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MEDICARE: House To Vote on Rx Price Negotiations Bill This Week
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House Democrats this week plan to seek passage of a bill (HR 4) that would require the HHS secretary to negotiate directly with pharmaceutical companies on prices for medications under the Medicare prescription drug benefit, the Miami Herald reports. The legislation, sponsored by House Ways and Means Committee Chair Charles Rangel (D-N.Y.) and Rep. John Dingell (D-Mich.), would require the HHS secretary to report to Congress on the progress of the negotiations every six months (Pugh, Miami Herald, 1/8). In addition, the bill would not allow the HHS secretary to establish a formulary under the Medicare prescription drug benefit to help negotiate lower prices for medications. The House likely will vote on the legislation on Friday, but the Senate "is expected to move more slowly," the Los Angeles Times reports (Alonso-Zaldivar, Los Angeles Times, 1/6). The Senate Finance Committee on Thursday plans to hold a hearing on the legislation. Meanwhile, Senate Majority Leader Harry Reid (D-Nev.) "has introduced a placeholder bill (S 3) that is intended only to show that Democrats want to 'provide for fair prescription drug prices for Medicare beneficiaries,'" CQ Today reports (Reichard, CQ Today, 1/5).
Some Criticism
Some critics maintain that the provision in the bill that would not allow the HHS secretary to establish a formulary would take "away a powerful lever commonly used in such pricing negotiations," the Los Angeles Times reports. Robert Laszewski, a consultant to health insurers and other health care companies, said, "If you don't have the power to bump a drug off the formulary, you have no negotiating clout. Any good capitalist will tell you that you can't negotiate with somebody unless there is the expectation that you may not purchase their product" (Los Angeles Times, 1/6). Alan Garber, director of the Center for Health Policy at Stanford University, said, "To obtain drugs at low prices, a purchaser must be able to say no to covering a particular drug" (Pear, New York Times, 1/7). An unnamed House Democratic leadership aide said that the provision is a "trade-off" because Democrats "felt we couldn't go as far" as the Department of Veterans Affairs, "where they actually take drugs off the formulary." AARP Federal Affairs Director David Certner said of the bill, which the group supports, "It takes one tool away, but that's not the whole story here." According to Certner, under the legislation the HHS secretary would have the ability to increase copayments for medications manufactured by pharmaceutical companies that do not agree to lower prices. Ron Pollack -- executive director of Families USA, which supports the bill -- said, "If that provision wasn't in there, the drug companies would probably be going nuts." He added that the provision "makes it politically palatable without harming the intent of giving the (administration) the obligation to bargain" (Los Angeles Times, 1/6).
Elimination of the 'Doughnut Hole'?
In related news, a number of experts have said that savings from the legislation would not eliminate the so-called "doughnut hole" coverage gap in the Medicare prescription drug benefit. The Congressional Budget Office has estimated that the elimination of the doughnut hole would cost $450 billion over 10 years but has not estimated savings from the bill. Brendan Daly, a spokesperson for House Speaker Nancy Pelosi (D-Calif.), said, "We're hoping to get some savings, obviously, from the price negotiation, and then we can try to use some of that to start to close the doughnut hole." Daly added, "I don't think we're going to have enough to close it entirely" (Lee, Washington Post, 1/7).
Mental Health Legislation
In other congressional news, lobbyists and supporters maintain that bills to expand access to mental health services might "stand a better chance of passing" in the 110th Congress, USA Today reports. Supporters seek to pass mental health parity legislation, which would require health insurers to provide the same level of coverage for treatment of mental illnesses as they offer for physical illnesses. Sen. Pete Domenici (R-N.M.), who has introduced three previous mental health parity bills, said, "Now our prospects are the best that they've ever been." According to USA Today, other mental health bills "on the radar" include legislation that would provide funds to help Hurricane Katrina survivors with mental illnesses and help states establish programs to allow children with serious mental illnesses to live with their families during treatment. In addition, legislation to reauthorize the SCHIP program could include improved mental health coverage for children, according to Andrew Sperling of the National Alliance on Mental Illness (Elias, USA Today, 1/8).
