Republicans and Democrats don’t agree on much. But one thing they would agree on if they knew the facts is that because of the cozy relationship big drug companies have with our lawmakers in Washington, Americans pay far more for their medications than people anywhere else on the planet.
As a consequence, our health insurance premiums are much higher than they should be. And our Medicare program is costing both taxpayers and beneficiaries billions of dollars more than necessary.
Americans who are uninsured are at an even greater disadvantage: many of them have no choice but to put their health at risk because they can’t afford the medications their doctors prescribe for them.
Drug makers have so much influence in Washington that they’ve been able to kill numerous proposals over the years that would enable the U.S. government to regulate drug prices like most other countries do. Between 1988 and 2012, the pharmaceutical industry spent more on lobbying than any other special interest, forking over a total of $2.6 billion on lobbying activities, according to OpenSecrets.org. That’s far more than even banks and oil and gas companies spent.
That money helped them get a very sweet deal when members of Congress were drafting legislation that would eventually be the Medicare Part D prescription drug program. Drug makers were able to get their friends in Congress to insert language in the Part D legislation that prohibits the federal government from seeking the best prices from pharmaceutical companies.
According to a recent analysis by Health Care for America Now (HCAN), an advocacy group, the 11 largest drug companies reported $711.4 billion in profits over the 10 years ending in 2012, much of it coming from the Medicare program. They reaped $76.3 billion in profits in 2006 alone, 34 percent more than in 2005, the year before the Part D program went into effect.
“Americans pay significantly more than any other country for the exact same drugs,” said HCAN Executive Director Ethan Rome.
How much more do we pay than residents of other countries? Here are a few examples of what we pay on average for six brand name drugs compared to what residents of other countries pay, according to the International Federation of Health Plans:
– Celebrex (for pain) – U.S.: $162; Canada: $53
– Cymbalta (for depression and anxiety) – U.S: $176; France: $47
– Lipitor (for high cholesterol) – U.S.: $124; New Zealand: $6
– Nasonex (for nasal allergies) – U.S: $108; U.K.: $12
– Vytorin (for high cholesterol) – U.S: $123; Argentina: $31
– Nexium (for acid reflux) – U.S.: $123; Spain: $18
The Congressional Budget Office says that if Medicare could get the same bulk purchasing discounts on prescription drugs as state Medicaid programs already get, the federal government would save at least $137 billion over 10 years.
In his proposed budget for 2014, President Obama is asking Congress to require drug companies to sell their medications to Medicare at the best price they offer private insurance companies, which is what they are required to do for Medicaid.
On April 16, several members of Congress, led by Sen. Jay Rockefeller (D-W.Va.) and Rep. Henry Waxman (D-Calif.), introduced legislation to require drug companies to provide rebates to the federal government on drugs used by people who are eligible for both Medicare and Medicaid. One of the cosponsors was Independent Sen. Angus King, the former governor of Maine. The lawmakers noted that with the exception of Medicare Part D, all large purchasers of prescription drugs negotiate better prices. Their bill, they say, would correct excessive payments to drug companies, while saving taxpayers and the federal government billions of dollars.
As you can imagine, the drug companies don’t like what President Obama and the lawmakers are proposing. You can expect them to mount a multi-million dollar PR and lobbying campaign over the coming months to protect both their sweet deal with Medicare and their Wall Street-pleasing profits.
By: Wendell Potter, Guest Contributor, Politix, April 23, 2013
“Bullet Backdrops”: Arkansas Republican “Most Likely Won’t Try To Kill” Lawmakers Who Support Medicaid Expansion
Arkansas may become the first red state to accept the Obamacare Medicaid expansion, which the Supreme Court made optional in its decision last year, if the Department of Health and Human Services accepts its privatized plan.
(Of course, the states turning down Medicaid expansion are generally the ones that need it most.)
The notion of expanding government to improve health care outcomes apparently drove Chris Nogy of the Benton County Republican Committee a little nutty. In a recent newsletter, he encouraged his fellow Republicans to seek “Second Amendment” solutions against those who had voted for the expansion, and expressed dismay that he can’t actually back up these threats:
We need to let those who will come in the future to represent us [know] that we are serious. The 2nd amendment means nothing unless those in power believe you would have no problem simply walking up and shooting them if they got too far out of line and stopped responding as representatives. It seems that we are unable to muster that belief in any of our representatives on a state or federal level, but we have to have something, something costly, something that they will fear that we will use if they step out of line. If we can’t shoot them, we have to at least be firm in our threat to take immediate action against them politically, socially, and civically if they screw up on something this big. Personally, I think a gun is quicker and more merciful, but hey, we can’t.
Nogy’s wife is the group’s secretary and she claims the article was placed in the newsletter without her husband’s approval.
