Tag: Policy

Vast majority of Americans support government drug price negotiation
A September 2016 Kaiser Family Foundation poll reveals that a growing number of Americans say “no” to the way pharmaceutical companies are allowed to do business. They find drug prices unreasonable, 77 percent, up five points from just a year ago. They want the government to keep the pharmaceutical industry in check. The vast majority of Americans support government drug price negotiation for people with Medicare. And, even more Americans want pharmaceutical companies to publicly report how they set prices.

More than eight out of ten Americans (82 percent) support government drug price negotiation, up from 79 percent in April 2015. Americans are angry about how drug companies set prices. They want to understand their rationale (84 percent want a public accounting).

Almost eight in ten Americans (78 percent) now want the government to restrict the amount drug companies charge for expensive medications for costly conditions like hepatitis or cancer. In the meantime, more than seven in ten (71 percent) support legal drug importantion from Canada. They may not know that while it is illegal to import drugs from abroad, the FDA has never prosecuted anyone for importing medications for personal use or that some websites help people know which international pharmacies are safe to use and help people compare drug prices.

Two out of three Americans (66 percent) support Secretary Clinton’s proposal to create an independent panel that oversees drug prices for prescription drugs. The majority of Americans seem to be ok with allowing drug companies to advertise their drugs to consumers.

Interestingly, it seems that more Americans are concerned about the future of the Affordable Care Act (66 percent) and health insurance premiums (60 percent) than the cost of prescription drugs (51 percent). They say the Presidential candidates’ positions on health insurance and health care costs are more likely to affect their vote than their positions on prescription drug prices.

If you want Congress to rein in drug prices, please sign this petition to Congress.

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Here’s more from Just Care:
- Six tips for keeping your drug costs down if you have Medicare
- Free local resources to help older adults
October 5, 2016
New cuts proposed for Social Security Administration
Back in June, I reported for Just Care that Congress was keeping the Social Security Administration from spending its own money to administer benefits effectively. As a result, SSA was going to need to cut critical services. If that wasn’t bad enough, Kathleen Romig of the Center on Budget and Policy Priorities reports that there’s now a bill before the U.S. House of Representatives that calls for new cuts for the Social Security Administration in 2017.

Since 2010, Congress has cut SSA’s core operating budget by 10 percent, after inflation, to the detriment of people needing help with their Social Security benefits. The $100 million in new cuts proposed for SSA by the House Appropriations Committee would further hurt customer service and program integrity.

If the proposed cuts pass, it would mean that SSA would need to implement a total hiring freeze, which could:
- Delay decisions on disability benefit appeals; the wait is already 540 days, up from 360 in 2010, or
- Keep Social Security from hiring replacement staff as people retired or left, or
- Require Social Security to furlough staff for one to two weeks and close its 1,245 offices in the process; 600 field offices have been forced to close since 2010, or
- Further cut field office hours for the public, which are already cut back to a half-day on Wednesday and a 4 p.m. close every other day, or
- Reduce staffing on the Social Security 1-800 number, meaning longer hold times for the public; hold times already average 15 minutes and 10 percent of callers get busy signals, or
- Prevent modernization of Social Security’s computer systems
The bill does not increase funding for program integrity by $378 million as requested and as Congress previously had agreed to do, even though Social Security returns $8 for every $1 invested in its program integrity efforts.

If you agree that we need to expand Social Security, not make benefit or administrative cuts to it, sign this petition.

CBPP.org
September 29, 2016
The VA health system: Best in class and under fire
Some might say with good reason that the Veterans’ Health Administration or the “VA” health system is best in class–indeed, Phillip Longman, senior editor at the Washington Monthly, has written extensively about the VA, calling it “The best care anywhere.” The VA offers a national health care system with the government owning most of its care facilities and employing its 311,000 doctors and other staff. What makes the VA system so good and why is it under fire?

The VA system is the largest health care system in the U.S., covering 6.7 million veterans through a network of about 150 hospitals and more than 800 outpatient clinics. Different veterans are eligible for different levels of coverage, with veterans who were engaged in combat eligible to get the highest level of coverage. The VA does not charge a premium for coverage, but depending upon the nature of their service and injuries, veterans may pay copays. Copays tend to be low for veterans who sustained serious injuries while on active duty and are unable to find employment. Copays can be quite high for other veterans.

