PNHP

Most Physicians Endorse Single-Payer National Health Insurance

Most Physicians Endorse Single-Payer National Health Insurance

EMBARGOED UNTIL 4:01 PM, EST
February 9, 2004

Contacts: Danny McCormick, M.D., M.P.H.
Tel (617) 665-1032
Beeper (617) 546-9422
Steffie Woolhandler, M.D., M.P.H.
Tel (617) 665-1032 or 497-1268
Beeper (617) 546-0577

Most Physicians Endorse Single-Payer National Health Insurance
According to Harvard Study

Nearly two-thirds (64%) of physicians favor single-payer national health insurance, far more than support managed care (10%) or fee-for-service care (26%) according to a Harvard Medical School study published today in the Archives of Internal Medicine. National health insurance (NHI) received majority support from physicians of virtually every age, gender and medical specialty – even among surgeons, a plurality supported NHI. The breadth of physician support for NHI was highlighted by the fact that even most members of the American Medical Association and the Massachusetts Medical Society favor the single payer approach Despite this high level of support, however, only about half (51.9%) of physicians studied were aware that a majority of their fellow physicians support NHI.

The researchers surveyed a random sample of 904 Massachusetts physicians drawn from the AMA’s Master File of all doctors. The survey included questions about views on health care financing and medical practice issues. Eighty-nine percent believed that it is the responsibility of society, through its government, to provide everyone with good medical care, regardless of their ability to pay. Physicians also favored physician payment under a salary system (56.8%), and would be willing to accept a reduction in fees for a reduction in paperwork (67.1%). Doctors overwhelmingly (70.3%) rejected allowing the insurance industry to continue playing a major role in the delivery of medical care.

“The perception that physicians oppose national health insurance often serves to reinforce political barriers to health care reform. Our finding that a large majority of physicians actually support single-payer national health insurance could provide the impetus for national health insurance, particularly if physicians began to publicly advocate for their views” said Dr. Danny McCormick, a study author and researcher at Harvard Medical School.

Dr. David Bor, a study co-author who is an Associate Professor of Medicine at Harvard Medical School and Chair of the Department of Medicine at The Cambridge Health Alliance commented: “At first I was surprised at our results. But when I reflected on my own clinical experience with publicly funded programs like Medicare, I realized that I and many other doctors are convinced that the government can do an excellent job administering health insurance. The plain fact is Medicare works better for patients-and for doctors-than most private insurance plans.”

“Most doctors are fed up with the health care system. It’s not just the paperwork and insurance hassles, but knowing that many of our patients can’t afford to fill the prescriptions we write for them. And millions of people who are uninsured avoid care altogether until they’re desperately ill. That’s why more than 10,000 physicians have endorsed a proposal for national health insurance that appeared in the JAMA last August. This survey shows that the overwhelming majority of doctors now support NHI..” said Dr. Steffie Woolhandler, another study co-author and Associate Professor of Medicine at Harvard Medical School.

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Physicians for a National Health Program (PNHP) is a research and education organization with more than 12,000 physicians representing every state and specialty. PNHP was founded in 1987 and has physician spokespeople across the country. For a local spokesperson, call the national headquarters at 312-782-6006. Visit us online at www.pnhp.org

McCormick D, Himmelstein, DU, Woolhandler S, Bor DH, “Single-Payer National Health Insurance: Physicians’ Views”, Archives of Internal Medicine. 2004 February 9; 164:300-304

Will Lower Drug Prices Jeopardize Drug Research ?

Will Lower Drug Prices Jeopardize Drug Research?
Donald W. Light, University of Medicine & Dentistry of New Jersey
Joel Lexchin, School of Health Policy and Management, York University, Toronto, Ontario, Canada

This documented fact sheet provides evidence that all drug research by large firms, net of taxpayers’ subsidies, is paid for out of domestic sales in each country, with profits to spare. Prices can be lower without jeopardizing basic research for new drugs. More exposure to global price competition would encourage more innovative research and less of the derivative me-too research that now dominates.

