Recently, Gloria Mazza wrote, (and other Iowa Republicans signed), an essay in The Des Moines Register that urged President Trump and Iowa’s Republican Senators to oppose recent proposals by the Centers for Medicare and Medicaid Serivces (CMS) that would have taken reasonable steps to reign in increasing drug cost under Medicare Part D. It has now been reported that CMS and the Trump administration have backed off of important parts of the proposed changes.
Currently, Medicare Part D regulations require patient access to “all or substantially all” medications within “six protected classes” of drugs regardless of price. (Protected classes include drugs for HIV, mental illness, cancer, epilepsy, and organ transplants.)
Among other things, the proposed new rule would have allowed Medicare Part D plans to exclude a drug from coverage, 1) for an existing drug if the price increased more than the rate of inflation, or 2) for a new drug if it was simply a reformulation of an existing drug. Apparently, lobbying efforts were successful in getting these two provisions removed from the final new rule.
We don’t have a free market for prescription drugs under Medicare Part D. We should not allow drug makers to set their own price and still require coverage. It is unfortunate that the Trump administration caved-in to the lobbying pressure.
Link to Register essay by Gloria Mazza: https://www.desmoinesregister.com/story/opinion/columnists/2019/05/16/pro-life-advocates-dont-reduce-medicare-part-d-protection-drugs-congress-chuck-grassley-joni-ernst/3685349002/
As the Des Moines Register reported yesterday, the Mayor of Jamaica, Iowa and her husband were busted two days earlier at about 4:20 p.m. (no joke) for growing 18 marijuana plants inside their home. The various related charges include a Class “D” Felony for the manufacture and possession with intent to deliver less than 50 kilograms of marijuana.
It’s a shame that our laws in Iowa still make it a crime to do something that is peaceful, voluntary, and uses no force or fraud against others. Marijuana prohibition laws do little to make our state safer, and yet do great harm to people who are victimized by them. In this case, if these two people are found guilty of the felony, they could be sentenced for up to 5 years in prison, be required to pay up to $7,500, lose their voting rights, be disqualified for military service or student loans, and more. Compare that to the fact that nothing happens to a person in her home who is found to be brewing 5 gallons of beer – a standard home-brew batch – and possessing, say, 10 to 20 more gallons that were brewed earlier.
Marijuana is no more dangerous than alcohol, and yet today we see the same unintended consequences resulting from drug prohibition that we saw from alcohol prohibition in the 1920s and early 1930s: violence, deaths from impure products, and the arrest and punishment of people who are otherwise honest and peaceful. Make no mistake, the violence associated with the illegal drug trade is caused by prohibition laws. If Walgreens moves into a community, CVS doesn’t send out a gang to kill them. When drugs are delivered to a pharmacy, both parties don’t carry weapons to protect themselves. Instead, they call the police if someone uses violence against them. But you can’t can’t call the police for help if you’re dealing in illegal drugs.
We need to follow the trend in other states and around the world: Legalize recreational marijuana and treat addiction using a medical model, just like alcohol. Let your elected representatives know your feelings. That is the way to get these unjust laws changed.
Link to Register article: https://www.desmoinesregister.com/story/news/crime-and-courts/2019/01/17/jamaica-mayor-ladonna-kennedy-pot-weed-gurthrie-county-crime-marijuana-search-ames-shooting-suspect/2606455002/
Thanks to Susan Voss for her thoughtful essay about the complexities of our health care system, and how difficult it is to reduce costs. (See link to Register essay below.) I don’t claim to have “the answer”, but I do suggest that the following cost saving ideas be given serious consideration.
- Medicare, Medicaid and private insurance should not be required to cover every new drug, product, or procedure that is approved by the FDA. Some are very high cost but provide only marginal improvement over alternatives that cost much less. Also, at least some covered products and procedures would likely be considered not medically necessary by most people.
- Consider shortening the amount of time that government grants a monopoly for patents. Patents are not natural property: humans have copied one another since the beginning of time. Our U.S. Constitution allows patents to be granted to encourage inventiveness, but there is no objective reason why a patent must be granted for 20 years. Why won’t five or ten years work? Maybe the length of the patent should be based on the cost to develop the patented item and whether or not government funds were used to help develop the item.
- Don’t require limits on out-of-pocket payments such as co-payments, especially for very high cost items. A person should have “skin-in-the-game” if they expect their insurance to cover very high cost items. Today, we see the opposite: drug companies offer to help pay people’s out-of-pocket costs so there won’t be so much political pressure on them to lower their prices.
- Allow both pharmacies and individuals to purchase drugs from sellers in other countries that are “deemed” to have sufficient safety procedures in place. If drug companies are free to charge lower prices in other countries, then pharmacies and individuals should be free to purchase the drugs from those other countries.
- Allow Medicare and Medicaid to negotiate with drug companies on prices they pay for the drugs that are covered by the programs. Right along with that, Medicare and Medicaid should be allowed to develop formularies (lists of drugs that are preferred over other therapeutically similar drugs), that give beneficiaries a financial incentive to use the preferred drugs and a penalty for using higher cost drugs.
Our health care wants are unlimited. Our ability to pay is not. We, as citizens, should not expect private insurance or our government health care programs to cover everything, regardless of cost. We should expect our government to NOT do things that increase costs, or reduce our choices.
What is often missing in much of the opioid crisis discussion is how our government’s policy of prohibition has made a bad situation even worse. When a person becomes physically addicted to opioids, they will do almost anything to get the drugs they want. If the drugs are not available legally, or if legal drugs cost too much, addicts will find illegal alternatives. According to the CDC, 60% of opioid deaths do not involve prescription opioids. That is, in 60% of opioid deaths the person who died was using illegal opioids. (See CDC reference below.) A significant problem with illegal drugs is that is no way to assure the quality and potency of the drugs. In the case of opioids, that leads to inadvertent over-doses because the illegal drug was much more powerful than thought.
If opioid addicts were able to readily get prescription methadone or other FDA approved opioids at reasonable costs, many deaths would be prevented. That would also take the profit out of the illegal opioid drug trade. If opioid addicts were treated under a medical model rather than a criminal model, it is likely that more opioid addicts would seek help to solve their addiction problem. But as it is, under our drug war, prohibition policy, addicts have good reason to not seek help.
CDC reference: https://www.cdc.gov/drugoverdose/data/overdose.html
Our government, not free market capitalism, is to blame for this situation which has allowed Mylan Pharmaceutical company to jack-up prices for its EpiPen. The FDA is has created a huge delay in approving generic epipens. This has effectively given Mylan a monopoly. Established drug companies should have some type of fast-track authority to manufacture generic products without having to get advance approval from the FDA. Don’t blame private enterprise for problems created by government.