PhRMA's Final Push for Healthcare Reform

Via Ben Smith, PhRMA has put together its closing argument in favor of healthcare reform:

Say what you will about the PhRMA deal -- that the cost of bringing the industry inside the tent (i.e. nixing prescription drug reimportation) was too high -- its support has been key to helping sell healthcare reform. And although the bill is far from perfect, it does cover 30 million Americans (including 15 million to be added to the rolls of governmental programs like Medicaid and CHIP), all while greatly reducing the long-term deficit. Indeed, there is a reason why liberal support for healthcare reform has increased by 16 points in just the past month, providing pressure on Members like Dennis Kucinich to flip their vote in favor of the bill.

Tags: PhRMA, healthcare reform (all tags)




So, other than the post is regurgitated talking points about large numbers, you think the D's cattering PhRMA is the reason why liberals like Kucinich have been flipping?

by Jerome Armstrong 2010-03-17 02:52PM | 0 recs
RE: What?

No. My point is that covering 30 million Americans, along with the other reforms, is a big part of the reason why liberals appear to be coming home.

by Jonathan Singer 2010-03-17 03:12PM | 1 recs
RE: What?

If those other reforms were actually there....

The recission ban is a sham in this bill, for instance.

I think that many liberals are coming home is because it looks more like it will pass.

by jeopardy 2010-03-17 03:19PM | 0 recs
RE: What?

I agree with you, and I also suspect that the ban on discriminating for pre-existing conditions isn't real either. The insurance companies will also be able to work around the medical-loss ratio reform.

If those reforms were real, the health insurers' lobby would be fighting hard against this bill.

by desmoinesdem 2010-03-17 08:22PM | 0 recs
RE: What?

They aren't?  The insurance companies are practically all-in at this point, from what I can see.

by Steve M 2010-03-18 12:08PM | 0 recs
RE: What?

Nah, its not a very good point-- too abstract. The bill has basically become a total partisan; with little of the movement due to policy.

by Jerome Armstrong 2010-03-17 04:01PM | 0 recs

When they add these 30 million to the healthcare system, who will provide care and treatment? We currently have a shortage of providers, and there is nothing in the bill to address this issue.

by BuckeyeBlogger 2010-03-17 03:04PM | 0 recs
RE: So...

There are several provisions in the senate bill to increase the number of primary care doctors as well as fund more community health clinics.


by vecky 2010-03-17 06:31PM | 1 recs
RE: So...

Please elaborate....

by BuckeyeBlogger 2010-03-17 07:20PM | 0 recs
RE: So...

Quick Summary:

Pg 35:


• Improve workforce training and development:
– Establish a multi-stakeholder Workforce
Advisory Committee to develop a national
workforce strategy. (Appointments made by
September 30, 2010)

– Increase the number of Graduate Medical
Education (GME) training positions by
redistributing currently unused slots, with
priorities given to primary care and general
surgery and to states with the lowest resident
physician-to-population ratios (effective
July 1, 2011);

- Increase flexibility in laws
and regulations that govern GME funding
to promote training in outpatient settings
(effective July 1, 2010);

- Ensure the
availability of residency programs in rural
and underserved areas.

- Establish Teaching
Health Centers, defined as communitybased,
ambulatory patient care centers,
including federally qualified health centers
and other federally-funded health centers
that are eligible for Medicare payments for
the expenses associated with operating
primary care residency programs. (Initial
appropriation in fiscal year 2010)

– Increase workforce supply and support
training of health professionals through
scholarships and loans; support primary care
training and capacity building; provide state
grants to providers in medically underserved
areas; train and recruit providers to serve
in rural areas; establish a public health
workforce loan repayment program; provide
medical residents with training in preventive
medicine and public health; promote
training of a diverse workforce; and promote
cultural competence training of health care
professionals. (Effective dates vary)

- Support
the development of interdisciplinary mental
and behavioral health training programs
(effective fiscal year 2010) and establish a training program for oral health
professionals. (Funds appropriated for six
years beginning in fiscal year 2010)

