Friday, November 28, 2003

Broad Bills Stuffed With Lawmakers' Pet Items: "In public, members of Congress have spent hundreds of hours debating the future of Medicare and the need for a national energy policy. Behind the scenes, they have spent even more time working on little-known provisions of the legislation that would benefit specific health care providers and energy companies." Tucked inside the Medicare bill is an assortment of provisions that have nothing to do with providing prescription drug benefits to the elderly. The energy bill and the annual spending bills for federal agencies are also stuffed with pet projects, intended to win votes for the legislation. Congress gave final approval to the Medicare bill on Tuesday, but is still wrestling with the energy measure. The two bills � top priorities for President Bush and the Republican leaders of Congress � provided convenient vehicles for spending narrowly focused on special interests. Hundreds of health care providers and colleges now receive such largess, and the numbers have soared in recent years.� A provision benefiting a specific hospital in Tennessee was added to the Medicare bill at the last minute in an effort to get the vote of Representative Harold E. Ford Jr., Democrat of Tennessee.� The Medicare bill also increases payments for doctors in Alaska for a cancer treatment known as brachytherapy and for health maintenance organizations that have been dropping out of the Medicare market. The energy bill includes $1 billion for a new nuclear reactor in Idaho, $800 million in federal loan guarantees for a coal gasification plant in Minnesota and tens of millions of dollars in subsidies for timber companies to log national forests for energy production. Senator John McCain, Republican of Arizona, said "parochial projects" were siphoning money away from higher priorities at many agencies. Timothy M. Westmoreland, a professor at Georgetown University Law Center, said: "Big bills become larded with whatever bait it takes to get a majority vote. A lot of money in the Medicare bill is spent on things that have nothing to do with a prescription drug benefit." For decades, it has been common practice for lawmakers to designate money for specific military bases, post offices and waterways. In recent years, they have funneled increasing amounts to specific hospitals, medical schools and health care projects. Data collected by The Chronicle of Higher Education shows that spending on pork barrel projects at colleges and universities topped $2 billion this year for the first time. In a recent report, the Democratic staff of the House Appropriations Committee said the number of projects designated for assistance under the health and education spending bill nearly quadrupled, to 1,850, in the last three years.� Just before the Senate gave final approval to the Medicare bill on Tuesday, Dr. Frist displayed a chart listing 358 organizations that supported it. Members of many of those groups stand to benefit from the bill and participated in a lobbying campaign coordinated by Susan B. Hirschmann, a former chief of staff to Tom DeLay of Texas, now the House Republican leader. The push for special interest provisions to ensure passage of the Medicare and energy bills led, in some cases, to new variations on the traditional relationships between lobbyists and lawmakers. Lobbyists have long tried to influence members of Congress. But increasingly members of Congress have put pressure on lobbyists to support their legislative priorities. E-mail messages obtained from recipients provide details of such reverse lobbying. On Sept. 12, Senator Charles E. Grassley, Republican of Iowa, the chairman of the Finance Committee, sent a "wake-up call" to hospital executives around the country, asking for their help in fighting cuts proposed by the House. "I met with Washington representatives from the American Hospital Association, the Federation of American Hospitals, the Catholic Health Association, the Association of American Medical Colleges and the National Association of Public Hospitals," Mr. Grassley wrote. "I asked them to stand with me in opposing these cuts." Senator Grassley was successful. Hospitals were spared, and rural hospitals received substantial increases in payments.� http://www.nytimes.com/2003/11/27/politics/27LOBB.html?pagewanted=all&position=

Wednesday, November 26, 2003

Chicago Tribune | Governor to punish big drug companies: "With Congress moving to undermine his push to buy prescription drugs from Canada, Gov. Rod Blagojevich on Tuesday said he would seek to punish big drug companies that fought his initiative by making it more difficult or expensive for state workers to buy their drugs if safe alternatives are available."

