Democrats to use reconciliation to pass healthcare bill

[bascule]

And the majority of all medications perscribed do have a generic equivalent.

 

Source?

 

Which is a gratuitous assertion on your part as medications are still negotiated and purchased in bulk by numerous large and small pharmacies in the US.

 

Can you provide any good argument for why Medicare should be prevented for negotiating bulk discounts, besides making Big Pharma more money?

[Phi for All]

Medicare didn't have a drug benefit before the Medicare Pt D was created with the 2003 bill.

My mistake.

 

It's a matter of opinion, but I find it incredibly open to corruption to have the government negotiate directly with pharmaceutical companies while they also have regulator and oversight power on the same companies. The thought of giant deals being done as payback, without thought to cost or quality is not a new form of corruption in the Federal government.

That's a Slippery Slope argument. In actuality, the Veteran's Administration is allowed to negotiate in bulk and pays 58% less than Medicare does. No discernible corruption there.

 

Where I do suspect corruption is with the congressman who steered Medicare Part D through the House of Representatives. Republican Billy Tauzin retired from politics after the bill passed to take a $2M/year job with the main lobby group for the pharma industry. Sounds like "giant deals being done as payback" to me.

[Mr Skeptic]

In actuality, the Veteran's Administration is allowed to negotiate in bulk and pays 58% less than Medicare does.

 

Which is another fault of using the above study to compare Canada's healthcare to Medicare (it compares it to the VA)

[jryan]

Source?

 

http://www.myonlinewellness.com/topic/genericdrugs

 

Quote: "About 20% of drugs have no generic equivalent".. ergo, about 80% do.

 

Can you provide any good argument for why Medicare should be prevented for negotiating bulk discounts, besides making Big Pharma more money?

 

Because Medicare Part D already pays the bulk rate for medications from large pharmacy distributors like Rite Aid, Walmart, Etc.

 

To allow Medicare to negotiate bulk discounts Medicare would have to open up drug distribution sites to distribute and warehouse the drugs as Canada does, or Walmart, or Rite Aid. There is little to no reason for this in the American system as it is already handled privately.

 

The creation of such a distributorship also cost money, and we have no real way of knowing how that cost would impact the savings we seek to achieve.

[Mr Skeptic]

http://www.myonlinewellness.com/topic/genericdrugs

 

Quote: "About 20% of drugs have no generic equivalent".. ergo, about 80% do.

 

bascule asked about prescribed drugs, not just drugs in general. From your link,

 

"You can certainly talk to your doctor about it. Given the tremendous potential savings, doctors are increasingly prescribing generic drugs. According to a study by the AARP, generic prescriptions now account for over 65 percent of all prescriptions in the United States, up from only 27 percent in 1987. Your doctor will likely be glad to prescribe a generic drug if you request one and a generic is available."

 

Note that we still are going to spend more money on the brand name drugs overall, since they are much more expensive. Also note that they tell you to ask your doctor for a generic prescription (some doctors give the brand name ones if they can).

[jryan]

So if you educate yourself and speak with your doctor you can, more often than not, get a better deal on your prescriptions in the American system.

 

I haven't been able to find anything yet, but I would be interested in seeing the cost savings between Canada's largely name-brand program and the American generic equivalent. I have a hunch that in such a comparison the American system would look even better.

 

Walmart, for instance, based solely on the power of it's store to generate sales on everything else, draws customers to their pharmacies with cheap generic drugs. I would guess that Canadian Health services couldn't cover their cost for offering free antibiotics and $4 generics by making a killing on their electronics and toy departments...

 

By the way, I think you are free to ask the pharmacist for a generic even if your doctor prescribes a name brand.

 

Aslo, anyone with a prescription to check the FDA Generic database to see if their is a generic for what they take. Also, I take a rather expensive medication myself that does not yet have a generic form (Enbrel) but that is actually cheaper from American bulk online pharmacies than it would cost Canada to provide it to me through their system.