• Address the projected shortage of nurses and
retention of nurses by increasing the capacity
for education, supporting training programs,
providing loan repayment and retention grants,
and creating a career ladder to nursing. (Initial
appropriation in fiscal year 2010) Provide
grants for up to three years to employ and
provide training to family nurse practitioners
who provide primary care in federally qualified
health centers and nurse-managed health
clinics. (Funds appropriated for five years
beginning in fiscal year 2011)

• Support the development of training programs
that focus on primary care models such as
medical homes, team management of chronic
disease, and those that integrate physical and
mental health services. (Funds appropriated
for five years beginning in fiscal year 2010)

• Improve access to care by increasing funding
by $11 billion for community health centers
and the National Health Service Corps over five
years (effective fiscal year 2011); establishing
new programs to support school-based health
centers (effective fiscal year 2010) and nursemanaged
health clinics (effective fiscal year


by vecky 2010-03-17 07:30PM | 0 recs
RE: So...

Thanks, good information. The anticipated primary shortage is estimated to be between 40,000-65,000 by 2020. That being said they need to increase the number of primary care residency slots by about 5,000 each year. They also need to address primary care pay not just through medicare but via private insurance as well in order to attract new graduates towards primary care. Finally, the financial aid needs to be substantial to entice students. I proposed some sort of loan forgiveness, or large grants for students choosing primary care and practicing primary care for a ste period of time, say 5-7 years.

One of the things I dont like in this bill is that it creates too many new departments and so forth thereby driving up the costs of this bill. I think we need to leveage existing government agencies to handle this. Further I think we need to abolish the department of education and thereby allow the money to be shifted towards healthcare. Prior to 1979 there was no Dept of Ed and its creation was rightly opposed by several prominent democrats.


by BuckeyeBlogger 2010-03-17 07:43PM | 0 recs
RE: So...

I am reading through as much of the bill text and summaries to determine what is good and what is bad about the bill, rather than cherry pick. I am persuaded to support it I will, however if not, I will continue to oppose base on the facts. I still prefer the Wyden Bennett bill, however I will do some detailed analysis and make my own decision.

by BuckeyeBlogger 2010-03-17 07:55PM | 0 recs
RE: So...

That's fine. if you do decide to support it, I thank you. Just know that this bill is very much trade-off - so one can't be completely happy with very single provision.

I can't answer your question below - I assume that experts have looked at it and examined all the incentives and dis-incentives for companies providing insurance, the CBO estimates there will be no real change in the number of people who receive benefits from their employer (large firms). Also the mandate amounts were negotiated by Olympia Snowe if I remember correctly. Ofcourse even though those were included in the final bill she didn't vote for it, *sigh*.

Also another thing - the bill also provides a boost in paymnets for primary care physians - an extra $3 billion in 2014. So it's all steps in the right direction.

by vecky 2010-03-18 02:33PM | 0 recs
RE: So...

From the AAFP site, from an article reviewing the senate bill back in December. A step in the right direction for primary care physicans with regard to payment.

The legislation would provide a 10 percent bonus for five years for physicians who provide more than 60 percent primary care health services in their practices, a provision that Epperly called "an important step toward signaling to medical students that the nation is committed to investing in primary care."

According to both Heim and Epperly, however, more needs to be done.

"We have a primary care physician shortage, and we need to look at increasing the numbers of family physicians," Heim said.

Although she described the bonus payment for primary care as a positive starting point, "it is not going to be substantial enough to really change medical school students' interest in primary care."

The AAFP has called on Congress to make permanent the primary care bonus payment in the legislation and has urged that it apply to physicians who provide 50 percent primary care health services, not 60 percent, to allow more primary care physicians to qualify for the bonus.

In addition, the legislation does not contain a permanent fix for the sustainable growth rate formula, which has triggered steep reductions in Medicare physician payment rates during the past eight years, although the Senate has pledged to work on this issue.

The bill also does not provide comprehensive tort reform, something the AAFP has long championed. It does, however, include funding for states to explore alternative dispute resolution systems.

by BuckeyeBlogger 2010-03-18 03:34PM | 0 recs
RE: So...