In the U.S., the FDA Commissioner, Mark McClellan, and the drug industry are responding to pressures for lower costs by mounting a large campaign to pressure all other affluent countries to raise their prices to U.S. levels. They claim that lower prices do not pay for drug research costs, but we provide evidence that this is untrue. Ultimately, however, such nationalistic arguments are based on regarding basic research and new discoveries, which can happen anywhere, and the cost of trials, which are carried out in the countries deemed most commercially advantageous, as part of national companies and national accounts, when in fact they are part of a global economy for pharmaceutical products.

FDA Myths
1. FDA Commissioner, Mark McClellan, holds that other affluent countries like Canada and the UK set their prices for patented drugs so low that they do not pay for research and development (R&D) (McClellan 2003). We can find no evidence to support that claim.

On the contrary, audited financial reports of major drug firms in the UK, show that all research costs are paid, with substantial profits left over, based solely on domestic sales at British prices (Pharmaceutical Price Regulation Scheme 2002). Likewise, 79 research drug companies in Canada submitted reports showing their R&D expenditures have risen more than 50% since 1995, all paid for by domestic sales at Canadian prices (Patented Medicine Prices Review Board 2002). Sales to the U.S. and elsewhere are in addition to the positive, domestic balance sheets.

2. FDA Commissioner McClellan says that European or Canadian prices are “slowing the process of drug development worldwide” (McClellan 2003). There is no known verifiable evidence to support this claim. In fact, drug research has been increasing steadily in Europe as well as in the U.S., with some countries having a more rapid increase than the U.S. (Patented Medicine Prices Review Board 2002).

3. FDA Commissioner McClellan says that “price controls discourage the R&D needed to develop new products” (McClellan 2003). But there is no known verifiable evidence to support this claim.

R&D expenditures have been growing rapidly, though it is becoming more and more difficult to discover breakthrough drugs on targets not already hit (Harris 2003). The truth kept from Americans is that first-line treatment for 96% of all medical problems requires only 320 drugs (Laing et al. 2003). In wealthy countries, more drugs might be appropriate to treat people who do not respond to first-line agents.

4. FDA Commissioner McClellan charges that efforts to negotiate lower prices for patented drugs by other countries (and by major employers, unions and governors in the U.S.) are “no different than violating the patent directly” to make cheap copies (McClellan 2003). This charge echoes the drug industry and implies that large buyers seeking better value should be considered a criminal act.

5. FDA Commissioner McClellan paints a picture of other wealthy countries driving down their prices to marginal costs, but the widening gap between prices for patented drugs in the U.S. and other countries is due to drug companies raising U.S. prices, not other countries lowering theirs (Sager and Socolar 2003; Families USA 2003).

6. The “free-rider” problem that McClellan emphasizes can be solved by U.S. prices coming down to European levels, where they will cover all R&D costs, plus profits that are higher than those in most industries.

7. Drug company profits, after all R&D costs, have long been more than double the profits of Fortune 500 corporations. In recent years they have jumped to triple and even quadruple the profits of other major companies (National Institute for Health Care Management 2000). The global firms spend two and a half to three times more for marketing and administration than for research (Families USA 2001).

8. Americans pay for more R&D than any other country because the United States accounts for more sales than any other country. But while the U.S. accounts for 51% of world sales, it took 58% of global R&D expenditures invested in the US to discover only 43% of the more important new drugs (NCEs) (European Federation of Pharmaceutical Industries and Associations 2003). This means that other countries are helping to pay for the large, inefficient U.S. R&D enterprise, the opposite of what the editors of Business Week claimed (Business Week editors 2003). William Safire’s claim of a “foreign rip-off” as Americans pay for the world’s R&D is contradicted by the facts above (Safire 2003).

Research is misdirected by the industry, against patients’ interests
9. Most drug innovation provides little or no therapeutic advantage over existing

Independent review panels plus a major industry review conclude that only 10 – 15 % of “new” drugs provide a significant therapeutic breakthrough over existing drugs and involve a new chemical or molecule (Barral 1996; Prescrire International 2003; National Institute for Health Care Management Research and Education Foundation 2002). Other industry-sponsored figures are much higher but not reliable.