[Pangloss]

There was a report on ABC News the other day in which the reporter spent considerable time challenging Republican congresscritters on the subject of why there was "insufficient regulation" for forcing the drug companies to stop making drugs "whose names all sound alike".

 

Then he actually went into a bit about how WalMart has addressed this by coming up with new pill bottle designs and procedures based on a suggestion from a customer. But rather than take that as a sign that maybe regulation might not be necessary to fix this problem, what was his next step? He went back to Congress to ask why the FDA couldn't make that a regulation!

 

I'm no libertarian -- I believe in regulation. But I just had to shake my head over that one.

[bascule]

So if you educate yourself and speak with your doctor you can, more often than not, get a better deal on your prescriptions in the American system.

 

I pay with an HSA, which is a plus to me both because I get the money tax free and because contributions are matched by my employer.

 

That said, I use said HSA to buy 3 medications with no generic alternative (the only medications I can buy generically are now all available OTC, namely Prilosec and Claritin D)

 

Refilling my prescriptions runs me about $500 a pop.

 

Were I to buy the same prescriptions from a Canadian pharmacy, it'd cost me approximately $75.

 

I'm buying my prescriptions through a Kroger-owned pharmacy. I guess your next suggested step would be to try Wal-Mart?

 

All that said, sorry, I'm not buying it. American pharma will charge you an arm and a leg to get the drugs you need, because they expect your insurance is paying for it, and if it's not, you're screwed.

 

All your myopic and unsubstantiated free market BS isn't going to convince me otherwise.

[jryan]

I pay with an HSA, which is a plus to me both because I get the money tax free and because contributions are matched by my employer.

 

That said, I use said HSA to buy 3 medications with no generic alternative (the only medications I can buy generically are now all available OTC, namely Prilosec and Claritin D)

 

Refilling my prescriptions runs me about $500 a pop.

 

Were I to buy the same prescriptions from a Canadian pharmacy, it'd cost me approximately $75.

 

I'm buying my prescriptions through a Kroger-owned pharmacy. I guess your next suggested step would be to try Wal-Mart?

 

All that said, sorry, I'm not buying it. American pharma will charge you an arm and a leg to get the drugs you need, because they expect your insurance is paying for it, and if it's not, you're screwed.

 

All your myopic and unsubstantiated free market BS isn't going to convince me otherwise.

 

I got you beat there. A months supply of Enbrel can cost as much as $4,500 (16 syringes taken every other day). I pay $20.00, but if I didn't have insurance and went through an online bulk reseller I could get it for $1700, but Canada (last I checked) still had it around $6,800.

 

Granted, debilitating arthritis and psoriasis are not life threatening, and therefor treated far differently in socialized systems, but I sure am glad to have it... and the use of my hands back.

 

By the way, when I was originally prescribed Enbrel I was immediately given an application at the doctors office from those money grubbing Big Pharma bastards at Amgen to apply to get Enbrel free of charge if I could not get it through my insurance and could not afford it otherwise.

 

Those bastards.

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On a separate note, I read an interesting article today about the ongoing reconciliation process that made a very interesting point: Abortion is the only real sticking point in getting this reconciliation passed.

 

The problem is that the Senate bill includes abortion, and the House bill doesn't... but since reconciliation can only deal with financial, and not legal, aspects of a bill the reconciliation can not remove abortion from the final bill.

 

This makes for a hard road as the house has a lot of pro-life democrats from heavily pro-life districts who have stated that they can not vote to reconcile the Senate bill as the abortion laws remain.

 

This has lead to a lot of round table bargaining that has so far gone nowhere since the only way to placate the pro-life group in the house is to promise them a new bill after the fact that will eliminate the abortion wording from the law. This is a hard sell as pro-life Democrats know that there is no way the House and Senate in it's current form would pass such a bill before November, and even less of a chance that Obama would sign it into law.

Edited March 12, 2010 by jryan
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[iNow]

The problem is that the Senate bill includes abortion, and the House bill doesn't...

That is inaccurate. Neither bill will fund abortions with tax-payer dollars (at best, a subsidy would be provided a low income person who purchases a plan on the private market which just happens to cover abortion), which makes most of the rest of what you said irrelevant.