I do have one grave concern. The provision in the bill which states that companies with more than 50 employees are mandated to provide coverage. Thats fine. However if they do not, there is a $750 per employee penalty for not offering insurance. Well, if a company is paying $10,000 per employee now to cover insurance, why bother. Why not simply stop offering benefits and pay the $750 penalty for each employee, thereby dumping thousands of employees out of employer based coverage with generally affordable costs in favor of employees being forced to buy int plans on their own and significantly higher costs? Whats the incentive to a large company to continue to pay the healthcare costs? The penalties need to be much stiffer, in fact they should be equal to greater than what the company would have paid to provide coverage. Say the penalty is Cost+5%?

by BuckeyeBlogger 2010-03-17 08:10PM | 0 recs
RE: So...

If a company would drop coverage because the penalty is "only" $750 per employee, you have to explain why they haven't already dropped coverage, considering the penalty is $0 under current law.

by Steve M 2010-03-18 11:50AM | 0 recs
RE: So...

yeah, i never really understood that particular talking-point.

Why would they be more likely to drop coverage if it becomes more expensive to do so?

by jeopardy 2010-03-18 12:18PM | 0 recs
RE: So...

I think a lot of people on both sides don't really understand the market forces that cause employers to offer insurance under the current system.

by Steve M 2010-03-18 11:30PM | 0 recs
RE: So...

That's a ridiculous argument. Because of a shortage of providers, we should continue to leave tens of millions of Americans without access to health insurance?

by desmoinesdem 2010-03-17 08:23PM | 0 recs
RE: So...

Uh yo do realize if their arent enough physicians you end up with a new set of problems related to access, availability of physicians and if current primary care doctors are forced to see more and more patients and spend less time with each quality of care declines, not to mention many more will become fed up and leave the system altogether. Thats no small problem. Thats why adeqaute measures need to be in the bill to see that we stimulate the number of primary care doctors and they can earn a reasonable income.

by BuckeyeBlogger 2010-03-17 11:07PM | 0 recs
Is this true?

I saw Tim Kaine on the teevee this morning saying that no overhaul of healthcare has ever passed out of a single Congressional Committee until this year.  Is that true?  If so, it puts all of this into a different light.  Maybe the Professor-in-Chief isn't just a teleprompter-reading, Rahm-worshipping dolt after all.

by the mollusk 2010-03-17 03:08PM | 0 recs
RE: Is this true?

Well, from the last time it was attempted - 1993 - every bill (and there were several) died in committee. I don't know about before that...

by vecky 2010-03-17 06:33PM | 0 recs
RE: Is this true?

That does it.  I'm sticking to my diet of Arugula, cigarettes, and iced green tea.  I'm also planning to grow a few inches and become black.

by the mollusk 2010-03-18 12:57AM | 0 recs
RE: Is this true?

Well then you have to read this:

Was written in 1994 after the failure of that effort. It's amazing how similar some of situations are - including the GOP playbook to defeat the reform.

by vecky 2010-03-18 02:29AM | 0 recs
second part of the deal

Was with hospitals, in leaving out the PO:

It makes sense of something that hasn't made any at all to date (the abandonment).

by Jerome Armstrong 2010-03-17 04:04PM | 0 recs
RE: second part of the deal

Bit out of date no? The early hearing in the HELP committee and Ways n Means nixed a PO paying strict Medicare rates. It was always going to be +5 or negotiated, dating back to the beginning of the process.

by vecky 2010-03-17 06:35PM | 0 recs
RE: PhRMA's Final Push for Healthcare Reform
Unable to Pay for Health Care Bill, Dems Look to Raise Excise Tax on Middle Class


"They already stole at least $10 billion in the student loan reform bill from community colleges to pay for this PhRMA bailout. Jon Walker notes that adding a public option would save at least $25 billion in the bill. The House paid for its bill by taxing the richest Americans.

