Kaiser Daily Health Policy Report
Dorgan Seeks To Include Amendments in Prescription Drug User Fee Reauthorization Legislation
VA Should Institute Better Claims Process for PTSD, Study Finds
Florida Medicaid Reform Pilot Program 'Appears To Be Reducing' Number of Participating Physicians, Study Finds
CDC Requires $1B in Additional Funds in FY 2008, Gerberding Writes in Report to Lawmakers
FDA Documents Question Safety of Anemia Medications in Advance of Meeting
Purdue Pharma Agrees to $19.5M Settlement With States Over Allegations of Illegal Marketing of OxyContin
Minnesota Legislature Approves Two-Year Budget That Includes $10B in Health Provisions
The Latest Reports in Health Policy
KaiserEDU.org Announces Essay Contest Winners; JAMA Perspective Outlines Influenza Pandemic Possibilities; Report Examines Baby Boomers' Effect on Health Care
Medicare Trustees Report Indicates Need for 'Major Overhaul,' Op-Ed States
Strategy of Democrats on Health Care a 'Loser,' According to Opinion Piece
Capitol Hill Watch
Hearing Addresses Concerns About Oversight of Medicare Prescription Drug Benefit, Including Identification of Beneficiaries Qualifying for Subsidies
[May 09, 2007]
Lawmakers at a Senate Finance Committee hearing on Tuesday criticized CMS for the agency's oversight of Medicare's prescription drug benefit and for its efforts to protect seniors from administrative problems and aggressive sales tactics, Dow Jones reports (Mantell, Dow Jones, 5/8). Problems discussed at the hearing included complaints about the 1-800-MEDICARE information hot line and payment issues between health plans and pharmacists (Carey, CQ HealthBeat, 5/8). Other pharmacy concerns discussed included low reimbursement levels and lack of pricing transparency, which can be more pronounced in rural settings and in settings with large populations of low-income or uninsured patients (Dow Jones, 5/8).
Tuesday's hearing coincided with the release of two Government Accountability Office reports, one of which found that Medicare paid prescription drug plans $100 million in 2006 for retroactive reimbursements for dual eligible beneficiaries that were never distributed. The second report found that 4.7 million Medicare beneficiaries are eligible but not enrolled in the program's low-income subsidy (CQ HealthBeat, 5/8).
Witnesses at the hearing said that the Social Security Administration could identify greater numbers of Medicare beneficiaries who qualify for the subsidy if it were able to work with the Internal Revenue Service. Barbara Bovbjerg, GAO's director of education, workforce and income security issues, said SSA could identify potential participants from a pool of 19 million from 1099 tax forms. However, current law prohibits the IRS from sharing information from tax forms unless an individual has submitted an application for the subsidy (CongressDaily, 5/9).
 The GAO report addressing dual eligible beneficiaries is available online. In addition, GAO testimony from the hearing is available online. Note: You must have Adobe Acrobat Reader to view the documents. Comments
Beatrice Disman, chair of SSA's Medicare Planning and Implementation Task Force, and Abby Block, director of the Center for Beneficiary Choices with CMS, said their agencies are working to resolve issues with the program and asked senators to send specific complaints to the agencies (CQ HealthBeat, 5/8). Block said it is too early to discuss legislative solutions to problems with the drug benefit, adding that the agencies would "like a little more time to see how things work and to determine what is working well." She added, "We have zero tolerance for ripping seniors off. I am as concerned and disturbed as you are by some of the allegations."
Senate Finance Committee Chair Max Baucus (D-Mont.) said, "I just don't get the feeling that CMS is rigorously protecting seniors. Frankly, there is a very deep sense that CMS is not sufficiently scrutinizing private plans." Committee ranking member Chuck Grassley (R-Iowa) said that "there are some persistent problems that should have been fixed by now," noting that he is particularly concerned about issues with pharmacies (Dow Jones, 5/8).
 C-SPAN on Tuesday broadcast the hearing. Video of the hearing is available online.
