PNHP

Senate HELP amendment on “data exclusivity”

Senate HELP amendment on “data exclusivity”

NVCA Study Supports 12-Year Data Exclusivity Period

By Donald Zuhn
Patent Docs
Biotech & Pharma Patent Law & News Blog
July 13, 2009

On Friday, the National Venture Capital Association (NVCA) released the results of a study suggesting that “a data exclusivity period of at least 12 years for innovator products is a critical fulcrum in the effort to balance cost with the preservation of biotech innovation.”

http://www.patentdocs.org/

And…

Executive Session on the Affordable Health Choices Act

U.S. Senate HELP Committee
July 13, 2009

Consideration of the Enzi/Hatch/Hagan amendment on establishing a data exclusivity period of 12 years for biotech innovation

Sen. Orin Hatch: I don’t know a biotech company that isn’t for this bill, for this 12 year data exclusivity.

****

Sen. Kay Hagan: These individuals are out there looking for venture capital to obviously help them get these drugs to market… In order for our country to maintain this innovation and this research we need 12 years of data exclusivity.

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Sen. Judd Gregg: Money flows into biologics research because capital moves there to make money. That’s the way a market system works.

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Sen. Tom Harkin: Keep in mind what we’re talking about here. We’re not talking about patents. Everybody gets a 20 year patent… What we’re talking about here is data, data exclusivity… How do you get that data? You get it through FDA supervised trials… Where do they do those clinical trials? Academic health centers. Who supports academic health centers? Our taxpayers… When should that data be released so that another company out there, some other entrepreneurs, can look at the data and say… I’ll bet if we changed this and did this, we might come up with a new formulation that might actually help something else. They’re still going to have to go through their clinical trials… At least they’ll be able to look at the data. If you don’t do that that means that the company can sit on that data for 12 years. Then they let the data out. Clinical trials will take another 7 years or more, so you’re going to have at least a whole 20 year run in there… before anyone can ever surface with anything even comparable to what that drug or that biologic is.

****

Sen. Bernie Sanders: Let’s find out why year after year the drug companies make hugh profits, look at why the drug companies have never once, to the best of my knowledge, have never lost a political debate here in Congress… (medicine) doesn’t do anybody any good if they can’t afford it. I think for year after year we’ve been paying a lot of attention to our friends in PhRMA, who are spending, I don’t know what they spend in lobbying and campaign contributions, a whole lot of money. Maybe it’s time that we start worrying about the people who have to pay for this medicine.

****

Sen. Sherrod Brown: You know what we’ve not talked about, Mr. Chairman? We’re not talking about how much these biologics are costing patients. Let me give you some numbers. (examples)… 48 thousand dollars… 20 thousand dollars …100 thousand dollars. You know what the average wage in my state is? 46 thousand dollars… If we do this giveaway to the drug industry, this giveaway to the biologic companies, it means profits are up for them, it means executive salaries are up for them, it means we can all feel good, but let’s think about the patients, let’s think of the patient with breast cancer who has got to spend 1000 dollars a week… the patient with colon cancer who’s got to spend 2000 dollars a week… What kind of progress is that, Mr. Chairman?

****

The data exclusivity amendment passed by a vote of 16 to 7, with several Democrats voting in support.

421 minute video of the July 13 afternoon session:
http://help.senate.gov/Hearings/2009_06_17_E/2009_06_17_E.html

Comment:

By Don McCanne, MD

For the past week or so I’ve been live-streaming the Executive Session of the Senate HELP Committee as they have been marking up the Kennedy health care reform bill, the Affordable Health Choices Act. It has been running at the corner of my computer screen while I have worked on other projects. Since I am not competent at multi-tasking, I’m pretty jaded right now.

Last evening’s session devoted to the data exclusivity amendment was the longest amount of time they spent on any issue in the reform legislation. I stopped my other work to watch it. This morning, I’m not only jaded, but I’m also depressed. I’ll tell you why.

Earlier in the day yesterday, I sent out the following quote from Bill Moyers: “Nothing will change — nothing — until the money lenders are tossed out of the temple, the ATM’s are wrested from the marble halls, and we tear down the sign they’ve placed on government — the one that reads, ‘For Sale.'”

