Return of the Socreds

Presto Manning is contemplating a run for the leadership of the Party of Calgary. Somethings never change. Preston Manning Expresses Interest In Replacing Klein

That would mean 35 years of Socred power that ended with his father, Ernest, being replaced with a lame duck Premier, then 33 years of PC power starting with Peter Lougheed and ending with a lame duck Premier, and then the possibility of that strange beast the Reformed PC Socreds under Presto.....noooooooo.

Preston Manning, who was once the second-most-powerful leader in Canada as leader of the opposition, is apparently now considering his chances of becoming the second-most-powerful leader in Canada as premier of Alberta.

King Ralph is dead
The Alberta Tories' regicide of Ralph Klein was big news for 12 hours. Then Preston Manning trumped it, telling reporters he was considering running for Klein's job.

Daddy Ernest Manning gave up party power to Peter Lougheed, thus assuring a Liberal Conservative Socred Alliance that was Seventies PC's. That alliance was shattered as neo-cons took over under Klein, the fiscal right was far less powerful than the social conservatives. The social conservatives align behind Oberg, the Reform types around Morton, and the liberal wing under Dinning. Alberta Tories in disarray

Dining did the dirty deed of balancing the budget on the backs of the working class, with wage and benefit cuts to the public sector. Then with victory in his back pocket he left the government.

The neo-cons in the party then went on to shape the Ralph Revolution, using the the debt and deficit hysteria of the ninties to impose their Republican Lite vision on Alberta, while promoting it for the rest of Canada with Prestos Reform Party.

Government that governs least is best — or not

When Mr. Klein became premier, the province had a $3.4-billion deficit and a $23-billion debt. He argued these burdens arose, in part, from governments having involved themselves too much in the economy. There were bad investments. The government taxed too much. Government regulations were too onerous. The free market, he asserted, would be encouraged if the government got out of the way.

This contrasted with the approach of Peter Lougheed, who led the Conservatives to power in 1971. Mr. Lougheed was no socialist, but he did believe the government should try to direct, cajole and even force the market in directions he believed Alberta needed. Only that way, he reasoned, could Alberta's economy be diversified and energy revenues used not just for today's needs, but for the future.

Mr. Lougheed's dirigiste preferences evaporated under Mr. Klein, but now some Albertans want that kind of guiding hand back, at least in a modified form. In a free-enterprise province, the critics are now demanding a “plan” for using the revenues that would be more than driving up spending on ongoing programs.

Presto would be an interesting add to the mix but his chances of winning are less than none. Unless he has something up his sleeve, oh like say Medicare Reform. If anyone could enunciate and promote the Third Way in Medicare it would be Presto.

“Where I think we're headed is a system of universal care, where everybody is covered ... with two tracks for delivery, and two tracks for payment. It's not a question of private versus public, but what mix of the two is appropriate.”

Mr. Manning left what he likes to call "active partisan politics" in 2002 to become more involved in the public-policy debate. He quickly got on board with the Fraser Institute and the Canada West Foundation, and he set up the Manning Centre for Building Democracy.

He and Mike Harris authored the Fraser Institute Report on exactly the musings that King Ralph has been tossing about for the past decade. And perhaps that would be the reason for him to run, otherwise Third Way Medicare Reform is dead in the water.

Third Way predicted to meet Klein's fate

Dead-end way Tories mull future of health-care reform if Ralph exits scene



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Wall Street 'overjoyed' as Biden lets Medicare Advantage insurers off easy

Jake Johnson, Common Dreams
April 10, 2023

UnitedHealth Group, a dominant force in the lucrative Medicare Advantage market, has seen its stock jump over the past week as Wall Street analysts and investors embrace the Biden administration's decision to delay reforms aimed at tackling abuse in the privately run, government-funded health program.

STAT reported late last week that "Wall Street was overjoyed" by the announcement from the Centers for Medicare and Medicaid Services (CMS), which said it would phase in changes to the model that dictates how much government funding Medicare Advantage insurers receive to cover patient care.

Instead of implementing the changes all at once, the Biden administration will roll out the reforms over a three-year period, allowing Medicare Advantage insurers to continue overbilling the federal government in the meantime.

Recent federal audits and investigative reports have detailed how Medicare Advantage plans overcharge the government to the tune of billions of dollars a year by making patients appear sicker than they are, piling on diagnoses with little to no supporting documentation. Medicare Advantage plans also frequently deny necessary care and use algorithms to prematurely end coverage.