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MEDICARE: HHS Lowers 2007-2016 Rx Benefit Cost Estimates
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The Bush administration on Saturday said the projected federal cost of the Medicare prescription drug benefit from 2007 through 2016 is now $964 billion, a 10% decrease from a July 2006 estimate of $1.077 trillion, the New York Times reports. HHS Secretary Mike Leavitt said the lower estimate demonstrates that it is not necessary for Congress to pass legislation that would require the agency to negotiate with pharmaceutical companies under the drug benefit to lower prices. "Our new estimates provide clear evidence that consumer choice is working," Leavitt said, adding, "Government interference will result in fewer choices and less consumer satisfaction." Acting CMS Administrator Leslie Norwalk said drug costs have been increasing more slowly than expected, while enrollment in the drug benefit has been lower than expected because some beneficiaries have drug coverage from other sources (Pear, New York Times, 1/7).
Compliance Plans
In related news, 72 of the 79 antifraud "compliance plans" filed with CMS by insurers that sponsor Medicare prescription drug plans are missing required information, according to a recent report by HHS Inspector General Daniel Levinson, CQ HealthBeat reports. Under the 2003 Medicare law, insurers sponsoring PDPs are required to develop compliance plans that meet eight elements designed to reduce fraud. Many of the insurers that did not submit complete plans were missing elements that require the companies to develop internal monitoring and auditing procedures and to designate compliance officers and committees, the report found. The report said that those two elements are "essential" to successfully implementing an antifraud program. The report also found that many insurers' filings did not include details about how they would comply with the plans. Those details "are essential for ensuring that a compliance plan is actually functioning within an organization," according to the report. In addition, the report found that CMS to date "has not specifically audited PDP sponsors' compliance plans or fraud, waste and abuse programs to determine whether sponsors have addressed the eight elements established by regulation." CMS plans to begin routine audits of the plans beginning this year and will hold PDP sponsors accountable for meeting the requirements, the report said.
CMS Response, Recommendations
CMS in comments included in the report said that its managers have been conducting "routine compliance efforts" with PDP sponsors since the drug benefit began in 2006, CQ HealthBeat reports. Some sponsors might not have met the requirements because of the short timeframe for implementing many provisions of the 2003 Medicare law, CMS said. In addition, CMS said it might not have been possible for some sponsors to address all requirements by the time they were reviewed by OIG. However, OIG said in the report that PDP sponsors were informed of all requirements in a summary document issued in June 2005. That document should have provided sponsors with adequate time to address the requirements, OIG said. OIG recommended that CMS "encourage sponsors to provide sufficient detail" to demonstrate how they are implementing the plans. CMS also should ensure that sponsors meet all requirements for compliance plans, OIG said. CMS spokesperson Jeff Nelligan said, "We are reviewing the recommendations exceedingly closely" (Reichard, CQ HealthBeat, 1/5).
Letter to the Editor
"By their decisions on switching to lower-cost drug plans after Humana's huge premium hike, we shall see how much 'consumers' surplus' Medicare beneficiaries are willing to surrender to Humana," Uwe Reinhardt, a professor of political economy as Princeton University, writes in a letter to the editor of the Boston Globe in response to an article that examined increases in the price of Humana's Medicare prescription drug plans for 2007. Consumers' surplus "is what economist mean by the difference between the maximum price consumers would have been willing to pay for a thing and the price they actually have to pay," Reinhardt writes, adding, "For most buyers and most goods and services, the former price exceeds the latter." He continues, "Americans must realize that, in any market system, the supply side will always seek to minimize the consumers' surplus left on the table for consumers to enjoy. It is part of the suppliers' natural instinct to maximize their profits and must be judged perfectly fair under the ethics ruling the marketplace." Reinhardt concludes, "If Americans find that ethic unsuitable for health care, they question the suitability of the market approach for health care" (Reinhardt, Boston Globe, 1/8).
