What Was Billy Tauzin Thinking?

Imagine that you are Billy Tauzin. You’re known as a brazen politician, with few scruples. You helped shepherd the Bush administration’s Medicare bill through Congress—legislation that included a startling provision that actually forbid Medicare from even trying to negotiate discounts with drug-makers.

Mission accomplished, a few weeks later you quit Congress (after having assured your constituents that you planned to run for re-election), and take a $2 million job as president of Pharma, the trade organization representing the very drug-makers who benefited, so handsomely, from the legislation.

Flash forward to 2009:  you find yourself up against a progressive White House, and a president who targeted you personally, in a televised advertising campaign.

What do you do?

You keep your friends close, your enemies closer.

You pledge that your industry is willing to give up $80 billion in cost savings over 10 years to help fund reform. The White House appears pleased.

Pharma begins making reverse “Harry & Louise ads,” helping to underwrite a multimillion-dollar TV advertising campaign to promote health-care reform. In 1994 Harry & Louise helped sink Clinton’s hopes. This time around, they’re all similes. “A little more cooperation, a little less politics, and we can get the job done this time,” Louise declares.

Indeed, you have become so friendly with the administration that you hire AKPD, White House strategist David Axelrod’s former firm to help make the ads. (The White House didn’t ask for the favor; AKPD is good, and you want to cement your relationship with new friends.)

Then out of the blue, you’re blindsided by House liberals who mange, at the 11th hour, to tack on an amendment to the House bill giving Medicare the authority to negotiate discounts on drugs.  How can this be?  This is America.  The governments of other countries may try to regulate prices, but we believe in free markets. Drug manufacturers should be able to charge whatever the market will bear—and when people are in pain, and afraid, let me tell you, the market will bear quite a bit. What right does government have to interfere in the Pharma-patient relationship?

 “We had a deal!” you squeal.  Furious, you spill your guts to the New York Times, explaining that when Pharma “volunteered” to contribute $80 billion to the cause over ten years, the White House agreed to limit the industry’s concessions to that amount.

Aggrieved, as only a crook can be aggrieved, you spell out the details to the Times, which prints your accusations on the front page of its Wednesday edition: "We were assured . . . . ‘If you come in first, [promising concessions before other health care lobbyists come around]   you will have a rock-solid deal.’ Who is ever going to go into a deal with the White House again if they don't keep their word?” you fume.
Reportedly, Senator Max Baucus, Rahm Emanuel, and White House deputy chief of staff Jim Messina (who used to work for Baucus) cut the deal. (Some blame Emanuel, but I can’t help but notice that every time I hear about a compromise that reeks to high heaven, Max Baucus appears, center stage.)

Wednesday night, Messina, Baucus’ former staffer, comes forward and declares that what Tauzin told the Times was true. The White House shares the drug lobbyists’ interpretation of the agreement: any health care overhaul would not include allowing direct government negotiation of drug prices.

But then, other representatives of the White House began telling different stories. Meanwhile, members of Congress who believe that they, too, are supposed to play a part in the Democratic process, are  growing apoplectic.

By Friday, the White House is “recalibrating” its position. The New York Times reports that, on Friday night, the administration begins to “back away” from Tauzin’s tale:

 “In a telephone interview, Linda Douglass, a White House spokeswoman on health matters, said the question of government drug-price bargaining ‘was not discussed during the negotiations.’ Asked if that meant such a provision was excluded, as the top drug lobbyists had previously said, Ms. Douglass declined to comment, repeating, ‘It was not discussed.’”

The Times elaborates: “White House officials said Friday that Mr. Messina, the deputy chief of staff who sent the e-mail message, had not intended to confirm that the deal ruled out price negotiations.
“Several people involved in the negotiations of the original drug industry deal with the White House said there had been some ambiguity in the original discussions, conducted primarily through the Senate Finance Committee, over whether the overhaul might include the government negotiations of drug prices.”

The Mystery: What Was Billy Tauzin Thinking?

 Now here is what I don’t understand.  Why did Billy Tauzin “out” his new-found friends by telling the Times that, in exchange for $80 billion the executive branch had pledged to block certain legislation that Congress might attempt to pass?

 Sure doesn’t sound like “checks and balances” to me. The bald fact is that, legally, the executive branch doesn’t have that authority. The story was, to say the least, embarrassing.