I didn’t sleep last night. Instead of counting sheep, I kept watching, in my nightmare, each of those Senators who voted yes picking up their bundle from the ATM machine in the marble halls on their way out as they passed the “For Sale” sign at the door.

But this isn’t about my nightmare. It’s about the 307 million of us who are the merchandise in Congress’s rummage sale. That’s why I’m depressed.

Bill Moyers on "The Select Few"

Bill Moyers & Michael Winship: Some Choice Words For “The Select Few”

Bill Moyers Journal
July 10, 2009
Enter “the select few who actually get it done.” Three out of four of the big health care firms lobbying on Capitol Hill have former members of Congress or government staff members on the payroll — more than 350 of them — and they’re all fighting hard to prevent a public plan, at a rate in excess of $1.4 million a day.
Health care policy has become insider heaven. Even Nancy-Ann DeParle, the White House health reform director, served on the boards of several major health care corporations.
President Obama has pushed hard for a public option but many fear he’s wavering, and just this week his chief of staff Rahm Emanuel — the insider del tutti insiders — indicated that a public plan just might be negotiable, ready for reengineering, no doubt, by “the select few who actually get it done.”
That’s how it works. And it works that way because we let it. The game goes on and the insiders keep dealing themselves winning hands. Nothing will change — nothing — until the money lenders are tossed out of the temple, the ATM’s are wrested from the marble halls, and we tear down the sign they’ve placed on government — the one that reads, “For Sale.”
http://www.pbs.org/moyers/journal/blog/2009/07/bill_moyers_michael_winship_so.html

The public option was the strategy of a large group of progressives to circumvent “the select few” who have continued to make sure that comprehensive reform was not politically feasible. With the favorable election results and with their campaign to market “your choice of health plans,” the progressives were confidant that they would be able to use the public option as a backdoor entry to affordable health care for all.
Once you think that you’ve closed the deal, you’re supposed to take down the “For Sale” signs. These progressives forgot to do that, and “the select few” came in with a lot more money and bought the place out from under them.
Who is left to toss the money lenders out of the temple? Or do they own the place in perpetuity?

Bill Moyers on "The Select Few"

Bill Moyers & Michael Winship: Some Choice Words For "The Select Few"

Bill Moyers Journal
July 10, 2009

Enter “the select few who actually get it done.” Three out of four of the big health care firms lobbying on Capitol Hill have former members of Congress or government staff members on the payroll — more than 350 of them — and they’re all fighting hard to prevent a public plan, at a rate in excess of $1.4 million a day.

Health care policy has become insider heaven. Even Nancy-Ann DeParle, the White House health reform director, served on the boards of several major health care corporations.

President Obama has pushed hard for a public option but many fear he’s wavering, and just this week his chief of staff Rahm Emanuel — the insider del tutti insiders — indicated that a public plan just might be negotiable, ready for reengineering, no doubt, by “the select few who actually get it done.”

That’s how it works. And it works that way because we let it. The game goes on and the insiders keep dealing themselves winning hands. Nothing will change — nothing — until the money lenders are tossed out of the temple, the ATM’s are wrested from the marble halls, and we tear down the sign they’ve placed on government — the one that reads, “For Sale.”

http://www.pbs.org/moyers/journal/blog/2009/07/bill_moyers_michael_winship_so.html

Comment:

By Don McCanne, MD

The public option was the strategy of a large group of progressives to circumvent “the select few” who have continued to make sure that comprehensive reform was not politically feasible. With the favorable election results and with their campaign to market “your choice of health plans,” the progressives were confidant that they would be able to use the public option as a backdoor entry to affordable health care for all.

Once you think that you’ve closed the deal, you’re supposed to take down the “For Sale” signs. These progressives forgot to do that, and “the select few” came in with a lot more money and bought the place out from under them.

Who is left to toss the money lenders out of the temple? Or do they own the place in perpetuity?