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SCIENCE: Failure To Pass Spending Bills Could Affect Research
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The failure of the 109th Congress to pass most fiscal year 2007 appropriations bills "has produced a crisis in science financing" that could result in the closure of large research facilities, delay studies and leave thousands of scientists without jobs, according to federal and private sector officials, the New York Times reports. Last year, Congress approved two of 11 FY 2007 appropriations bills and passed a continuing resolution to fund most federal agencies at FY 2006 levels until February 2007. According to the Times, with inflation, the "budgets translate into reductions of about 3% to 4% for most fields of science and engineering." Democrats last month said that they would seek a CR to fund most federal agencies at FY 2006 levels until the fall, rather than pass the FY 2007 appropriations bills. Scientists maintain that the delay in passage of the FY 2007 appropriations bills could affect a number of important studies. Raymond Orbach, undersecretary for science at the Department of Energy, in a recent statement said, "A yearlong continuing resolution takes away many of the opportunities for advancing science. We urge Congress to continue critical investments in America's scientific leadership." Michael Lubell, a senior official at the American Physical Society, said, "The message to young scientists and industry leaders, alike, will be, 'Look outside the U.S. if you want to succeed'" (Broad, New York Times, 1/7).
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FTC: Fines Marketers of Four Weight Loss Supplements $25M
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Marketers of four weight loss supplements on Thursday agreed to pay $25 million in fines and penalties to settle FTC charges that they falsely advertised the effects of their products, USA Today reports. Under the settlement, marketers of the supplements Trimspa, Xenadrine EFX, One-A-Day WeightSmart, and CortiSlim and CortiStress can continue to sell their products but cannot make unproven claims that they result in weight loss (Iwata, USA Today, 1/5). New Jersey-based RTC Research & Development will pay at least $8 million and as much as $12.8 million for its marketing of Xenadrine EFX, manufactured by New Jersey-based Nutraquest, formerly known as Cytodyne Technologies. A $12 million fine was levied to California-based Window Rock Health Laboratories, which markets CortiSlim (De La Cruz, AP/Philadelphia Inquirer, 1/5). Window Rock also marketed CortiStress, which the company falsely claimed would reduce the risk of cancer, heart disease and other ailments, FTC said (USA Today, 1/5). Goen Technologies, marketer of TrimSpa, will pay $1.5 million for not providing adequate scientific evidence to support claims that the drug results in rapid and substantial weight loss. New Jersey-based Bayer will pay a $3.2 million civil penalty for marketing its One-A-Day WeightSmart supplement with false claims that it increases metabolism. Tricia McKernan, spokesperson for the company, said, "It's a multivitamin. We don't market ourselves as a weight-loss product." Although the company refuted FTC's charges, it decided to settle the case out of court (AP/Philadelphia Inquirer, 1/5). FTC Chair Deborah Platt Majoras said the settlement with Bayer "is a wake-up call to any company that wants to push the envelope. Every claim they make they have to have the science to back it up" (Shin, Washington Post, 1/5). She added, "Testimonials from individuals are not a substitute for science. And that's what Americans need to understand" (Saitz, Newark Star-Ledger, 1/5).
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WAL-MART: Public Ad Campaign Will Highlight Employee Health Care
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Wal-Mart on Monday will launch a television advertising campaign to highlight its employee health insurance plan and "its record as an employer and corporate citizen," the AP/New York Times reports. The ads aim to counter criticism from union-supported groups that claim Wal-Mart pays low-wages and pushes employees into public health care programs, among other allegations. Wal-Mart last year also was the target of two unsuccessful efforts by lawmakers in Maryland and Chicago that would have required the company to spend a fixed percentage of payroll on workers' health insurance and raise wages, respectively. The Maryland law was overturned by a federal court. According to the AP/Times, union-funded groups also have "recruited national Democratic figures to back their calls for higher wages and better health care at Wal-Mart," including Illinois Sen. Barack Obama and 2008 presidential candidate John Edwards. One of the ads features positive facts about Wal-Mart's private insurance for its 1.3 million U.S. employees, such as an employee health plan that costs $23 per month. Wal-Mart spokesperson David Tovar said, "This campaign is part of a long-term effort to inform the public about the company's positive impact on communities, including some of our core values like affordable health care." The ads will be launched on national broadcast and cable stations as well as selected individual markets and run for an undetermined period of time. The AP/Times reports that the union-backed group WakeUpWalMart.com says the ad campaign shows that the company's bottom line is being damaged by a worsening public reputation (AP/New York Times, 1/7).