Dorgan Seeks To Include Amendments in Prescription Drug User Fee Reauthorization Legislation
[May 09, 2007]
Sen. Byron Dorgan (D-N.D.) has requested the inclusion of three amendments he proposed Tuesday in a manager's package of amendments for a bill (S 1082) that would reauthorize the Prescription Drug User Fee Act, CongressDaily reports. According to CongressDaily, two of the amendments, which Dorgan proposed "after being handed a defeat" on prescription drug reimportation, "appear to be tongue-in-cheek rebukes to importation foes, including the pharmaceutical industry" (Edney, CongressDaily, 5/9).
The Senate on Monday by voice vote approved an amendment proposed by Dorgan and Sen. Olympia Snowe (R-Maine) that would allow reimportation. However, before the vote, the Senate voted 49-40 to approve a second-degree amendment proposed by Sen. Thad Cochran (R-Miss.) that would not allow reimportation until the HHS secretary certifies the practice would "pose no additional risk to the public's health and safety" and would significantly reduce costs for consumers. The approval of the Cochran amendment effectively nullified the Dorgan amendment because HHS secretaries in the current and previous administrations have refused to certify the safety of reimportation (Kaiser Daily Health Policy Report, 5/8). Three Amendments
One of the three amendments Dorgan proposed on Tuesday would require HHS to certify the safety of medications sold in the U.S., "essentially applying the Cochran amendment to domestic prescription drugs," CongressDaily reports. Dorgan spokesperson Barry Piatt said the amendment "would force the issue that they're asking the impossible" with the Cochran amendment.
A second Dorgan amendment would require medications to include labels that indicate the nation where they were manufactured. Piatt said that the amendment is a response to reimportation opponents who question the safety of the practice, although pharmaceutical companies currently sell medications in the U.S. that were manufactured at facilities in other nations.
A third Dorgan amendment would require the placement of tracking devices on medications to prevent counterfeiting (CongressDaily, 5/9). The Senate this week will continue to finalize the manager's package of amendments to the reauthorization bill and determine which amendments will receive votes (CongressDaily, 5/8).
VA Should Institute Better Claims Process for PTSD, Study Finds
[May 09, 2007]
A combined panel from the Institute of Medicine and the National Research Council released a report on Tuesday stating that the Department of Veterans Affairs needs to revise its standards for evaluating post-traumatic stress disorder, the San Diego Union-Tribune reports (Rogers, San Diego Union-Tribune, 5/9). The report found that the VA uses insufficient criteria for rating disabilities due to mental illness and is not consistent in applying standards for relapsing conditions.
PTSD claims increased from 120,265 in 1999 to 215,871 in 2004, and payments increased from $1.72 billion to $4.28 billion during the same period. The panel suggested that VA develop new standards for evaluating PTSD based on those set by the American Psychiatric Association. The panel also recommended that VA establish certification programs for workers who handle PTSD claims. In addition, the panel said VA should base PTSD awards on how greatly the disorder affects all aspects of a veteran's life, not just his or her ability to gain employment (Schmid, AP/Dayton Daily News, 5/8). The panel also noted that female veterans are less likely to receive compensation for PTSD, in part because of the difficulty in some cases of proving that the sexual assault and harassment that caused the condition took place during military service (Adams, McClatchy/Philadelphia Inquirer, 5/9).
Nancy Andreasen, chair of the committee that released the report and head of the psychiatry department at University of Iowa's Carver College of Medicine, said, "As the increasing number of claims to the VA shows, PTSD has become a very significant public health problem. Comprehensive revision is needed" (San Diego Union-Tribune, 5/9). VA press secretary Matt Burns said, "VA is studying the findings, conclusions and recommendations of the report to determine actions that can be taken to further enhance the services we provide." He added, "VA is a recognized leader in the diagnosis and treatment of PTSD, and we will continue to take steps to ensure veterans have timely and seamless access to compensation for which they are eligible" (AP/Dayton Daily News, 5/8). Dave Gorman, executive director for Disabled American Veterans, said, "It's a step forward. It insists on training and accountability and more thorough examinations -- a lot of the things we've been seeking for a long time" (San Diego Union-Tribune, 5/9).