Again, pretend that you are Billy Tauzin. When you heard about the House amendment why wouldn’t you just pick up the phone and say “Rahm, this is not what we discussed . . . ,” confident that Rahm would then have a quiet talk with House Speaker Nancy Pelosi, explaining that the amendment allowing Medicare to bargain with drug-makers “just isn’t go to fly in the Senate.”

Maybe, because you don’t trust Rahm Emanuel not to double cross you?  Maybe you’re afraid he’ll say “Deal, what deal? Did the president say that?  . . . I never heard the president say that.”  Or “Sorry, Billy, we were just kidding!

 Perhaps you’re not certain that Rahm can control Nancy Pelosi?

Or, maybe, the president never signed off on a quid pro quo.

So you decide to do what any whistle-blower would do: you go to the newspapers, and spill the whole story. What can the White House do then?

It turns out that they can tell the Times that they don’t remember any discussions about whether or not Medicare would bargain for discounts.

Did Tauzin Ever Have a Deal?


No one knows what was or wasn’t said when Tauzin, Baucus, Emanuel and Messina talked. No one knows what the president said or didn’t say.

Earlier this summer, when the White House was extracting concessions from members of the health care industry, I heard industry representatives gloat: “Now, we have a seat at the table!”

Wary, I watched very closely and I never found a single statement from the President, or any of his senior advisers, suggesting that the White House had promised something concrete in return.  As I wrote in a recent post, I suspected that drug-makers, for example, were celebrating prematurely.

Could it be that Tauzin never clinched a “deal”? I have talked to enough corporate lobbyists to know that they are salesmen. And like any good salesmen, just as they sell others, they sell themselves. They must believe that they have “closed” the deal—even if they haven’t.

One can imagine Tauzin’s confusion when he heard about the House amendment. Don’t these people understand, I scratch your back, you scratch mine? One hand washes the other. This is how the world works!”

Whatever implicit promises healthcare lobbyists assumed were embedded in those cordial discussions with the administration, I have long thought that, at the very end of this legislative process, the health care industry’s lobbyists might be in for a rude surprise.

Of course, I could be wrong.  But I still am inclined to believe that the Obama administration can afford to stand up to lobbyists. After all, Obama’s team is able raise large amounts of money from grassroots supporters.

And I’m willing to hazard a guess that if Tauzin felt confident that he had a rock-solid commitment that went all the way to the top of the White House, he wouldn’t have gone to the Times. He would have made that phone call to Rahm Emanuel. Or perhaps, he did make the call, and the conversation didn’t go as well as he hoped.

What’s certain is that talking to the Times w
as either a terribly stupid or a very desperate move. Tauzin put the White House in a totally untenable position. Whether or not Baucus and/or someone in the administration had made a quid-pro-quo promise—once the story broke, the administration had no choice but to deny the deal.

Thanks to Tauzin’s Loose Lips, Drug Discounts Are More Likely

Now everyone is going to watch that last-minute amendment to the House bill very carefully. If the lines that authorize Medicare to negotiate suddenly disappear from the legislation, stories headlined “Democrats for Sale” will surface once again.

I suspect that Medicare is now one giant step closer to actually winning the right to haggle, just like every other big purchaser in virtually every other developed nation.

Sunday, the New York Times announced that Phrama is going ahead with its August advertising blitz, supporting reform. Once Tauzin took his foot out of his mouth, he probably realized what others in Pharma have said: reform will bring the drug industry millions of new customers who, in the past, could not afford to see doctors or fill prescriptions. Even if prices are lower, revenues and profits will grow on volume alone.

Medicare Can Bring Drug Prices Down

And if a dismal scientist from the Congressional Budget Office (CBO) tries to tell you that Medicare’s bureaucrats will never be able to score significant discounts, I would suggest that he take a look at the bargains that the Veteran’s Administration (VA) has secured. On average, the VA pays 58 percent less than Medicare for prescription drugs.

“But, but,” skeptics sputter—to be able to bargain with Phrama Medicare would have to be willing to say that it won’t include some drugs in its “formulary” (a continually updated list of preferred medications, representing the judgment of physicians, pharmacists and other experts.)