The VA has been praised as a model for delivery of integrated care for people with complex and costly conditions. Doctors employed by the VA can rely on an electronic medical record system that allows them to coordinate care; they use data to drive good health care outcomes. Not surprisingly, the VA gets high marks on quality relative to the private sector. And, its doctors have the expertise needed to treat a population of people with very serious conditions. Just one example of the V.A.’s expertise–a 2005 fall-prevention program has led to many fewer veterans falling and getting a hip fracture. By contrast, most hospitals don’t provide guidance to discharged patients who were hospitalized for a hip fracture resulting from a fall, let alone collect follow-up data.

But, at the same time, the VA, like all health care systems in the U.S., is experiencing a doctor shortage. It has too few doctors and other providers to treat the growing pool of veterans, including both aging Vietnam War veterans and younger Iraq and Afghanistan veterans–and wait times to see primary care doctors are excessive. A 2014 report by the VA Office of the Inspector General documents the issues. And, an April 2016 GAO report finds that wait times for primary and specialty care continue to be a serious concern and that the VA appointment scheduling policy needs upgrading.

To address long waits for care, just a few weeks ago, a bi-partisan Congressional Commission has made a series of recommendations. Not surprisingly, the conservatives on the Commission, along with outsiders like the Koch brothers and Donald Trump, would like to privatize the VA over the next two decades. Veterans are strongly opposed.

The Commission made many recommendations around infrastructure. Its biggest recommendation was to establish a new VHA Care System, expanding the pool of doctors and hospitals treating veterans with additional health care providers, from both government and the private sector. However, back in 2014 to address the long waits for care, Congress passed the Choice Act, which allowed veterans coverage for care from private doctors in certain situations. While this may sound good in theory, it did not work in practice. Indeed, wait times increased.

For sure, more doctors and hospitals are needed to treat veterans. But, why would relying on the private sector be a solution now, when it did not work back in 2014? We all experience long wait times to see doctors. Moreover, most primary care doctors outside the VA are not trained to treat war veterans And, commercial care brings with it large out-of-pocket costs. As Philip Longman says, “Offering unlimited, unmanaged choice of doctors and treatments would not only lead to dangerously fragmented care, it would also cost so much that in the real world, it would be a political non-starter and thus limit choice.”

There are other ways to reduce wait times for treatment. Some propose that the VA allow nurses with special expertise to practice without supervision from doctors, which is already permitted in 20 states. Or, as Longman proposes, in places where it lacks capacity, the VA could identify and contract with skilled outside doctors in an integrated fashion that allowed these providers to use the same electronic medical system as the VA doctors.

Longman sees the VA as our opportunity to move the U.S. towards a better, more cost-effective health care system. In his words, “The VA model of care, with its emphasis on integration, prevention, and evidence-based, cost-effective care, is also in the forefront of where the rest of the U.S. health care needs to go. If we lose the VA, the cause of real healthcare delivery system reform will be set back by at least another generation, with incalculably dire consequences health and finances of the American population.” Of course, moving towards a VA system for all threatens Aetna, Blue Cross and UnitedHealthcare among other big stakeholders in our health care system. And, that’s precisely why the VA system is at risk.

Here’s more from Just Care:
August 3, 2016
Trump, Republican platform on Social Security, Medicare and health care
Trump has not spent much time talking about his vision for Social Security, Medicare and health care. But, were he to become president, he has promised on day one to ask Congress to repeal the Affordable Care Act. And, while Trump’s campaign web site makes no mention of Medicare or Social Security, the Republican Party platform–Trump’s party platform–would cut and privatize Social Security and Medicare benefits. In short, if Trump is elected, health, financial and retirement security would be at serious risk for tens of millions of Americans.

To be clear, the 2016 Republican Party platform does not explicitly state that the Republicans support these cuts. Rather, it says: “we oppose tax increases and believe in the power of markets to create wealth and to help secure the future of our Social Security system.” You can check out Social Security Works’ annotated version of the Social Security section of the platform, translating the text, here.

Republicans say they will leave Medicare as is for people 55 and over. But, if Republicans have their way, when people under 55 today turn 65 and become eligible for Medicare, they will likely have far higher costs and far less choice of doctors and hospitals.

In ten years’ time, Republicans want to cap the amount that the government contributes to people’s care, moving Medicare from a defined benefit program covering all the care people need, to a defined contribution or “premium support” program that would likely cut benefits and shift more out-of-pocket health care costs to people. Republicans also likely want to privatize Medicare, a recipe for limiting choice of providers and driving up health care costs rather than reining them in.