A summary of the report is available online. Military Health Records System
Pentagon and VA officials in testimony before the House Veterans Affairs Subcommittee on Oversight and Investigations on Tuesday said that implementing a shared electronic health records system between the agencies might take years, the Arizona Daily Star reports. Stephen Jones, assistant defense secretary for health affairs, and Gerald Cross, the VA's acting principal deputy undersecretary for health, testified before the committee that the two agencies had just begun to take action on recommendations made by a presidential task force led by VA Secretary Jim Nicholson last month.
Jones and Cross said that an EHR system within the Pentagon might not be complete until 2012. In addition, they declined to say whether a joint fully operating EHR system could be in place within five years (Arizona Daily Star, 5/9). Additional VA Action
Nicholson during a tour of a VA hospital in Missouri on Tuesday announced the formation of a national advisory commission designed to boost care for younger veterans, the St. Louis Post-Dispatch reports. The 17-member advisory commission will be composed of veterans from the first Gulf War and veterans from the wars in Iraq and Afghanistan, in addition to members of their families (O'Neil, St. Louis Post-Dispatch, 5/9). Congressional Action
The House Armed Services Readiness Subcommittee by voice vote on Tuesday authorized a funding increase for military readiness and training, including improvements to Walter Reed under its portion of the 2008 defense authorization bill (HR 1585), CQ Today reports. The subcommittee authorized an unspecified amount of funding for modernization and revitalization of Walter Reed. The panel said the full committee first must decide whether to prohibit closure of the facility, which was ordered in 2005.
A ban on closing the facility was included in the fiscal year 2007 Iraq war supplemental bill (HR 1591) that Bush recently vetoed, along with funding to renovate the facility. It is "not clear whether the prohibition will be part of a revised war funding bill that appropriators are in the process of hammering out," CQ Today reports. The legislation is scheduled for markup on Wednesday by the full Armed Services Committee (CQ Today, 5/8). Further Action
Rep. Henry Waxman (D-Calif.) on Tuesday introduced legislation that would prohibit the sale or commercial development of any part of the West Los Angeles Veterans Affairs campus, the nation's largest VA medical center, the Los Angeles Times reports. Under the legislation, a 1988 ban on private development of 109 acres of the campus' property would be expanded to cover the site's entire 388-acre campus. Waxman previously had expressed concern that VA had leased portions of the campus to commercial vendors. The measure also would require VA to complete a 1998 congressional mandate that required that the agency create a master plan for the property in order to ensure veterans' future needs were met. The California Department of Veterans Affairs estimates that more than one million veterans live within 50 miles of the center, more than 42 other states combined. Broadcast Coverage
C-SPAN's "Washington Journal" on Tuesday included a discussion with Thomas Insel, director of the National Institute of Mental Health, about PTSD ("Washington Journal," C-SPAN, 5/8). Video of the segment is available online.
 In addition, NPR's "Talk of the Nation" on Tuesday in the first hour of the program included a discussion about traumatic brain injuries with Bob Woodruff, author and former co-anchor of ABC's "World News"; Rear Adm. Adam Robinson, commander of the National Naval Medical Center and chief of the Navy Medical Corps; Cmdr. Jim Dunne, commander of the trauma unit at the medical center; and Maria Mouratidis, head of the Traumatic Stress and Brain Injury Program at the medical center (Conan [1], "Talk of the Nation," NPR, 5/8). Audio of the segment is available online.
"Talk of the Nation" in the second hour of Tuesday's program included a discussion about advances in battlefield medicine with a military medic, surgeon, psychologist and nurse who served in Iraq (Conan [2], "Talk of the Nation," NPR, 5/8). Audio of the segment is available online.
