Billy Tauzin, head of PhRMA, strutting his stuff.

Anyone who can go from negotiating the Medicare Prescription Drug Act as a congressman, a huge windfall for pharma that eliminated the right of the government to negotiate prices, to a bonus of 2 million dollars as head of PhRMA, without a federal enditement, deserves some kind of prize.

Why we have to negotiate with these guys who probably should be behind bars for how they have screwed the American public over the past decade or two is beyond me.

However if you take away the right to negogiate prices then sooner or later you are going to get runaway medical costs.

Meanwhile, those large crowds of chowder headed peoples that are being herded onto buses to mob Congressman and shout out angry statements about healthcare are being organized in part by convicted criminal Rick Scott who as head of the for profit hospital chain HCA had to pay 1.7 billion in fines for fraud. He now heads the healthcare industry front organization Conservatives for Patient Rights.

Karen Ignagni, head of the American Insurance Health Plans (AHIP), the health insurance lobby, gets the Golden Greed award for electing to make no concessions and choosing to go full bore against public option healthcare insurance. Why we should continue to pay bloated and ineffecient healthcare insurance companies just because, well, they want us to, any more than we should pay Chrysler to make cars we don’t want, is beyond me. They use a lot of bogus rhetoric about stopping socialized medicine and innovation in healthcare but it is all just a bunch of nonsense. They have the gravy train going and they don’t want it to stop.

Karen Ignagni, head of AHIP health insurance lobby

 Karen my dear I think you may find yourself out in the cold and all your friends may have run off with all of the yummies. Obama is not gonna wanna play with you anymores. Especially when you wouldn’t give insurance coverage to his momma when she was dying of cancer. Oops.

Amidst all the bluster and misinformation here was an interesting piece on cbsnews.com called “Top 10 myths about healthcare reform”

1. The House Health Care Bill Mandates or Encourages Euthanasia

At a tele-town hall meeting with members of the senior advocacy group AARP last month, President Obama could not help but describe one question he received as “kind of morbid.”

“I have been told there is a clause in (the health care bill) that everyone that’s Medicare age will be visited and told to decide how they wish to die,” said a caller named Mary from North Carolina. “This bothers me greatly, and I’d like for you to promise me that this is not in this bill.”

There is nothing in any health care reform bill before Congress that would require people to “decide how they wish to die.” Conservative talking points from activists and legislators, however, would suggest otherwise.

In fact, section 1233 of the House bill would allow Medicare for the first time to cover patient-doctor consultations about end-of-life planning, including discussions about drawing up a living will or planning hospice treatment. Patients would, of course, seek out such advice on their own — they would not be required to. The provision would limit Medicare coverage to one consultation every five years.

2. Americans Will Lose Their Private Insurance

A prevalent conservative talking point is that the proposed government-sponsored health insurance plan, or “public option,” could drive private insurers out of business and that millions of Americans would lose their current health insurance.

 

In fact, that figure represents Americans who would presumably change their plans voluntarily. The bill does not force private insurers out of business or force people onto the public plan.

 

 

 

3. You Will Be Able to Keep Your Plan

 

 

 

“Here’s a guarantee that I’ve made,” the president said at the AARP tele-town hall conference. “If you have insurance that you like, then you will be able to keep that insurance.”

Democrats would indeed compel employers to continue to shoulder some of the cost burden of health care by creating a “pay or play” mandate, requiring companies to either provide insurance for their workers or pay a fine. However, employer coverage would have to meet certain requirements; for example, plans would not be allowed to charge co-pays for preventive care. It is possible some companies would have to alter their coverage, or would instead choose to drop their coverage all together and pay a fine.

4. The Blue Dogs Are Primarily Interested in Cutting Government Costs in Health Care Reform

“I think, rightly, a number of these so-called Blue Dog Democrats — more conservative Democrats — were concerned that not enough had been done on reducing costs,” Mr Obama said in an interview with CBS News.

Indeed, the Blue Dogs convinced their Democratic colleagues to cut government costs by reducing the amount the government will spend in subsidies to make health care more affordable for low- and middle-income Americans. The compromise also shifts some of the cost of expanding Medicaid from the federal government to the states.