Bill Moyers on “The Select Few”

Bill Moyers & Michael Winship: Some Choice Words For “The Select Few”

Bill Moyers Journal
July 10, 2009

Enter “the select few who actually get it done.” Three out of four of the big health care firms lobbying on Capitol Hill have former members of Congress or government staff members on the payroll — more than 350 of them — and they’re all fighting hard to prevent a public plan, at a rate in excess of $1.4 million a day.

Health care policy has become insider heaven. Even Nancy-Ann DeParle, the White House health reform director, served on the boards of several major health care corporations.

President Obama has pushed hard for a public option but many fear he’s wavering, and just this week his chief of staff Rahm Emanuel — the insider del tutti insiders — indicated that a public plan just might be negotiable, ready for reengineering, no doubt, by “the select few who actually get it done.”

That’s how it works. And it works that way because we let it. The game goes on and the insiders keep dealing themselves winning hands. Nothing will change — nothing — until the money lenders are tossed out of the temple, the ATM’s are wrested from the marble halls, and we tear down the sign they’ve placed on government — the one that reads, “For Sale.”

http://www.pbs.org/moyers/journal/blog/2009/07/bill_moyers_michael_winship_so.html

Comment:

By Don McCanne, MD

The public option was the strategy of a large group of progressives to circumvent “the select few” who have continued to make sure that comprehensive reform was not politically feasible. With the favorable election results and with their campaign to market “your choice of health plans,” the progressives were confidant that they would be able to use the public option as a backdoor entry to affordable health care for all.

Once you think that you’ve closed the deal, you’re supposed to take down the “For Sale” signs. These progressives forgot to do that, and “the select few” came in with a lot more money and bought the place out from under them.

Who is left to toss the money lenders out of the temple? Or do they own the place in perpetuity?

Excluding seasonal agricultural workers

Harvesting Justice

By Bruce Goldstein
July 10, 2009
Sen. Hagan (D-NC) introduced Amendment 200 for the health care reform bill being discussed in the Senate Health, Education, Labor and Pensions (HELP) Committee, called the “Affordable Health Choices Act.”
Hagan’s amendment would exclude from the definition of “employees” any “temporary or seasonal agricultural workers . . . for the purposes of determining the size of an employer.” Agricultural employers of seasonal farmworkers would not be required to participate in the system because they would be considered to be too small. Seasonal farmworkers would be denied health care coverage.
Seasonal agricultural workers earn an average of $12,500 to $15,000 per year . They put food on our table by cultivating and harvesting fruits and vegetables, raising chickens, herding sheep, cutting flowers, and harvesting our Christmas trees. They work in the second or third most dangerous occupation. They cannot afford health insurance. It’s morally wrong — and it’s counterproductive economically — to exclude farmworkers from the plans for a reformed health care system.
http://www.harvestingjustice.org/

Everyone should have health care. Everyone.

Excluding seasonal agricultural workers

Harvesting Justice

By Bruce Goldstein
July 10, 2009

Sen. Hagan (D-NC) introduced Amendment 200 for the health care reform bill being discussed in the Senate Health, Education, Labor and Pensions (HELP) Committee, called the “Affordable Health Choices Act.”

Hagan’s amendment would exclude from the definition of “employees” any “temporary or seasonal agricultural workers . . . for the purposes of determining the size of an employer.” Agricultural employers of seasonal farmworkers would not be required to participate in the system because they would be considered to be too small. Seasonal farmworkers would be denied health care coverage.

Seasonal agricultural workers earn an average of $12,500 to $15,000 per year . They put food on our table by cultivating and harvesting fruits and vegetables, raising chickens, herding sheep, cutting flowers, and harvesting our Christmas trees. They work in the second or third most dangerous occupation. They cannot afford health insurance. It’s morally wrong — and it’s counterproductive economically — to exclude farmworkers from the plans for a reformed health care system.

http://www.harvestingjustice.org/

Comment:

By Don McCanne, MD

Everyone should have health care. Everyone.