Medicaid
Florida Medicaid Reform Pilot Program 'Appears To Be Reducing' Number of Participating Physicians, Study Finds
[May 09, 2007]
A Medicaid pilot program in two Florida counties "appears to be reducing" the number of physicians who accept beneficiaries there, according to a study released on Tuesday by the Georgetown University Health Policy Institute, the Miami Herald reports (Dorschner, Miami Herald, 5/9). Former Florida Gov. Jeb Bush (R) in December 2005 signed into law legislation that created a pilot program to shift some of the state's Medicaid beneficiaries to managed care plans and cap spending growth on the program at 8% for the next five years. Under the new system, the state pays HMOs higher rates for treating sicker beneficiaries than for treating healthy beneficiaries. The plan began July 1 in Duval and Broward counties (Kaiser Daily Health Policy Report, 1/31/06).
Of 186 doctors in the two counties who responded to a Georgetown survey, more than 25% who had participated in the Medicaid program before the new plan was implemented said that they no longer would participate. Fifty-one percent of doctors said that the new program's restrictions and requirements made it more difficult to provide medically necessary services to children, according to the study (Miami Herald, 5/9).
Two-thirds of physicians dropping out of the program are specialists, the study found. In addition, nearly 40% of doctors who accept Medicaid beneficiaries have continued treating half or fewer of their patients since the program changed. A significant number of physicians also said that under the new system, paperwork has increased and reimbursement for services has declined or stayed the same, CQ HealthBeat reports (Adams, CQ HealthBeat, 5/8).
Researchers noted that only 8% of doctors responded to the survey, so the findings "should not be considered generalizable to the entire membership of these organizations." Meanwhile, four focus groups each comprising about 10 beneficiaries led the researchers to conclude that fewer than 50% of beneficiaries had spoken to "choice counselors" intended to help them understand their health care options (Miami Herald, 5/9). Reaction
Joan Alker, lead investigator of the study and a senior researcher at Georgetown, said, "There are a lot of warning signs ... with respect to ... some of the experiences beneficiaries are having, and there's concern about providers leaving the program, which could very significantly affect access to needed care." She added, "The study raises a lot of really important questions that need to be ... addressed before the pilots continue any further."
Florida Agency for Health Care Administration officials in a statement said, "As with all studies based on focus groups and surveys, the information is a snapshot of a specific audience at a specific time. We do not agree with all the findings and have asked the university for their data so we can better understand their analysis and conclusions" (Karkaria, Florida Times-Union, 5/9). A CMS spokesperson said that the agency needed more time to review the study (CQ HealthBeat, 5/8).
The study is available online.
Administration News
CDC Requires $1B in Additional Funds in FY 2008, Gerberding Writes in Report to Lawmakers
[May 09, 2007]
CDC, which faces budget reductions in fiscal year 2008, requires a $1 billion increase in funds to operate effectively, according to a 10-page report that agency Director Julie Gerberding recently submitted to lawmakers at the request of the House Appropriations Committee, Cox/Atlanta Journal-Constitution reports. President Bush in his FY 2008 budget has proposed to reduce the CDC budget by about $500 million from $9.2 billion in FY 2007.
In the report, Gerberding wrote that CDC requires almost $400 million in additional funds to address infectious diseases, more than $100 million for health promotion campaigns, $80 million for bioterrorism preparedness and more than $65 million for global health programs. Gerberding wrote, "Terrorism, infectious disease outbreaks and pandemics and natural disasters that affect a greater number of Americans and people around the globe are the likely outcomes for which CDC and its partners must prepare." She added, "The growing babble of junk science, unsubstantiated opinion and distracting debate that occupies an increasing proportion of cyberspace makes CDC's highly trusted role in distinguishing credible health information all the more critical." Gerberding submitted the report, which the Campaign for Public Health made public, to committee Chair David Obey (D-Wis.) on April 20 (Nesmith, Cox/Atlanta Journal-Constitution, 5/9).
Prescription Drugs
FDA Documents Question Safety of Anemia Medications in Advance of Meeting
[May 09, 2007]
FDA on Tuesday posted documents on its Web site questioning the safety of higher doses of anemia drugs manufactured by Amgen and Johnson & Johnson that are used by chemotherapy and kidney failure patients, the Wall Street Journal reports. FDA released the documents in advance of an advisory panel meeting scheduled for Thursday that will consider whether the labels for Amgen's Aranesp and Epogen and J&J's Procrit require new warnings for cancer patients (Loftus, Wall Street Journal, 5/9).