In addition to delaying full implementation of its reforms, CMS—which has faced aggressive lobbying from UnitedHealth and other major Medicare Advantage players in recent weeks—announced it would boost payment rates for Medicare Advantage plans by 3.3% in 2024—a larger-than-expected increase.

CMS said Medicare Advantage payments would rise by nearly $14 billion next year under the new plan.

As STAT's Bob Herman noted, "health insurance companies that participate in Medicare Advantage will retain billions of extra taxpayer dollars next year" thanks to the Biden administration's changes, which drew criticism from progressive lawmakers and some policy experts.

"The phased-in approach will continue to reward those insurers with the most abusive practices over the next two years," warned Mark Miller, executive vice president of healthcare for the philanthropy Arnold Ventures.

Herman reported that following the CMS announcement, "investors raced to buy stocks of the largest Medicare Advantage insurers, including UnitedHealth, Humana, CVS Health, Elevance Health, and Centene." STAT cited one analyst estimate suggesting that UnitedHealth Group could see $900 million in additional profit next year thanks to the CMS policy revisions.


"It was 'a sigh of relief' for the industry, according to Jailendra Singh, a healthcare stock analyst at Truist Securities," Herman wrote. "Chris Meekins, a health policy analyst at Raymond James, called the White House's move 'a clearing event for the space.'"UnitedHealth, Cigna, Humana, CVS/Aetna, Elevance Health, Centene, and Molina have seen their combined revenues from taxpayer-funded programs like Medicare Advantage soar from $116.3 billion in 2012 to $577 billion in 2022, according to a recent analysis

by Wendell Potter, a former Cigna executive who now heads the Center for Health and Democracy.

Those companies have been at the forefront of what The New York Times recently described as a "lobbying frenzy" on Capitol Hill, a blitz that appears to have influenced the Biden administration's decision to go easy on Medicare Advantage despite promising bold reforms.

The Times noted that the administration's earlier proposals to revise the Medicare Advantage risk-adjustment model "unleashed an extensive and noisy opposition front, with lobbyists and insurance executives flooding Capitol Hill to engage in their fiercest fight in years."

"The largest insurers, including UnitedHealth Group and Humana, are among the most vocal, according to congressional staff, with UnitedHealth's chief executive pressing his company's case in person," the newspaper reported. "Since the proposal was tucked deep in a routine document and published with little fanfare in early February, Medicare officials have been inundated with more than 15,000 comment letters for and against the policies, and roughly two-thirds included identical phrases from form letters."

The Better Medicare Alliance, a lobbying organization backed by top Medicare Advantage insurers, purchased a Super Bowl ad decrying the Biden administration's earlier reform proposals as an effort to "cut" Medicare Advantage.

Rep. Pramila Jayapal (D-Wash.), chair of the Congressional Progressive Caucus, said in a statement late last week that she was disappointed by the Biden administration's decision to weaken its reforms in the face of industry pressure.

"It is now clear that Medicare Advantage is simply a profiteering venture that hurts patient care," said Jayapal. "Without a complete overhaul, it will be impossible to stop bad actors. These plans have spent years scamming seniors and overcharging the government to pad their own profits. We were on the cusp of immediate reform when the Biden administration proposed fixes to stop price gouging by insurance companies."

"Sadly," she added, "health insurance companies used taxpayer dollars meant for medical care to instead buy Super Bowl commercials and desperately lobby to stop these changes that would cut down on their profiteering."

How Medicare for All Would Affect Union Health Plans

Medicare for All would save IUPAT members $4,868 to $7,866 per year.

3P ORIGINAL REPORT NO.019

BY Matt Bruenig and Jon Walker
August 17th, 2020

Download Full Report


In the political discourse around health care reform, commentators frequently raise concerns about the effect of any given reform on union health plans. In this paper, we use data provided by the International Union of Painters and Allied Trades (IUPAT) to determine what the net financial impact of implementing Medicare for All or Bidencare would be on their members. In short, we find that Medicare for All would save their members $4,868 to $7,866 per year while Bidencare could save them $676 to $3,253 per year if they take advantage of new individual exchange subsidies.
Union Health Plans

In a normal employer health plan, an individual firm provides insurance to the workers employed by the firm. In a union health plan, also known as a multiemployer plan or a Taft-Hartley plan, a union and various employers establish a separate trust fund that jointly administers an insurance plan. During collective bargaining, the union agrees to forego wages so that the employers can contribute money to the trust fund, which then uses that money to provide health benefits to the union’s workers.