 

 

http://www.slate.com/id/2246905/

Given these stakes, it's worth making some effort to find out what led Stupak and the bishops to think that health reform would spend federal funds on abortion.

 

"If you go to Page 2069 through Page 2078 [of the Senate bill]," Stupak told George Stephanopoulos on March 4 on Good Morning America, "you will find in there the federal government would directly subsidize abortions, plus every enrollee in the Office of Personnel Management-enrolled plan, every enrollee has to pay a minimum of one dollar per month toward reproductive rights, which includes abortions." Stupak is here referring to the exchanges created under health reform and to a nonprofit plan managed by the Office of Personnel Management that would be sold through the exchanges. The latter was a consolation prize to supporters of a public-option government health insurance program that didn't make it into the bill.

 

Let's go to Page 2069 through Page 2078 of the Senate-passed bill. It says, "If a qualified plan provides [abortion] coverage … the issuer of the plan shall not use any amount attributable to [health reform's government-funding mechanisms] for purposes of paying for such services." (This is on Page 2072.) That seems pretty straightforward.

No government funding for abortions.

(Except in the case of rape, incest, or a threat to the mother's life—the same exceptions granted under current law.) If a health insurer selling through the exchanges wishes to offer abortion coverage—the federal government may not require it to do so, and the state where the exchange is located may (the bill states) pass a law forbidding it to do so—then the insurer must collect from each enrollee (regardless of sex or age) a separate payment to cover abortion. The insurer must keep this pool of money separate to ensure it won't be commingled with so much as a nickel of government subsidy. (This is on Pages 2072-2074.)

 

<...>

 

What really rankles Stupak (and the bishops) isn't that the Senate bill commits taxpayer dollars to funding abortion. Rather, it's that the Senate bill commits taxpayer dollars to people who buy private insurance policies that happen to cover abortion at nominal cost to the purchaser (even the poorest of the poor can spare $1 a month) and no cost at all to the insurer. Stupak and the bishops don't have a beef with government spending. They have a beef with market economics.

[jryan]

That is inaccurate. Neither bill will fund abortions with tax-payer dollars (at best, a subsidy would be provided a low income person who purchases a plan on the private market which just happens to cover abortion), which makes most of the rest of what you said irrelevant.

 

No it doesn't iNow. It is a very real discussion going on between Nancy Pelosi and pro-life Democrats.

 

http://electoral-vote.com/evp2010/Senate/Maps/Mar12-s.html

 

You and Slate are splitting hairs as nobody worries about abortion funding for people who don't choose abortions or abortion coverage. The problem is with providing money to people to spend on abortions or abortion coverage.

 

That may be a small thing for you and the Slate author, but you can not take the fact you could care less and project that on Bob Stupak or other pro-life Democrats.

 

If the bill were to include money to buy health insurance from religious organizations what would your stance be?

[jackson33]

It's my understanding that the Senate bill is ambiguous on the issue or could be interpreted to pay for Abortion. While being promised to be corrected under reconciliation, Stupak has argued, this could not be done.

 

Rep. Bart Stupak, D-Mich., says he and a dozen fellow Democrats who supported the House bill will vote against it this time unless the Senate language is replaced with stiffer restrictions previously adopted by the House. The House health care bill passed by 220-215 last November, only after Pelosi was forced to give Stupak a floor vote that incorporated his strict abortion funding provision in the measure.[/Quote]

 

http://www.google.com/hostednews/ap/article/ALeqM5ig2n-N48bvgGAWA-wHlMPQpOdinQD9E8K6D81

 

Personally I believe, as many or more will not vote for anything with out a Government Option, or single payer, based on economics. If a socialist myself, am not, I think that's a good argument. With out at least the option, or the preferred single payer, which is inevitable under any HC Bill passage, nothing COULD work,IMO.

 

Fox, is now reporting the Senate WILL NOT, word their bill to ban abortion, or could it be reconciled, think a Senator Bill Moyer Quote.