The Republican platform also suggests that Republicans continue to want to raise the age of eligibility for Social Security and Medicare and further means-test Medicare. It calls for “setting a more realistic age for [Medicare] eligibility.”

On his web site, Donald Trump recognizes the high price of prescription drugs. He calls for allowing people to import drugs at lower prices from abroad in the spirit of free trade. “Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.”

For Trump’s views on Social Security and Medicare over the last 17 years, check on the National Committee to Preserve Social Security and Medicare’s interactive timeline.

Here’s more from Just Care:
July 28, 2016
Should you care whether doctors take money from pharmaceutical and medical device companies?
A recent Pro Publica report finds that doctors at for-profit and southern hospitals are more likely to take money from pharmaceutical companies and medical device companies. What does that mean about the hospitals at which these doctors work? And, why should you care?

In prior Just Care posts based on earlier Pro Publica research, we’ve explained that some doctors take tens or even hundreds of thousands of dollars in money and gifts from pharmaceutical and medical device companies. You can learn about your doctors’ relationship with these industries here. We’ve also explained that doctors who accept gifts from industry, even free lunches, are more likely to prescribe the products to which the gifts were linked.

The question we should care about is whether the doctors who accept industry gifts and use these products are acting in the best interest of their patients. Or, are they conflicted, prescribing drugs and using products on their patients that are more expensive and deliver less value?

Overall, two out of three doctors take money and gifts from the drug and device companies. In some states, an even higher proportion of doctors take money from these companies. In New Jersey, Pro Publica found that eight out of ten doctors took money and gifts from these companies. And, in Louisiana, Mississippi, Florida, South Carolina and Alabama, more than three out of four doctors accepted drug and device company money and gifts.

The rate of acceptance appears to turn in part on whether states have had policies in place requiring public disclosure of gifts, policies that predate federal disclosure requirements. In some hospitals, three of ten doctors or fewer accept fees and perks from the drug and device industries. Vermont has the lowest rate, at fewer than one in five doctors. In Minnesota, three of ten doctors accept fees. And in Maine and Massachusetts, fewer than half do.

Not surprisingly, hospitals that have rules banning drug and device company reps from meeting with doctors in their hospitals to promote a drug or device have the lowest rates of gift acceptances by doctors. Kaiser Permanente has such a ban. Since 2014, Kaiser staff may not accept anything of value from industry. “Our intent was to disrupt the strategy of using what industry calls ‘food, friendship and flattery’ to develop relationships with prescribers and influence the choice of drugs, the choice of devices, implants, things like that,” said Dr. Sharon Levine, an executive vice president of the Permanente Federation.

Pro Publica also found some instances in which a small proportion of hospital doctors took money or gifts but that those doctors accepted large gifts.

There is no consensus as to when it is appropriate for doctors to take money or gifts and, if it is, how much is too much. And, we don’t understand the degree to which these gifts are driving up health care costs or hurting patients. Based on the amount of money the pharmaceutical and medical device companies invest in building and maintaining these relationships, we can be sure it’s helping their bottom lines.

Here’s more from Just Care:
- How to choose a doctor
- Five questions to ask your doctor to avoid overtreatment
- Don’t let your doctor intimidate you: A personal story
- Six reasons you need a primary care doctor in this age of specialization
- Could your hospital make you sick?
July 13, 2016
Large 2017 Medicare premium increase projected
Note: For information on Medicare premiums in 2017 click here. The post below explains why Medicare premiums are increasing.

Some people with Medicare could face a 20% increase in their Part B premiums in 2017 unless Congress intervenes this fall and prevents it. The warning of the increase came in late June in the annual report of the Medicare Trustees to Congress, on the financial state of the program.

The trigger for the increase is complex but has to do in part with increasing costs in Part B, which covers doctors visits and other types of outpatient care. A 2015 law that prevented premium increases for 2016 for most people with Medicare collecting Social Security benefits is a contributing factor in the increase.

The Trustees report indicates that up to a third of people paying $121.80 a month for Part B in 2016—up from $104.90 in 2015 for many—could see another increase to as much as $149. Congress may view that as too significant an uptick in a short period and move to limit it, especially in an election year.

Increases of the same magnitude or more could be in store for wealthier people with Medicare, too. Since 2007, individuals earning more than $85,000 and couples earning more than $170,000 a year—about six percent of the Medicare population—pay substantially higher premiums than everyone else with Medicare.