10. The FDA approves drugs that are better than nothing (placebo) but does not test them against the best existing drugs for the same problem. Most research is for “new” drugs to treat problems already treated by other drugs.

11. About 18% of the drug industry’s research budget goes to basic research for breakthrough drugs. About 82% goes to derivative innovations on existing drugs and to testing.

The long-standing survey of basic research by the National Science Foundation estimates that basic research has increased to 18% of the total research and development (R&D) budget for the pharmaceutical industry. It used to be less (National Science Foundation 2003). Industry-sponsored figures based on secret unverifiable data are much higher but not reliable (DiMasi, Hansen, and Grabowski 2003). The 85-90% of “new” drugs that have little therapeutic gain reflects equal protection from competition for much less investment and risk.

12. Congress has repeatedly extended patent protection for drugs beyond what other industries enjoy, despite much higher profits year in and year out. Government protection from normal competition is now more than 50% greater for the drug industry than a decade ago (National Institute for Health Care Management 2000). These incentives reward research into derivative large markets, rather than to finding effective treatments for diseases that have none.

13. These facts constitute the Blockbuster Syndrome: the lure of monopoly pricing and windfall profits for years spurs the relentless pursuit for drugs that might sell more than $1 billion a year, regardless of therapeutic need or benefit. Research projects for the disorders of affluent nations proliferate, as do clinical trials. Doctors are paid like bounty hunters to recruit patients for thousands of dollars each. Most patients get the misimpression that the experimental drug will be better than existing ones (Wolpe 2003). The corruption of professional judgment, ethics and even medical science follow (Williams 2003; Wazana 2000; Barnett 2003; Lexchin, Bero, Djulbegovic et al. 2003; Bekelman, Mphil, and Gross 2003; Villanueva, Peiro, Librero et al. 2003; Fletcher 2003).

Drug research costs much less than claimed
14. Drug companies claim to spend 17% of domestic sales on R&D, but more objective data reports they spend only 10% (National Science Foundation 2003). Thus, only 1.8% of sales goes to research for breakthrough new drugs (18% x 10%) (Love 2003).

15. Taxpayers pay for most research costs, and many clinical trials as well.

In 2000, for example, industry spent 18% of its $13 billion for R&D on basic research, or $2.3 billion in gross costs (National Science Foundation 2003). All of that money was subsidized by taxpayers through deductions and tax credits. Taxpayers also paid for all $18 billion in NIH funds, as well as for R&D funds in the Department of Defense and other public budgets. Most of that money went for basic research to discover breakthrough drugs, and public money also supports more than 5000 clinical trials (Bassand, Martin, Ryden et al. 2002). Taxpayer contributions are similar in more recent years, only larger.

16. The average amount of research funds the drug industry needs to recover appears to be much less than the industry’s figure of $800 million per new drug approved (NDA).

The $800 million figure is based on the small unrepresentative subsample of all new drugs. It excludes the majority of “new” drugs that are extensions or new administrations of existing drugs, as well as all drugs developed by NIH, universities, foundations, foreign teams, or others that have been licensed in or bought. Variations on existing drugs probably cost much less because so much of the work has already been done and trials are simpler.

About half of the $800 million figure consists of “opportunity costs”, the money that would have been made if the R&D funds had been invested in equities, in effect a presumed profit built in and compounded every year and then called a “cost.” Drug companies then expect to make a profit on this compounded profit, as well as on their actual costs. Minus the built-in profits, R&D costs would average about $108 million 93% of the time and $400 million 7% of the time.

The $800 million estimate also does not include taxpayers’ subsidies via deductions and credits and untaxed profits (DiMasi, Hansen, and Grabowski 2003; DiMasi, Hansen, Grabowski et al. 1991). Net R&D costs are then still lower.

Contrary to some press reports from the industry, screening for new compounds is becoming faster and more efficient and the time from initial testing to approval has shortened substantially (Kaitin and Healy 2000). The large size of trials seems more due to signing up specialists to lock in substantial market share. Advertising firms are now running clinical trials (Bassand, Martin, Ryden et al. 2002; Peterson 2002; Moyers 2002).