Premium increases in non-profit health plans

Health-plan costs soar for individuals

By Kyung M. Song
The Seattle Times
July 9, 2009
In what is becoming an annual ordeal for policyholders, Regence BlueShield is raising premiums for 135,000 individual health-plan members in Washington by an average 17 percent on Aug. 1.
It is the third consecutive year that the state’s largest provider of individual coverage has boosted rates by double digits. And it comes after two other insurers, Group Health Cooperative and LifeWise Health Plan of Washington, recently imposed similarly steep premium increases.
North Seattle resident Gail Petersen said having more choices won’t make health plans any more affordable. Petersen, 55, and her husband pay more than $1,400 a month to Regence to cover their family of five and will pay $300 more starting in August.
In 2008, Group Health rolled out eight products to join its lineup of a dozen individual health plans. They included high-deductible health savings accounts, which allow people to put aside up to $5,950 annually in pretax dollars — if they have that much upfront — to pay for medical expenses.
By catering to different population segments, Group Health in the past 15 months has nearly doubled its individual-plan members to 36,000. But those new customers are facing a 13 percent rise in premiums because Group Health underestimated anticipated medical claims, said Mike Foley, a spokesman for the co-op.
http://seattletimes.nwsource.com/html/health/2009436261_regence09m0.html

Once Congress passes a mandate for individuals to purchase health plans, presumably non-profit Regence BlueShield, as the largest provider of individual plans in the state of Washington, would be a provider of those plans. Also, Group Health Cooperative is the co-op that has been proposed to serve as a model for the public option.
Group Health has been shifting more costs to patients through consumer-directed high deductible plans and HSAs, and still has a double digit hike in premiums. Some model.
Can anyone seriously state, with a straight face, that mandating purchase of these plans will somehow magically end the double digit increases in premiums for these plans?
The answer to this question is actually quite complex, but the fundamental truth is that the cost containment measures under consideration in Congress will have very little impact in slowing the escalation of health care costs.
All other nations have health care financing systems that are much more effective in containing costs and without leaving people out, as we do. One simple click on this link will demonstrate in a single image how the United States is an outlier (and will remain so without bona fide financing reform):
http://economix.blogs.nytimes.com/2009/07/08/us-health-spending-breaks-from-the-pack/
In this graph, note that Canada and the United States followed the same curve until Canada established its single payer system. Then look at what happened.

Premium increases in non-profit health plans

Health-plan costs soar for individuals

By Kyung M. Song
The Seattle Times
July 9, 2009

In what is becoming an annual ordeal for policyholders, Regence BlueShield is raising premiums for 135,000 individual health-plan members in Washington by an average 17 percent on Aug. 1.

It is the third consecutive year that the state’s largest provider of individual coverage has boosted rates by double digits. And it comes after two other insurers, Group Health Cooperative and LifeWise Health Plan of Washington, recently imposed similarly steep premium increases.

North Seattle resident Gail Petersen said having more choices won’t make health plans any more affordable. Petersen, 55, and her husband pay more than $1,400 a month to Regence to cover their family of five and will pay $300 more starting in August.

In 2008, Group Health rolled out eight products to join its lineup of a dozen individual health plans. They included high-deductible health savings accounts, which allow people to put aside up to $5,950 annually in pretax dollars — if they have that much upfront — to pay for medical expenses.

By catering to different population segments, Group Health in the past 15 months has nearly doubled its individual-plan members to 36,000. But those new customers are facing a 13 percent rise in premiums because Group Health underestimated anticipated medical claims, said Mike Foley, a spokesman for the co-op.

http://seattletimes.nwsource.com/html/health/2009436261_regence09m0.html

Comment:

By Don McCanne, MD

Once Congress passes a mandate for individuals to purchase health plans, presumably non-profit Regence BlueShield, as the largest provider of individual plans in the state of Washington, would be a provider of those plans. Also, Group Health Cooperative is the co-op that has been proposed to serve as a model for the public option.

Group Health has been shifting more costs to patients through consumer-directed high deductible plans and HSAs, and still has a double digit hike in premiums. Some model.

Can anyone seriously state, with a straight face, that mandating purchase of these plans will somehow magically end the double digit increases in premiums for these plans?

The answer to this question is actually quite complex, but the fundamental truth is that the cost containment measures under consideration in Congress will have very little impact in slowing the escalation of health care costs.

