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Posted at 3:19 PM ET, 02/15/2011

The Leonard Lance saga, ctd.

By Greg Sargent

Okay, so yesterday I brought you the tale of one Leonard Lance, a GOP House member from New Jersey who got called out by his local paper for supporting repeal of the Affordable Act even while he enjoys a very generous health insurance plan that's paid for by New Jersey's taxpayers. Now the story has taken an amusing new turn.

What's funny about Lance's saga is that his state-level insurance might never have come to light if his staff hadn't loudly protested when Blue America PAC, a liberal group, started running ads demanding that he forego the health plan enjoyed by members of Congress. As I noted here yesterday, Lance's staff got the ad pulled after they insisted that he was not taking that insurance.

That, in turn, was what led the Courier-Post to do the digging necessary to ferret out his state insurance. In short: If Lance's staff had just kept quiet about the initial ad, and hadn't declared that he was foregoing the federal-level insurance, the whole thing would have blown over and disappeared.

But now that his state plan has come to light, Blue America PAC is up with another radio ad lampooning Lance all over again:

The ad, which parodies a New Jersey reality TV show, recaps the entire saga, with a narrator concluding in a pronounced Jersey accent:

"This guy deserves his own reality show: New Jersey's biggest hypocrite."

This is the sort of tale that has viral potential and can get out of control very quickly. Something tells me this isn't the last we're going to hear about this Lance fellow.

By Greg Sargent  | February 15, 2011; 3:19 PM ET
Categories:  Health reform, House GOPers  
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Comments

Beating a dead horse?

Posted by: mark_in_austin | February 15, 2011 3:41 PM | Report abuse

@mark_in_austin "Beating a dead horse?"

Whistling past the grave yard of Obama's budget release and subsequent press conference.

Posted by: jnc4p | February 15, 2011 3:50 PM | Report abuse

Going off topic here.

Mark, you were wrong this morning when you said you can't get people to take entitlement reform seriously. A lot of us take it very seriously. Medicare and Medicaid suffer from the same dilemma we all suffer from, the high cost of health care. There's a big difference between cutting benefits or using vouchers and bringing the cost down by taking on the big HIC big three, insurance, pharmaceuticals and hospitals. Here's a little something in the Obama budget that addresses pharmaceuticals. It's not nearly enough but if it squeaks through it may give us all courage to tackle more of the same. The pay for delay, something you may know about as a lawyer, is especially egregious IMO.

""Big pharmaceutical companies could face increased competition from generic drugmakers under two proposals put forth by the Obama administration on Monday despite earlier savings extracted from drugmakers as part of last year's healthcare law.

President Barack Obama, as part of his 2012 budget proposal, called for cutting the number of years drugmakers could exclusively market brand-name biologic drugs to 7 years from 12.

He also set his sights on ending controversial "pay-for-delay" deals that affect traditional, chemical drugs by giving the U.S. Federal Trade Commission power to block them. Under such pacts, brand-name and generic drugmakers settle patent challenges with payoffs that delay lower-cost rivals from reaching the market.""

Posted by: lmsinca | February 15, 2011 3:51 PM | Report abuse

Once again, the liberals rush off to solve the symptoms instead of curing the disease.

In this case lmsinca is touting a massive interference in the market that the left hopes will lower drug costs. After all those nasty pharmacy companies in the same moral and ethical league and insurance companies and hospitals, right? If there were a god of ignorance I'm convinced it would look like Dennis Kuchinich or someother moonbeam liberal.

If the life of a patent is reduced from 12 years to seven the ROI for the investment in a given molecule will change dramatically. This will mean that the developer must recoup the initial investment in a shorter time frame. that could mean, inter alia, that initial price of the drug will skyrocket. Wait, don't liberals love it when prices sky rocket? O no that is just for mundane unimportant things like electricity and gasoline.

so we'll face a situation where a new drug may not make it to market because the cost at launch will be so high that no one will buy it. Ever wonder what the first doses of penicillin must have cost?

