Anyone who thinks it’s going to be easy to get any kind of reasonable health care reform through the Senate is kidding themselves. The way I see it, the United States spends an ungodly amount more on health care per capita than any other country on earth. Any reasonable reform — even if it’s something fairly watered down — will probably have to reduce this. That means money coming out of the pockets of insurers, of HMOs, of pharmaceutical companies, etc. We’ve seen what happens when you try to take money away from, or let’s face it, just reduce the amount of money being given to, well-heeled interests. They don’t take it lying down. Here’s a pretty clear sign from K Street that Big Pharma is going to fight health care reform tooth-and-nail:
Yet another pharmaceutical company is considering putting a Republican in charge of its Washington operations, frustrating some congressional Democrats.
[….]“It’s absurd, at a time when we have the Congress and the White House, that any company in this town would consider hiring a Republican to head their shop,” said a chief of staff for a senior Democratic congressman on a key health subcommittee.
Further aggravating Democrats, the in-house lobbying operations of at least eight of the nation’s largest drug makers are run by Republicans: Abbott Laboratories, Merck, Bristol-Myers Squibb, Novartis, Pfizer, Eli Lilly, Genzyme and AstraZeneca.
I’m not sure this is so smart. The failure of cramdown legislation showed just how easily some Democratic Senators can be bought. But the thinking might be that 40 Republicans plus Ben Nelson or one of the LA Senators equals a bill defeated. That calculation probably makes sense too.
Lev
It’s going to take a lot more than that for the GOP to stop it…the Dems can ram it through with reconciliation, remember?
DougJ
You think they’ll really do that?
Xenos
Just makes it easier to defeat Republican senators one and a half years from now. These interests could think a couple moves ahead and look for ways to carve out money-making businesses out of the new system. Instead, they want to empower republicans to block all reform.
The show as much foresight as the automotive executives, and are arranging the same fate for themselves. And they can’t seem to help it. It is like the tragedy of the commons, where the commons is the people able to afford health care. There used to be lots of people who could afford health insurance, but they are facing the fate of the cod.
TenguPhule
If enough Democrats get their ganders up from pharmas hiring the enemy, maybe spite will work where civic duty failed.
jon
The Health care insurers are looking/begging for a deal to forestall this gov. health plan alternative, they offered to take a whole host of regulations from Congress if Congress would just stop reform now. Smells like they think its going to make it through.
dmv
That is such a slimy, disgusting thing to complain about. Waaaaaaah. We’re in power! Hire our people to bribe us!!!!11!!ELEVENTY!!
Jeebus. Politics is so freakin’ dirty.
Gus
Fixt.
arguingwithsignposts
This has always been the reason why I’ve been skeptical of any kind of serious health reform being passed. The monied interests have too much at stake. They’d rather 50 million Americans face financially-crippling, life-threatening decisions without a safety net than slim down their fat wallets.
Same as Wall Street. Same as multinational corporations off-shoring. Same as the Galtian idiots on the right. I’ve got mine, screw you.
{sigh}
Zifnab
@DougJ: Universal Health Care… scrub that – successful universal health care – could be for America what Social Security was in the 30s, or the Civil Rights Act was for minorities. Completely game changing. The political capital you could reap from an effective health care system would be enormous, and it would be the kind of institution that future liberals could crusade to protect for generations.
Look at what an attack on Social Security did to Bush’s poll numbers. Count the number of black Republicans. Programs like this are what make the progressive movement win. They are why the progressive movement exists.
What else does Obama plan on being President for, if not to get this legislation passed? Why wouldn’t he?
Hugh Jass
I’m not nearly smart enough to know the right solution to how health-care should be structured, but when you talk about reducing the money going to pharmaceutical companies, I think that ultimately means (a) fewer jobs in that industry, and (b) less innovation. What DougJ describes as “well-heeled interests” are, in fact, employers who create, make and sell medications that improve and prolong people’s lives.
DougJ
Yeah, I know.
DougJ
If worst comes to worst, they can resume their operations at Galt’s Gulch.
Joel
@Hugh Jass: The simplest reform is to encourage the usage of non-patented effective drugs over their patent equivalents. That would cost the pharmaceutical industry an awful lot of not-really-deserved coin. There hasn’t been all that much innovation emerging from within the pharmaceutical industry recently, anyways. A large share of innovation is coming from the smaller biotechs and NIH/NSF-funded research.