That’s exactly right. The Veterans Administration has a formulary—a list of drugs that it is has approved for its patients. The Mayo Clinic has a formulary. Why shouldn’t Medicare have a formulary?
 Formularies protect patients. When Mayo saw that Vioxx was no more effective than other pain-killers for most patients—(and recognized that because doctors knew less about the new drug, it might well be riskier) Mayo stopped giving it to most patients—as did the VA. They both acted more than a year before the manufacturer was forced to pull it product from the market.  This is how an efficient medical system creates a formulary that puts patients first.

And this, in the end, is the goal of the Comparative Effectiveness Research funded by the administration’s fiscal stimulus package. Unbiased physicians and medical researchers will sift through head-to-head comparisons of various treatments, and assess which work best for patients who fit a particular medical profile.

 If a new drug isn’t any better than existing medications, why include it in Medicare’s formulary? (If it is better, it would be included, even if it’s more expensive. Though Medicare might well balk at paying 500% more for an arthritis drug that is only 5% more effective than existing treatments. At that point, the negotiations would begin.)

Consider another scenario: what if the new product is as good as older products? Medicare and a public sector insurer might well agree to include it in the formulary--if the manufacturer is willing to sell it for less. That’s what we call free market competition: one company makes a product, another comes along with a similar, equally effective treatment product, and offers it at a lower price. That’s how efficient markets keep quality high and prices down.

But someone has to have the power:  first to make a disinterested comparison of the two products, and secondly to say, “no we won’t pay that much.” Cancer patients don’t have that clout. They can’t wait for a cheaper drug to come down the pike. Private insurers don’t fight for the deep discounts that the VA manages to secure. Insurers simply pass exorbitant prices on in the form of higher premiums and  co-pays. We need a large government insurer, like the VA, who can say:  “We represent millions of people. We are protecting their interests.”

In part 2 of this post I explain that progressive reformers need to use the month of August to make one point very clear to the public: We are ready to stand up to the lobbyists

23 thoughts on “What Was Billy Tauzin Thinking?

  1. Tauzin is a lying scoundral of monumental proportions.
    He embodies all that is wrong about sleazy politicians morphed into overpaid mega-lobbyists.
    If I were credible CEO’s of PhRMA(the few remaining)I would call for his removal from head of this trade association. He is an embarrassment.
    Having the likes of Billy Tauzin around does not help this beleaguered former miracle industry which has gone almost completely sour.
    It will take years for PhRMA to regain the trust of intelligent American citizens.
    Dr. Rick Lippin

  2. As we’ve discussed before, the VA formulary is very narrow compared to most commercial insurance formularies. The VA formulary, for example, does not pay for the very popular cholesterol lowering drug, Lipitor. I wonder how Medicare beneficiaries would react if Medicare suddenly stopped paying for Lipitor. The commercial insurers all use tiered formularies now which helped drive generic utilization to nearly 70% of all prescriptions. This is one area where the insurers have done a good job, I think. Indeed, for the last few years, drug costs increased at a far slower rate than hospital charges which continue to escalate far faster than general inflation.
    For most health insurers, their claims costs fall into three broad buckets as follows: 40% for hospital inpatient and outpatient charges, 40% for physician fees, PT, labs, rehab, etc., and 20% for drugs. For Medicare, hospital charges approach 50% of costs while drugs account for around 10%. The insurers are working as hard as anyone to mitigate cost growth. They are not happy to just pass on rising costs in higher premiums because they know there is a significant and growing problem with affordability for both employers and individuals.

  3. They can do what they did in the 90s Barry. Patients pay out of pocket if they want Lipitor.

  4. Barry Carol reports that the VA does not cover lipitor. He neglects to mention that is *does* offer less expensive drugs for cholesterol. There is no reason to believe that the more expensive version is better than the less expensive version. Just because people like the brand name doesn’t mean it’s necessary. More expensive does not equal better, it just means better marketing.

  5. I disagree alot of times with Maggie, but I can certainly agree that Medicare should have a formulary. They are the only plan without one, why should they be so priviledged. Common areas between the right and left we should be setting in stone. One example I think the right and left could agree on is direct incentives to patients. For example a graduated tax credit based on your BMI. Make it completely voluntary. If you have a BMI < 24 you get a 500 dollar tax credit and graduated up and down. People with lower BMIs, live longer, cost the system less and they either exercise or consume less. All good things. It would be much more efficient than trying to incentivise a physician to talk to a patient about weight loss.