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CAREMARK Rx: Board Rejects Express Scripts Acquisition Offer
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The board of pharmacy benefit manager Caremark Rx on Sunday announced the rejection of an acquisition offer from PBM Express Scripts and plans to continue with a rival offer from CVS, Bloomberg/Tennessean reports (Bloomberg/Tennessean, 1/8). CVS in November 2006 made an offer to acquire Caremark for about $21.3 billion. Under the offer, which has received approval from the Federal Trade Commission, Caremark shareholders would receive 1.67 shares of CVS stock for each Caremark share. CVS shareholders would own 54.5% of the combined company --CVS/Caremark -- and Caremark shareholders would own 45.5%. Express Scripts in December 2006 made a rival offer to acquire Caremark for about $26 billion. Under the offer, Caremark shareholders would receive $29.25 in cash and 0.426 shares of Express Scripts stock for each Caremark share. Caremark shareholders would own about 57% of the combined company, and Express Scripts shareholders would own about 43% (American Health Line, 1/5). Caremark in a statement said that the Express Scripts offer raises antitrust issues and "does not constitute, and is not reasonably likely to lead to, a superior proposal." Caremark Chair Edwin Crawford said, "Our board gave careful consideration to Express Scripts' proposal. In the end, our conclusion was simple and straightforward: Express Scripts' proposal is not in the best interests of Caremark, its shareholders, customers and consumers." Crawford added that Caremark remains "fully committed" to the CVS offer (Reuters/New York Times, 1/8). However, according to Express Scripts, Caremark officials are "attempting to use antitrust as a red herring to distract stockholders" (Beckerman, Wall Street Journal, 1/8).
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BJ's: To Close 46 Store Pharmacies, Leave Business
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Officials for Massachusetts-based BJ's Wholesale Club on Thursday announced that the company will close 46 store pharmacies over the next two months and leave the business, the Boston Globe reports. BJ's, which has 171 stores in 16 states, entered the pharmacy business in 2002. BJ's officials said they decided to close the store pharmacies to focus on core business and online sales. According to the Globe, BJ's "was a late comer to the pharmacy market" and entered the business to "boost sales and woo consumers who would be willing to pay the club's annual membership fee for lifestyle drugs, like Viagra, that were 20% cheaper than at a typical drugstore." However, increased competition in the pharmacy business and a new Medicare policy that reduced reimbursement rates for pharmacies and that made payments less prompt led to problems for BJ's, Laura Miller, senior economist for the National Association of Chain Drug Stores, said. Interim BJ's CEO Herb Zarkin said that the company did not have an adequate number of store pharmacies in convenient locations to attract customers. "We haven't seen the (prescriptions) grow on a regular basis," he said, adding, "It just didn't make a lot of sense for us to keep on putting the investment in" (Abelson, Boston Globe, 1/5).
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CALIFORNIA: Insurers Deny Coverage Based on Occupation, Rx Use
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Some health insurers in California refuse to sell individual health insurance policies to people in high-risk occupations or to those who use certain prescription medications, according to the confidential underwriting guidelines of four health plans, the Los Angeles Times reports. The guidelines obtained by the Times -- for health insurers Blue Cross of California, Blue Shield of California, PacifiCare Health Systems and Health Net -- are used by health plan sales agents to determine coverage eligibility. According to the Times, all of the insurers except Blue Cross of California deny individual coverage based on occupation. All four insurers deny or limit coverage on the basis of prescription drug use. Such restrictions are legal in California, and the health insurers maintain that the restrictions are necessary to keep premiums down. According to Davis Olson, a spokesperson for Health Net, "This is something that has been actuarially determined to keep insurance affordable for a very, very broad range of people." However, some consumer advocates say the policies are too restrictive. The companies' guidelines feature detailed tables outlining whether to accept, accept with a premium surcharge or decline insurance applicants for a number of conditions, the severity of existing conditions and other factors, such as height and weight. In some cases, individuals are denied coverage because a drug they are using costs more than the premium an insurer charges for the coverage. Eight of the 20 top-selling prescription drugs in the U.S. -- including the No. 1 drug Lipitor, an anticholesterol medication -- are included on two of the health plans' lists. California lawmakers are considering ways to expand coverage to uninsured state residents, including a plan supported by California Gov. Arnold Schwarzenegger (R) to mandate health insurance coverage. Those familiar with the governor's plan say Schwarzenegger seems to understand that mandating coverage would not be feasible if insurers are able to deny coverage for all but the healthiest residents. In addition, Blue Shield of California officials have said they believe the underwriting process should be eliminated and all insurers in the state should share the risk (Girion, Los Angeles Times, 1/8).