Further drugs aimed at specific clinical issues that are focused on a relatively small group of patients will not make it to market either, for the same reason. A drug that could extend the life of a few people, but at a significant expense because of the limited time for patent exclusivity won't see the light of day.

the liberals will respond by claiming that government sponsorship of basic research will offset these market loses. The problem with that is simple: then the kids in DC decide which maladies get fundage. That never works out. Here's an example: today in america more people die of MRSA than of AIDS. Which disease is getting the attention? According to Kaiser, the 2010 budget contained 2.8 billion for AIDS research. I can find no reference to any funding for MRSA research. In fact there are zero new drugs in the pipeline to handle MRSA and it is going to explode as an issue for us. So much for government intervention.
I understand the desire to reduce healthcare costs. But the left keeps ignoring the workable solutions, just as lmsinca did. It seems to this observer that the left is more interested in punishing successful businesses than is solving problems.

Posted by: skipsailing28 | February 15, 2011 4:16 PM | Report abuse

OT-

This Op-Ed by Gerson is really on the mark, IMO, regarding the stupidity of cutting aid programs by the GOP- http://www.washingtonpost.com/wp-dyn/content/article/2011/02/14/AR2011021404500.html

Posted by: ChuckinDenton | February 15, 2011 4:17 PM | Report abuse

lmsinca, it's good to know these things are in the budget. I hope they end up in the final product. As imperfect as the healthcare bill was, I always thought its funding for pilot projects to test ways to bring down healthcare costs and make delivery systems more efficient was a promising part of it.

Posted by: AllButCertain | February 15, 2011 4:21 PM | Report abuse

Mr chuck in denton is proving something I predicted a while ago. Every nickel spent by the gummint has a breathless champion that will predict dire consequences if the fundage halts.

Every nickle. Whatever it is that gerson is talking about is no different from all the other vastly important expenditures that will be threatened in the coming weeks.

CATO has started a "slasher" blog wherein people can share stories from the media about how "slashing" so and so will mean that we're all going to die after living short, brutish, nasty and cold lives.

I hardly think so. some things aren't going to be funded. The only way to reduce the amount we spend is to reduce the amount we spend.

Posted by: skipsailing28 | February 15, 2011 4:22 PM | Report abuse

Imsinca -- those two provisions are expected to save about $8.5 billion over 10 years. While welcome, Medicare Part A alone will spend $203 billion next year. Total Medicare for next year: $548 billion.

Stuff like pay-for-delay, if it even survives the budget process, won't address the structural problems facing entitlements, which starts with their "such sums as necessary" nature.

See p. 59 for the line items on the 2 drug provisions.

http://www.hhs.gov/about/FY2012budget/fy2012bib.pdf

Posted by: NoVAHockey | February 15, 2011 4:28 PM | Report abuse

skip

I've heard your argument before but not everyone agrees including the FTC.

Posted by: lmsinca | February 15, 2011 4:38 PM | Report abuse

then there is this:
=============
He also set his sights on ending controversial "pay-for-delay" deals...
============

What is controversial about these? Are they in any way illegal? Or are they controversial simply because you don't like them?

Posted by: skipsailing28 | February 15, 2011 4:39 PM | Report abuse

"pilot projects to test ways to bring down healthcare costs and make delivery systems more efficient"

There is nothing new in the ACA, there are more mandates for everything that already exists. We don't need any more pilot projects that work fine and then get eliminated. These have been going on for years, medical home/integrated delivery models, FQHCs, in home delivery systems...we all ready know how to bring down health costs and make delivery systems more efficient. We just don't want to.

Posted by: shrink2 | February 15, 2011 4:40 PM | Report abuse

Which argument is that? Are you saying that it is not valid? Based on what?

Posted by: skipsailing28 | February 15, 2011 4:40 PM | Report abuse

Did you actually read Gerson? I don't know why I'm going to waste keystrokes on this, but, what the hell: there are plenty of good reasons why we ought to spend money on the types of aid he mentions. Try and see if you can find a modicum of space inside your cranium to understand that.

Posted by: ChuckinDenton | February 15, 2011 4:42 PM | Report abuse

Hey you guys, I wasn't listing the two little pharma concerns in Obama's budget as a be all, end all to health care costs. Just something that may help lower costs.