This structure has a few main advantages not found in single-employer plans. First, the larger size of multiemployer plans allows them to be more administratively efficient and allows them to negotiate better rates from third-party insurers. Second, in industries where workers frequently move between firms, such as the construction industry where IUPAT represents workers, the multiemployer nature of the plans means that workers can retain coverage even as they move from job to job. Lastly, unions can use the enticement of a multiemployer plan to assist in organizing workplaces that are not currently unionized.

But these advantages don’t insulate the plans from the general problems of the overall healthcare system. Ever-escalating healthcare prices have consistently increased the per-member costs of the funds, requiring unions to continually forego wage increases in order to free up money for employers to contribute to the funds. Plan members also face the prospect of dropping their insurance or having to pay hefty out-of-pocket premiums if they lose their job, have their hours cut, or change jobs to an employer who does not participate in the multiemployer plan.

Multiemployer plans are also uniquely vulnerable to macroeconomic shocks that cause large amounts of prolonged unemployment, such as the shock coinciding with the coronavirus pandemic. This is because many multiemployer plans base eligibility for benefits on how many hours a member worked in the last quarter or even sometimes in the last calendar year. This lagging eligibility criteria means that, during a mass disemployment event, the funds stop receiving employer contributions even though their members continue to be eligible for benefits based on their prior work record. When this happens, fund reserves are quickly depleted, threatening the solvency of the health plan.
Medicare for All

In order to determine the effect of moving to a Medicare for All system, we used detailed wage and health plan information from three IUPAT locals and compared the status quo arrangement to what would prevail under Medicare for All. The results are summed up in the following graph.


Bidencare

We did the same thing with the Bidencare proposal. Unlike Medicare for All, the Bidencare proposal lacks a number of key details, such as the precise sliding scale that will be used to determine exchange subsidies and what the employer shared-responsibility payment will be. We filled in those gaps with reasonable guesses in order to produce the graph below.



This graph assumes that the union and employers agree to stop providing health insurance so that the workers can buy an individual exchange plan using Biden’s proposed individual exchange subsidies.
Conclusion

Combining the Medicare for All and Bidencare graphs together producesthe following graph.



As a historical matter, it was smart for unions to take advantage of the Taft-Hartley Act to create multiemployer union health plans for their members. One of the things that gets lost in the discussion about healthcare reform is how similar Medicare for All is to these union plans. What unions recognized long ago is that it is much better for workers to create a central healthcare fund that many employers contribute into than to have a bunch of independent plans organized within each company. Medicare for All is just the logical extension of this insight to the whole economy. It is, in a sense, just one big multiemployer fund.

In light of the coronavirus catastrophe and the objective superiority of Medicare for All to existing union health plans—in terms of cost, solvency, and continuity of coverage—we believe that unions like IUPAT should take a stance in favor of Medicare for All for the benefit of their own members and the working class generally.


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Democrats want to allow 60-year-olds into Medicare as part of Biden's infrastructure package

jzeballos@businessinsider.com (Joseph Zeballos-Roig) 

© Getty/Pool Rep. Pramila Jayapal. Getty/Pool

Democrats are attempting to expand Medicare as a part of Biden's infrastructure plans.

"Medicare expansion means more coverage for more people," a top Democrat said.

The effort may be derailed by Joe Manchin, who says he opposes enlarging Medicare access.

The latest Democratic battle to expand Medicare access is under way.

A group of more than 150 House Democrats from the progressive and centrist wings of the party are launching a campaign to include an expansion of Medicare in President Joe Biden's infrastructure plan, The New York Times reported.

They sent a letter on Thursday to Biden and Vice President Kamala Harris arguing to widen the federal health program so it includes a broader range of Americans, along with growing the range of benefits provided so it includes dental, vision, and hearing aids.

"Medicare expansion means more coverage for more people - and by finally allowing Medicare to negotiate drug prices, it's at a lower cost for taxpayers," Chair of the Congressional Progressive Caucus Pramila Jayapal, a leader of the effort, said in a Friday tweet. "Let's get this done."


Tighten Facial Skin Without a FaceliftSEE MORESponsored by DAILY SKIN HARMONY


The plan would cut the eligibility age from 65 to 60, adding roughly 23 million Americans into the government health insurance program. The group projects it would amount to $200 billion over a decade. They say the price tag would be offset with another proposal: empowering Medicare to negotiate the cost of prescription drugs, which Democrats have failed to achieve in the past.



Video: Whitmer, GOP leaders cut deal on budget talks, work rules (WZZM-TV Grand Rapids-Kalamazoo-Battle Creek)


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The effort is certain to trigger Republican opposition and potentially reopen a fierce debate among Democrats on healthcare. The last Democratic presidential primary was largely defined by policy brawls over Medicare for All and whether Americans should be able to keep their private coverage in a reform effort.