All other nations have health care financing systems that are much more effective in containing costs and without leaving people out, as we do. One simple click on this link will demonstrate in a single image how the United States is an outlier (and will remain so without bona fide financing reform):

http://economix.blogs.nytimes.com/2009/07/08/us-health-spending-breaks-from-the-pack/

In this graph, note that Canada and the United States followed the same curve until Canada established its single payer system. Then look at what happened.

Single-payer reduces waste dramatically

By Jeremy B. Stern
SouthCoastToday.com
July 07, 2009

I am an orthopedic surgeon who has been practicing in this community over the past 16 years and may be familiar to many of your readers. As our Congress debates the future of our health-care system, I am writing to urge my fellow citizens to get involved in the process. The debate in Congress is being framed largely by the insurance companies. This is problematic because of the large sums of money donated by the insurance lobby to the same senators who are crafting the reform.

What is not being considered fairly is H.R. 676, a single-payer health-care system.

In the U.S. today we spend approximately two times as much as other industrialized nations, over $7,000 per person per year, yet have nearly 50 million uninsured residents. What causes this waste of health-care dollars? We are the only industrialized nation that does not have a single-payer system. Instead our system is based on privately owned for-profit insurance companies.

In the average private health insurance company, one-third of the money paid in premiums is used for “administrative costs.” That means that one-third of all the money you and I now pay for our insurance is used to pay for things like salaries, marketing, overhead and, of course, profits and bonuses. Not to provide health care.

In addition, hospitals, nursing homes and physicians need to employ large staffs just to negotiate the maze of rules and regulations from multiple insurance companies. By eliminating these multiple insurance companies, the cost savings to the system would be more than a staggering $350 billion each year.

Many people are scared to have a single-payer system run by the federal government for two main reasons. First, there is a general impression that the government is inefficient and will be unable to manage the system well, and second, people fear that the government would limit their choice of providers. Most people don’t realize that the government plan we all know best, Medicare, runs at about 3 percent overhead while most HMOs run 15 to 20 percent overhead, and the Canadian system has 1 percent overhead. The government, then, is more efficient than the private sector.

As to the second fear, lack of choice, in the single-payer plan being talked about for the United States, the majority of the health-care system would run just as it does today. That means that most people would have greater choice of providers because they would no longer have an HMO telling them who they could see. Unlike the VA or Army system where the doctors and hospitals are run directly by the government, in a single-payer system here in the United States there would be no change in the providers; only the payers would change.

What would happen is that we and our employers would all pay taxes instead of premiums. These taxes would amount to a fraction of what we used to pay in insurance premiums. For those taxes we would have insurance that would pay for literally all of our health needs, from glasses to dental care to medical and surgical care.

The large cost savings of a single-payer system would come in various ways. By buying in bulk and demanding volume discounts, the single-payer plan would greatly decrease the cost of medication. The VA system in the United States gets a 40 percent reduction in medicine costs over what we all pay. A single-payer system would also greatly increase the country’s access to preventative care. This in turn would reduce the inappropriate overuse of highly costly emergency rooms. Having diseases diagnosed earlier and treated appropriately vastly decreases the overall cost of treatment of that disease. For example, by treating high cholesterol early with medicine, you may well eliminate the need for a very costly coronary artery bypass later in life.

While doctors and hospitals would be paid somewhat less, their costs of doing business would be drastically reduced since there would be a very low cost to billing and administration, and providers would get paid more quickly and reliably.

Lastly, but perhaps most importantly, there would be improvements to our actual patient care with a single-payer system. Having only one payer would allow us to use a unified computer system. With this single computer system, whenever you went for health care of any kind, the health-care provider would have all the information needed to treat you safely, such as the medications you take and the allergies you have. There would be fewer medical errors and a greater awareness of interrelated medical problems.

I strongly encourage you all to call, write, text or otherwise contact your congressmen and senators, and encourage them to strongly consider H.R. 676, the single-payer system that will fundamentally eliminate a huge waste of health-care dollars and restore our health-care system.