Lev
@DougJ: The way I figure it, 48 Senators supported the cramdown bill so they will probably vote for healthcare. If they’re willing to take on big business for something that was right but that nobody but insurance companies cared about, we should be good. Toss in Max Baucus and another random Dem and it should go.
Maybe I’m being complacent, but I’m fairly positive that something called Obama’s Health Plan will pass. The one thing I worry about is if the Blue Dogs strip out all the stuff that offends insurance companies.
NonyNony
@Hugh Jass:
Not necessarily. It could also mean that more of the money makes it down to the folks doing the innovation and providing the services and less makes it into the pockets of corporate-raider CEOs and bankster-style investors who think they’re more valuable to the system than they actually are.
There’s a HUGE amount of waste in our health care system right now. But we don’t call it waste because it’s in CEO salaries, unrealistic payouts to investors, and other areas that we’ve become convinced are necessary for “capitalism” to function. It’s why we pay so much more per capita than anyone else in the developed world and yet have worse overall coverage.
TenguPhule
Only found in Canada?
Zifnab
@Hugh Jass: Lulwhat? I think you’re confusing jobs with profits. For-profit medical businesses have this little thing called “shareholders”. Those “shareholders” are what inflate the cost of health care.
And with blockbuster drugs like Vioxx and Phen-Fen, I’m not sure why you’re worried about a lack of innovation. The current “innovation” we’ve been seeing seems to involve more legal fees than research costs.
Why are we relying on companies for all our pharmaceudical research needs anyway? We’ve got Universities and hospitals for a reason, after all. Do we really need – or want – proprietary licensed designer drugs for everything from cancer to restless leg?
A Question
When people give the per-capita calculation of health care costs in this country, is that total dollars divided by total number of people, no fiddling around with determining who’s getting costs paid by insurance that they paid for already, and so on? Or is it just taking total dollars paid divided by number of insured individuals?
gizmo
What I’m worried about is watered-down, wimpy health care bill that allows Obama and the Democrats to claim some measure of success, but doesn’t move us far enough in the right direction. I’m expecting that we are going to get some sort of half-ass hybrid plan that keeps Big Medicine happy.
David Hunt
Perhaps it’s just inertia from Delay’s infamous K Street Project. Maybe he managed to get so many Republicans into the Lobbying firms that they will now hire them preferentially despite the Dems being in the majority.
Just brainstorming…
dbrown
@Hugh Jass: You missed the biggest developer of most new meds – NIH (the government really does work better than most private companies) and State Universities. These two groups are major players and the Pharmaceutical companies buy their developments and sell them to us at outrageous markups claiming they spent all this R&D (yes, final testing can take years and is expensive but when do these fuckers ever credit the real agencies that produce so many of the drugs.) Propaganda by the Pharm companies suckers so many into their self-serving load of crap. These so-called service companies spend many times more on free trips and gifts on MD’s than they do R&D on all their drugs.
Of course, the rest of your post is right on.
SnarkIntern
What Doug refers to are the big, powerful drug companies. But innovation seems to be coming from smaller, more entrpreneurial firms too. The lie here is that the great big drug firms are where the lifesaving drugs will come from, so, you know, we need to protect their interests. No, that’s just not true. And the big rich drug firms are apparently more interested in making products they can advertise on tv than they are in creating drugs that have the greatest capacity for prolong lives or cure deadly disease.
These firms also appear to be more interested in protecting a lucrative market (the U.S.) than they are in doing thing like saving lives by reducing the cost of drugs to their customers. It’s not an accident that people go offshore to buy drugs to save money, or that these firms work so hard to promote the lie (pimped by that great man, GW Bush himself) that we can’t “guarantee the safety and quality” of drugs sold outside the United States.
Fuck these big drug firms, their lies, their lobbyists, and their apologists.
gwangung
Not seems. Does.
While the big companies does a lot of in house research, they can’t follow all leads, all lines. And they certainly aren’t doing basic research that’s more than 7-10 years down the line. Smaller companies do more speculative research and universities/NIH-fueled places do more basic research. Big companies often BUY these smaller companies, as it’s cheaper than funding a lot of research that doesn’t go anywhere.