FDA in March issued a black box warning for the drugs -- known collectively as erythropoietin drugs -- to warn doctors that they should use only the lowest dose necessary to avoid the need for blood transfusions. FDA's warning pertains to the use of EPO drugs to raise anemia patients' hemoglobin levels to more than 12 grams per deciliter of blood, the lowest hemoglobin level considered non-anemic (Kaiser Daily Health Policy Report, 3/15).
FDA in the documents released on Tuesday said, "Further modifications to product labeling may be appropriate to minimize risks to patients, through restrictions of the indicated patient population or further limitations on dosing to achieve the minimal hemoglobin level necessary to avoid transfusions." FDA said clinical studies have shown EPO drugs prescribed in certain ways to cancer patients can increase the risk of death, cardiovascular disease and tumor growth. Five randomized clinical trials demonstrated that cancer patients who received EPO drugs had decreased survival times compared with patients who received blood transfusions, FDA said.
Moreover, three randomized clinical trials found that tumor outcomes for patients taking EPO drugs were inferior to the outcomes of patients who received transfusions, according to FDA. Most of the studies targeted higher-than-recommended hemoglobin levels, FDA said. Reaction
Amgen in documents submitted to FDA in advance of Thursday's meeting said that the findings of studies assuming a "negative impact on tumor progression and survival in cancer patients" were "questionable" (Wall Street Journal, 5/9). Eric Schmidt, an analyst at Cowen & Co., said, "There are more questions than answers right now. But if I'm reading the tea leaves, I would say the companies shouldn't be waiting for positive news." Schmidt added that EPO drug sales are predicted to fall by about 20% this year and that additional restrictions might reduce sales by an additional 20% (Costello, Los Angeles Times, 5/9). Physician Payments
The New York Times on Wednesday examined how Amgen and J&J pay "hundreds of millions of dollars to doctors every year" to treat patients with EPO drugs. Federal law prohibits pharmaceutical companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients at pharmacies, but companies can rebate part of the price to doctors who purchase treatments that are administered in their offices. Anemia drugs are injected or delivered intravenously in doctors' offices or dialysis centers. Physicians receive rebates after they buy the drugs from the companies. Rebates generally are higher for physicians who agree to use one company's EPO drugs exclusively. Doctors also receive reimbursements from Medicare or private insurance companies for the drugs, often at a markup more than the purchase price.
Neither Amgen nor J&J has disclosed the total sum of their payments to physicians, but the Times was given documents showing that one medical practice in the Pacific Northwest employing six cancer physicians received $2.7 million from Amgen in 2006 for administering $9 million worth of its EPO drugs. According to the Times, "very few people outside of the doctors who receive them are aware" of the size of the payments, and some cancer and kidney doctors argue that the payments "give physicians an incentive to prescribe the medicines at levels that might increase patients' risks of heart attacks or strokes."
Dialysis patients in the U.S. receive doses of EPO drugs more than twice as high as patients in Europe. U.S. cancer patients are three times as likely as European patients to receive the drugs, which they receive at somewhat higher doses. Ajay Singh -- an associate professor at Harvard Medical School who led a clinical trial that reported last year that the drugs might be unsafe in kidney patients at commonly prescribed doses -- said that the companies have a "burden of proof" to show that the drugs are safe at prescribed levels. Amgen and J&J said that rebates are a normal component of market competition (Berenson/Pollack, New York Times, 5/9).
Purdue Pharma Agrees to $19.5M Settlement With States Over Allegations of Illegal Marketing of OxyContin
[May 09, 2007]
Purdue Pharma has agreed to pay $19.5 million to 26 states and Washington, D.C., to settle claims that the company promoted its painkiller OxyContin for off-label uses, the company announced on Tuesday, the Wall Street Journal reports (Wall Street Journal, 5/9). According to Connecticut Attorney General Richard Blumenthal and state Consumer Protection Commissioner Jerry Farrell, Purdue also allegedly violated FDA rules by promoting OxyContin for use every eight hours, rather than the approved dosage of every 12 hours (Hathaway, Hartford Courant, 5/9).