Expanding Medicare access is popular with voters, however, particularly reducing prescription drug costs. Up to now, however, Biden and Democrats have directed their efforts at expanding the insurance subsidies available under the Affordable Care Act.

Widening Medicare coverage could run into roadblocks in the Senate from centrist Democrats. Sen. Joe Manchin of West Virginia has stated his opposition, complicating the path ahead for other Democrats supportive of the measure. "No, I'm not for it, period," he told The Washington Post last month. It's unclear why Manchin opposes it, although he told The Hill in 2019 the government "can't even pay for Medicare for some."

Biden continues negotiating with Republicans on an infrastructure plan, and the talks are set to stretch into at least early June. The White House did not include a Medicare expansion or a blueprint to cut the price of prescription drugs in its economic plans, though it called on Congress to approve the measures in its budget without laying out specific policies.

FOR PROFIT HEALTHCARE

Medicare is overpaying for generic drugs

Disturbing financial practice by Medicare Part D sponsors revealed in UC San Diego study of data from the Centers for Medicaid and Medicare Services

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - SAN DIEGO

Medicare is the single largest provider of health insurance in the United States, serving 63.8 million senior citizens as of 2022. Three-quarters of these recipients are enrolled in optional Medicare Part D plans, which provide outpatient prescription drug coverage to seniors through private insurance companies. In 2022, Medicare paid more than $160 Billion for prescription drugs, making it the single largest payer of pharmaceuticals in the US.

While Medicare is meant to keep healthcare affordable for seniors, millions of Americans still face steep costs for prescription medications. Researchers at Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California San Diego, West Health, and the University of Washington have now explained part of the problem.

The researchers found evidence that the private insurers that sponsor Medicare Part D are artificially inflating the costs of certain generic drugs by overpaying pharmacies. The findings published December 5, 2023 in the Journal of the American Medical Association.

Generic over-reimbursement is one of the areas targeted for reform by the United States Senate, after anecdotal evidence submitted earlier this year by the non-profit manufacturer CivicaRx raised concerns about Part D sponsors potentially over-reimbursing pharmacies for abiraterone, a cancer drug. The concern: that patients are ultimately impacted by these reimbursement practices because of how out-of-pocket costs, such as copayments and deductibles) are calculated.

“For instance, if a patient pays 30% as a copayment for a drug, that 30% would be applied to the inflated price, which could mean higher out-of-pocket costs for seniors,” said corresponding author Inmaculada Hernandez, PharmD, PhD, professor at Skaggs School of Pharmacy and Pharmaceutical Sciences at UC San Diego.

However, whether Part D Plan sponsors are engaging in generic over-reimbursement has been an outstanding question until now.

“This is the first study to investigate whether these practices actually take place in the Medicare Part D program,” added Hernandez.

To fill prescriptions, pharmacies purchase drugs wholesale and are reimbursed by insurers. In order to be reimbursed, pharmacies must adhere to contractual obligations that allow insurers to take back money in certain circumstances, such as when the reimbursement to the pharmacy is higher than a certain threshold or if the pharmacy’s cost of acquisition is very low. These ‘clawbacks’ by Part D Plans can be financially devastating to a pharmacy.

“It doesn’t make sense that insurers would overpay for drugs, then use clawbacks to retroactively adjust payments after the patient has paid their co-payment,” said co-author Sean D. Sullivan, PhD, professor of pharmacy at the University of Washington. “This practice is opaque and ultimately harms patients and pharmacies.”

The researchers gathered and analyzed data from the Centers for Medicare and Medicaid Services (CMS), focusing on spending and reimbursement data for the 50 generic drugs that Medicare Part D spent the most on in 2021. They found that some Medicare Part D sponsors were reimbursing at much higher rates than what pharmacies spent to acquire the drugs.

“The results are alarming,” said Hernandez. “We are talking about markups of 6000% or 7000% in some cases.”

In one of the most dramatic examples, the researchers found that insurers were reimbursing pharmacies an average of $126 per tablet for a cancer drug that cost $4.20 per tablet to the pharmacy. This corresponds to an average markup of 3000%, or $3600 per 30-day prescription. Some insurers paid even more.

“Seniors are clearly paying more for their medications as a result of these markups,” said Hernandez. “More research is needed to confirm the scope of these practices, but the evidence is concerning.”

Co-authors include: Nico Gabriel at UC San Diego, Anna Kaltenboeck at ATI Advisory, Cristina Boccuti at West Health Policy Center and Ryan N. Hansen at the CHOICE Institute, School of Pharmacy, University of Washington.