Medicare notifies people of their Part B premium changes for the following year in the fall, before Medicare open enrollment, which occurs in November and December.

Part of the reason for the increase is that all Medicare costs, including for Part B, are trending upwards as more baby boomers enter the program and healthcare costs have again ticked up. For example, Part B costs rose an average 5.6% a year from 2010 to 2014; that average rate of rise is projected to increase to 6.9% a year from 2015 to 2020.

The average per person cost is projected to rise from $12,925 in 2016 to $19,400 in 2025. That reflects an average annual rate of increase over the next decade of almost three times what it was in the years 2010 to 2015 (4.3% versus 1.5%).

At the same time, Medicare enrollment is projected to rise from 57 million today to 73 million in 2025 as 10,000 baby boomers enter Medicare every day.

As a result, the Medicare hospital trust fund (Part A of the program) is projected to be insolvent by 2028, two years earlier than the Trustees projected last year, the Trustees said.

Even so, they expressed mild optimism that the Affordable Care Act (Obamacare) and several other recent laws were constraining the overall growth in healthcare costs, even as they asserted strongly that more needs to be done. In their words: “Notwithstanding recent favorable developments, current-law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation. Such legislation should be enacted sooner rather than later to minimize the impact on beneficiaries, providers, and taxpayers.”

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To support expanding Social Security benefits to offset Medicare premium increases, click here. For money-saving tips and advice, as well as peace of mind, subscribe to our weekly newsfeed.

Here’s more from Just Care:
June 30, 2016
Congress keeps Social Security from spending its own money to administer benefits effectively
It’s bad enough that Congressional leaders want to cut Social Security benefits. But did you know that Congress also is keeping Social Security from spending its own money to administer benefits effectively? Earlier this month, the Senate Appropriations Committee refused to allow the Social Security Administration (SSA) the $13.067 billion it needs–less than 1 percent of its budget–“to execute critical service delivery efforts” and ensure people have appropriate access to benefits.

Instead, the Senate Appropriations Committee cut SSA’s administrative budget by 5.5% or $600,000. According to SSA, this means a serious cut in customer service, jeopardizing and delaying people’s access to benefits. To be crystal clear, the money the Appropriations Committee is denying SSA is SSA’s money, expressly for use by SSA, not general revenue.

What exactly are the members of the Senate Appropriations Committee thinking? The Acting SSA Commissioner describes Social Security’s state of service as “fragile,” in her explanation of why it requires its full budget request. The Committee’s behavior makes no sense; it harms constituents and Social Security’s reputation.

There are 65 million people in the U.S. receiving Social Security or Supplemental Security Income (SSI), up more than 12 percent in the last five years. Yet, Senator Roy Blunt of Missouri, who chairs the Appropriations Committee, and his members, have effectively cut SSA’s administrative budget. It is still $10.5 billion, what it was five years ago, with six million fewer enrollees.

Keep in mind that almost all Social Security applicants are older adults or people with disabilities and many have mental impairments, low literacy levels and speak English as a second language. They often need personalized assistance. And, SSA is not authorized to spend as much funds as are needed to provide it.

Kathleen Romig at the Center on Budget and Policy Priorities reports that in 2016 the typical caller to SSA must wait 15 minutes on hold and 10 percent of callers receive busy signals. Moreover, SSA has been forced to close almost 600 field and mobile offices since 2010, making it harder for people to apply for benefits. While you can apply online, staff at SSA need to do follow-up work for people applying for Social Security Disability Income and Supplemental Security Income. Adequate resources are not available.

People whose applications are denied must now wait more than a year and a half to have their appeals heard, from 360 days in 2010 to 540 days today. Moreover, short-staffed, SSA is typically delaying paying widows benefits four months. The toll on lower income individuals who depend heavily on Social Security benefits to pay their rent, utilities, and for other basic needs can be devastating.

Here’s more from Just Care:
June 23, 2016
Drug industry spending tens of millions to keep states from lowering drug prices
The drug industry is on the defensive. The federal government may be doing precious little to bring down prices, but some states are on the offensive. And, according to Stat News, the drug industry is spending tens of millions to keep states from lowering drug prices.

However, just last month, Vermont passed a law that requires drug companies to justify price increases. In California, the Senate has passed a similar requirement and there’s an upcoming ballot measure that would limit the price of some drugs. Ohio has a similar upcoming ballot measure.