And yet, faced will trying to contain the costs of this bill, Democrats’ first instinct is to raise taxes on the middle class even further. Brilliant!"


by jeopardy 2010-03-17 06:22PM | 0 recs
RE: PhRMA's Final Push for Healthcare Reform

The notion that the costs of the excise tax will be principally borne by the middle class is one of the biggest puke-inducing lies of this entire debate.  But this exemplifies one of my biggest problems with modern progressivism: everyone wants a comfortable middle-class safety net, but if any portion of the burden falls on anyone outside the top 1% of earners then everybody screams bloody murder.  The excise tax is not even a direct revenue measure; it is a cost-control measure that happens to be projected to raise money at the end of the day.

It's worth thinking about the economic theory by which the excise tax is projected to raise money.  It raises money by putting more taxable income in the pockets of those who currently receive "Cadillac" health care benefits in lieu of wages.  Yes, some of these people fall within the category of middle class, but the reality is that there is only a "middle-class tax increase" in the sense that someone making $60,000 last year might make $65,000 this year, and thus have a higher tax bill.  I call this a win-win for the taxpayer and the revenue coffers.

Of course, there are those who doubt the theory that wages will go up at all as a result of the elimination of the tax incentive for offering "Cadillac" plans, but if wages don't go up then there sure as heck isn't a tax increase.

I wish liberals could figure out a way to argue against something without sounding like conservatives.  The people at FDL are not doing God's work on this issue.

by Steve M 2010-03-18 12:06PM | 0 recs
RE: PhRMA's Final Push for Healthcare Reform

I agree generally with your points.

But I think you are missing the main point about this newest development.

the problem here is that when they need more money, they are trying to decrease the value of plans at which the tax kicks in, thus getting *more* of the middle class than before.

Your post seems to miss that point.

I'm not sure how it is sounding like conservatives to point that out.

by jeopardy 2010-03-18 12:14PM | 0 recs
RE: PhRMA's Final Push for Healthcare Reform

It's called death by CBO.... The CBO likes the excise tax, thinks it's a swell "cost control" idea and keeps scoring it highly. They think it's better than the original millionaire surcharge (which they scored poorly). So it keeps being put in the bill. My own thinking is that the excise tax will become a lot like the AMT.

by vecky 2010-03-18 01:42PM | 0 recs
RE: PhRMA's Final Push for Healthcare Reform

Skeptics believe the excise tax will never kick in at all, because it is so unpopular it will just be scrapped sometime between now and the start date of 2018.

Personally I don't get why they don't just phase it in, as an experiment to see if there is really an impact on wages.

by Steve M 2010-03-18 11:34PM | 0 recs
RE: PhRMA's Final Push for Healthcare Reform

Well, it might kick in depending on the deficit situation in 2018. And no one has yet made the case that such high-cost insurance plans are basically a giveaway to the insurance companies. A $28K policy does represent a pretty sweet deal. If you say the average household income is $65k then such a policy represents 33% of income. That's way higher than the average cost - which is closer to the nominal GDP rate, i.e.: 17%. So someone is pocketing the difference.

As I said no one has made the case - yet.

Also if the reform works and is expanded - there won't be much need for the tax, because the new social safety net including caps on total out-of-pocket expenses will make such high cost plans unnecessary.

by vecky 2010-03-19 12:38AM | 0 recs

nevermind, you were right. I should have looked back over it before I commented (or had more coffe first).

by jeopardy 2010-03-18 12:16PM | 0 recs
it's not just the re-importation sellout

Democrats have been promising for years to let Medicare negotiate for lower drug prices. Magically, that cost control is not in the bill.

But we have to tax the "Cadillac" plans, which will force millions of people to downgrade their level of insurance coverage.

by desmoinesdem 2010-03-17 08:21PM | 0 recs
would you make the same excuses

for a Republican president who cut the same deal with PhRMA, against the interests of the American people?

by desmoinesdem 2010-03-17 08:32PM | 2 recs
RE: would you make the same excuses
I've been running into a lot of "my party, right or wrong!" People lately.
by jeopardy 2010-03-17 09:20PM | 0 recs


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