17. Because clinical trials have become a high-profit sub-industry, trial “costs” appear to be much more than is necessary.

An international team of experts estimates that clinical trials could be done for about $500 per patient rather than $10,000 per patient, a 95% reduction (Bassand, Martin, Ryden et al. 2002). The most detailed empirical study of trial costs also concludes that costs can be much less than reported (The Global Alliance for TB Drug Development 2001).

U.S. drug prices very high

18. Americans seem unaware how much more they are paying for drugs than other countries, in the name of the “free market” where prices are controlled by corporations. So-called “price controls” abroad are negotiated wholesale prices. Corporate price controls in the U.S. are un-negotiated monopoly prices, which then large buyers negotiate down.

According to a detailed analysis, American employers and health plans pay at wholesale 2.5-3.5 times the prices in Australia and other countries with comparable prices for patented drugs (Productivity Commission of Australia 2001). There is no evidence that these prices do not cover research costs. U.S. generic prices shadow patent drug prices and are also 2.5-3.5 times more.

19. High American prices are essentially monopoly rents charged to employers in every other industry. They shift profits from other industries to the drug industry.

20. If American prices were cut in half, research budgets would not have to suffer unless executives decided to cut them in favor of marketing, luxurious managerial allowances or high profits. They probably would not, because R&D gets such favorable tax treatment compared to other expenses. Lower prices would save other Fortune 500 companies billions in drug benefit costs, and drug company profits could come into line with the profits of the companies who pay for their drugs.

Realign incentives to reward true innovation
21. Current incentives strongly reward derivative innovation. We get what we reward.

22. Because the U.S. is by far the biggest spender, it has by far the most R&D and new drugs. Four other industrialized countries, however, devote more of their GDP to R&D for new drugs than the U.S. (Patented Medicine Prices Review Board 2002).

23. Officials of drug companies commonly claim that nearly all new drugs are discovered in the U.S. However, the industry’s own studies (and others) show that over the past quarter century, the U.S. has accounted for less than or about the same as its proportionate share of international new drugs, not more and certainly not nearly all (Barral 1996; European Federation of Pharmaceutical Industries and Associations 2000). Until 2002, even the U.S. pharmaceutical industry was investing an increasing percent of its R&D budget in highly productive research teams abroad (Pharmaceutical Research and Manufacturers of America 2002).

24. Americans are getting less innovation and paying a lot more. Competing countries profit from these American self-delusions by covering their R&D and keeping their own drug prices reasonable, while leaving drug companies to make bonanza profits from the monopoly American market.

25. Price competition has been the greatest spur to innovation for over 200 years. Price protections reward derivative and me-too innovation as well as excessive costs and a focus on blockbuster marketing. If we want lower prices and more breakthrough innovations, we need to change the incentives to reward those goals (Baker and Chatani 2002).

Authors’ Disclosure Statement
In 1996, JL received funding from Sandoz (now part of Novartis) for travel and accommodation to attend a meeting in Basle, Switzerland with Sandoz executives to discuss marketing practices.

Please click here to view pdf

Higher Premiums Mean Higher Profits: Why Your Health Care Insurance Is More Expensive

Higher Premiums Mean Higher Profits: Why Your Health Care Insurance Is More Expensive
by Milton Fisk January 2004

Cost shifting is the name of the game as management grapples with the rising expense of employee health care. Employers are having employees pay more out of pocket through higher deductibles, larger drug co-pays, and higher premiums.

Read the full article at http://www.labornotes.org/archives/2004/01/articles/e.html

Employers are segregating retirees into high-cost risk pools

The New York Times
February 3, 2004
Companies Limit Health Coverage of Many Retirees
By Milt Freudenheim

Employers have unleashed a new wave of cutbacks in company-paid health benefits for retirees, with a growing number of companies saying that retirees can retain coverage only if they are willing to bear the full cost themselves.

The costs can be a shock. According to surveys by benefits consultants, companies that offer health benefits to retirees typically have subsidized about 60 percent of the premium. Losing that support all at once can mean hundreds of dollars a month in unexpected costs.