This study was funded by West Health Policy Center.

###

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JOURNAL

JAMA

DOI

10.1001/jama.2023.21481 

The role of marketing in disrupted health care markets: It’s time to move beyond conventional strategies to account for new actors, roles, and exchanges

News from the Journal of Marketing

Peer-Reviewed Publication

AMERICAN MARKETING ASSOCIATION

Researchers from Duke University, University of New South Wales, University of Wisconsin, and University of Washington published an editorial for the Journal of Marketing that calls for marketing to tackle the challenges and opportunities in dynamic contemporary health care markets.

The editorial, introducing a special issue on “Marketing in the Health Care Sector” for the Journal of Marketing, is titled “Marketing in the Health Care Sector: Disrupted Exchanges and New Research Directions” and is authored by Christine Moorman, Harald J. van Heerde, C. Page Moreau, and Robert W. Palmatier. The special issue editors introduce a series of articles that offer novel contributions regarding marketing’s role in the health care sector as well as a research agenda outlining more opportunities for marketing scholars to examine whether and how these disrupted exchanges are improving health, empowering choice, and fostering competition.

Health care is vital to our interconnected world and, as demonstrated during the COVID-19 pandemic, societies are deeply affected by its successes and failings. Over the last decade, health care has been disrupted on both the demand and supply sides and these changes have impacted the creation, provision, and consumption of health care in fundamental ways.

However, the role of marketing in this dynamic health care industry remains only partially understood and is often focused on conventional strategies such as business-to-business transactions (e.g., detailing or advertising to doctors) and business-to-consumer transactions (e.g., direct-to-consumer advertising). “While important,” Moorman explains, “this limited view ignores the new actors, roles, and exchanges that characterize disrupted health care markets. As a result, the health care sector is not acting on the full range of opportunities associated with these changes, including understanding their effects on consumer welfare.”

At the heart of the editorial lies a set of disrupted exchanges involving conventional and new health care producers, health care providers, and health care consumers. Health care producers refer to those who develop health-related products, services, and information, even though they do not administer health care directly to patients. Health care producers come in two categories: i) conventional health care producers (i.e., pharmaceutical and medical device companies); and ii) new health care producers (i.e., technology and diagnostic companies).

Health care providers deliver information, products, and services to consumers. These providers also come in two categories—traditional providers that include doctors, nurses, hospitals, and health centers as well as new providers that include retail health care providers, complementary and alternative health care providers, and physician influencers who preach their health gospel to the marketplace.

Health care consumers receive and use information, products, and services created by producers and providers. Traditionally, they are exclusively on the receiving end of value. In today’s health care systems, however, consumers may also be peer creators of value when they participate in health care communities, provide reviews, and/or become influencers.

The editorial focuses on two types of disrupted exchanges: i) the influence of new actors on their conventional counterparts and ii) the influence of these new actors on one another. It observes a merging of roles across producers, providers, and consumers manifesting in a “race to the provider role” that is disrupting many exchanges and changing consumer and firm behavior and the operation of these markets.

The editorial identifies initial potential impacts of these disrupted exchanges on three outcomes. The health-enhancing impact refers to the degree to which mental and physical health outcomes might be improved. The choice-empowering impact refers to the degree to which consumers have an actual or perceived improvement in their ability and motivation to understand and make health-related choices. One concern is that more information does not always equate to better choices. The competition-inducing impact refers to the degree to which the change fosters competition that improves quality, increases access, and lowers prices. These competitive effects are determined by whether consumers use new health care exchanges as substitutes or complements. If used as substitutes, disrupted exchanges may spur competition. If used as complements, the effects may be minimal or they may produce beneficial partnerships in the industry.

More research is needed to assess how the marketplace will be transformed and how marketing might contribute in positive or negative ways. Will health be improved, choice enabled, and competition fostered on quality care, access, and lower prices? Or will health be managed differently, but with no effects on morbidity and mortality, with more confusion than empowerment, and with more competition but no welfare gains?

“We see an enormous opportunity for the marketing discipline to help understand and address the complexities arising from the unprecedented pace and level of change in health care exchanges. Asking questions about how the new actors and new roles are participating in these exchanges and to what end in terms of health, choice, and competition outcomes is a valuable role we can play,” says van Heerde. The editors invite contributions for creating a stronger role for marketing in the study and management of health care.