Firms' medicines to be off state list
The five pharmaceutical firms impacted by the decision, which have been limiting supplies of their pills to Canada, criticized Blagojevich and said the governor was playing politics with an issue that affects public safety. The pharmaceutical industry's trade association also suggested the governor's insistence on punishing the companies could hamper another effort he is pushing to make prescription drugs more affordable--a consumer-discount club aimed at bringing lower-priced drugs to seniors. The club, which is set to begin operations Jan. 1, is designed to allow senior citizens to join forces with state agencies that now buy $1.8 billion in medicines, creating an entity with massive buying power that could have the clout to command price breaks. The state still must negotiate those savings with drug companies, and critics have questioned whether that effort could be impeded by Blagojevich's Canadian drug purchase campaign, which has antagonized the pharmaceutical industry. "He should give the buying club a chance to work, and it hasn't even been implemented yet," said Jeff Trewhitt, spokesman for the Pharmaceutical Research and Manufacturers of America, a drug-industry lobby. Blagojevich said he doubted drug companies would retaliate. "They're not going to cut their nose to spite their face when they run the risk of losing even more business in Illinois," Blagojevich said. Though the drug buying club could potentially affect hundreds of thousands of seniors, Blagojevich's initiative unveiled Tuesday deals only with drugs for state employees and retirees, inmates in state prisons and patients at state mental facilities. Still, it is the Democratic governor's latest effort in a battle to seize the initiative on a controversial issue with compelling appeal to voters. Because Canada has price controls on medicine, Blagojevich has said the state could save $91 million if the U.S. Food and Drug Administration allowed Illinois to buy prescriptions north of the border. The FDA, however, has said the governor's savings claims are exaggerated and that the agency cannot certify the safety of medication coming from Canada, which is often ordered over the Internet. Medicare reform legislation passed by Congress Tuesday did not include a provision sought by many Democrats and fought by big drug companies that would have allowed states and cities to import cheap Canadian drugs. "It should have been in the bill," Blagojevich argued. "It's a missed opportunity." As the debate has raged in recent months, the five companies Blagojevich has targeted chose to begin limiting drug supplies to Canada, saying it was done to prevent Canada from becoming a middleman supplying drugs to the U.S. while endangering the drug supply for Canadians. According to Blagojevich's new plan, the state will remove from its preferred drugs list name-brand pharmaceuticals made by the firms when safe equivalents are available. The five companies--AstraZeneca, Eli Lilly, GlaxoSmithKline, Pfizer and Wyeth--currently make up between 20 and 25 percent of the market share in Illinois.� http://www.chicagotribune.com/business/chi-0311260109nov26,1,4720596.story

Tuesday, November 25, 2003

Op-Ed Columnist: The Uncivil War: "One of the problems with media coverage of this administration,' wrote Eric Alterman in The Nation, 'is that it requires bad manners.' He's right. There's no nice way to explain how the administration uses cooked numbers to sell its tax cuts, or how its arrogance and gullibility led to the current mess in Iraq." So it was predictable that the administration and its allies, no longer very successful at claiming that questioning the president is unpatriotic, would use appeals to good manners as a way to silence critics. Not, mind you, that Emily Post has taken over the Republican Party: the same people who denounce liberal incivility continue to impugn the motives of their opponents. Smart conservatives admit that their own side was a bit rude during the Clinton years. But now, they say, they've learned better, and it's those angry liberals who have a problem. The reality, however, is that they can only convince themselves that liberals have an anger problem by applying a double standard. When Ann Coulter expresses regret that Timothy McVeigh didn't blow up The New York Times, The Wall Street Journal laughs it off as "tongue-in-cheek agitprop." But when Al Franken writes about lies and lying liars in a funny, but carefully researched book, he's degrading the discourse. More important, the Bush administration � which likes to portray itself as the inheritor of Reagan-like optimism � actually has a Nixonian habit of demonizing its opponents.� http://www.nytimes.com/2003/11/25/opinion/25KRUG.html