Moreover, in dropping their subsidies, many companies push retirees into insurance pools that are separate from those of younger, healthier workers, executives said. That lowers the company’s costs for insuring its current workers, while raising the premiums charged to retirees even further.

Last month, a study for the Kaiser Family Foundation by Hewitt Associates found that among employers that have maintained retiree coverage, about 15 percent have required at least some retirees to assume the full cost of their insurance in the last two years. Another 31 percent said they would probably adopt these so-called access-only health plans within the next three years.

“Twenty years from now, no company will offer retiree health care,” Uwe Reinhardt, a health economist at Princeton University, said.

http://www.nytimes.com/2004/02/03/business/03CARE.html?hp

Comment: Current policies are designed to defeat the purpose of risk pooling. Employers keep younger, relatively healthy, currently-employed individuals in the risk pools to which they contribute funds. But employers are placing older, higher-cost, retired individuals into separate risk pools. Premiums have to be much higher to adequately fund these risk pools. And now, more and more, employers are requiring retirees to pay the full premium if they wish to continue coverage.

If the employers are not contributing to the premium, why would a retiree participate? There are two reasons. Coverage is assured, which is not the case in the individual insurance market. And group plans tend to offer better benefits than the individual plans. But what good is this coverage if it is unaffordable because of the very high premiums that must be charged for a risk pool that concentrates high-cost patients?

We can anticipate further innovations in risk segmentation, cost shifting, individual segregated health accounts, adverse selection, and other measures
that are designed to provide coverage for low-cost individuals with few health care needs, while segregating or excluding precisely those high-cost individuals for whom risk-pooling is designed.

We won’t get it right until we accept the concept that we need one universal risk pool. Then we can decide on the most equitable method of funding that pool. Until we are ready to agree on this, we will watch health care becoming less and less affordable for those who need it the most.

Shifting health care costs to teachers and state employees

WHAS11.COM
February 2, 2004
Kentucky News

Raising health insurance on teachers, state employees caught Republicans off guard By Charles Wolfe / Associated Press

Gov. Ernie Fletcher’s proposal to make teachers and state employees pay more for health insurance took most of his fellow Republicans by surprise in the General Assembly.

Higher health insurance costs, coupled with a pay raise too modest to offset them, translates into an effective pay cut for tens of thousands of state employees and teachers.

It was a stunning disclosure. “They’ve lost their mind,” one Democratic legislator said in a stage whisper.

http://www.whas11.com/sharedcontent/APStories/stories/D80ETIT80.html

Comment: Shifting health care costs to underpaid teachers and state employees is not a solution to the problem of ensuring affordable access and coverage for everyone. It only makes the problem even worse.

Since the majority agree that we now need a national solution, the process will be political. But we can no longer allow it to be destroyed by partisan division.

We agree that we need affordable, effective coverage for everyone. Let’s reject the rhetorical lie of “bipartisan cooperation” that permeates our political process today. Though the solutions must be political, destructive partisanship has to be set aside.

And if it happens that only one partisan faction will agree that the health care of the nation is more important than partisan ideology, then we may have to support that faction. But in that manner, politics would trump partisanship.

It’s our political system. Let’s take control.

Don

P.S., Please don’t throw the brickbats at me. Sling them toward the politicians who are failing to act on our national crisis in health care.

Politics and egos: Can we compromise?

Rocky Mountain News
January 30, 2004
Politics blamed for impeding health care
By Rachel Brand

Health insurance for all Americans is again likely to become a presidential campaign issue…

Support for the issue is “a mile wide and an inch thick,” said Ron Pollack, who spoke at the conference, which was sponsored by Health Affairs, a leading policy journal. Scratch deeper and you’ll find the issue rife with political gridlock, moral posturing and wary voters.

“Up until now the issue has been about altruism for a discrete part of the voting public,” said Pollack, executive director of Families USA, a consumer group. “It needs to be viewed as an issue of self-interest for middle-class, working families.”

Pollster Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health, said Americans increasingly are concerned about what would happen if they lost their insurance. They also support plans to help the uninsured, from tax credits to expanding public programs.