Full article and author contact information available at: https://doi.org/10.1177/00222429231213154

About the Journal of Marketing 

The Journal of Marketing develops and disseminates knowledge about real-world marketing questions useful to scholars, educators, managers, policy makers, consumers, and other societal stakeholders around the world. Published by the American Marketing Association since its founding in 1936, JM has played a significant role in shaping the content and boundaries of the marketing discipline. Shrihari (Hari) Sridhar (Joe Foster ’56 Chair in Business Leadership, Professor of Marketing at Mays Business School, Texas A&M University) serves as the current Editor in Chief.
https://www.ama.org/jm

About the American Marketing Association (AMA) 

As the largest chapter-based marketing association in the world, the AMA is trusted by marketing and sales professionals to help them discover what is coming next in the industry. The AMA has a community of local chapters in more than 70 cities and 350 college campuses throughout North America. The AMA is home to award-winning content, PCM® professional certification, premiere academic journals, and industry-leading training events and conferences.
https://www.ama.org

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JOURNAL

Journal of Marketing

DOI

10.1177/00222429231213154 

ARTICLE TITLE

Marketing in the Health Care Sector: Disrupted Exchanges and New Research Directions

Proletarian Doctors

Medicare reform can only occur when we break the doctors business monopoly and 'their haughty power' over health care. One of the ways is to put doctors on salary.

Another is by creating integrated community medical centers and thus the proletarianization 0f Medicare through the use of salaried Nurse Practitioners and Physician's Assistants. It's an idea Norman Bethune would approve of.

Dr. Sigurdson, who worked with a physician assistant during a fellowship in Atlanta, just completed a master of business administration degree at Saint Mary's University during which he examined the business case for physician assistants.

"We could do things much better here," he said Wednesday.
Dr. Sigurdson said in an average 10-hour day set aside for operating, he only spends about six hours in the operating room and the rest of the time waiting for patients to be moved, the room to be cleaned and so on.

But much of what he does in the operating room could easily be done by a trained physician assistant.

He said it doesn't require a surgeon to prepare and drape a patient for surgery, sew up an incision or dress a wound.

"A (physician assistant) could sew up just as good as I can," Dr. Sigurdson said.

In fact, by his calculations, a surgeon is needed for only about 37 per cent of what happens during an operation. And a physician assistant could handle 51 per cent of the patients he now sees in a clinic.

About 100 patients were booked to see Dr. Sigurdson on Thursday morning. He needs to see patients having or recovering from major procedures like breast reconstruction. But when the appointment is simply to check whether someone who's had a minor procedure is faring well, a physician assistant would do just as well.

Comparing the cost of hiring a physician assistant at about $70,000 per year to a conservative estimate of Dr. Sigurdson's increased productivity, he estimated the province would see a modest cost saving over 10 years.

But when he compared the cost of a physician assistant plus the space and staff to run two operating rooms at once to simply hiring a second surgeon to work in a second room, he found the province could save $1 million in today's dollars.

A full-time surgeon at the QEII is paid an average $432,521 a year under a contract with the province, meaning the doctor would get no extra pay for doing twice as much surgery.

"I'm a young surgeon; I like operating," Dr. Sigurdson said. "And I'd like to operate more. You don't train 14 years to do something and then you only get to do it a day or a day and a half a week. It's frustrating."

He said it's much too late now to hope that increasing the number of doctors trained in Canada can meet the mushrooming demand for care. The country is just now experiencing the leading edge of a huge group of aging baby boomers who will not accept years-long waits for health care.

"To take business concepts and bring them into the public system is a strategy that we really should be thinking very strongly about before we throw the baby out with the bathwater and bring in a parallel private-care system," Dr. Sigurdson said.

Physician assistants work well in the private American system and could easily be incorporated into the public system, he said.

And there are trained physician assistants in Nova Scotia eager to work, he said. Those employed by the military frequently take early retirement and are left with few work options save providing care on oil rigs.

SEE

Ex Pat Attacks Medicare

Privatizing Health Care

Socialized Medicine Began In Alberta

Laundry Workers Fight Privatization

Two Tier Alberta

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Big Pharma Flooding Airwaves With Disinformation to Kill Drug Price Reform

"Powerful interest groups out there don't want this legislation to succeed, so they're pouring dark money into efforts to stop it," said one Democratic senator.


The group American Commitment is running ads in several states attacking Democrats' plan to lower prescription drug prices. (Photo: Screengrab/American Commitment)

JAKE JOHNSON

July 29, 2022

While its thousands of lobbyists work fervently on Capitol Hill, the pharmaceutical industry is flooding the airwaves in several states with deceptive ads in a last-ditch campaign to block Senate Democrats' plan to curb the unchecked pricing power of drug corporations.