Medicaid expansion will provide health insurance for up to 250,000 Arkansans, ultimately saving dozens if not hundreds of lives, while driving down the costs of the state’s insured — who already subsidize the uninsured through higher rates.
Most of Arkansas’ estimated uninsured 401,100 are working families who simply can’t afford coverage.
Several Arkansas Republicans made it clear that they were appalled by Nogy’s comments.
“I’m embarrassed for the Benton County Republican Committee for including this article in their newsletter,” said State Senator Jon Woods (R). “I would think the Benton County Committee would have better judgment and not allow this to be sent out.”
The Benton County Republican Committee offered a statement:
“The letter was not approved and Mr. Nogy had no authority to submit it through the newsletter. As a committee, we respect the right of our legislators to vote based on their knowledge and feedback from the voters they represent. We will discuss this issue further with our executive committee.”
He explained why he is more angry at Republicans than Democrats:
I don’t feel the same way about the Democrats as bullet backstops as I do about the Republicans who joined them. The Democrats were doing what their party told them they had to do because they were elected to do that job.
He concluded by saying that his threats were only meant to attract attention and he “most likely” won’t kill those Republicans who supported the Obamacare provision. He simply thought it was important to put a face behind his threats so lawmakers will take him seriously:
And for the record, I didn’t advocate violence. I mentioned violence to get people’s attention, and it worked. I advocated a serious political and social stand, an assured and significant negative response to any politician who breaks a primary voter/elected official promise contract. We have only one mechanism to maintain the ‘government of the people, by the people, and for the people’, and that is to elect those who promise to do as we demand they do. If we cannot make these people understand that we will not tolerate this kind of breach of contract, then we lose our ability as the people to control the government. And in this age of death threats from nameless, faceless thugs, we need these folks to know that while we most likely won’t try to kill them or harm their families, they should be much more certain of our response than fearful of the actions of those who will not identify themselves.
The contentious battle over expansion has shown that Republicans are eager to take the federal funds without getting any Obama on them. Lawmakers are so afraid to be caught pandering to the president or “takers” that they’ve officially declared that Medicaid expansion is not an entitlement.
Mr. Nogy should be happy to know that another feature of Obamacare is mental health parity.
By: Jason Sattler, The National Memo, April 22, 2013
As promised, President Obama sent Congress his budget for the 2014 fiscal year this morning, and there’s just enough in it to make everyone unhappy from a variety of directions.
Republicans won’t like everything about this plan that makes it progressive: it expands Medicaid, undoes sequestration cuts while ignoring Paul Ryan’s demands to slash public investments, pursues a universal-preschool initiative though new tobacco taxes, expands the Earned Income Tax Credit, invests another $50 billion in job-creating infrastructure, gives a big boost to federal R&D, and takes away breaks for Big Oil.
Democrats won’t like everything about this plan that makes it conservative: it includes additional Medicare reforms, it adopts chained-CPI to lower Social Security benefits, and it focuses more on the spending side of the ledger than the revenue side. On a fundamental level, Obama’s budget starts in the middle, rather than the left, making negotiations that much more difficult.
Today’s budget is the White House’s effort to reach the bedrock of the fiscal debate. Half of its purpose is showing what they’re willing to do. They want a budget compromise, and this budget proves it. There are now liberals protesting on the White House lawn. But the other half is revealing what the GOP is — or, more to the point, isn’t — willing to do. Republicans don’t want a budget compromise, and this budget is likely to prove that, too.
As the White House sees it, there are two possible outcomes to this budget. One is that it actually leads to a grand bargain, either now or in a couple of months. Another is that it proves to the press and the public that Republican intransigence is what’s standing in the way of a grand bargain.
So, which of these two outcomes is more likely?
I think the smart money is on the latter. The president has called every GOP bluff and put his cards on the table — Republicans said Obama wouldn’t have the guts to go after entitlements and isn’t tough enough to risk the ire of his base. And now we know these assumptions were wrong — the president has presented a White House budget that includes the very entitlement “reforms” GOP leaders asked for, and liberals are furious.
It is, in other words, “put up or shut up” time. Republicans, out of excuses, can either meet Obama half-way or they’ll be exposed as craven. And if the last several years are any indication, GOP lawmakers will chose the latter without a moment’s thought.
Indeed, as Greg Sargent noted, congressional Republican leaders have already spent the afternoon arguing that Obama should simply give the GOP what it wants, and abandon the Democratic priorities, reinforcing the perception that Republicans still do not yet understand the difference between an offer and a gift.
In fact, I should mention that I received an email the other day from a long-time reader asking why I don’t seem more worked up about chained-CPI. The reader asked whether I support it (I don’t) and whether I’ve been relatively quiet about it out of some ideological or partisan predisposition.