The market for FOB's (follow on biologics) is considerably different than generics so it seems to me the sooner we get these drugs to market the better. From an FTC report from 2009

""The Commission’s Report states that competition by FOBs is unlikely to be similar to branded-generic drug competition because:

* The substantial costs to obtain FDA approval, plus the substantial costs to develop manufacturing capacity, will limit the number of FOB competitors;
* The lack of automatic substitution between an FOB drug and a pioneer biologic drug will slow the rate at which FOBs can acquire market share;
* An FOB drug also may have difficulty gaining market share due to concerns about safety and efficacy differences with the pioneer biologic drug;
* Biologic drugs currently are not reimbursed according to strategies that insurers often use to encourage the use of lower-priced drugs;
* As a result of these factors, FOB entry, although important, will be less-dramatic than generic drug competition. FOB entry is likely in biologic drug markets larger than $250 million in annual sales. Only two or three FOB manufacturers are likely to attempt entry for a given pioneer drug product. These entrants are unlikely to introduce their drugs at discounts any larger than between 10 and 30 percent of the pioneer product’s price;
* The effect on pioneer manufacturers also will be different. They are expected to respond and offer competitive discounts to maintain market share and are likely to retain 70 to 90 percent of their market share and will continue to reap substantial profits, even after FOB entry.

Based on these findings, the Report concludes that patent protection and market-based pricing will promote competition by FOBs, as well as spur biologic innovation. It states that legislation to put a process in place for the abbreviated FDA approval of FOBs is likely to be an efficient way to bring FOBs to market, because of the time and cost savings it would provide.""

Posted by: lmsinca | February 15, 2011 4:46 PM | Report abuse

Nothing will make the delivery system more efficient more quickly than forcing providers to go retail.

by moving the source of funding away from the gummint and the managed care companies and placing it with the patients the same dynamics that control costs in other industries will be brought to bear on healthcare.

I've lived through any number of these cost cutting experiments, some had a decent impact (DRG's for example) but many were just mental-gymnastics with a grant for funding.

I agree with shrink (for a change of pace) we don't need anymore pilot projects. Let's go to a retail model and let the good old American demand for better, faster and cheaper work its miracle.

Posted by: skipsailing28 | February 15, 2011 4:47 PM | Report abuse

My take on Obama's remarks about Social Security today:

http://voices.washingtonpost.com/plum-line/2011/02/obama_social_security_isnt_the.html

Posted by: Greg Sargent | February 15, 2011 4:55 PM | Report abuse

@ChuckinDenton: I agree with Gerson that we shouldn't "symbolically" cut spending on the Global Fund.

He points out: "Our massive debt is mainly caused by a combination of entitlement commitments, an aging population and health cost inflation."

If you're like me you wondered how in the heck Obama's budget addressed any of these debt problems - (A. not at all).

Would you agree that Obama's budget represents a "net subtraction from public seriousness on the deficit?"

Posted by: sbj3 | February 15, 2011 4:55 PM | Report abuse

shrink, you would know more about this than I do, but have you read the Atul Gawande New Yorker articles or seen interviews with him? He was very much on board with the pilot projects that take into consideration the effectiveness of various approaches in different states and regions.

As someone who has used the medical system a lot in the last couple of years, I've always thought some costs might come down if doctors and their patients with good coverage actually knew the price of scans, and drugs and things like transfusions. I often ask the question, and doctors simply don't know.

Posted by: AllButCertain | February 15, 2011 4:58 PM | Report abuse

I do agree with skip (in this regard, just so there is no confusion, no bracket creep so to speak). ☻

Posted by: shrink2 | February 15, 2011 5:00 PM | Report abuse

"But have you read the Atul Gawande New Yorker articles or seen interviews with him?"

Yes definitely, those were must reads back at the time. He made some good points, but missed the main point, which is that you have to dismantle stuff that does not work well into order to turn the pilot projects into the standard of care and dismantling what is not working is almost possible. That is always a considered a slippery slope, eliminating an existing entitlement is, even if it isn't working.

Some but not all doctors (I have lots of price lists at hand) have been harassed and infantalized into ignorance cocoons by the caste of "care" managers that have installed themselves all around the doctor patient relationship, but I won't excuse their ignorance.

Posted by: shrink2 | February 15, 2011 5:10 PM | Report abuse

shrink

On the pilot programs or everything he's said? You want the whole system to go retail? I believe a starting point would be to eliminate employer provided insurance coverage but I don't think that's what he's talking about. I admit though between all the misrepresenting my comments and attitude I'm having trouble swimming through the current.

See y'all, it's hard to have a real convo here sometimes.