Included as part of a reconciliation package negotiated by Sen. Joe Manchin (D-W.Va.) and Senate Majority Leader Chuck Schumer (D-N.Y.), the proposal would require Medicare to negotiate the prices of a small number of drugs directly with pharmaceutical companies, which can currently drive up costs as they please—boosting their profits at the expense of patients.

"We aim to pass reforms to lower Rx prices in the coming days and curb pharma's power to dictate prices to Americans. Let's see it through."

The measure would also cap out-of-pocket medicine costs at $2,000 a year for recipients of Medicare Part D, the prescription drug benefit provided through private plans approved by the federal government.

The drug industry—which has repeatedly fought off price regulation attempts in recent decades—has lashed out furiously against Democrats' plan, even though it is in some ways significantly weaker than a proposal that the House passed last year. Republicans bankrolled by Big Pharma are also working to tank the bill.

Roll Call reported Friday that the "Pharmaceutical Research and Manufacturers of America (PhRMA), the National Association of Manufacturers, and a group called American Commitment have collectively spent millions of dollars on ads in July" to attack Democrats' proposal, key parts of which are overwhelmingly popular with the American public.

"We're going to use every tool in the toolbox to relentlessly educate lawmakers about the flaws in this bill," declared Stephen Ubl, president of PhRMA, the nation's leading drug industry trade group.

American Commitment, a nonprofit with ties to the Koch Brothers, launched a new seven-figure ad buy on Thursday, targeting audiences in Washington, D.C. as well as West Virginia, Nevada, and Georgia.

The ads, which can be viewed in full on American Commitment's website, recycle the false and repeatedly debunked claim that Democrats' bill would cut "nearly $300 billion from Medicare," distorting the Congressional Budget Office's estimate that the legislation would save the federal government roughly $290 billion over ten years.

The American Prosperity Alliance, a dark money group, is running similarly misleading ads.



Sen. Catherine Cortez Masto (D-Nev.) responded directly to the ads—one of which attacks her directly—in a speech on the Senate floor earlier this week, noting that the 30-second spots led hundreds of constituents to call her office seeking an explanation.

"They were anxious and alarmed over a deliberately misleading ad that is running on TV, on Facebook, and via a text campaign," said Cortez Masto. "In Reno this past weekend, Nevadans came up to me because they were concerned about these false accusations. This ad incorrectly claims that I support a bill that would strip $300 billion dollars from Medicare. This couldn't be further from the truth."

"Powerful interest groups out there don't want this legislation to succeed, so they're pouring dark money into efforts to stop it," the senator continued. "Well, let me just say this: it won't work."

In an analysis of Democrats' proposal published Wednesday, the Kaiser Family Foundation (KFF) concluded that the bill has the potential to "limit annual increases in drug prices for people with Medicare and private insurance" and "provide substantial financial protection to people on Medicare with high out-of-pocket costs."

The precise impact of the legislation, KFF stressed, will depend on which prescription drugs Medicare chooses to negotiate. A separate KFF analysis released last year found that a small number of drugs make up a major share of Medicare's prescription drug spending.

"We are inches from the goal line," David Mitchell, the founder of Patients for Affordable Drugs, tweeted Friday. "We aim to pass reforms to lower Rx prices in the coming days and curb pharma's power to dictate prices to Americans. Let's see it through."

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GOP 'Working Hand in Hand With Big Pharma' to Kill Drug Price Reform Behind Closed Doors

"Republicans are going to use every tool they have to keep drug prices high and drug industry profits higher," said one Democratic senator.


Sen. Mike Crapo (R-Idaho) talks with Sen. Rob Portman (R-Ohio) during a hearing

JAKE JOHNSON

July 27, 2022

Republican lawmakers are working behind closed doors to convince the Senate parliamentarian—the chamber's unelected rules arbiter—to tank Democrats' watered-down but still potentially impactful proposal to require Medicare to negotiate the prices of a small number of prescription drugs directly with pharmaceutical companies.

Sen. Mike Crapo (R-Idaho), a major beneficiary of pharmaceutical industry campaign cash, admitted as much in remarks to reporters on Tuesday, saying that he and his GOP colleagues are "going through line by line, literally, making objections" in private meetings with the Senate parliamentarian, who is tasked with offering advice on whether reconciliation provisions comply with chamber rules.

"Folks in Idaho need to know he's not working for them—he's working for Big Pharma."

Under the Senate's Byrd Rule, every provision of a reconciliation package must have a direct, not "merely incidental," impact on the federal budget. Democrats contend their Medicare proposal meets that requirement, citing the Congressional Budget Office's recent estimate that the plan would save the federal government $290 billion over 10 years.