Monday, November 24, 2003

Medicare Debate Turns to Pricing of Drug Benefits: "With Congress poised for final action on a major Medicare bill this week, some of the fiercest debate is focused on a section of the bill that prohibits the government from negotiating lower drug prices for the 40 million people on Medicare. That provision epitomizes much of the bill, which relies on insurance companies and private health plans to manage the new drug benefit. They could negotiate with drug companies, but the government, with much greater purchasing power, would be forbidden to do so." Supporters of the provision say it is necessary to prevent the government from imposing price controls that could stifle innovation in the pharmaceutical industry. Critics say the restriction would force the government and Medicare beneficiaries to spend much more for drugs than they should. The House passed the Medicare bill on Saturday by a vote of 220 to 215, after an all-night session and an extraordinary three-hour roll call. President Bush and House Republican leaders persuaded a few wayward conservatives to vote for the bill, which calls for the biggest expansion of Medicare since its creation in 1965. In the Senate, debate continued on Sunday, with Democrats asserting that the bill would severely undermine the traditional Medicare program. Senator Edward M. Kennedy, Democrat of Massachusetts, said he would lead a filibuster against the measure. Democrats acknowledged they did not have the votes to sustain a filibuster. But they said they would use points of order to slow the legislation, whose passage is a priority for President Bush.� No provision has been mentioned more often in Congressional debate than the section that prohibits the government from interfering in negotiations with drug companies. Democrats have repeatedly asserted that Medicare could provide more generous drug benefits if, like other big buyers, it took advantage of its market power to secure large discounts. But many Republicans have expressed alarm at the possibility that federal officials might negotiate drug prices. The Medicare program, they say, dwarfs other purchasers, and the government is unlike other customers because it could give itself the power to set prices by statute or regulation, just as it sets the rates paid to doctors and hospitals for treating Medicare patients. Under the bill, the government would subsidize a new type of insurance policy known as a prescription drug plan. "In order to promote competition," the bill says, the secretary of health and human services "may not interfere with the negotiations between drug manufacturers and pharmacies and prescription drug plan sponsors, and may not require a particular formulary or institute a price structure for the reimbursement" of drugs.� Representative Tom Allen, Democrat of Maine, said it struck him as absurd that "the government will not be able to negotiate lower prices" for the drugs on which it plans to spend $400 billion in the next decade. "The bill will allow the pharmaceutical industry to continue charging America's seniors the highest prices in the world," Mr. Allen said. Representative Peter A. DeFazio, Democrat of Oregon, said, "We could provide a much more meaningful benefit if we negotiated lower prices as other nations have done." Representative Rahm Emanuel, Democrat of Illinois, said: "We could bring down drug prices if we allowed the secretary of health and human services to negotiate on behalf of 40 million seniors. That is what Sam's Club does." http://www.nytimes.com/2003/11/24/politics/24MEDI.html?pagewanted=all&position=

Sunday, November 23, 2003

An 800-Pound Gorilla Changes Partners Over Medicare: "AARP, the organization representing retirees, has long been the 800-pound gorilla in the Medicare prescription drug debate. So when the group endorsed a Republican-backed Medicare bill last week, Democrats reacted with anger and alarm." Representative Nancy Pelosi of California, the Democratic leader in the House, complained that AARP was "in the pocket" of Republicans, and suggested that the group, which also sells insurance to its members, had a financial conflict of interest. Eighty-five House Democrats announced they would either resign from AARP, or refuse to join. But behind all the Democratic barbs at the organization itself is a seismic political shift that represents a broader threat to the party's appeal to older Americans. For decades, older Americans were reliable, and crucial, Democratic voters. As recently as last year, Senator Trent Lott, the former Senate Republican leader from Mississippi, derided AARP as a "wholly owned subsidiary" of the Democratic Party. Yet today's older Americans are increasingly voting Republican, a trend that experts say will likely continue as the baby boomers age and the generation of Eisenhower replaces the generation of F.D.R. Before making their endorsement, AARP officials conducted polls and focus groups of Americans 45 and older. The responses, they said, suggested support for a bill that would help the indigent and encourage employers to continue to provide the drug benefits they already offer. Still, surveys of people eligible for Medicare, those 65 and older, have repeatedly found what Drew Altman, president of the Kaiser Family Foundation, calls "a big expectation gap" between what retirees believe the prescription drug bill offers and the limited coverage it actually affords. But in the end, with Congress willing to spend $400 billion over 10 years, on the first-ever Medicare drug benefit for retirees, AARP decided an imperfect bill was better than no bill at all. "Well, we represent a constituency that doesn't have that much time to wait," said John Rother, AARP's chief lobbyist. "There was no prospect in the short term that we were going to get a better bill, and there was a real risk that we could end up with a worse bill." The endorsement was a huge victory for Republicans, but it came at a price: the AARP demanded bigger subsidies for low-income people, and incentives for employers to continue offering drug benefits.� But AARP's critics say its executive director, William D. Novelli, a former public relations man who took the helm of the organization two years ago, is playing a dangerous game by aligning himself so closely with Republicans. Mr. Novelli, who wrote a forward to a book by Newt Gingrich, the former Republican House speaker, defended himself last week against Democratic claims that he was a "closet Republican." "We intend to mend fences as soon as this is over," Mr. Novelli said of the Democrats on Friday. The fundamental debate over Medicare is whether the program should be administered privately, as many Republicans prefer, or by the government, the preference of Democrats and the AARP. By promoting a Republican-backed bill, the AARP is assisting a political party whose long-term goals are at odds with its own.� http://www.nytimes.com/2003/11/23/weekinreview/23STOL.html