Posted by: lmsinca | February 15, 2011 5:15 PM | Report abuse

Docs often don't know their own fees. This is especially true in large clinical practices such as the Cleveland Clinic near my home.

As for the public display of pricing this is an old failure, sorry to say. Most states have laws mandating that hospitals make available on request copies of their charge structure, often called a charge description master file or CDM. Nobody ever looks at it.

why? because patients know that they won't be paying the retail cost for anything. Either thier insurance plan has negotiated a price or they aren't going to pay or they plan to pay but will negotiate a rate of their own. We have a saying in healthcare finance: nobody pays retail.

As an example, I mentioned to a physician that the retail cost of a topical, Mupricin, was $60 a tube. I then asked why he decided not to continue a bactrim prescription. "Well," he said, "Bactrim's expensive too." What he apparently didn't know is that bactrim is free at the local pharmacy. Cost is no part of that guy's thought process.

This is why I'm convinced that the retail model is our best approach. Patients ignore costs now because they don't pay them. Doctors ignore costs too because the patients don't make an issue of them. Once money is flowing from the hands of the patients into the hands of the providers, the questions will come HHH.

lmsinca, the follow on biologic comment was interesting. Thanks for the insight. That's not a part of healthcare finance I dabble in so I learned something. Much appreciated.

Posted by: skipsailing28 | February 15, 2011 5:21 PM | Report abuse

"As someone who has used the medical system a lot in the last couple of years, I've always thought some costs might come down if doctors and their patients with good coverage actually knew the price of scans, and drugs and things like transfusions. I often ask the question, and doctors simply don't know."

If you'll pardon my interjection, I think it needs to go beyond knowing the price/cost, there has to be a direct benefit for the consumer (no offense Bernie) that will result in the consumer choosing a more cost effective option. I won't say the word, but I'd advocate it, along with the consumer (again, apologies Bernie) keeping a substantial percentage of the savings, even if it meant passing on that savings via inheritence if certain costly "end of life" decisions were foregone. Just my $.02. I apologize if I've offended anyone.

Posted by: TrollMcWingnut | February 15, 2011 5:21 PM | Report abuse

"As someone who has used the medical system a lot in the last couple of years, I've always thought some costs might come down if doctors and their patients with good coverage actually knew the price of scans, and drugs and things like transfusions. I often ask the question, and doctors simply don't know."

If you'll pardon my interjection, I think it needs to go beyond knowing the price/cost, there has to be a direct benefit for the consumer (no offense Bernie) that will result in the consumer choosing a more cost effective option. I won't say the word, but I'd advocate it, along with the consumer (again, apologies Bernie) keeping a substantial percentage of the savings, even if it meant passing on that savings via inheritence if certain costly "end of life" decisions were foregone. Just my $.02. I apologize if I've offended anyone.

Posted by: TrollMcWingnut | February 15, 2011 5:27 PM | Report abuse

"You want the whole system to go retail?"

No, the high end disability system for example, people with severe, life long neurological disease, etc. involving multiple systems of care (and money silos) need medical homes and specialized delivery models in order to be efficient and effective (to keep people functional and out of hospitals).

Posted by: shrink2 | February 15, 2011 5:32 PM | Report abuse

""lmsinca, the follow on biologic comment was interesting. Thanks for the insight. That's not a part of healthcare finance I dabble in so I learned something. Much appreciated.""

I believe this is what the budget proposal was addressing but I could be wrong. You're welcome, and thanks for treating me like an adult.

Posted by: lmsinca | February 15, 2011 5:34 PM | Report abuse

You know what I'd like to see is a discussion here between the professionals, shrink, skip, and NoVA. You three know a lot more than the rest of us and also have different political perspectives as far as I can tell. It might clarify issues for a lot of us.

Just a suggestion.

Posted by: lmsinca | February 15, 2011 5:43 PM | Report abuse

lmsinca, that's a good idea if shrink, skip, and NoVa are willing to do it, though not on this thread, which won't draw much more traffic. Maybe tonight's? It's always refreshing when people talk about what they know instead of hurling insults.

Posted by: AllButCertain | February 15, 2011 6:09 PM | Report abuse

Further Imsinca, there should not be a political valence to health care delivery models discussions (perhaps accounting for skip's and my agreement on retail risk management and incentives in the delivery model for people like us (presumably teachable if not competent to be empowered in these decisions) And for the brain disabled, very sick etc., folks, little kids with cancer and so on... everyone wants excellent access and outcomes delivered as efficiently as possible. No one wants money wasted on stuff that doesn't work, redundant, meaningless forms... bye for now.

