the hell: there are plenty of good reasons why we ought to spend money on the types of aid he mentions. Try and see if you can find a modicum of space inside your cranium to understand that.
Posted by: ChuckinDenton | February 15, 2011 4:42 PM | Report abuse
Hey you guys, I wasn't listing the two little pharma concerns in Obama's budget as a be all, end all to health care costs. Just something that may help lower costs.
The market for FOB's (follow on biologics) is considerably different than generics so it seems to me the sooner we get these drugs to market the better. From an FTC report from 2009
""The Commission’s Report states that competition by FOBs is unlikely to be similar to branded-generic drug competition because:
* The substantial costs to obtain FDA approval, plus the substantial costs to develop manufacturing capacity, will limit the number of FOB competitors;
* The lack of automatic substitution between an FOB drug and a pioneer biologic drug will slow the rate at which FOBs can acquire market share;
* An FOB drug also may have difficulty gaining market share due to concerns about safety and efficacy differences with the pioneer biologic drug;
* Biologic drugs currently are not reimbursed according to strategies that insurers often use to encourage the use of lower-priced drugs;
* As a result of these factors, FOB entry, although important, will be less-dramatic than generic drug competition. FOB entry is likely in biologic drug markets larger than $250 million in annual sales. Only two or three FOB manufacturers are likely to attempt entry for a given pioneer drug product. These entrants are unlikely to introduce their drugs at discounts any larger than between 10 and 30 percent of the pioneer product’s price;
* The effect on pioneer manufacturers also will be different. They are expected to respond and offer competitive discounts to maintain market share and are likely to retain 70 to 90 percent of their market share and will continue to reap substantial profits, even after FOB entry.
Based on these findings, the Report concludes that patent protection and market-based pricing will promote competition by FOBs, as well as spur biologic innovation. It states that legislation to put a process in place for the abbreviated FDA approval of FOBs is likely to be an efficient way to bring FOBs to market, because of the time and cost savings it would provide.""
Posted by: lmsinca | February 15, 2011 4:46 PM | Report abuse
Nothing will make the delivery system more efficient more quickly than forcing providers to go retail.
by moving the source of funding away from the gummint and the managed care companies and placing it with the patients the same dynamics that control costs in other industries will be brought to bear on healthcare.
I've lived through any number of these cost cutting experiments, some had a decent impact (DRG's for example) but many were just mental-gymnastics with a grant for funding.
I agree with shrink (for a change of pace) we don't need anymore pilot projects. Let's go to a retail model and let the good old American demand for better, faster and cheaper work its miracle.
My take on Obama's remarks about Social Security today:
http://voices.washingtonpost.com/plum-line/2011/02/obama_social_security_isnt_the.html
Posted by: Greg Sargent | February 15, 2011 4:55 PM | Report abuse
@ChuckinDenton: I agree with Gerson that we shouldn't "symbolically" cut spending on the Global Fund.
He points out: "Our massive debt is mainly caused by a combination of entitlement commitments, an aging population and health cost inflation."
If you're like me you wondered how in the heck Obama's budget addressed any of these debt problems - (A. not at all).
Would you agree that Obama's budget represents a "net subtraction from public seriousness on the deficit?"
shrink, you would know more about this than I do, but have you read the Atul Gawande New Yorker articles or seen interviews with him? He was very much on board with the pilot projects that take into consideration the effectiveness of various approaches in different states and regions.
As someone who has used the medical system a lot in the last couple of years, I've always thought some costs might come down if doctors and their patients with good coverage actually knew the price of scans, and drugs and things like transfusions. I often ask the question, and doctors simply don't know.
Posted by: AllButCertain | February 15, 2011 4:58 PM | Report abuse
I do agree with skip (in this regard, just so there is no confusion, no bracket creep so to speak). ☻
"But have you read the Atul Gawande New Yorker articles or seen interviews with him?"
Yes definitely, those were must reads back at the time. He made some good points, but missed the main point, which is that you have to dismantle stuff that does not work well into order to turn the pilot projects into the standard of care and dismantling what is not working is almost possible. That is always a considered a slippery slope, eliminating an existing entitlement is, even if it isn't working.
Some but not all doctors (I have lots of price lists at hand) have been harassed and infantalized into ignorance cocoons by the caste of "care" managers that have installed themselves all around the doctor patient relationship, but I won't excuse their ignorance.
On the pilot programs or everything he's said? You want the whole system to go retail? I believe a starting point would be to eliminate employer provided insurance coverage but I don't think that's what he's talking about. I admit though between all the misrepresenting my comments and attitude I'm having trouble swimming through the current.
See y'all, it's hard to have a real convo here sometimes.
Posted by: lmsinca | February 15, 2011 5:15 PM | Report abuse
Docs often don't know their own fees. This is especially true in large clinical practices such as the Cleveland Clinic near my home.
As for the public display of pricing this is an old failure, sorry to say. Most states have laws mandating that hospitals make available on request copies of their charge structure, often called a charge description master file or CDM. Nobody ever looks at it.
why? because patients know that they won't be paying the retail cost for anything. Either thier insurance plan has negotiated a price or they aren't going to pay or they plan to pay but will negotiate a rate of their own. We have a saying in healthcare finance: nobody pays retail.