Yet that support drops dramatically when they’re told the cost of programs. “When you read voters a list of policies to cover the uninsured, they say, ‘Hey, let’s have it,’ ” Blendon said. “But if you make a single negative argument, it sinks their confidence.”

Blendon recommends that policy-makers embrace plans that include elements of
tax credits, expanding existing programs, and a few employer and individual
mandates, saying it would be less vulnerable to criticism.

Pollack and others said politicians need to get their egos out of the way. In years past, if their policy wasn’t adopted, they’d walk away without trying to compromise.

http://www.rockymountainnews.com/drmn/business/article/0,1299,DRMN_4_2615598,00.html

Comment: Blendon and Pollack again make the plea for compromising, while reiterating their long-standing opposition to uncompromising,ego-driven advocates (single payer advocates?).

Yet, Pollack, and to some extent Blendon, have been uncompromising in their
advocacy for their very specific model of reform: employer mandates (perhaps
with individual mandates), tax credits, and expansion of public programs
(especially Medicaid and S-CHIP). Their model has been analyzed extensively.
It is the most expensive model of reform at a time when affordability is the
number one public concern about our health care system. Their model also
falls short on comprehensiveness, equity, and even on universality. In contrast, the single payer model is the least expensive and most comprehensive model that does ensure true universality.

Is this the time to abandon discussion of fundamental health policy principles that might shed some light on the problems and potential solutions? Should we walk away from our great body of health policy science and follow the dictates of ego-driven individuals (as we all are) who have labeled their favorite model a “compromise,” when it is just another specific model in the list of options?

Is compromise the solution? Ignoring health policy science is not compromising, but it is abandonment of valuable tools that should be used to craft health care reform. We shouldn’t accept less than universality, comprehensiveness and affordability, which means that we shouldn’t compromise with special interests that would sacrifice these goals for their own benefit. That would not be compromise; that would be a cop-out.

Where can we compromise? How about compromising on the process? Actually,
we’ve already begun to do this. Cover the Uninsured Week, sponsored by the
Robert Wood Johnson Foundation, has already brought together diverse interests that now agree that we must provide coverage for everyone. That’s a crucial first step. And that was the easy part. But now we must encourage the special interests that have permeated this process to join in a sincere and dedicated effort to make this a reality.

It is time for each interest to decide how much of a compromise can be accepted on its own part to attain this universally-agreed-upon goal. The process should not allow compromise of universality, comprehensiveness and affordability, but rather it should be directed to negotiated compromises made between the various interests involved. Funding should be equitable, which means that we need to negotiate between businesses, individuals and the government the means by which the greatest equity could be achieved. Insurers must negotiate an end to their profound administrative waste as they transform themselves into essential health care partners by providing much-needed services such as an integrated information technology system (in partnership with the National Institutes of Health and the National Research Council). Health care providers should negotiate the establishment of a process that will cover their expenses while still providing a fair profit, and agree on a reasonable method of allocating resources.

We can provide affordable, comprehensive care for everyone, and we shouldn’t
compromise on that. But all interests need to sit down at the negotiating
tables and begin an open process of compromising on each of our own interests. The $1.6 trillion that we are already spending is enough to go around. Let’s negotiate a compromise on how we should spend it. After all, it is for the benefit of our patients. And isn’t that what it’s all about?

http://covertheuninsuredweek.org/

Uwe Reinhardt responds to Joel Segal's comments on the moral outrage of uninsurance

Uwe Reinhardt responds to Joel Segal’s comments on the moral outrage of our failure to enact a program of universal health care (which was in response to Reinhardt’s editorial):

I could not agree more. If the nation’s czar of morality Bill Bennett cared about such matters, he’d write another book entitled: Where’s the Outrage?

Alas, we live in America, and I merely reported in the editorial–and in the paper I reference therein–what I have learned about America in these past 35 years.