HyperIon
OT but this is an excellent post on AfPak
I supply it here because JC’s post on Obama’s bloody hands (according to drama king Cole) is pretty dead. This article has actually policy discussions, not just finger pointing.
Newshoggers is a great site but it gets almost 0 comments. I don’t get it. Atrios calls someone a WATB and 400 people comment. These guys write carefully thought out posts and sometimes I wonder if I’m the only one reading them. I never would have found them but for the B-J blogroll.
Legalize
That’s what I’m saying. I live in a fairly conservative neck of the woods and the folks here don’t have health insurance; they are aging; they are broke; they have ailments; and they are scared shitless. These are people who did not vote for Obama. Yet, these folks and their kids will be Obama-Dems for LIFE if Barack manages to meaningfully reform the health care system in this country. This is the biggest game-changing moment of my life-time. All that is required is that Dems in Congress display enough spine to make it happen.
Which is why I am dubious about it happening. If the Dems fail at this, they will open the door to a GOP comeback.
I believe that if Barack puts all or most of his weight behind health care reform and is successful, everything else will follow because the public will finally see a political party and its leader actually fucking doing something that needs to be done. Something so sensible, effective and broad. I believe that Obama is for it all the way. If I’m him I’m talking about excommunication to all Dems who don’t get in line. I’m talking no money, no campaigning and active endorsement of primary challengers.
Fuck Ben Nelson, et al right in the ear if they don’t play ball. It’s either us (all of us) or the fucking assholes all over again.
TenguPhule
Because after you read it, there’s not much you can say except, “yeah, you’re right.”
TenguPhule
Fixed.
I’m perfectly happy with steady sustainable growth of companies I own shares in.
But I hold for long term.
HyperIon
There are plenty of models in the world to choose from. We do not have to re-invent the wheel…just steal Switzerland’s or Germany’s or the UK’s.
But everyone is going to have to participate AND no one can make a profit off of it. So right there you have two big groups of pissed off people: 1. folks who do not have insurance now and do not want to pay a cent for it (about 30% according to the figures I have seen) 2. most of the health insurance industry and its stockholders.
gwangung
Yeah, well what the drug companies are doing now is the Hollywood blockbuster version of drug development: looking for big home runs, not small profit makers.
Zifnab
@HyperIon: That’s not even true. When you’ve got 47 million uninsured people, and you decided to insure them, someone is going to make a profit.
Will it be the small down doctor’s office that suddenly sees a jump in business? Will it be the hospital that no longer needs to treat people pro bono out of the ER?
What’s more, the number of people who don’t want insurance represent a tiny fraction of the number of people who don’t buy insurance. Even inside a company, health insurance gets up into the thousands of dollars a year. This for a service you are unlikely to see any real use in. Affordable health insurance that doesn’t leave an individual fearing he’s going to be screwed out of a payment because of pre-existing conditions or sudden spikes in premiums or drops in coverage will make the service far more palatable.
So I think you’ll be seeing far fewer ruffled feathers than you’d anticipate. The people you WILL be pissing off, however, will be the ones milking the system the hardest. Insurance CEOs and shareholders will howl loudly. And they’ll have big expensive microphones to do the howling out of.
If we’re lucky, they’ll join up with the teabaggers and double down on looking stupid.
Brandon
Yes, the Dems really will use reconciliation unless Congress passes something by October. If Cramdown is any indication, the calculus is actually 40 R’s + 12 shameless D’s. Those dumbass D Senators have to know that Obama’s reelection rests on passing health care reform. But I doubt any of them care, as long as they got 5 grand from every Big Pharma PAC. Gawd why is corruption actually so cheap?
Just Some Fuckhead
Don’t get yer hopes up about health care reform, Legalize. It’ll be a boon to the corporatists, prolly force everyone to buy health insurance and we’ll keep the same lousy system with insurance companies making even more money.
Comrade Kevin
@dmv:
It’s basically retaliation for the Bush years, when the congressional GOP told the lobbying firms that they wouldn’t get anything unless they systematically got rid of all of their employees who were Democrats.
Mike G
In 2004-2006 there were 45 Dem senators and Harry Reid et al were constantly whining that they couldn’t stop anything because they were a minority against a Repig majority and a Repig White House.