However, the compromise also would require the government-sponsored health insurance option that would be created to negotiate its own payment rates, rather than using Medicare payment rates. This would create a more level playing field for private insurers, Blue Dogs said. The compromise also exempts more small businesses from the “pay or play” mandate, giving businesses a smaller share of the cost burden.

“Allowing doctors and other health care providers to negotiate rates with the government under a public option would cost the government about $60 billion, according to a preliminary CBO estimate,” Politico reported.   “And exempting small businesses with a combined salary of $250,000-a-year to $500,000-a-year would cost the government $30 billion, according to the same estimates.”

5. The Health Care Legislation Mandates Taxpayer Dollars Pay for Abortions

Anti-abortion rights advocacy groups and legislators alike have complained that the health care legislation includes a “hidden abortion mandate,” as some congressmen have put it.

 

In late June, 19 Democrats sent a letter to House Speaker Nancy Pelosi calling the issue a deal-breaker. “Plans to mandate coverage for abortions, either directly or indirectly is unacceptable,” they wrote.

6. Health Care Reform Will Be Paid For

“Health insurance reform cannot add to our deficit over the next decade, and I mean it,” Mr. Obama has said on numerous occasions.

Lawmakers are still grappling with ways to pay for the large cost of expanding health care to all, but they will use at least one accounting trick to make the legislation appear deficit-neutral over 10 years. As part of the proposed reform package, Democratic legislators want to reform projected Medicare payments to avert a 20 percent pay cut to doctors — creating $245 billion in new costs that have not been accounted for.

Democrats argue it does not have to be paid for because they already exempted it from congressional “pay-as-you-go” rules, the AP reported.

Furthermore, while lawmakers focus on trying to create a bill that is deficit-neutral over 10 years, the longer-term costs may be even more difficult to predict. The Congressional Budget Office recently concluded that the legislation under consideration in both the House and Senate would not control costs.

Mr. Obama has said that there will be savings from the efficiencies implemented into the nation’s health care system through the legislation, but those savings are impossible for the CBO to score.

7. Cuts to Medicare?

Republicans have blasted Democrats for planning cuts to Medicare, a program that benefits millions of seniors. President Obama has insisted that there will be no reductions to benefits.

Technically, Republicans are right that health care reform plans include cuts to Medicare’s projected budget; however, Mr. Obama has given specific examples of how cuts can be made by rooting out waste from the program.

The House bill reduces projected increases in Medicare payments to providers by more than $500 billion over 10 years, the Associated Press reports, but puts nearly $300 billion in new provider payments back into the program (as explained in myth No. 7). That creates a net cut of $200 billion.

 

 

“What we hear from our members is that to them Medicare savings sounds like cuts,” Nora Super, AARP’s chief health care lobbyist, told the AP. “Our members over 65 really value their Medicare program … and numbers like $500 billion are huge numbers, so that is really scary to our members.”

Mr. Obama said at the AARP tele-town hall meeting in July that there is no discussion of cutting Medicare benefits.

“Nobody is talking about reducing Medicare benefits,” he said. “What we do want is to eliminate some of the waste that is being paid for out of the Medicare trust fund that could be used more effectively to cover more people and to strengthen the system.”

8. Americans Don’t Want a Government-Run Health Care Plan

 

Republicans have consistently berated the proposal for a government-sponsored health insurance plan, or “public option,” as unpopular.

http://www.cbsnews.com/stories/2009/08/05/politics/main5215880.shtml

 

“The American people oppose a government takeover of health insurance, and they know if the Democrats and the administration get their way and create a new government-run plan, tens of millions of Americans will lose their health insurance,” Rep. Mike Pence (R-Ind.), chairman of the Republican Conference, said on Fox News Sunday.

In fact, a CBS/New York Times poll  from late July shows that, even though doubts have grown in recent months about Mr. Obama’s health care proposals, 66 percent of Americans still want the government to provide a health insurance plan like Medicare to compete with private health insurers.

9. Rationing of Care

One of the misleading buzzwords in the health care debate is “rationing” — the idea that patients will have limited treatment options if the government becomes more involved in health care delivery.