  6. Sharon MD and jenga,
    I’m strongly in favor of drug formularies and tiered co-pays. The point I was trying to make in bringing up the VA not paying for Lipitor is that seniors tend to be a vocal, demanding and entitled group. They don’t like being told they can’t have something and they’re not enthusiastic about self-paying either. This is one reason why Congress is largely incapable of empowering CMS to control costs. It needs an organization like MedPAC, modeled after the Federal Reserve Board, to do the job for them, and it needs to be as independent of the political process as possible.
    As it happens, I’m a heart patient myself and I’ve been taking five heart related prescription drugs for years of which four are generics including Simvistatin, the generic version of Zocor. It works fine. According to Drugstore.com, a 90 day supply of a 40 mg dose of Simvistatin would cost a self-payer $75.97 vs. $359.97 for 90 days of 40 mg Lipitor. I don’t fault the VA at all for not covering it. On the commercial side, last year, UnitedHealth Group stopped paying for Nexium because Prilosec and its generic equivalent are far cheaper and comparably effective. More power to them.
    As for aligning incentives, which I also support, self-funded health plans like Safeway are able to offer employees discounts from their required health insurance premium if the don’t smoke or quit smoking, maintain a normal weight and achieve healthy levels for blood pressure and cholesterol. In their infinite wisdom, regulators don’t allow insurers to do the same. Go figure.
    Finally, I don’t think Medicare itself offers a prescription drug plan. The original legislation called for a trigger that would let Medicare offer a plan if the private sector effort proved inadequate. Since competition is keen in most markets, the public Part D plan hasn’t been deemed necessary.

  7. Barry—
    On Lipitor–see below. There is a generic.
    More generally, The notion that the VA’s formulary prevents Vets from getting valuable drugs is a lie that has been spread by somewhat hysterial far-right-wing think tanks that insist that government healthcare can never be any good.
    They also hate evidence-based medicine becuase the evidence often shows that the more expensive drug is no better for most–or all patients.
    All of the medical research on outcomes for VA patients–published in legitimate medical journals–show that they do not suffer from the formulary. VA patients do better than patietns covered by private-sector insurance and hosptials because care at the VA is evidence-based.
    The VA uses its database to see which drugs work and which drugs don’t work for particular patients.
    (During the Bush years, the VA was not getting enough funding, so there were long waiting lines for services–but that is a separate issue-and now the Obama administration is fudning them in a way that should solve the problem in most VA hospitals)
    As the debate on health care reform heats up, it becomes more and more obvious that these neo-con think tanks have absolutely no compunction about lying.
    You can see and hear their lies everywhere–on their websites, in TV ads, on talk radio.
    And they don’t give anyeone a chance to say “wait a minute–here’s the evidence.”
    Have you noticed their websites often don’t take comments?
    I was asked to “debate” someone from teh Heritage foundation on Polico.com.
    The idea was that I woudl submit a paper on the subject, he would submit a paper on the subjec,t and then we would rebut each other.
    But after I wrote my paper, Heritage announced “no rebuttals.”
    Guess they didn’t want me to use evidence to take his argument apart.
    As for Lipitor,
    Sharon points out, there are cheaper drugs that are just as good as Lipitor-and much less expensive.
    In fact there is a generic version of Lipitor. PFIZER
    But finally, the generic is here. And do you know what it is? Pfizer gives Lipitor to the Generic company, the company puts it in a new bottle with a new lable and sells it for 50% to 60% less.
    IT’s not just very similar to Lipitor. It is Lipitor. They can sell it for so much less because Pfizer has been gouging patients for all of these years.
    The generic company can sell it for so much less–even though they had to pay Pfizer $1.7 billion for the right to sell it at all.
    (This information is all from Business Week.)
    Finally, the VA doesn’t just prescribe drugs in its formularly. If the drugs in the formulary won’t work for a particular patient, the VA goes outside the formulary.
    The VA’s chief pharmacy officer , Michael Valentino, explains in a journal published by the American Society of Healht-System Pharmacists:
    “Valentino acknowledged that Pfizer’s atorvastatin drug, Lipitor, the most commonly prescribed drug for U.S. seniors, is not on VA’s national formulary.
    Instead, he said VA’s formulary includes simvastatin—a high-potency statin—generic lovastatin, and fluvastatin, which may be recommended for patients who also use potent inhibitors of cytochrome P-450 isoenzyme 3A4.
    But Valentino reiterated that VA patients can obtain nonformulary drugs.
    “We use evidence-based criteria for use for nonformulary drugs to make sure they’re available for people that need them,” he said. In the case of Lipitor, he said, VA pharmacies dispensed more than 700,000 30-day prescriptions last year.
    The notion that the VA promotes “one size fits all” medicine and only prescribes drugs in its formulary is another lie spread by those who hate the VA (beucase it is a government plan, gets such good outcomes, and such good discounts on drugs.)
    John Stossel cites “the Cato Insitute” as his source for saying:
    ” The cholesterol-lowering drug Lipitor, for example, isn’t on the VA’s list, even though it’s shown remarkable success at lowering the risk of heart attack and stroke. “.
    In other words, the department keeps a rein on costs by withholding drugs from veterans.
    ” When government controls prices, it must eventually ration supplies. Consumers suffer. When the product is medicine, the results could be catastrophic.”
    Guess Cato didn’t mention the 700,000 prescriptions for Lipitor that VA pharmacies dispensed last year.