So why is it that just 40 Repig senators, with a Dem White House, can bring the senate to a grinding halt? Reid doesn’t even have the guts to make them filibuster, just the merest threat of a possibility that they might do so sets him cringing. Grow a damn spine.
Gus
@Comrade Kevin:
I really hope that the Dems won’t spend the next 8 or however many years seeking vengeance against the likes of Tom DeLay, but I wouldn’t be surprised if they do.
WereBear
I think it could work if there was accompanying legislation that would make the insurance companies follow through on their contracts.
Right now, they just up and decide you don’t get coverage. You’re too young to have the disease your doctor says you have, or it must have started when you were in the womb and it’s a pre-existing condition; they’ve got all kinds of ways to get out of paying and no one can do anything about it.
Heck, I got whisked into the operating queue by my doctor with something that couldn’t wait, and I spent the most time on the phone getting permissions to have this important procedure!
Close off all of that, and the insurance companies wouldn’t be raking the bucks with what is no more than a scam, at this point.
They could bail with the excuse they aren’t making enough profit.
This would fit President Obama’s patient style.
Laura W
Lizz Winstead is gonna be on The Ed Show (now on MSNBC in the east) soon to yak about something. I have not seen her for ages and love her for co-founding The Daily Show. God she was hysterical. I really miss seeing her on teevee regularly.
The Cat Who Would Be Tunch
Why do people care so much about health care reform in the US? The lack of access to good health care contributes to increasing the mortality rate, thereby reducing the carbon footprint of the American population. This is a win for global warming!
Stupid liberals – can’t ever make up your minds on what you want.
someguy
I’m with the Dem staffers on this one and really don’t see a problem here. The Dems are in charge and like the Republicans before them should engineer a purge of K Street. It won’t really matter to the firms because Republicans can’t effectively lobby Democrats on this issue anyhow, so what are they going to do – turn up the shriek volume of the rump of the I Can Haz Cheezburger No Deejon Pls Party? It would also control the terms of the debate – law and lobby shops and trade associations wouldn’t be able to crank up the right wing echo chamber because the cost to their business would be too high. This is why Norquist pushed the K Street Project so hard – to control the debate. It would also be simple. If I was whip, I’d impose an internal rule that firms employing Republicans don’t get face time with staffers, much less elected officials. It’s not a legal rights problem – they’d be free to send all the letters and to astroturf all they want.
Since Republicans are all about ideological purity I’m sure their fatcat lobbyists would understand, and welcome the opportunity to go John Galt.
Mr. Stuck
A regular order Health Bill was always a non-starter imo. Unless it was watered down to the point it could be called the HMO Rescue Bill, with all the according wingnut welfare.
And the fact that we are talking about democrats upset about who and what party the KStreet/Big Pharma/Hmo chief lobbyist will be, speaks volumes. It’s kind of like the Pro/Con torture controversy in the way of, why are we even talking about it as a reality. We shouldn’t do torture period, and lawmakers should care less who the lobbyists hire.
When this bill comes up, it will likely be worse than the election campaign will all the shit slung, and we’ll be lucky in the end to get 51 votes.
someguy
@ Mike G.
Nothing personal, but were you born last night or something? Blaming the wingers is the all purpose excuse for not getting it done. If a bunch of Dem senators feel vulnerable on an issue, blame the Repigs and hold a party line vote minus two or three Dems from safe seats, just to make sure whatever measure it is fails and you can still blame the Repigs – or maybe kill it in the committee you control or in the other house, and blame the Repigs. If you need money for campaigns, 61 senators ain’t enough, you need at least 80 senators because 39 Repigs are just too damn powerful.
Haven’t you figured that out yet? The Senators aren’t on board the progressive agenda. That’s why it’s important to move the debate to their left and to shut up the right wing echo chamber. Otherwise they have a handy excuse that is sometimes true, but which is always a convenient fundraising narrative and easy out.
rs
Thank you for that link to Newshoggers. Pretty good site that I hadn’t seen before. I’d already read the Pepe Escobar article it linked to at Asia Times Online, and would recommend him (as well as the Whiskey Bar inspired Moon of Alabama and Chris Floyd at Empire Burlesque) to anyone wanting to increase their understanding of the evolving situation in Pakistan and Afghanistan.