But Crapo insisted Tuesday that "there are many Byrd objections," and Politico reported that Democrats are currently "making tweaks" to the legislation to ensure it survives the parliamentarian's scrutiny—even though the official's opinions are nonbinding and can be overruled.

"Republicans are working hand in hand with Big Pharma to try to block Democrats from lowering drug prices," warned Social Security Works, a progressive advocacy group.

The GOP's efforts come as the pharmaceutical industry is mobilizing its huge army of Capitol Hill lobbyists in a last-ditch campaign to defeat Democrats' plan, which would require Medicare to directly negotiate the prices of a subset of prescription drugs—an idea that is overwhelmingly popular with the U.S. public.

While Democrats' proposal has faced criticism from progressive lawmakers who say it doesn't do enough to challenge the pharmaceutical industry's power to drive up costs, advocates and experts say the bill could still have a significant effect on prices for seniors and people with disabilities, given that a small number of medicines account for a major portion of Medicare's prescription drug spending.

"Sen. Mike Crapo is proud that he's trying to gut legislation to lower drug prices supported by more than 70% of Americans," said David Mitchell, the founder of Patients for Affordable Drugs. "Legislation to improve health and save Americans money. Folks in Idaho need to know he's not working for them—he's working for Big Pharma."

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Big Pharma Has Raised Drug Prices 1,186 Times This Year, Analysis Shows

Senate Majority Leader Chuck Schumer (D-N.Y.) is aiming to get the Medicare proposal as well as a plan to extend Affordable Care Act subsidies through the chamber before the August recess, which is set to begin next week.

In the face of unanimous Republican opposition, Democrats will need the support of all fifty senators in their caucus to pass the reconciliation package, which is exempt from the 60-vote filibuster.

"Republicans are going to use every tool they have to keep drug prices high and drug industry profits higher," Sen. Chris Murphy (D-Conn.) warned Tuesday.

Sen. Brian Schatz (D-Hawaii) added that "every single elected Republican in the Senate is about to vote against reducing the cost of prescription drugs for those on Medicare."

"This is not a show vote or a symbolic thing—we are going to make a new law," Schatz wrote. "It will save seniors thousands of dollars a year."
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‘Is it better than nothing? I suppose’: Sanders disappointed by Dems’ drug pricing plan

"It's a very weak proposal" but "we're dealing with the power of PhRMA over the Congress," he said, taking aim at industry lobbyists.

By

 Jessica Corbett

 -

July 27, 2022

SOURCECommon Dreams

Bernie Sanders (Crush Rush via Shutterstock)

Senate Budget Committee Chair Bernie Sanders on Tuesday blasted Democrats’ watered-down drug pricing plan and suggested pharmaceutical industry lobbying weakened the proposal.

“It goes nowhere near as far as it should.”

“It’s a very weak proposal. It goes nowhere near as far as it should,” Sanders (I-Vt.) told NBC News‘ Sahil Kapur.

The deal unveiled earlier this month would enable Medicare to negotiate the prices of a limited number of prescription drugs. Other provisions include creating a $2,000 out-of-pocket cap for Medicare Part D beneficiaries, stopping brand-name manufacturers from blocking generic options, and penalizing companies that raise prices faster than inflation.

The plan is notably backed by Sen. Joe Manchin (D-W.Va.)—who last year blocked a House-approved budget reconciliation package and said this month that he wouldn’t support new climate spending or tax hikes on the rich and large corporations.

Sanders, who pushed for a sweeping package last year and has long been a leading Medicare for All advocate, pointed to the U.S. Department of Veterans Affairs (VA) as a model for drug price negotiation.

“The American people want Medicare to negotiate prescription drug prices like the VA does,” the senator said Tuesday, according to The Hill.

“The VA has been doing that for decades. The prices they pay are about half as much as Medicare. This thing will only apply to a certain number of drugs,” Sanders continued, noting that parts of the proposal would not take effect until 2026.

“So it’s a weak proposal. Is it better than nothing? I suppose,” he added of Democrats’ plan.

Sanders also took aim at industry lobbying, specifically calling out the trade group Pharmaceutical Research and Manufacturers of America (PhRMA). As he put it: “We’re dealing with the power of PhRMA over the Congress. They don’t lose very often.”

As Common Dreams reported last week, Big Pharma is mobilizing an army of lobbyists to tank Democrats’ drug reform plan while hiking the price of prescription medications.

“Pharma is spending millions to defeat a very modest drug pricing bill,” Sanders tweeted Friday. “Joe Manchin, who is blocking climate action, is the major recipient of fossil fuel campaign contributions. This is how a corrupt political system works.”