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SOUTH FLORIDA: Area Hospital Employees Cannot Afford Housing
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South Florida hospitals and other employers, which have had "a difficult time hiring or retaining workers" because of the high cost of housing in the area, have begun to consider plans to provide affordable housing to attract employees, the Miami Herald reports. According to the Florida Association of Realtors, in November 2006, an average home cost $372,400 in Miami-Dade County and $362,000 in Broward County. Baptist Health South Florida, which operates five hospitals and is the largest private employer in the area, might begin to build or purchase affordable housing for employees. Baptist Health CEO Brian Keeley said, "People want out because they can't afford to live here. We need to do something." Keeley said that, without affordable housing for employees, Baptist Health will not have the ability to staff a new hospital scheduled to open in 2009 (Dorschner, Miami Herald, 1/5).
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CONFLICTS OF INTEREST: Hypertension Society To Address Issues
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The American Society of Hypertension has decided to include a panel discussion at its upcoming annual meeting about conflicts of interest related to financial ties between the drug industry and medical journals and societies, the Boston Globe reports. In December 2006, a panel discussion titled "Conflicts of Interest" was rejected from the ASH annual meeting agenda because ASH said the proposed panel -- which included only critics of drug companies' practices -- "lacked balance," the Globe reports. However, Melissa Levine, ASH's associate executive director, recently said the society is "committed to conducting a session on conflicts of interest," adding, "Over the next few weeks we will be working to finalize the session and confirm the speakers." ASH invited two industry advocates to join the panel, one of whom has confirmed that he accepted the invitation, according to the Globe. Three drug industry critics invited to the original panel also were asked again to participate. One of those invitees, Jerry Avorn -- a Harvard Medical School professor and physician at Brigham and Women's Hospital who is considering accepting his invitation -- said, "This seems like a very different panel than the one originally proposed." He added that two industry advocates "will be expressing views that are quite different from those that were originally envisioned." According to the Globe, many professional medical societies across the nation "are grappling with ethical questions about how much drug industry money their officers, authors and presenters should accept and whether those financial relationships taint scientific and clinical recommendations, reports and medical journals" (Rowland, Boston Globe, 1/5).
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COGNITIVE REHABILITATION: Not Covered by Many Health Insurers
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The Wall Street Journal on Monday examined how many brain injury patients who experience subsequent problems with memory, mental processing or behavior often do not receive cognitive rehabilitation because their health insurers do not cover the treatment. According to the Journal, cognitive rehabilitation seeks to "reteach injured parts of the brain how to perform basic functions, like organizing the day or tuning out distractions," through the use of card games and computer programs, as well as memory aides, such as stickers, timers, notebooks and handheld recorders. Preliminary studies indicate the effectiveness of cognitive rehabilitation, but research into the treatment remains limited because of a lack of funding by pharmaceutical companies. A committee established by NIH in 1998 to evaluate cognitive rehabilitation concluded that the "evidence supports the use of certain cognitive and behavioral rehabilitation strategies" as part of a structured plan. In addition, an analysis of 87 studies published in the Archives of Physical Medicine and Rehabilitation in 2006 found "substantial evidence to support cognitive rehabilitation for people with traumatic brain injury." However, many health insurers maintain that research to support the effectiveness of cognitive rehabilitation remains insufficient. In 2002, the BlueCross BlueShield Association Technology Evaluation Center said, "Available data are considered insufficient to make conclusions on whether cognitive rehabilitation results in beneficial health outcomes." WellPoint covers cognitive rehabilitation for patients involved in accidents but not for those who experience strokes. Thomas Watanabe, a professor of physical medicine and rehabilitation, said, "It's hard to demonstrate cognitive progress to the insurance company," adding, "If a patient starts out in a wheelchair and then starts walking with a cane, you can measure that progress" (Burton, Wall Street Journal, 1/8).