[swansont]

We don't need that program. We have CVS, Walmart, Safeway, Rite-Aid, Giant Food, Target and many other companies that already negotiate bulk rates with Pharmacies.

 

Then why is there a push to reimport drugs from Canada? Why do people go cross the border to get drugs? Are they morons?

 

Edit: Also, Bank of Canada did a study of 27 top selling drugs in Canada and compared them to the same 27 drugs in the US. Guess what they found? Canadians pay on average 56% more for those perscriptions (PDF of study here). Hardly a ringing endorsement of Canadian bulk discounting.

 

 

Correction: 27 top selling generic drugs

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http://www.myonlinewellness.com/topic/genericdrugs

 

Quote: "About 20% of drugs have no generic equivalent".. ergo, about 80% do.

 

But you know what? Those 20% represent the newest drugs, or else they wouldn't still have patent protection. Presumably (but unfortunately not always) these are better than the drugs which have generic alternatives. This 80% represents some old drugs.

[bascule]

Then why is there a push to reimport drugs from Canada? Why do people go cross the border to get drugs? Are they morons?

 

Demand for Canadian drugs dropped off quite a bit since Republicans created a drug entitlement, so people don't care how much the drugs cost.

[jryan]

Then why is there a push to reimport drugs from Canada? Why do people go cross the border to get drugs? Are they morons?

 

Give me an example and I'll tell you whether they are morons. I have shown that on generic medications the US provides the greater savings over Canada, and that roughly 80% of prescription drugs have a generic, and that I can shop around if I don't have insurance for varying levels of deals in the US for my prescriptions that beat the Canadian system.

 

I am sure their are certain drugs in Canada that can be purchased cheaper, for whatever reason (maybe related to higher demand in Canada leading to large bulk purchases, but I couldn't tell for certain)

 

I do know from my years as a social worker that there are a lot of people that will simply assume what they are told is true, especially if told enough times, and never do the research themselves... and I would guess some shopping in Canada is driven by that.

 

On that same line, why do Canadians come to the US for medical treatment?

 

 

But you know what? Those 20% represent the newest drugs, or else they wouldn't still have patent protection. Presumably (but unfortunately not always) these are better than the drugs which have generic alternatives. This 80% represents some old drugs.

 

That is a double edged sword because those big bastard pharmaceutical companies spend billions every year developing those new breakthrough drugs because they are lucrative investments. We have new and innovative drugs because we pay for them.

 

If the US, the most lucrative pharmaceutical market in the world, suddenly goes on the cheap you will also find that the rate of new pharmaceutical patents and FDA applications will slow.

 

Does anyone have any stats of per-capital drug research expenditure by country? I'm trying to find it.

 

Also, while we bemoan the skyrocketing cost of health care, we should also consider that in that same time medical research spending in this country skyrocketed as well. It seems to me that we are now punishing the organizations that invested so much capital in developing the medications and procedures that we now take for granted.

 

Our health care isn't expensive just because. Also you must consider the cost of medical training (also a factor of the complexity born of new medical discovery).

 

Would it be a fair trade to grant 5% more people health insurance at the cost of medical research?

[swansont]

That is a double edged sword because those big bastard pharmaceutical companies spend billions every year developing those new breakthrough drugs because they are lucrative investments. We have new and innovative drugs because we pay for them.

 

I give you … capitalism.

 

If the US, the most lucrative pharmaceutical market in the world, suddenly goes on the cheap you will also find that the rate of new pharmaceutical patents and FDA applications will slow.

 

Yes, it will. Again … capitalism.

 

So why are pharmaceutical companies bastards for being capitalist? Does this ire extend to other industries? And what's the alternative — socialism, perhaps?

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Demand for Canadian drugs dropped off quite a bit since Republicans created a drug entitlement, so people don't care how much the drugs cost.

 

True, but there was a big push for this a few years back, until that entitlement was approved.

 

http://www.cnn.com/2003/ALLPOLITICS/06/20/medicare.senate/index.html

Edited March 12, 2010 by swansont
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