The states allege that Purdue violated FDA rules by promoting the drug as the painkiller "to start with and the one to stay with" for a variety of pain, including from surgery and broken bones, even though the drug was approved by FDA for limited use in people who need long-term pain management. In addition, the states allege that Purdue tied the pay of its sales representatives to how much OxyContin doctors prescribed, while playing down the addictive properties of the drug (Jadhav, St. Louis Post-Dispatch, 5/9). The cumulative effect of such practices has led to "misuse, diversion and abuse" of OxyContin by increasing the amount of the drug in circulation, according to Blumenthal.
Purdue denied the allegations of the lawsuit (Hartford Courant, 5/9). According to a statement from the company, OxyContin prescribing information "has always included clear warnings and precautions about abuse potential, addiction and other potentially adverse effects" (Bowman, Richmond Times-Dispatch, 5/9). The company added, "It has always been Purdue's written policy that promotion of its products must adhere to FDA-approved prescribing information for those products as well as applicable laws" (Eaton-Robb, AP/Greensboro News & Record, 5/8). Settlement
Under the settlement, Purdue must halt off-label marketing practices, follow the warning label on its packaging and maintain an internal abuse-diversion detection program (Wall Street Journal, 5/9). The abuse-diversion detection program will include additional training for sales representatives on active monitoring of physicians' prescribing habits to prevent overprescribing (St. Louis Post-Dispatch, 5/9).
Each state can spend its portion of the settlement as it deems appropriate, which could include consumer protection, education and outreach programs, litigation, attorneys' fee or other uses, according to a statement from the Washington state Office of the Attorney General. The settlements do not establish a consumer refund program (Spokane Spokesman-Review, 5/9). North Carolina Attorney General Roy Cooper said, "Some medicines can do more harm than good when used the wrong way. Drug makers need to give doctors and patients accurate information about their drugs or expect to face the consequences" (AP/Greensboro News & Record, 5/8).
State Watch
Minnesota Legislature Approves Two-Year Budget That Includes $10B in Health Provisions
[May 09, 2007]
Minnesota state legislators in both chambers on Monday voted to approve a two-year $10 billion health and human services bill, but it could face a veto by Gov. Tim Pawlenty (R), the Minneapolis Star Tribune reports (Draper, Minneapolis Star Tribune, 5/7). Health provisions, which would account for more than a quarter of the state budget, would:
- Expand insurance coverage to 72,000 uninsured state residents -- including 30,000 to 40,000 children -- by 2011 through a variety of state health program reforms, including higher income eligibility limits and a shorter application;
- Allow military families to enroll in MinnesotaCare without premiums for one year;
- Fund an outreach campaign to encourage qualified residents to enroll in public health programs and offer incentives to beneficiaries who follow medical advice for chronic conditions, such as diabetes and heart disease;
- Create a health care access commission to develop a proposal for statewide universal health care; and
- Institute the health insurance exchange proposed by Pawlenty to allow state residents to purchase insurance tax free (AP/St. Paul Pioneer Press, 5/7).
The bill also provides funding for mental health services and pay increases for workers in nursing homes and other long-term care facilities, among other programs. According to the St. Paul Pioneer Press, the budget proposed by lawmakers would increase health coverage access for employees of small businesses, farmers, Medicare beneficiaries and childless adults (Stassen-Berger, St. Paul Pioneer Press, 5/7). Pawlenty is expected to veto the budget because of concerns that it would cause "a serious undoing of welfare reform" and because the bill is in "an entire different fiscal galaxy than the governor recommended," according to Pawlenty's spokesperson Brian McClung. According to Senate figures, the budget provides about $170 million more than Pawlenty's proposed budget. However, the governor's office said the legislation provides about $275 million more than Pawlenty recommended (Minneapolis Star Tribune, 5/7).