  8. This was well done, Maggie! Good analysis, good economics, and good suggestions!
    It’s high time that Medicare gets the right to negotiate prices. And, I might add, “generic Lipitor” has been available in Canada for quite some time.

  9. I agree, but I also think that the process is suffering from too much secrecy and back room deals. That whole senate finance committee meeting in secret for so long and doing nothing is troubling. And the taking of campaign cash from the very people being regulated, that wont work. As a citizen they take my cash in the form of medicare tax and federal tax, isn’t that more important than campaign contributions??
    I think we need some Justice Department investigations and some headlines about crooked Pharma and Providers and Insurers ASAP to stem the tide.
    Isn’t their a bunch of investigations already in progress or recently quietly closed when there was good evidence of collusion or conspiracy or lies, and damned lies?
    I mean seriously, Rick Scott asking to be believed as a reformer??
    Way too much Political Correctness going on, lets see some real truth about the abuses.
    What ever happened to Sen. Grassley’s efforts to look into any and all healthcare abuses?
    Let’s get serious Justice action!

  10. I agree Barry that regulation should be dropped. There is no reason we shouldn’t be directly incentivizing people be healthy. It is much more efficient to go to the source, patients, and there is much less waste. They should pay less in premiums or be paid directly to do things such has keep their AICs low, BP controlled, BMIs < 25, neg drug test. That also seems to be one of the biggest problems with the public plan. If someone is 65, I can't fault paying for their healthcare. They've paid at least a portion in their entire lives and they can't help being old. If someone is young < 15 they've barely had time to make bad decision for themselves. But if someone is 40 a smoker and obese and wants in on a public plan, I should have the right to walk up to them and tell them "Drop the donut fatty, I'm paying for your bad decisions. If you have a right for me to pay for your healhtcare, then I have the right to tell you eat rice and water until your BMI is 25."

  11. I agree with incentivizing people to be healthy but we don’t get anywhere by ad hominems such as “fatty” especially after the revelations that fast-food chains have been putting the addictive 5th taste in their “food.” Many poor people live in areas with no access to fresh fruit and vegetables. I am so disgusted with Big PhRMA’s massive amounts of dollars spent lobbying, with their ghost-writing of “research” articles, with the amount of their drugs that don’t work or actually make things worse, I stay away from any of their products and focus on a plant-based whole foods way of nutrition, per Arnold Ehret’s mucus-less diet and T. Colin Campbell’s CHINA STUDY.

  12. Great post, Maggie. And I agree that the president never signed off on this quid pro quo. Because historically, reciprocity was a tacit expectation.
    Lobbyists influence decisions made by government lawmakers on behalf of the industry they are involved with in order to assure continued financial gain.
    The relationship between lobbyists and lawmakers is situational, yet symbiotic, historically.
    Lobbyists from corporate industries should not be allowed to attempt to influence my government’s lawmakers, as they do not represent me as a citizen.
    The lawmakers, however, are expected to represent me, and my best interests as a U.S. Citizen.
    With the for profit industries in our health care system, the U.S. should consider assessing the health systems that exist in every Western country.
    During these assessments, discover common elements in their system. Then we shall have our own based on these assessments.