I’ll tell you what I told him: I’m not worked up about it because I don’t see the scenario in which Republicans get chained-CPI by giving Obama hundreds of billions of new revenue. It’s easy to remain detached about a bad idea that seems highly unlikely to go anywhere. As Kevin Drum added today, “I don’t doubt that Obama’s offer is sincere, but it doesn’t matter. Republicans aren’t going to take it. Obama will get his proof that Republicans simply aren’t willing to negotiate seriously, and who knows? Maybe it will do him some good. But that’s all he’ll get.”
For me, the more interesting question is how the political world will process these developments when they occur. The Beltway said Obama needed to reach out to Republicans, so he reached out to Republicans. The Beltway said Obama needed to schmooze Republicans in a more personal way, so he did that, too. The Beltway said Obama needed to be willing to alienate his own supporters, and the president’s base has been duly outraged. The Beltway said Obama needed to put Medicare and Social Security on the table, and they’re on the table.
Will pundits who continue to blame “both sides” for partisan gridlock look ridiculous in the coming months? I sure as hell hope so.
By: Steve Benen, The Maddow Blog, April 10, 2013
“Insurance And Freedom”: How Many Americans Will Be Denied Essential Health Care In The Name Of Freedom?
President Obama will soon release a new budget, and the commentary is already flowing fast and furious. Progressives are angry (with good reason) over proposed cuts to Social Security; conservatives are denouncing the call for more revenues. But it’s all Kabuki. Since House Republicans will block anything Mr. Obama proposes, his budget is best seen not as policy but as positioning, an attempt to gain praise from “centrist” pundits.
No, the real policy action at this point is in the states, where the question is, How many Americans will be denied essential health care in the name of freedom?
I’m referring, of course, to the question of how many Republican governors will reject the Medicaid expansion that is a key part of Obamacare. What does that have to do with freedom? In reality, nothing. But when it comes to politics, it’s a different story.
It goes without saying that Republicans oppose any expansion of programs that help the less fortunate — along with tax cuts for the wealthy, such opposition is pretty much what defines modern conservatism. But they seem to be having more trouble than in the past defending their opposition without simply coming across as big meanies.
Specifically, the time-honored practice of attacking beneficiaries of government programs as undeserving malingerers doesn’t play the way it used to. When Ronald Reagan spoke about welfare queens driving Cadillacs, it resonated with many voters. When Mitt Romney was caught on tape sneering at the 47 percent, not so much.
There is, however, an alternative. From the enthusiastic reception American conservatives gave Friedrich Hayek’s “Road to Serfdom,” to Reagan, to the governors now standing in the way of Medicaid expansion, the U.S. right has sought to portray its position not as a matter of comforting the comfortable while afflicting the afflicted, but as a courageous defense of freedom.
Conservatives love, for example, to quote from a stirring speech Reagan gave in 1961, in which he warned of a grim future unless patriots took a stand. (Liz Cheney used it in a Wall Street Journal op-ed article just a few days ago.) “If you and I don’t do this,” Reagan declared, “then you and I may well spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” What you might not guess from the lofty language is that “this” — the heroic act Reagan was calling on his listeners to perform — was a concerted effort to block the enactment of Medicare.
These days, conservatives make very similar arguments against Obamacare. For example, Senator Ron Johnson of Wisconsin has called it the “greatest assault on freedom in our lifetime.” And this kind of rhetoric matters, because when it comes to the main obstacle now remaining to more or less universal health coverage — the reluctance of Republican governors to allow the Medicaid expansion that is a key part of reform — it’s pretty much all the right has.
As I’ve already suggested, the old trick of blaming the needy for their need doesn’t seem to play the way it used to, and especially not on health care: perhaps because the experience of losing insurance is so common, Medicaid enjoys remarkably strong public support. And now that health reform is the law of the land, the economic and fiscal case for individual states to accept Medicaid expansion is overwhelming. That’s why business interests strongly support expansion just about everywhere — even in Texas. But such practical concerns can be set aside if you can successfully argue that insurance is slavery.
Of course, it isn’t. In fact, it’s hard to think of a proposition that has been more thoroughly refuted by history than the notion that social insurance undermines a free society. Almost 70 years have passed since Friedrich Hayek predicted (or at any rate was understood by his admirers to predict) that Britain’s welfare state would put the nation on the slippery slope to Stalinism; 46 years have passed since Medicare went into effect; as far as most of us can tell, freedom hasn’t died on either side of the Atlantic.
In fact, the real, lived experience of Obamacare is likely to be one of significantly increased individual freedom. For all our talk of being the land of liberty, those holding one of the dwindling number of jobs that carry decent health benefits often feel anything but free, knowing that if they leave or lose their job, for whatever reason, they may not be able to regain the coverage they need. Over time, as people come to realize that affordable coverage is now guaranteed, it will have a powerful liberating effect.