Dr. Jeremy B. Stern is an orthopedic surgeon. He lives in Marion.

http://www.southcoasttoday.com/apps/pbcs.dll/article?AID=/20090707/OPINION/907070310/-1/NEWS10

ECONOMIC SCENE: The missing piece of the healthcare debate

The idea of a government-paid national healthcare system hasnĆ¢ā‚¬ā„¢t gotten very far in the Washington debate.

By David R. Francis
Staff Writer
The Christian Science Monitor
July 1, 2009 edition

If no one is paying any attention, create a fuss.

Maybe that explains why 13 doctors and nurses got arrested last month when they disrupted a Senate hearing. Their protest: The committee wasn’t considering a single-payer solution to fix America’s healthcare system.

In fact, as healthcare reform works its way through Congress, the idea of a government-paid national health-insurance system hasn’t gotten very far in the Washington debate.

Perhaps it’s too politically radioactive. Or too difficult to pass. For whatever reason, neither the most Democratic Congress in decades nor the most liberal president since Jimmy Carter have opted for a sweeping national health-insurance system, as exists in Europe and Canada, where private insurers disappear and government pays the tab.

“There are countries where a single-payer system works pretty well,” President Obama, a onetime single-payer supporter, told the American Medical Association June 15. “But I believe … that it’s important for our reform efforts to build on our traditions here in the United States.”

That stance leaves single-payer advocates in a political quandary.

“We haven’t yet applied enough pressure to get done what has to be done,” says David Himmelstein, cofounder of Physicians for a National Health Program (PNHP). Maybe, he added, “we will have to give strong consideration to civil disobedience.”

Why are single-payer advocates so passionate? For one thing, many of them see medical healthcare as a civil right for all Americans.

Call up the Internet home page of Rep. John Conyers (D) of Michigan and immediately, without further clicking, a video shows the congressman talking on the House floor about one of “the biggest challenges of the 21st century” — healthcare reform. His bill would provide national health insurance to every person with no deductibles or copayments for medical treatment. Uncle Sam — via citizens — would pay the bill.

Prospects for his bill in Congress don’t appear strong, although 80 House members have signed on to his bill and 59 percent of physicians back national health insurance, according to a new poll.

Public support has also grown over the years. In 1979, 40 percent of Americans thought the federal government should provide national insurance; last month, 72 percent supported the idea, according to CBS News/New York Times polls.

“Things have gone very well for us,” says Quentin Young, PHNP’s national coordinator. “There has been a new surge of support in the last few months.”

Economic stress may explain some of that shift. In 2007, even before the recession, medical bills were the cause for more than 60 percent of bankruptcies, a new Harvard study finds. More than 75 percent of these bankrupt families had health insurance, but it wasn’t enough, Dr. Young points out.

Reformers of every stripe figure that today’s system is unsustainable in the long run. The Congressional Budget Office projects national healthcare costs to rise from today’s 18 percent of gross domestic product, the total output of goods and services in the nation, to more than 30 percent in 2030 and 50 percent by 2080. That assumes modest cost-cutting measures are imposed. Without them, healthcare costs would consume nearly the entire economy by 2080, an impossibility.

Compromise reforms under consideration in Congress are economically “not feasible,” Dr. Himmelstein says, “The likelihood we can afford what they are offering is nil.”

So he figures a single-payer plan is essential. Just cutting the system’s bureaucratic overhead from today’s 31 percent of total expenditures to Canada’s level (1 percent) would save nearly $400 billion annually, more than enough to cover the 48 million now uninsured, he argues.

So why hasn’t Congress moved toward a single-payer system? The financial and political clout of health industries, charges Himmelstein.

And who was the top recipient of their largess in the 2008 election cycle? Mr. Obama.

Health care reform, front and center

Cantwell, health care officials discuss issue at Vancouver forum

By Kathie Durbin
The Columbian
Thursday, July 2

A boisterous audience of more than 100, including a large contingent of seniors, packed a Vancouver hospital auditorium Wednesday to hear U.S. Sen. Maria Cantwell, D-Wash., and a panel of health care providers dissect national health care reform.