  13. Dan:
    Let’s say that for-profit health insurers are abolished, in favor of a public health option?
    Wouldn’t the lobbyists still represent the health care industry that survived?
    Don Levit

  14. jenga —
    I don’t know how many times this has to be repeated, but people with high risk health habits actually cost LESS to insure over their lives than people who have good habits.
    So while a fat smoking alcoholic may cost more when he is in his 40’s and 50’s, he will die and cost less (or nothing) in his 70’s and 80’s than a slender non-smoker who exercises. Over time, all those cataract surgeries, prostate surgeries, joint surgeries, and age related cancers, as well as the eventual costs terminal illness death add up to more money caring for the people with good habits than for the “fatties.”
    Consequently, although people with poor habits will cost taxpayers more early in their lives, if they are covered by a program paid by taxes, the real pressure on the taxpayer comes from people with good habits who live to collect Medicare for decades.
    This does not mean that people should not engage in good habits. They should, but the reason is not financial but rather humanistic, related to the better lives they will lead into their 80’s and 90’s.
    Also, one more note on this topic. The US has now been passed by Germany, Finland, Greece, the Czech Republic, and several other countries in the rate of obesity, and those countries still spend less money and get better results on health care than we do. Other countries are gaining fast, as it were. Of course, we have been way better than most European countries on smoking and alcoholism for decades.
    Personal health habits are not a solution to the health care problem. The problem is with the health care system itself.

  15. Dr Rick, Gregory,Barry, Sharon, Jenga, Jegna, BArry, Dr. Cecile Pat S. (one response on obesity),
    Tor Dahl, Ed
    Rick– Yes, Tauzin ranks up there with Rick Scott. I don’t know how many credible CEOs of drugmakers there are out there–perhpas some of the smaller ones . . .
    Gregory– Thanks very much
    Barry– Your numbers on what percent of Medicare spending goes to drugs are wrong because you aren’t including drugs administreted in a hospital, doctors’ office or nursing home, and you are not including the devices that big Pharma now sells.
    In addition, the statement that for-profit insurers try to keep spending down is yet another lie spread by the industry and its
    See the chart I have run many times showing that
    spending by private insurers has been growing by 8% a year for the last ten years, while Medicare spending has been growing by “only” 5% a year.
    And Medicare covers a larger percentage of patients suffering from disases where spending has been growing fastest: Cancer (the cost of cancer drugs has been levitating) as well as Alzheimer’s and other chronic diseases associated with old age.
    Meanwhile, look at how health-care premiums have been sky-rocketing as insurers pass on these rising costs as fast as they can–without trying to contain them.
    Sharon– you’re absolutely right: more expensive usually just means more expensive marketing.
    Jenga– glad we agree about formularies– but I’m afriad many on the right wouldn’t agree (they are beholden to drug-companies who do not want Medicare to have the power to refuse to include their drugs.)
    Jenga, Barry, Dr. Cecile, Pat S.
    Pat S. is correct: obese people cost us less, as do smokers, for the reasons he cites.
    Cecile also makes the very good point that obese people are often poor people, and dont’ have access to fresh fruits, fish,safe places to exercise, etc.
    All of the studies show that even when obese patients cut way back on calories and excercise, under a doctor’s supervision, and are perfectly compliant–they may lose weight but they almost alway put it back on–even though they stay on the diet. People put on weight while eating 900 calories a day. (Google my name, “Fat” and Fredericks and you’ll find a post I wrote about a briliiant documentary on obesity directed by Fredericks.)
    Obesity is a very complex disease and it is all tied up with signals that your brain is sending to your stomach as well as genetics.
    Do you really think that most obese people want to be obsese in a society where cruel, crude people refer to them as “fatties”????
    AT this point, medical science help them–except with bariatric surgery, a very dangerous last resort.
    We do know that if they exercise, they will be healthier– even though they won’t look different– and so we should encourage dance classes for obese people, etc.
    But the idea of blaming them for being fat — charging them more for insurance, or giving discounts to people who are merely 20 pounds overweight and can lose weight — is simply blaming the victim for somethint that he cannot help.
    Stopping smoking is something else. We can help people stop smoking, and most can stay off cigarettes. But the work done by Dr. Steven Schroeder shows that the majority of adult in the U.S. who smoke are both poor and
    suffer from some form of mental illness. (Chronic depression, anxiety, schizoprhenia). They smoke to try to calm themselves or to lift their spirits.)
    This isn’t to say that we shouldn’t try to help them stop– Emphysema is a pretty terrible way to die–but rather than blaming them, we should feel empathy for them.
    Tor Dahl– Thanks very much.
    And I’m not surprised generic Lipitor has been available in Canada for quite a while.
    I agree. Sometimes I think we won’t get true healthcare reform until we
    change the campaign finance laws.
    That will be very, very difficult to do.
    First we need to shorten our campaigns. Pooitical campaigns in the U.S. are much longer than in countries like the UK
    because so many people make so much money on campaign advertising.
    Just as we have turned healthcare in a Big Business we have turned electing a president into a Big Business.
    Presidential campaigns should last no longer than 3 months–start to finish.
    That woudl save a huge amount–there are only so many ads you can run in 3 months.
    And I think that most short TV ads should be prohibited– they really can’t provide meaningful information.
    Instead we should ahve televised debates with networks donating some of the time.
    We do need an investigation of what exactly has been going on with the Senate Finance Committee– and of lobbying in general.
    Alex Gibney, who made the film of Money-Driven Medicine, is now making a film about lobbyists. I’m really looking forward to it.
    Perhpas, over the next 4 years, we will get a new, more progressive and honest Congress. Then perhaps we could get new rules about lobbyists and campaign finance.