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THE UNINSURED: States Examining Ways To Expand Coverage
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USA Today on Monday examined states' "aggressive and potentially expensive attempt[s]" to expand health care coverage for uninsured residents. According to USA Today, "[g]overnors and state legislators in both parties and most states" have pledged to make health care a priority for upcoming legislative sessions, while Congress has "put health care lower on its agenda." States might find it easier to pass health care reform because state legislatures tend toward greater bipartisanship, "avoiding the deadlock between Democrats and Republicans in Congress," according to USA Today. In addition, states tend to have budget surpluses, flexible federal rules for Medicaid spending and successful reforms in other states to use as models -- all of which "make it easier to expand programs," USA Today reports. Many state health care plans feature proposals including expanded insurance to cover all children; tax incentives to businesses and individuals to increase money available for insurance coverage; medical insurance subsidies for small businesses; improved access to preventive care; and increased price competition for health-related costs. A few state proposals focus on universal health care for all state residents. Missouri Gov. Matt Blunt (R) said, "The states, as we've done on other issues such as welfare reform, are acting as the real innovators and making changes that will affect national policy" (Cauchon, USA Today, 1/8).
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AMNIOTIC FLUID: Stem Cells Appear To Offer Research Benefits, Study Says
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Stem cells derived from human amniotic fluid appear to offer many of the benefits of embryonic stem cells -- including the ability to grow into brain, muscle, bone and other tissues -- according to a study published online in the journal Nature Biotechnology, the Washington Post reports. For the study, researchers from the Institute for Regenerative Medicine at Wake Forest University and Children's Hospital Boston found that amniotic cells in the laboratory can grow into all of the major types of cells, dividing at the rate of once every 36 hours. Researchers coaxed amniotic fluid stem cells to develop into brain cells and injected them into the skulls of mice with diseased brains. The stem cells replaced the diseased areas and appeared to create new connections with surrounding healthy neurons, the researchers reported. Researchers also coaxed amniotic fluid stem cells to become bone cells and implanted them in a mouse. The study found the stem cells calcified and turned into dense, healthy bone. The researchers also coaxed amniotic fluid stem cells to develop into muscle, fat, blood vessel and liver cells. Stem cells extracted from amniotic fluid can be isolated starting at 10 weeks' gestation from fluid taken during tests performed to identify birth defects, according to the study. The stem cells, even after more than two years in the laboratory, did not show signs of aging or of having the potential to grow into tumors, the study found. Amniotic stem cells can be frozen for later use, the Post reports.
Reaction
According to the Post, amniotic fluid stem cells are "adding credence to an emerging consensus among experts that the popular distinction" between human embryonic stem cells and adult stem cells is "artificial" and that there is a "continuum of stem cell types" (Weiss, Washington Post, 1/8). Amniotic fluid stem cells are a "different kind of stem cell" that is "not as early as a human embryonic stem cell, and it's not as late as the adult stem cells," Anthony Atala, senior author of the study and director of the Institute for Regenerative Medicine at Wake Forest, said, adding, "So far, we've been successful with every cell type we've attempted to produce from these stem cells" (Kaplan, Los Angeles Times, 1/8). Atala said that if 100,000 women donated their amniotic stem cells to a cell bank, it would provide enough cells for "99% of the U.S. population with a perfect match for genetic transplantation" (Weise, USA Today, 1/8). He added that the stem cells can be found not only in amniotic fluid but also in the placenta, which is discarded after birth (Washington Post, 1/8). Richard Doerflinger, deputy director of the U.S. Conference of Catholic Bishops Secretariat for Pro-Life Activities, said that the study "is one in a line of studies showing very versatile stem cells can be obtained from a number of different products after live birth -- amniotic membrane, amniotic fluid, cord blood, placenta, even umbilical cord tissue," adding, "There is no reason why the amniotic fluid couldn't be obtained, raising no moral problem whatever" (Hall, San Francisco Chronicle, 11/8). Atala said it is unclear how many different cell types can be produced from amniotic stem cells, and researchers said that it will be several years before preliminary tests can be performed on patients, the AP/Houston Chronicle reports (Elias, AP/Houston Chronicle, 1/7). Amniotic fluid stem cells "can clearly generate a broad range of important cell types, but they may not do as many tricks as embryonic stem cells," Robert Lanza, head of scientific development for Advanced Cell Technology, said (Los Angeles Times, 1/8). The study is available online.