People saved their loudest applause for speakers who expressed support for a single-payer system of national health insurance, such as Dr. David Baughan, a family care physician with Group Health Cooperative in the Puget Sound area.

Citing the battles that preceded passage of the 1965 Voting Rights Act, Baughan said, “Political will was mobilized after a lot of people died. In 2009, people die every day because they don’t have health insurance.”

The public would not tolerate a police or fire department that serves only two-thirds of a city, he said, but the nation continues to accept a system in which one-third of Americans lack adequate health coverage.

Some in the audience tried to pin Cantwell down on where she stands on a government-run “public option” that would compete with private health insurance and cover the uninsured.

“We need something like a public plan to purchase health care,” said Cantwell, who has sent mixed signals on the issue over the past two weeks. Members of Congress are still wrestling with how such a public plan would work and how to pay for it, she said.

Cantwell sits on the Senate Finance Committee, which is drafting a bill to spell out how the federal government would pay for a plan to cover the nation’s 47 million uninsured while reducing health care costs through efficiencies and a focus on disease prevention.

Single payer

Asked “what happened” to the single-payer option, which would cut private insurers out of the picture altogether, Cantwell said, “I don’t think that single payer has vanished from the discussion.”

She said she expects amendments to the Senate bill calling for a single-payer system to be introduced on the Senate floor.

A single-payer bill introduced in the House by Rep. John Conyers, D-Michigan, has 79 co-sponsors but has stalled and has little support from House leaders or President Obama. Conyers’ bill would create a publicly financed health care program, modeled on Medicare and funded through a payroll tax, that would cover all Americans without charging co-pays or deductibles.

“I think a public plan represents many of the same elements” as a single-payer system, Cantwell said. For example, she said, both would use the power of the federal government to drive down health care costs through its power to negotiate with hospitals, doctors and drug companies.

However, a government plan would not guarantee that people could find physicians, she added. Cantwell is pushing for financial incentives to train more primary care physicians, who are in short supply in many parts of the country.

Diverse views

Speakers at Wednesday’s panel at Southwest Washington Medical Center represented a range of views on how health care reform should be structured. Most agreed, however, that the nation no longer can afford an open-ended “fee for services” system in which insurance companies pay doctors for whatever drugs and procedures they prescribe, without, they contend, regard to cost or effectiveness.

Ross Baker, a lobbyist for Regence Blue Shield, which insures more than 1 million Washington residents, said his company is moving to control costs.

“We would all admit that the system has major problems and change is needed,” Ross said. Regence supports improved primary care, evidence-based medicine, more use of generic drugs, and elimination of medically unnecessary tests and procedures, he said.

But whether the nation chooses a public plan or tweaks the current plan, he said, real reform won’t happen until Americans take responsibility for their health through changes in diet and exercise.

Dr. George J. Brown, chief executive officer of Legacy Health Systems, said his concern is the growing burden hospitals are shouldering in treating the uninsured. Legacy treats 75,000 people annually in six hospitals in Oregon and Southwest Washington.

“The economic crisis facing our nation has drastically increased the demand for charity care,” Brown said. Further cutting Medicare reimbursements to hospitals, as some in the Obama administration have proposed, is not a solution, he said. “National health care reform is the ultimate solution.”

Charles E. Reed of AARP said his organization, with 40 million members, insists that any health care reform bill address coverage for people in the 50-to-64 age range. Those people are vulnerable, he said, because they are not yet eligible for Medicare, and if they lose employer-provided coverage, they’re often unable to buy private insurance because they have pre-existing conditions.

AARP also supports programs to keep seniors out of expensive nursing homes and development of generic versions of expensive drugs such as those used to treat cancer.

Lack of will

Dr. David Ruiz, a board-certified family physician who now directs a residency program that trains others in his specialty, offered some historical perspective on health care reform. He said the failure of the nation’s leaders to pass universal health coverage is a story of a lack of political will. Presidents Franklin D. Roosevelt, Harry Truman and Lyndon B. Johnson all were afraid to tackle it, he said, and President Bill Clinton’s reform never came to a vote in Congress.