In fact, Americans will not face “rationing” in health care any more than they do now. While a public plan would not be able to cover all procedures, private insurance plans do not either.

“We don’t want to ration by dictating to somebody, ‘Okay, you know what? We don’t think that this senior should get a hip replacement,’” Mr. Obama said at the AARP tele-town hall. “What we do want to be able to do is to provide information to that senior and to her doctor about this is the thing that is going to be most helpful to you in dealing with your condition.”

10. A Health Care Bill Will Bring Quick Changes

Democrats have created a misleading sense of urgency over health care reform. The president has spoken about suffering Americans who need help right away. It is a talking point more commonly used by liberal grassroots groups rallying support.

However, significant provisions of the health care legislation under consideration — including the federal health insurance exchange, the public option, subsidies and the employer mandate — would not go into effect until 2013.

Mr. Obama addressed this fact at an Ohio town hall.

“Most of these changes would be phased in over several years,” he said. “So it’s not as if you’re going to wake up tomorrow and suddenly the health care system is all changed completely. We are going to phase this in, in an intelligent, deliberate way.”

The letter specifically referred to the “essential benefits package” a Health Benefits Advisory Committee and the Secretary of Health and Human Services would be responsible for defining. Nothing in the legislation, however, has “mandated” that abortion services be included in the benefits package.

In fact, the House Energy and Commerce Committee on Thursday adopted an amendment, proposed by Rep. Lois Capps (D-Calif.), that would prohibit taxpayer dollars from funding abortions. The amendment would not allow the federal government to either require or prohibit abortion coverage by private insurers. It requires at least one plan from the federal health insurance exchange in each region of the country to cover abortion, and at least one of the plans to not cover abortion.

“Private health care providers are free to cover abortion, but not with federal funds,” reports Dan Gilgoff of U.S. News and World Report. “The public plan would cover abortion, but not with federal funds; a Capitol Hill aide tells me money for abortions would come from what participants pay into the public plan.”

It has yet to be determined how this issue will finally be settled.

Mr. Obama told CBS Evening News anchor Katie Couric in July that “I’m pro-choice, but I think we also have the tradition in this town, historically, of not financing abortions as part of government-funded health care.”

The goal is to have a means and a mechanism to keep the private insurers honest. The goal is non-negotiable; the path is negotiable.

Them’s some ominous words.

With both Charles Grassley (R-Iowa) in the Senate and Max Baucus (D-Montana) opposed to a public option, it looks like our leaders have sold us down the river yet again as I have predicted before. It is my opinion that without a public option things will only deteriorate as the healthcare industrial complex cannot cut costs on its own.

The Obama administration state that they want nonprofit cooperatives to compete with private insurance plans. They say that if they don’t find evidence of competition, that the public option will “kick in” at a later date.

There has been a lot of negotiating going on. For instance, the hospital lobby just agreed to taking 155 billion in cuts over the next decade, mostly in reduced Medicare and Medicaid payments. This is in addition to cuts agreed to by pharma. They have been admonished not to bitch about the process if they want to keep their spot at the negotiating table with Baucus. Meanwhile we stories like this one about expensive treatments for prostate cancer that are being performed with the cost of over $100,000 when they have never been shown to be better than the “wait and see” approach (i.e. doing nothing). Only in America guys.

It looks our industry friends will agree to just about anything with the Obama administration to avoid going on a diet. Problem is they are for-profit and motivated by making money.

Richard Umbdenstock (AHA), Karen Ignagni (AHIP), Nancy Nielsen (AMA), Billy Tauzin (PhRMA), and David Nexon (AMTA)

Yep. Our friends from the American Hospitals Association (AHA), American Health Insurance Plans (AHIP), American Medical Association (AMA), and American Medical Techonology Association (AMTA) can all be counted on for one thing. Following their instincts. Which are greed.

I wonder if David is going to get some of the yummies or if they are going to let him get up to the table.

Meanwhile, 69% of Americans support a public option insurance plan, as do 59% of doctors. Only a third are opposed to it. And only 19% of doctors are members of the AMA, which officially opposes it. So those right wingers like Dr Bill Frist in the Senate do not represent our views.