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ILLICIT DRUG USE: Rate Highest in San Francisco Area, Study Finds
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The San Francisco area has the highest percentage of regular illicit drug users among U.S. metropolitan areas, and the Houston area has the lowest percentage, according to a study recently released by the Substance Abuse and Mental Health Services Administration, USA Today reports. The study, based on data from the National Surveys on Drug Use and Health 2002-2005, found that almost 13% of San Francisco area residents reported use of illicit drugs -- such as marijuana, cocaine or heroin -- in the previous month, compared with a national average of 8.1%. According to the study, 9.6% of Seattle area residents, 9.5% of Detroit area residents, 9.1% of Philadelphia area residents and 8.5% of Boston area residents reported use of illicit drugs in the previous month. About 6.2% of Houston area residents and 6.5% of residents in the Washington, D.C.; Dallas; and Riverside-San Bernardino, Calif., areas reported use of illicit drugs in the previous month, the study found. The study also found that the Chicago and Houston areas have the highest percentage of residents who binge drink -- consume five or more alcoholic drinks on one occasion -- among U.S. metropolitan areas. About 25.7% of Chicago area residents and 25.6% of Houston area residents reported binge drinking in the previous month, compared with a national average of 22.7%, according to the study. Beverly Watts Davis, senior adviser for substance abuse prevention at SAMHSA, said local prevention groups should use the study to help focus their programs. She said, "If they can pinpoint what's going on where and why, it really helps them plan better to know where resources should be allocated" (Leinwand, USA Today, 1/8).
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DEMOCRATS: Editorials, Opinion Pieces Address Agenda
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Several newspapers recently published editorials and opinion pieces on health care issues included in the Democratic agenda for the 110th Congress. Summaries appear below.
Editorials
- Chicago Sun-Times: The Democratic agenda includes a number of "worthy items" -- such as legislation that would reduce restrictions on federal funding for embryonic stem cell research and require the HHS secretary to negotiate directly with pharmaceutical companies on prices for medications under the Medicare prescription drug benefit -- but whether those bills should "be at the top of the list" is questionable, a Sun-Times editorial states. The editorial states that President Bush likely would veto the stem cell research bill. In addition, the editorial questions the need "to have the federal government negotiate drug prices now, since most Medicare recipients say they are satisfied with the way the new Medicare drug plan works" (Chicago Sun-Times, 1/4).
- New York Times: Increasing federal funding for embryonic stem cell research, authorizing HHS to negotiate with pharmaceutical companies under the Medicare prescription drug benefit and other legislation included in the House Democratic leadership's agenda for the first 100 hours of the 110th Congress "are all commendable goals, ... [b]ut what is sorely lacking is the oft-invoked, more often abused ideal of bipartisanship -- despite the Democrats' campaign pledge to end the practice of relegating minority lawmakers to the legislative wilderness," a Times editorial states. The editorial concludes, "If Democratic candidates were smart enough during the campaign to realize that voters demand bipartisanship, they should be quick enough to try it from the start" (New York Times, 1/7).