“You have a window of opportunity that opens infrequently,” Ruiz said. But he admitted his skepticism, borrowing from the 15th-century Italian writer Niccolo Machiavelli, who wrote in “The Prince:” “He who innovates will have for his enemies all those who are well off under the existing order of things, and only lukewarm supporters in those who might be better off under the new.”

Community health

Dawn Doutrich, who teaches in the community master’s program for nursing at Washington State University Vancouver, urged a greater investment in public health to prevent disease and reduce the wide disparity in health care that exists between rich and poor.

“We need to re-examine the assumption that health care fits into a corporate model,” she said.

Barbe West, the new executive director of the Free Clinic of Southwest Washington, urged a shared community responsibility for health care. Every major public decision, from whether to close a community grocery store to whether to site a school where all children will have to ride the bus to school, should be analyzed for its impact on public health, she said.

Joe Kortum, president and chief executive officer of Southwest Washington Medical Center, summed things up by urging Americans to have a “dramatic cultural conversation” about what health care means to them.

People in other industrialized countries find it immoral that millions of Americans have no health coverage, Kortum said.

The United States has the capacity to deliver world-class health care, he said, “and yet we have a shipwreck in this system.”

Can Medicaid fill the gap?

To: Sen. Judd Gregg, Ranking Member, Senate Budget Committee
From: Douglas W. Elmendorf, Director
Congressional Budget Office
Letter
July 7, 2009
In response to your request, the Congressional Budget Office (CBO) has considered the likely effects on federal spending and health insurance coverage of adding a substantial expansion of eligibility for Medicaid to the Affordable Health Choices Act, a draft of which was recently released by the Senate Committee on Health, Education, Labor, and Pensions (HELP).
CBO has not yet had time to produce a full estimate of the cost of incorporating any specific Medicaid expansion in the HELP committee’s legislation. However, our preliminary analysis indicates that such an expansion could increase federal spending for Medicaid by an amount that could vary in a broad range around $500 billion over 10 years. Along with that increase in federal spending would come a substantial increase in Medicaid enrollment, amounting to perhaps 15 million to 20 million people. Such an expansion of Medicaid would also have some impact on the number of people who obtain coverage from other sources (including employers). All told, the number of non-elderly people who would remain uninsured would probably decline to somewhere between 15 million and 20 million. (For comparison, CBO’s analysis of the draft legislation that was released by the HELP committee found that, absent any expansion of Medicaid or other change in the legislation, about 33 million people would ultimately remain uninsured if it were to be enacted.)
http://www.cbo.gov/ftpdocs/104xx/doc10445/07-07-2009-ExpandingMedicaid.pdf

From the start it was recognized that insurance exchanges, even if they included a public option, could never provide affordable coverage for low-income individuals. The Medicaid program would have to be expanded to cover this more vulnerable population.
It was also recognized that, even with subsidies, there are many individuals who could not afford to purchase plans through an exchange yet have incomes above the thresholds that would qualify them for Medicaid.
That has led to the new definition of universal coverage as being “close to 95 percent.” This CBO analysis provides support for that view. Leaving only 15 to 20 million people without coverage has become one of the parameters that will define “success” in the reform efforts.
And costs? This Medicaid expansion can be accomplished for only half a trillion dollars (federal component), that is if it is agreed that the program will continue to be chronically underfunded. If it is eventually decided that Medicaid must cover actual health care costs, then add those costs to this half a trillion dollars plus to the funds already obligated for the 60 million people now covered by Medicaid. Once 75 to 80 million people are on Medicaid – over one-fourth of our population – adequate funding will be essential if there are to be enough willing providers to be there to give care when needed.
Keep in mind that all health care costs still must be met one way or another in a fragmented multi-payer system, but with the inevitability of inequitable cost shifting. This inequity potentially can have an adverse impact on the health and finances of tens of millions of Americans. However the total costs are much higher than they need to be because of the profound inefficiencies of this dysfunctional financing system which Congress has elected to protect and expand.
Under a single payer system – a reformed Medicare for all – everyone would be included automatically and without the projected cost overruns that are plaguing the current reform process. Those were the goals of reform, but they seem to have been chewed up in the legislative sausage machine of Congress.