Give your senator a call, especially if they’re a Democrat and/or on the Finance Committee, and ask why there were no proponents of single payer at the hearing earlier this week. Give Chairman Baucus a call, too, just to remind him what a fucking whore he is.
Roger Moore
@Zifnab:
Fixed. Most of what big pharma does these days is marketing, not drug development or legal stuff. Startups, universities, and the like do the really innovative development. Then big pharma moves in, either buying the small company or licensing the drug from the university or other non-profit. The main thing that the big pharma does is market the drug, schmooze doctors to prescribe it, and the like. That’s why you may notice that big pharma always talks about how expensive it is to “bring a drug to market” rather than to develop it. Most of the cost they’re complaining about is for marketing, not development.
One of the cheapest and fastest things we could do to bring down prescription drug costs would be to eliminate marketing directly to consumers. It would cut costs directly by eliminating that whole class of costs and indirectly by reducing the number of people who demand unnecessary prescriptions. The drug companies will cry bloody murder if the FDA tries any such thing, but I think it would be a really good idea.
Just Some Fuckhead
If you’d like Terry McAuliffe to stop calling, press 1 now. If you’d like to revoke Terry McAuliffe’s Virginia residence, press 2 now. If you’d like to apply a powerful electric shock to Terry McAuliffe’s tiny little mouse balls, press 3..
33333333333333333333333333333333333333333333333333333333333333
geg6
I say we take the terrists from Gitmo and the K Street lobbyists and trade them out. The poor bastards in Gitmo are and always will be less destructive to the average American than the Big Business lobbyists. WIN!
Michael
OT, but it looks like Patrick McHenry says the era of Reagan is over.
http://www.dailykos.com/story/2009/5/7/728855/-Republican-Says-Reagan-Era-Is-Over-
wmd
Couple of health care anecdotes:
I’m without health insurance since December 2008, 48 years old and basically healthy. I’ve been taking an ACE inhibitor for the past 7 years after an annual physical showed pre-hypertension 130/82 or so if I recall correctly. I needed to get my prescription renewed after my former primary care physician moved and I could not establish a new primary care physician without insurance. I checked with the county health department, was told to fill in a bunch of information forms regarding my assets and income for evaluation for Medicaid/Medical.
I had a gut feeling that my assets would lead me to not qualify and went to Planned Parenthood. They asked me to state my income – that’s it. They wrote my prescription, ordered annual blood work (liver/kidney, lipids, glucose). Charged me $5.00 including lab work. I paid $20.00 so as to support access for others. I took my prescription to my local pharmacy, told them I did not have insurance and received my prescription for $8.30 for 30 days – I had been paying $5.00 copays previously under my $500/month COBRA coverage.
Interesting.
The other anecdote comes from a conversation I had with a social worker – one of his client families is receiving MediCal. He said there’s rampant fraud and illustrated by saying they receive meds costing the state of California $400 per month, and he had checked that a generic version was available for $100 per month but was not allowed under MediCal rules.
Personally I wouldn’t call that fraud, I’d call that pharmaceutical company lobbying to fleece Medicare. It’s evidence of policy abuse that benefits stockholders, but does not benefit public health and is a transfer from taxpayers to stockholders. I think there’s an interesting contrast between the charitable health care i received via Planed Parenthood and the public funded health care the Social Services client family received.
Gus
@Laura W: She just did a standup gig at a theater in Minneapolis to commemorate Obama’s first 100 days. She was hit and miss. Some good laughs, some dry spells.
HyperIon
@Zif: Sorry to have been unclear about who cannot profit. I simply meant: the insurance companies.
My understanding of Switzerland’s approach is that everyone is covered, everyone pays something (but income level is used to determine how much), and the private insurance companies are highly regulated and not for profit.
As for how many of the uninsured in the US choose to be uninsured, I have seen figures that say about half. But I can cite no concrete evidence at this time.
cosanostradamus
.
The Obama budget eliminates oil subsidies, and invests in green energy. Wait till the Twits hear. I’m twitting their twats now.
.
Kirk Spencer
OK, I see a lot of pessimism about health care passing. Gentle readers, I’m telling you it’s inevitable. It may take a couple more years, but it will happen.
That was locked in the cards in February of 2007. That’s when Andy Stern and Lee Scott jointly told the world they were working for health care reform, and intended it to be in place no later than 2012. Oh – respectively, that’s the president of the SEIU and CEO of WalMart. [ source ] They weren’t alone at that table – AT&T, Intel, Kelley, and the CWA (among others) were also present.