Opinion Pieces
- Mike King, Atlanta Journal-Constitution: "Democrats and Republicans in the new Congress have widely divergent views about the best way to improve access to health insurance for adults," but they "should come together quickly and renew" the SCHIP program, editor Mike King writes in a Journal-Constitution opinion piece. "Without an infusion of money from the state or Congress, the program will have to cut eligibility or severely curtail the services covered by the plan" he writes, adding, "The cost of renewing the program is relatively small compared to what it will cost if these children return to the ranks of the uninsured" (King, Atlanta Journal-Constitution, 1/4).
- Yong Suh, Baltimore Sun: A bill proposed by Democrats that would require the HHS secretary to negotiate directly with pharmaceutical companies on prices for medications under the Medicare prescription drug benefit "not only could fail to deliver the Democrats' promise to close the 'doughnut hole'" but also could "stifle new drug discovery and harm multiple sectors of the economy," Suh, a former Marshall Scholar in biomedical research at Oxford University who is employed in the finance industry, writes in a Sun opinion piece. "The government would make a poor negotiator compared with private-sector pharmacy benefit managers that have negotiated drug prices for two decades," he writes, adding, "Medicare lacks the infrastructure, a working formulary of drugs, the experience and the management capabilities necessary to compete against PBMs in negotiating drug prices" (Suh, Baltimore Sun, 1/5).
- Grace-Marie Turner, Houston Chronicle: Democrats plan to "fix" the Medicare prescription drug benefit with a bill that would require the HHS secretary to negotiate directly with pharmaceutical companies on prices for medications under the program, despite a recent announcement by CMS that the program "came in significantly under budget, costing about 30% less than expected," Turner, president of the Galen Institute, writes in a Chronicle opinion piece. The Medicare prescription drug benefit is a "rare" federal program that is "both successful and under budget," she writes, adding, "Instead of trying to revamp it, Congress should apply the Part D model to other government programs" (Turner, Houston Chronicle, 1/4).
- Victor Fazio, Washington Post: A proposal by House Democrats that would reduce restrictions on federal funding for embryonic stem cell research "is the quintessential example" of how House Speaker Nancy Pelosi's (D-Calif.) agenda for the first 100 hours of the 110th Congress "is less about radical policy shifts than about bringing policy in line with what Democrats believe is common wisdom to Americans," former Rep. Fazio (D-Calif.), a senior adviser at Akin Gump, writes in a Post opinion piece. "Of course, no matter how carefully Pelosi has selected the issues for her first 100 hours, the legislation will not necessarily steamroll through Congress unquestioned," Fazio writes, adding that President Bush might once again veto legislation on stem cells. He adds, "[I]f the speaker can shepherd her initiatives through Congress, she will have established herself and her Democratic caucus as advocates for the middle class as well as the poor -- and her party as one that keeps its word" (Fazio, Washington Post, 1/7).
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MALPRACTICE: Creation of Specialized Health Courts Would Limit Costs
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An end to "[s]kyrocketing" health care costs cannot occur without "restoring reliability to the justice system" through the creation of specialized health care courts, Philip Howard, chair of the not-for-profit Common Good, writes in a Wall Street Journal opinion piece. Howard believes that one of the "largest drivers" of excessive health care costs is concern about "erratic jury decisions" in malpractice cases, which has "spawned a culture of fear, causing inefficiencies that infect every level of medicine." According to Howard, a recent Pennsylvania study found that more than 90% of physicians practice "defensive medicine" and order "procedures and tests that are not clinically indicated" -- costing tens of billions of dollars, according to some estimates. Howard writes that the solution is the creation of specialized health care courts, which will "restore reliability" to malpractice decisions and "foster confidence" among doctors when making medical decisions. Howard's proposed health care courts would have specially trained administrative judges who would be advised by neutral experts and would "make decisions and write opinions on standards of care." The courts would provide a standardized way of addressing malpractice claims, providing compensation to patients if the injury "should have been avoidable," he says. Under Howard's plan, injured patients would receive compensation for all of their medical bills as well as lost income, and compensation for pain and suffering would be determined by a preset schedule dependent on the type of injury. Howard writes that health care providers should not "go through the day looking over their shoulders instead of doing what they think is right." He concludes, "The only way to overcome this distrust, and all its debilitating errors and waste, is to create a special health court that is trustworthy" (Howard, Wall Street Journal, 1/6).
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