As I recently put it before a high level health-policy meeting in Washington, D.C.:
“One major source of our national economic strength –that is to say, our average GDP-per-capita-prowess–is a by international standards unusually high tolerance for misery among the nation’s economic losers, to wit:

1. people who made imprudent decisions somewhere along the way;

2. people who lack the intellectual acumen, or the education, or the training to fend for themselves in this highly demanding market economy;

3. people who are victims simply of pure bad luck (e.g., because they got sick, or wounded in combat, or hit by some accident, or were born into a household that was not supportive enough in the accumulation of human capital, etc).

For folks not falling into these three categories, this can be (and usually is) a truly fantastic country. Alas, for the folks who fall into these dire categories, it is a harsh, cruel and, in my own judgment, unjust country–whether we look at health care, education of our so-called ‘justice’ system.”

That is what I have learned about America in these past 35 years. I have come to accept it, as my editorial and my paper suggests.

Best,

Uwe

Uwe Reinhardt responds to Joel Segal’s comments on the moral outrage of uninsurance

Uwe Reinhardt responds to Joel Segal’s comments on the moral outrage of our failure to enact a program of universal health care (which was in response to Reinhardt’s editorial):

I could not agree more. If the nation’s czar of morality Bill Bennett cared about such matters, he’d write another book entitled: Where’s the Outrage?

Alas, we live in America, and I merely reported in the editorial–and in the paper I reference therein–what I have learned about America in these past 35 years.

As I recently put it before a high level health-policy meeting in Washington, D.C.:
“One major source of our national economic strength –that is to say, our average GDP-per-capita-prowess–is a by international standards unusually high tolerance for misery among the nation’s economic losers, to wit:

1. people who made imprudent decisions somewhere along the way;

2. people who lack the intellectual acumen, or the education, or the training to fend for themselves in this highly demanding market economy;

3. people who are victims simply of pure bad luck (e.g., because they got sick, or wounded in combat, or hit by some accident, or were born into a household that was not supportive enough in the accumulation of human capital, etc).

For folks not falling into these three categories, this can be (and usually is) a truly fantastic country. Alas, for the folks who fall into these dire categories, it is a harsh, cruel and, in my own judgment, unjust country–whether we look at health care, education of our so-called ‘justice’ system.”

That is what I have learned about America in these past 35 years. I have come to accept it, as my editorial and my paper suggests.

Best,

Uwe

All Medicare fight-back initiatives in the House to date

In December, Chet Edwards, a Texas Democrat, with more than 70 cosponsors, introduced HR 3672, to authorize HHS to negotiate Rx prices.

This week, one of those cosponsors, Dennis Moore, a first-term Kansas Democrat, introduced HR 3707, which at first glance is nearly identical, and has a handful of cosponsors including Jo Ann Emerson, Missouri Republican, who was not on Edwards’s bill.

http://www.house.gov/edwards/releases/pr_031209.html

http://www.house.gov/moore/nr-Meds-1-21-04.htm

Benjamin Cardin, a Maryland Democrat, this week, without cosponsors, introduced HR 3702. It provides authority to negotiate prices, “guaranteed prescription drug benefits,” full reimbursement for qualified retiree prescription drug plans, repeal of the comparative cost adjustment (CCA) program, repeal of the MA Regional Plan Stabilization Fund, and repeal of cost containment provisions.

Also this week Robert Wexler, a Florida Democrat, introduced two bills. HR 3710 (no cosponsors) specifies procedures under which pharmacists and wholesalers – and, in some cases, individuals – could reimport most drugs from Canada and directs that these procedures be instituted through regulations. The bill provides, however, that the regulations shall “contain any additional provisions determined by the Secretary to be appropriate as a safeguard to protect the public health or as a means to facilitate the importation of prescription drugs.”   HR 3711, with three cosponsors, repeals the premium support demonstration programs now set to start in 2010.

http://www.wexler.house.gov/press_releases/Jan_21_04.htm

—
Sidney J. Socolar
PHANYC Representative to APHA Governing Council

Phone 212-666-5925
Fax   212-316-1405

Border Wars: The Prescription Drug Battle With Canada

Nobel laureate Dr. Milton Friedman and Other Experts to Debate Drug Importation, Medicare, Uninsured, Single-Payer Health Care, and More

SAN FRANCISCO – Today experts will debate the importation of prescription drugs from Canada, a practice just recently supported by San Francisco’s Board of Supervisors. Legislation is now in the works in California, and cities and states around the country are on the drug importation bandwagon. The panelists will also discuss Medicare reform, how best to solve the problem of the uninsured, and whether the United States should adopt single-payer health care.