Actually the suppressed book release was over a year ago before they made the papers for too close ties to pharma. So it might have been a conspiracy, that actually wasn’t a conspiracy, that actually was a conspiracy. If that makes any sense.

But what was involved in the conspiracy probably wasn’t what he had in mind.

Gary Schwitzer showed interest in something that combines “academic freedom, double standards, and blog censorship.” Other comments are here and here and here, including one entitled “University Throws Doctor Under the Bus for Pharma Ties“. I liked that one, so here you go.

University throws doctor under the bus for pharma perks. That's Billy Tauzin, head of PhRMA lobbying group, at the wheel.

It’s getting a little tight down here.

On the actual questions of fact, the head of the American Association of University Professors offered his opinion in the Inside Higher Ed piece that the university absolutely had no right to block me from identifying myself as a member of that university. This seems in contradistinction from the “policy” of preventing the use of the name for “non-university” activities which could be construed as anything other than buying pencils on your university account. I mean alot of professors are writing blogs, writing books, speaking in public, making movies, whatever, and I think it really strikes a nerve to say that they cannot identify themselves as a university professor in the things they do, which is why this case has basically drawn national attention. As for the blog, I think many professors see their blogs as an extension of their professional life, and in fact it is an excellent way to quickly express ideas on newly breaking events in their field and get instant feedback. Not to mention twitter.

Amy Philo wrote the following about this situation: There is a case called Garcetti v. Ceballos involving government employees that limits the employee’s right to free speech if the speech is considered part of their official duties. Therefore if your university declares your blog ‘personal’ that would imply that you could not be retaliated against for whatever you write on the blog. On the other hand having you remove their name could be considered retaliation since it does relate to academic freedom. However, in Garcetti the Supreme Court said that their decision does not apply to scholars / academic freedom, implying that a professor would still have the First Amendment right to say whatever they wanted.

Statements made by public employees pursuant to their official duties are not protected by the First Amendment from employer discipline…

…The Court instead found a reason for limiting First Amendment protection to public statements made outside the scope of official duties “because that is the kind of activity engaged in by citizens who do not work for the government.

The Court also reserved for a future decision the issue of whether its analysis would apply in the same manner to a case involving speech related to scholarship or teaching.

Hat tip to Amy Philo [this does not represent legal advice]

Richard Umbdenstock of AHA makes his move to push back against healthcare reform

Nancy Nielsen (AMA), Billy Tauzin (PhRMA), Karen Ignagni (AHIP)

David Nexon, AMTA. Go team!

Maybe it’s time we did a little “pushing back”, like pushing back against the AMA for their greedy and selfish opposition to healthcare reform, or against the medical establishment for the huge disparities in regional medical spending without differences in care that demonstrate the gaming of the system to make money.

Mmmm. Supper time for medical Gang of Four: (from L) Max Baucus (D-Mont), Karen Ignagni (AHIP), Rich Umbdenstock (AHA), Billy Tauzin (PhRMA), Nancy Nielsen MD (AMA).

Don’t forget to toss some yummies to David Nexon (Medical devices, AMTA). Ruff!

The unidentified man looking away is probably a Canadian spy.

Well just in case you were feeling depressed the Medical Gang of Four all gave us a laugh last week by offering to (as I wrote before) voluntarily cut spending by two trillion over the next ten years (how they would do this is a mystery, but it surely won’t involve cutting out the 30% of medical tests, scans and screenings that are useless for the patient). Conveniently this is about what Obama would need in order to introduce a government health insurance. However Karen at the AHIP is probably flipping out about him using the “g” word since she knows that private health insurance companies in the US with their bloated 25% administrative overhead costs could never compete with a government plan that has a 2% administrative overhead cost, and that anyone in their right mind would choose the government plan, unless they had money to burn. Billy also doesn’t want a healthcare plan that would be able to negotiate lower drug costs. In fact as we speak they are lobbying to get the government plan parceled into many smaller entities or relegated to the states. In other words take the teeth out of any negotiating power that the plan would have. An alternative floated by Olympia Snowe (R-Maine) is to have the government plan only come into effect if it is “triggered” by excessive healthcare costs somewhere several years down the road (i.e. never). One thing for sure is that whomever kills the healthcare plan doesn’t want to be caught with the murder weapon in their hands. It looks like all of this is going to go down pretty quick as Obama just announced that he wants to finish this during this legislative session.