Pharmaceutical companies are responding by giving tens of millions to opponents of the ballot measures, which were initiated by the AIDS Healthcare Foundation. Merck and Pfizer, among others, have given some $68 million to fight the California ballot measure alone.

At the same time, they continue to raise drug prices ever higher. Why not so long as they can? The average price of brand name drugs rose 14 percent last year, according to the market research firm Truveris. We are now paying three times more than people in the United Kingdom for the top 20-selling drugs in the world.

Pfizer has raised its drug prices almost 9 percent recently. And, six months ago it had raised its drug prices 10 percent. Johnson & Johnson upped its price for rheumatoid arthritis drugs 30 percent in the last 18 months. Amgen did the same. Biogen’s multiple sclerosis drug now costs 18 percent more.

The pharmaceutical companies are continuing to blame insurers for high drug prices. But, so long as they charge a lot for unique brand-name drugs, insurers have no choice but to raise premiums, deductibles and/or copays.

Brand name prices will remain high until there are generic substitutes. And, unfortunately, there is a long list of generic drugs waiting for approval by the FDA.

Here’s more from Just Care:
June 23, 2016
Support Social Security to reduce risk of recession: Larry Summers
In a recent talk for the Brookings Institute’s Hamilton Project and a subsequent opinion piece in the Washington Post, Lawrence Summers speaks to how to address the real risk (better than 50-50 chance) of a U.S. recession in the next few years. He makes a compelling case that we need to speed up the pace of economic growth. And, he argues that we should support Social Security to reduce the risk of a recession.

In brief, Summers says that current economic forecasts indicate that our economy is likely to perform as poorly in the 11 years between 2007 and 2018 as it did in the 11 years between 1929 and 1940. Fiscal policy, increasing demand to permit growth that is sustainable financially, is a tool for stabilizing the economy. Monetary policy is not a viable option; the Federal Reserve will not be able to lower interest rates the standard 4-5 percent, to address recessionary risks, given that interest rates already are so low.

We need to invest in infrastructure, which will both create more jobs and increase demand. We need to invest in housing, particularly residential investment. And, we need to support Social Security. Summers emphasizes that “social security is good economics when, as at present, the growth rate far exceeds the government borrowing rate. Further it raises demand without enlarging government deficits.”

Put differently, expanding Social Security benefits, even through greater payroll contributions, will tend to reduce the need for savings and help to stimulate economic growth.

Social Security is also helpful in stabilizing the economy during a recessionary period because it gives older workers a guaranteed income–not linked to the stock market or the nation’s economic health–allowing them to retire if they choose or lose their jobs. Private retirement plans, such as 401(k) plans, in contrast, tend to exacerbate economic downturns; older workers are hard pressed to retire when the value of their 401(k) plan plummets and face increased risk, with less in savings, if they lose their jobs.

Moreover, expanding Social Security would help address our retirement income crisis. Click here to let Congress know that we need to expand Social Security.

Here’s more from Just Care:
June 2, 2016
Most Americans favor Medicare for all
Most Americans favor Bernie Sanders’ “Medicare for all” proposal, according to a new Gallup poll. Indeed, nearly six in ten Americans support a single-payer health care system for all Americans. And, they support replacing the ACA with this federally funded system.

Poll results reveal that 58 percent of Americans would like to see a single-payer health care system replace the ACA as compared to 37 percent who oppose this; 5 percent did not have an opinion. Notably, 73 percent of Democrats and those who lean Democrat support this proposal and 41 percent of Republicans and those who lean Republican support it. About half of Americans are OK with the ACA as it is.

Hillary Clinton’s proposal to keep the ACA in place received lukewarm support, with 48 percent of Americans supporting it and 49 percent opposing it; 2 percent did not have an opinion. Of those Americans who support keeping the ACA in place, 72 percent also support replacing it with Medicare for all.

When asked to choose between keeping the ACA in place and replacing it with a Medicare-for-all system, the 35 percent of Americans surveyed who had supported both policies chose Medicare-for-all by a two-to-one ratio–64 percent to 32 percent.

Just over half of people surveyed, 51 percent, said that they supported Donald Trump’s proposal to repeal the ACA. Forty-five percent opposed ACA repeal and 3 percent had no opinion. That said, 27 percent of Americans who favor repealing the ACA would like to replace it with Medicare for all.

Here’s more from Just Care:
May 26, 2016