“We are deeply concerned about the quest of American politicians to import prescription drugs from Canada,” said panelist Sally C. Pipes. “The San Francisco supervisors seek to reduce drug prices by imposing the price controls of other nations on us. Such importation will create higher prices and scarcity in Canada, and in America it will quash research and development for promising new therapies, degrading overall health care in the long term,” she said.

In a November 2003 open letter to Congress, Nobel laureate Milton Friedman and other economists warned: “Even if people were to realize that price controls are preventing new drugs from being developed, undoing the effects of those controls would be a difficult task. Customers would have to pay higher prices for years before they saw benefits.”

Panelists:
Milton Friedman, Nobel laureate
Sally C. Pipes, President and CEO, Pacific Research Institute
Don McCanne, M.D., President of the Physicians for a National Health Program
Congressman Gil Gutknecht, R-MN
James K. Glassman, American Enterprise Institute (moderator)

Click Here to listen to the debte

Please click here to view the Transcript

Mr. Bush's unhealthy inaction

The Washington Post
January 25, 2004
Editorial
Unhealthy

For an insight into the inadequacy of the president’s health care proposals
put forward in his State of the Union speech last Tuesday, look closely at a
strike by supermarket workers in Southern California.

Labor leaders acknowledge that this is a national problem, one that they cannot solve at the negotiating table, even if the supermarkets ultimately improve their offer. But does the president acknowledge it? From his speech, it was hard to tell.

Mr. Bush did state that he remains opposed to a “government-run health system.” Fine — but if he wishes to avoid that outcome, Mr. Bush needs to
think more creatively about how he is going to keep the nation’s private health care system viable. A peculiar jumble of old ideas, long discussed but never acted upon, isn’t going to do it.

http://www.washingtonpost.com/wp-dyn/articles/A45228-2004Jan24.html

Comment: There is now near unanimous agreement that the funding crisis in
health care requires “a national solution.” There is no escaping the fact that this means federal action. Decades of social experimentation and advancement of health policy science have proven that “a peculiar jumble of old ideas” cannot possibly adequately address our problems in the funding health care.

Now that we accept the fact that a federal solution would be required, we must face squarely the real question. Do we move towards equity and affordability by adopting a federal solution, or do we accept the tragic status quo by rejecting reform through adherence to the politically divisive “government-run” rhetoric?

Let’s dump the rhetoric of the ideologues and get on with reform!

Mr. Bush’s unhealthy inaction

The Washington Post
January 25, 2004
Editorial
Unhealthy

For an insight into the inadequacy of the president’s health care proposals
put forward in his State of the Union speech last Tuesday, look closely at a
strike by supermarket workers in Southern California.

Labor leaders acknowledge that this is a national problem, one that they cannot solve at the negotiating table, even if the supermarkets ultimately improve their offer. But does the president acknowledge it? From his speech, it was hard to tell.

Mr. Bush did state that he remains opposed to a “government-run health system.” Fine — but if he wishes to avoid that outcome, Mr. Bush needs to
think more creatively about how he is going to keep the nation’s private health care system viable. A peculiar jumble of old ideas, long discussed but never acted upon, isn’t going to do it.

http://www.washingtonpost.com/wp-dyn/articles/A45228-2004Jan24.html

Comment: There is now near unanimous agreement that the funding crisis in
health care requires “a national solution.” There is no escaping the fact that this means federal action. Decades of social experimentation and advancement of health policy science have proven that “a peculiar jumble of old ideas” cannot possibly adequately address our problems in the funding health care.

Now that we accept the fact that a federal solution would be required, we must face squarely the real question. Do we move towards equity and affordability by adopting a federal solution, or do we accept the tragic status quo by rejecting reform through adherence to the politically divisive “government-run” rhetoric?

Let’s dump the rhetoric of the ideologues and get on with reform!