  16. Maggie’s point that health insurance reform will benefit the pharmaceutical industry by adding new customers underscores an ominous but often overlooked element of reform proposals. America’s healthcare costs are rising at unsustainable rates. Insurance reform will make healthcare access more equitable but it will accelerate the rush to disaster unless healthcare itself is reformed to reduce duplicate or unnecessary facilities, tests, procedures, or specialists driven by a fee for service paradigm that rewards excess. Drug costs are only a small part of the problem, which must be addressed in all its forms. The solutions will require comparative effectiveness analysis and guidelines, evidence-based medicine, bundling, and replacement of fee for service by a payment mechanism based on value rather than quantity. It is not only inadequate to reform insurance alone, but actually dangerous.
    Fred Moolten

  17. Fredmoolten–
    Luckily the Medicare Payment Advisory Commission (MedPac)has been thinking and writing about this for several years.
    White House Budget Director Peter Orszag is very famliar with MedPac’s reports and supports their
    recommendations. (this is why he and the White House want an independent panel, protected from Congress and lobbyists, overseeing Medicare and setting fees.)
    The House bill has an entire section on Medicare reform. It would give Medicre latitude to re-set fees with an eye toward lowering fees for procedures and tests that are marginally effective–at best. Co-pays also are likely to be hiked. Meanwhile, Medicare will lower-co-pays for effective care (the bill says no co-pays for primary care–and this includes private insurers) and raise fees for effective care (primary care docs fees up 5 to 10% plus bonuses for quality, plus loan-forgiveness and shcolarships for med students.)
    Medicare also will be using financial sticks and carrots to encourage hosptials to be more efficient. Eventually, Medcare will no longe rpay for care at hospitals that don’t meet benchmarks for quality adn efficiency –and those hospitals will close.
    And under the House bill, Medicare will be moving away from fee-for-service paymeyents.
    By the time the public sector plan is rolled out in 2013, we will have more proof that we can reduce waste.
    The 10 successful communitites that I write about in “Proof . ..”
    also illustrate that it can be done.

  18. In addition to the lifestyle choices, so called, that contribute to obesity, and other forms of self comforting in people who have few resources for other forms of exercise or relaxation, please remember that many prescription medications contribute to substantial weight gain, even when patients are careful about what they eat.
    Before we decide that incentives are the way to go, I’d like to see a breakdown of causes for obesity, including: social class and ethnicity, personal and employment stress levels, medication and diseases that cause weight gain, and other factors like access to healthy foods and time to prepare and eat them. At the bottom of the income ladder, all these factors are in short supply.
    Obesity is not a single, avoidable behavior like smoking, and always, attention to differences is kinder than deciding that people who are different deserve their misfortunes and flaws.
    We must continue to work on the prejudices wherever they appear in our thinking. No one deserves to be called a “fatty” regardless of their weight; this is just a new form of the n-word.