Now while I want a good plan now, I have a strong suspicion that if the Republicans were smart they too would want one now. The reason is that given this organization it WILL happen, and the longer it takes to get something the more likely that “something” will be what progressives prefer. Right now the odds favor even MORE Dems in the Senate, and the house will still be Dem controlled, in 2011.
It’ll happen. The only question is when, and what the details look like.
HyperIon
Wow, this reform health care in America, I sure hope it doesn’t tear the country apart. I mean, we all WANT a good and cheap and effective health care system but not if it’s going to tear the country apart! /snark
The Cat Who Would Be Tunch
@Roger Moore:
I didn’t realize that was the case. So what is the ratio between, say, R&D versus marketing of an “average” pharmaceutical company? Or marketing versus acquiring startups? Any recommendations for sites with this kind of info? Yes, I’m too lazy for Google right now.
HyperIon
@Kirk Spencer:
yeah, well, this is one issue where the devil really IS in the details. so your point seems rather moot to me.
and you will die. the only question is when.
jody
I have lost three friends in my lifetime because they could not afford health care. The youngest was 18, the oldest, 49. ALL of them had treatable ailments. The most recent one was a few months ago.
Obama had better not fuck this up. And the shitbags in congress had better not either. This has gone WAY too far.
Kirk Spencer
@HyperIon: True, both remarks. For the former, however, I should note that I’m somewhat optimistic at this time. Not least because of what those people I cited were saying and why they were saying it. To put it coarsely, it’ll be good enough the unions will accept it and cheap enough all Walmart employees can have it.
Shygetz
This is not really true. Big pharma also does a whole lot of the latter phase clinical trials. Common procedure is for small businesses (often run out of academic labs, usually funded by a combination of small Federal grants and venture capital) to find and develop a lead compound, take it through animal model trials (if possible) and possibly through Phase I clinicals. Around that time, the company gets bought out by Big Pharma, which completes the trials and perfects the formulation for larger scale production and long term storage (which can be a very research-intensive process by itself).
The reason Big Pharma goes for the homerun drugs is because the failed leads are expensive failures. But they do serve an important role…not indespensible, but not the worst role for a private enterprise to play. The problem comes when Big Pharma threatens to COMPLETELY take over these roles, which shuts out necessary but low profit-margin drugs out of the development process altogether (e.g. drugs targeted at diseases of impoverished countries, or some classes of vaccines). NIH fills in some of the gap, but it’s still problematic.
(/The More You Know)
Steve Hynd
HyperIon @ 24 and TenguPhule @ 26, thank you very much for the kind words. Our frequency of commenters is proportionate to our readership, which averages out at a little more than 1,000 a day. We’d be very glad indeed if it was more than that, but alas the A-list doesn’t often link to us – perhaps they feel we have no message discipline or perhaps they just don’t think we’re very good :-)
Regards, Steve Hynd @ Newshoggers
Hypatia
Nice post, Shygetz
Joel
@Shygetz: Michael Phelps (the biophysicist, not the swimmer) gave a talk here recently. He dedicated a small portion of that talk to discussing the relative efficiencies of various research organizations (academic, small biotech, large biotech, pharma) at developing novel pharmaceutics. I don’t know if that means clinically available (FDA approved) drugs or just lead compounds, but unsurprisingly, the order proceeds as I listed them. Worth noting that the NIH is dedicating more money to pharmaceutical development with the latest budget (at least in theory).
asiangrrlMN
I am lukewarm about the possibilities of health care for all in Obama’s first term. I just don’t think it’s really high on the list for our congress people on either side of the aisle. If reconciliation is not used, then it’s DOA. Big pharma owns Congress about as much as does Wall Street.
Robert Waldmann
You’re over counting with 40 Republicans plus one of the La senators. One of the La senators is the Republican party’s own diaper Dave Vitter. I think you mean one of the Arkansas senators. However, you might have meant one of the Dakotan senators or … hell this is going to be tough.
...now I try to be amused
The opposition of Big Pharma and the insurance companies to any reform at all reminds me of Frederick the Great’s quote:
“In trying to defend everything he defended nothing.”
Please, let it be so.