As an example, I mentioned to a physician that the retail cost of a topical, Mupricin, was $60 a tube. I then asked why he decided not to continue a bactrim prescription. "Well," he said, "Bactrim's expensive too." What he apparently didn't know is that bactrim is free at the local pharmacy. Cost is no part of that guy's thought process.
This is why I'm convinced that the retail model is our best approach. Patients ignore costs now because they don't pay them. Doctors ignore costs too because the patients don't make an issue of them. Once money is flowing from the hands of the patients into the hands of the providers, the questions will come HHH.
lmsinca, the follow on biologic comment was interesting. Thanks for the insight. That's not a part of healthcare finance I dabble in so I learned something. Much appreciated.
"As someone who has used the medical system a lot in the last couple of years, I've always thought some costs might come down if doctors and their patients with good coverage actually knew the price of scans, and drugs and things like transfusions. I often ask the question, and doctors simply don't know."
If you'll pardon my interjection, I think it needs to go beyond knowing the price/cost, there has to be a direct benefit for the consumer (no offense Bernie) that will result in the consumer choosing a more cost effective option. I won't say the word, but I'd advocate it, along with the consumer (again, apologies Bernie) keeping a substantial percentage of the savings, even if it meant passing on that savings via inheritence if certain costly "end of life" decisions were foregone. Just my $.02. I apologize if I've offended anyone.
Posted by: TrollMcWingnut | February 15, 2011 5:21 PM | Report abuse
"As someone who has used the medical system a lot in the last couple of years, I've always thought some costs might come down if doctors and their patients with good coverage actually knew the price of scans, and drugs and things like transfusions. I often ask the question, and doctors simply don't know."
If you'll pardon my interjection, I think it needs to go beyond knowing the price/cost, there has to be a direct benefit for the consumer (no offense Bernie) that will result in the consumer choosing a more cost effective option. I won't say the word, but I'd advocate it, along with the consumer (again, apologies Bernie) keeping a substantial percentage of the savings, even if it meant passing on that savings via inheritence if certain costly "end of life" decisions were foregone. Just my $.02. I apologize if I've offended anyone.
Posted by: TrollMcWingnut | February 15, 2011 5:27 PM | Report abuse
No, the high end disability system for example, people with severe, life long neurological disease, etc. involving multiple systems of care (and money silos) need medical homes and specialized delivery models in order to be efficient and effective (to keep people functional and out of hospitals).
""lmsinca, the follow on biologic comment was interesting. Thanks for the insight. That's not a part of healthcare finance I dabble in so I learned something. Much appreciated.""
I believe this is what the budget proposal was addressing but I could be wrong. You're welcome, and thanks for treating me like an adult.
Posted by: lmsinca | February 15, 2011 5:34 PM | Report abuse
You know what I'd like to see is a discussion here between the professionals, shrink, skip, and NoVA. You three know a lot more than the rest of us and also have different political perspectives as far as I can tell. It might clarify issues for a lot of us.
Just a suggestion.
Posted by: lmsinca | February 15, 2011 5:43 PM | Report abuse
lmsinca, that's a good idea if shrink, skip, and NoVa are willing to do it, though not on this thread, which won't draw much more traffic. Maybe tonight's? It's always refreshing when people talk about what they know instead of hurling insults.
Posted by: AllButCertain | February 15, 2011 6:09 PM | Report abuse
Further Imsinca, there should not be a political valence to health care delivery models discussions (perhaps accounting for skip's and my agreement on retail risk management and incentives in the delivery model for people like us (presumably teachable if not competent to be empowered in these decisions) And for the brain disabled, very sick etc., folks, little kids with cancer and so on... everyone wants excellent access and outcomes delivered as efficiently as possible. No one wants money wasted on stuff that doesn't work, redundant, meaningless forms... bye for now.
shrink, how are you going to avoid spending money on things that don't work when, in many cases, the standard of care is based on studies that show efficacy in some patients but not others, and the research isn't fine enough to tell which patients will benefit?
Posted by: AllButCertain | February 15, 2011 6:26 PM | Report abuse
I really can't follow that FTC report excerpt on biologics. It seems contradictory.
The reason biologics are "different" is that they are large, complex molecules (usually proteins and protein combos) that are extremely expensive and difficult to develop and manufacture -- and to duplicate.
The desire to arrange a regulatory process to limit protection of pioneer biologics and "bring FOBs to market" quickly is really just another instance of wishing for something for nothing. To the extent it succeeds, it can only do so at the expense of developing biologics in the first place.
Posted by: quarterback1 | February 15, 2011 6:27 PM | Report abuse
Sorry to be offensive with an interjection. I wonder if Ph development costs would be reduced if the FDA just controlled for safety, rather than efficacy and safety. If I've been offensive, my apologies.
Posted by: TrollMcWingnut | February 15, 2011 6:38 PM | Report abuse
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