  19. Big Pharma prices would plummet if the FDA would allow harmless and safe non-toxic natural medicines and therapies that have been proven effective and safe to compete in the open market with patented drugs – especially for cancer. Read Daniel Haley’s book, the Politics of Healing (2000) to get the truth. The FDA is the Gestapo for Big Pharma. The FDA does not allow alternative natural medicine providers to publish or advertise information about the health benefits of their products. This is wrong. If anyone claims that US healhcare is not already socialized, then they don’t know the facts for how the FDA really works. On top of that, the FDA thinks it is above the law, defying even court orders to stop their heavy handedness.
    And then there’s all the studies paid for by drug companies. Case in point: Cholesterol lowering medications. If statins like Lipitor were so good at what they do, why have we not seen a significant reduction in heart disease since 1987 when Lipitor was introduced to the market and now is being given to those “at risk” as a preventive measure for life? I even had a Pfizer sales rep tell me that the only reason my doctor is recommending cholesterol lowering medications is because he is afraid of being sued. That is a telling line from a Big Pharma sales rep. These drugs cause more harm than good and we have the evidence that proves it. Statins reduce the enzyme CoQ10 which is required to boost your heart muscle and make it work properly. Also, between 30-40% of heart attack victims have LOW cholesterol. Why are we really taking this drug? It does reduce some inflammation and benefits patinets AFTER a heart attack, but it is very unnecessary and ill-advised as a preventive drug as it only reduces risk by maybe 5%. But it is the #1 selling drug in America. There are better ways to prevent heart attack because high cholesterol is not a ROOT CAUSE of CHD. There are a lot of root casues to long to list here. But the doctors have to comply with Official Medicine, else they will lose their license to practice. Finally, what’s wrong with a health system whereby 75% of medical schools do not require their doctors to take a single class on nutrition before they graduate? You’ve got to be kidding me. The US health system is rigged to perform drugs and surgery AFTER someone becomes sick, rather than preventing a problem from happening in the first place. And then doctors get rewarded for ordering as many tests as possible (because they have to in order to avoid being sued)and writing as many prescriptions as possible becasue they probably own stock in a Big Pharma company. What a conflict of interest.
    Hope some one listens to the real causes of high cost health care in the US, and I haven’t even mentioned medical errors and infections which kill up to 200,000 people per year and would be the 3rd leading cause of death if the CDC tracked it, but there’s no national system set up to do so.
    Oh and by the way, The Germans (and maybe others)don’t allow drug companies to advertise products on TV, radio, and the papers. It’s illegal. Hmmm. Let me see. US advertising increases demand whether a patient needs a drug or not. The price goes up because there’s no competition, thanks to the FDA. Insurance doesn’t argue about the price, they just pass it on. I couldn’t devise a better system myself for boosting the profits of the healthcare industry. It’s perfect! And now the government and taxpayers can pay for this system to stay in place to serve additional millions of uninsured Americans. Do you expect the cost to go down? Give me a break.
    Hugh Miller
    Houston, TX

  20. Hugh & Barbra–
    Welcome to HealthBeat and thanks for your comments.
    Hugh — You would probably
    be interested in these HealthBeat posts on “The Cholesterol Con” part 1– here http://www.healthbeatblog.org/2008/02/the-cholesterol.html
    and Part 2 here http://news2u-well.blogspot.com/2008/03/origins-of-cholesterol-con-by-maggie.html
    Regarding DTC drug advertising,
    New Zealand is the only other country in the world that allows it.
    Naomis will be publishing a post about DTC advertising soon.
    You wrote:
    “Obesity is not a single, avoidable behavior like smoking, and always, attention to differences is kinder than deciding that people who are different deserve their misfortunes and flaws.
    “We must continue to work on the prejudices wherever they appear in our thinking. No one deserves to be called a “fatty” regardless of their weight; this is just a new form of the n-word.”
    I agree completely.
    Neurologiste also are just beginning to get a fix on how the brain is communicating with the body, a major factor in obestiy.
    This is probably part of the genetic component.
    This is not something that obese people can control, But hopefully, one day, doctors will be able to help them manage a disease that causes so much suffering–psychological as well as physical.