Burning money to keep warm

Well as Sen Grassley said if he wants to take on healthcare reform himself he better put on his kid gloves. As I have said before he is swimming in shark infested waters taking on healthcare reform. 

Good luck.

The medical Gang of Four

Clockwise from upper left: Rich Umbdenstock, Director of the American Hospitals Assocation (AHA), Billy Tauzin, Director of the Pharmaceutical Research and Manufacturers Association (PhRMA), Nancy Nielsen, MD, President of the American Medical Association (AMA), and Karen Ignagni, Director of American Health Insurance Plans (AHIP, formerly HIAA). Dinner’s served, guys.

Oh, and don’t forget David Nexon, of the American Medical Technology Association (AMTA; you know, those guys that make expensive medical devices that don’t actually work, that are fighting against stuff like Comparative Efficacy Research, CER).

Come on puppy!

David Nexon, AMTA

President Barack Obama said that “it looks like the people in the Harry and Louise ads of the 1990s need healthcare reform now in 2009″ (referring to the TV ads where a fictional couple sit around and worry about the government taking over healthcare, part of a campaign by industry which derailed the Clintons healthcare reform). Meanwhile Nancy Pelosi (D-Cal) announced today that the Congress would have a sweeping healthcare reform bill ready by July, one that would cover the 50 million uninsured Americans as desired by Obama. This would be paid for by sin taxes on booze, smokes, and sody pop, and according to head of the Senate Finance Committee Max Baucus (D-Montana) who is leading the healthcare reform effort for the Democrats, a tax on employer provided health insurance.

Well I have been cynical in the past about the prospects for real healthcare reform and a little suspicious of Max Baucus. Max has been filling the troughs for the group and the industry guys say they are having so many meetings they don’t have time for anything else. Sounds like fun!

Max Baucus is keeping the industry guys well fed.

Mmmm, David sez that looks good to me! Does anyone know what Max is actually feeding them? Maybe it’s bull, like “we are all on the same page” or “don’t worry this too will pass”.

To bad the representatives of the Physicians for a National Health Program didn’t get to join the party, they actually got escorted out in handcuffs! (see Howard Brody MD blog).

Come on in, the water's fine.

In case you are Rip Van Winkle or someone dropped you on your head so you don’t remember, back in 1993 Hillary Clinton got torn to shreds by insurance lobbiests and other special interest groups. Remember the Harry and Louise ads funded by the Health Insurance Association of American (HIAA), where they sit around fretting about how to pay for their mandatory healthcare insurance?

Now the health insurance guys are whining again. They say they don’t want a “Medicare for all” plan cuz it will drive them all out of business. Or if there is an expanded healthcare they don’t want the government to have the chance to negotiate contracts with doctors and hospitals (unlike them). Oh, and if the government can negotiate with doctors and hospitals they will go out of business too. But isn’t that anti-capitalist to be against negotiating prices? What they might as well say is that they are bloated and inefficient and couldn’t compete with any alternative system. I call the organizations that represent hospitals, insurance, doctors and drug companies the evil Gang of Four.

Clockwise from upper left, AMA, HIAA, PhRMA, AHA

Did you know that Ronald Reagan made promotional videos for the American Medical Association (AMA) that they showed to their members way back in the day, about how they should fight against Medicare, because it was socialized medicine? The AMA really has a disgraceful history and I am glad that their flagship journal, JAMA, is running into rocky shores. The insurance guys and their pals the hospital lobby (American Hospital Association, AHA), the AMA, and pharma (Pharmaceutical Research and Manufacturer’s Association (PhRMA) are gonna do what they can to confuse and confound. But in the meantime, they have offered to not charge people more for insurance who have pre-existing medical conditions, if everyone is required to buy insurance. This looks like a crumb they are throwing out to try and avoid any new government insurance program or expansion of Medicare.

Here is a handy little chart comparing the pros and cons produced by the New York Times.

Hmmm, do we want more government control, or less of it? More government control, or less? Hmmm.
Maybe we should set up an office pool to see how long “healthcare reform” lasts this time around.