But what we still don’t know is how many Americans will be denied that kind of liberation — a denial all the crueler because it will be imposed in the name of freedom.
By: Paul Krugman, Op-Ed Columnist, The New York Times, April 7, 2013
“Inside The Anti-Obamacare Resistance”: A Facinating Glimpse Into Warped Conservative Ideology And Tactics
The two largest states that have so far failed to join in the Medicaid expansion provided for in the Affordable Care Act are Florida and Texas, where Republicans control the legislature and the governor’s office. Looking more closely at the intra-Republican battle over how and whether rich new federal funds can be captured without “surrendering” to the hated Obama provides a fascinating glimpse into conservative ideology and tactics.
Florida offers the murkiest situation. Gov. Rick Scott, who was beginning to look rather toasty in his 2014 re-election prospects, roiled conservative circles in his own state and nationally by suddenly coming out for Medicaid expansion in exchange for permission from the Obama administration to move Medicaid beneficiaries into private managed care plans. But Scott’s been stopped cold by GOP legislators, who in turn seem split between outright rejectionists centered in the state House and those in the Senate who want an even better “deal” that would utilize the state’s CHiP program, which is a privatized premium support scheme, instead of Medicaid for the expansion.
A conservative Florida reporter presents the views of the rejectionist camp quite vividly:
Tom Lauder, a reporter for Media Trackers Florida, which is closely following the Florida Obamacaid debate, says House Republicans appear likely to stand firm….
“Grassroots conservatives are particularly upset with Gov. Scott using the language of the left in his efforts to build momentum for Obamacaid,” Lauder explained. “When Scott argues, ‘I cannot, in good conscience, deny the uninsured access to care,’ he asserts that the only time people have access to goods and services is when government gives it to them as an entitlement. Scott has enraged his conservative base by making this big-government argument. This isn’t a question of whether government should give Medicaid to the poor and disabled, because the poor and disabled already qualify for Medicaid.”
At issue, Lauder says, is the rejection of Scott’s argument that federal funding will come without cost to state taxpayers.
“Scott’s conservative base also resents Scott talking about federal funding as if it were free money,” Lauder added. “Even if the federal government kept its promise to fund most of the Florida Medicaid expansion, which many conservatives doubt will be the case, Floridians pay federal taxes in addition to state taxes. Federal dollars flowing into Florida are not free dollars, even for Floridians.
In other words: Florida’s “true conservatives” don’t much care what mechanism is being used to expand coverage; they’re just flatly against it.
In Texas, meanwhile, the rejectionist camp is led by Gov. Rick Perry, as Ron Brownstein explains in a National Journal column:
Republican state Rep. John Zerwas, a health care leader who represents a district outside Houston, says legislators are getting an earful at home from providers and local officials worried about the state rejecting the money.
Against that backdrop, Zerwas and some GOP state House colleagues are searching for ways to steer Texas into the expansion. They assume the state will not move more people into the existing Medicaid program. But they consider it misguided to simply reject the federal money and deny insurance coverage to so many people who could obtain it. “We are not going to make this better … without doing something that substantially reforms how we deliver Medicaid,” Zerwas says. However, “we have to have a solution for this group of people.”
Last week, Zerwas introduced legislation that would authorize state health officials to negotiate with the Obama administration to expand while delivering coverage for the newly eligible through new means. He likes the deal the administration is discussing with Arkansas, which could allow the state to use Medicaid expansion dollars to instead buy private insurance for its eligible adults, and he believes that approach could be “sellable to the governor.”
Many here, though, wonder if Perry would take any deal. The widespread belief is that he intends to seek the GOP presidential nomination again in 2016, and accepting more Medicaid money would smudge his image of Alamo-like resistance to Obama.
This is an interesting scenario given recent efforts from the Perry camp (outlined earlier this week in another National Journal piece by Michael Catalini) to depict the swaggering, gaffe-prone Texan as “ahead of his time” in understanding the need for Republican outreach to Latinos. Notes Brownstein:
[I]f state Republicans reject federal money that could insure 1 million or more Hispanics, they could provide Democrats with an unprecedented opportunity to energize those voters—the key to the party’s long-term revival. With rejection, says Democratic state Rep. Rafael Anchia of Dallas, Republicans “would dig themselves into an even deeper hole with the Hispanic community.”
It’s unclear how this will all play out in Florida and Texas. But nobody recently has lost any money betting on the hard-core conservative approach, particularly on an issue as incendiary to the Right as Obamacare. That rejecting any sort of coverage expansion beyond that absolutely required by the ACA would mean leaving vast sums of federal money on the table would in fact be considered a badge of honor by a lot of the people involved.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, March 22, 2013