The Latest Reports in Health Policy
KaiserEDU.org Announces Essay Contest Winners; JAMA Perspective Outlines Influenza Pandemic Possibilities; Report Examines Baby Boomers' Effect on Health Care
[May 09, 2007]
- Essay Contest, KaiserEDU.org: KaiserEDU.org, , the Kaiser Family Foundation's website for students and faculty interested in health policy, announces five winners of its essay contest, in which graduate and undergraduate students were asked to propose a health care platform for a real or fictitious 2008 presidential candidate and a strategy for communicating that platform (KaiserEDU.org release, 5/8).
- "The Next Influenza Pandemic: Can It Be Predicted?" Journal of the American Medical Association: The perspective by Jeffery Taubenberger of the National Institute of Allergy and Infectious Diseases and colleagues examines the H5N1 avian influenza virus, its evolution and the possibility it will be transmissible between humans. The perspective also discusses what past pandemics have taught policymakers and possibilities for the next pandemic (Taubenberger et al., JAMA, 5/9).
- "When I'm 64: How Boomers Will Change Health Care," American Hospital Association: The report examines the effect baby boomers will have on the U.S. health care system when they turn 65 years old. The report discusses aspects of the health care system, such as chronic disease management, physician and nurse shortages, increased demand for services, new technology and care delivery (American Hospital Association release, 5/8).
Opinion
Medicare Trustees Report Indicates Need for 'Major Overhaul,' Op-Ed States
[May 09, 2007]
A report released last month by Medicare and Social Security trustees for the first time estimated that general revenue contributions will exceed 45% of total Medicare expenditures for two consecutive years, 2012 and 2013, and that "wake-up call" indicates "what is needed are not minor adjustments" but a "major overhaul" of the program, Thomas Saving, a public trustee and director of the Private Enterprise Research Center at Texas A&M University, writes in a Wall Street Journal opinion piece. According to Saving, "In general, no reform should be taken seriously unless it is specifically designed to slow the rate of growth of health care spending."
He writes, "On the demand side, someone must choose between health care and other uses of money," and, on "the supply side, the way health care is produced must fundamentally be changed, replacing cost-increasing innovations with cost-reducing ones." In addition, "we must still address the problem of pay-as-you-go financing" because currently, "every dollar in Medicare payroll taxes is immediately spent," rather than saved or invested, Saving writes.
"The alternative is to move to a funded system in which each generation saves and invests in order to pay for its own benefits," but "we need to act quickly" to "introduce reforms that capture the earning potential of the baby boom generation before they escape into retirement and leave the young with a burden that will be increasingly burdensome," according to Saving. He concludes, "If our policymakers wait to address the growing deficits until they are out of control, the solutions will be drastic and painful. Let us hope that the current wake-up call is not ignored" (Saving, Wall Street Journal, 5/9).
Strategy of Democrats on Health Care a 'Loser,' According to Opinion Piece
[May 09, 2007]
The Republican Party "might just be winning" the political "war" over health care, Wall Street Journal columnist Holman Jenkins writes. According to Jenkins, Medicare Advantage -- the system of private plans under Medicare, which is supported by Republicans -- is "thriving." And with the Medicare prescription drug benefit, Republicans "have usurped Democrats' role as Santa Clause to the middle class," Jenkins writes. He adds that the health insurance industry "increasingly looks to government to fill up their book of business," resulting in "a growing compatibility of interests between insurers and the senior lobby." Jenkins writes, "Even the universal access issue is slipping from Democratic grasp as Republican governors experiment with mandates requiring all citizens to have private insurance."
Jenkins says, "So far, the counterstrategy" to shift Medicare Advantage funds to SCHIP "has been pitiful." He concludes, "Republicans, however convoluted and spendthrift, have a strategy -- turning Medicare into a welfare program for poor seniors," adding that Democrats "have only a feckless hope that if they stall long enough, the problems will be so bad that the American people will vote for a universal government-run health system," a strategy that "is already a loser, however long the war drags on" (Jenkins, Wall Street Journal, 5/9).
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