Posted by: shrink2 | February 15, 2011 6:14 PM | Report abuse

shrink, how are you going to avoid spending money on things that don't work when, in many cases, the standard of care is based on studies that show efficacy in some patients but not others, and the research isn't fine enough to tell which patients will benefit?

Posted by: AllButCertain | February 15, 2011 6:26 PM | Report abuse

I really can't follow that FTC report excerpt on biologics. It seems contradictory.

The reason biologics are "different" is that they are large, complex molecules (usually proteins and protein combos) that are extremely expensive and difficult to develop and manufacture -- and to duplicate.

The desire to arrange a regulatory process to limit protection of pioneer biologics and "bring FOBs to market" quickly is really just another instance of wishing for something for nothing. To the extent it succeeds, it can only do so at the expense of developing biologics in the first place.

Posted by: quarterback1 | February 15, 2011 6:27 PM | Report abuse

Sorry to be offensive with an interjection. I wonder if Ph development costs would be reduced if the FDA just controlled for safety, rather than efficacy and safety. If I've been offensive, my apologies.

Posted by: TrollMcWingnut | February 15, 2011 6:38 PM | Report abuse

Troll, what does that even mean? Just develop drugs that are safe but have no proven use?

Posted by: AllButCertain | February 15, 2011 7:24 PM | Report abuse

"Troll, what does that even mean? Just develop drugs that are safe but have no proven use?"

Produce drugs that are as safe as they can be. If the FDA didn't test for efficacy, a lot to time and money can be saved, allowing drugs to enter the market sooner with, ideally less cost. Less cost because of reduced FDA testing required, along with a longer patent life because products can be put on the market sooner.

Thanks for reading my comment and inquiring about it. :-)

Posted by: TrollMcWingnut | February 15, 2011 8:37 PM | Report abuse

"shrink, how are you going to avoid spending money on things that don't work when, in many cases, the standard of care is based on studies that show efficacy in some patients but not others, and the research isn't fine enough to tell which patients will benefit?"

This is an entirely separate question. Above we were talking about what we already know does not work and which should be shut down. The interface between maybe and maybe not has to waste lots of money, it simply has to.

Posted by: shrink2 | February 15, 2011 8:52 PM | Report abuse

Troll, I guess I understand your point, but let's just consider life threatening situations. If a patient takes an ineffective drug and dies as a result, it doesn't matter if that drug didn't actively cause harm. The patient is still dead.

There is also the instance of a drug like Prempro. Millions of women took it in part because it was thought to have many medical benefits. Those benefits turned out to be illusory. And later appearing side effects included a significant increase in breast cancer and in cancer that led to death.

Posted by: AllButCertain | February 15, 2011 9:17 PM | Report abuse

shrink, you write: "The interface between maybe and maybe not has to waste lots of money, it simply has to."

Agreed. It reminds me of something my dad used to say. He worked on the treatment side in the prison system and said it was a hard truth that if some parolees didn't reoffend, the system wasn't doing its job. They simply could not keep everyone with even the slightest chance of recidivism incarcerated. It would mean wasting too many lives of people who'd been effectively rehabilitated.

I'll count on you to get the analogy.

Posted by: AllButCertain | February 15, 2011 9:29 PM | Report abuse


"Troll, I guess I understand your point, but let's just consider life threatening situations. If a patient takes an ineffective drug and dies as a result, it doesn't matter if that drug didn't actively cause harm. The patient is still dead."

True. It happens every day. Sometimes practitioners' guess wrong. I think it would change what we teach in school. A heavier emphasis on mathematics and the hard sciences. Also, critical thinking skills. It would also be incumbent upon the manufacturers and provider's to demonstrate, statistically that they are effective in treating whatever illness they're peddling pills/treatment for.

"There is also the instance of a drug like Prempro. Millions of women took it in part because it was thought to have many medical benefits. Those benefits turned out to be illusory. And later appearing side effects included a significant increase in breast cancer and in cancer that led to death."

It's awful. And it will happen again. You cannot take all risk out of life. I know that sounds depressing.

Thank you for reading my comments and asking questions. :-)

Posted by: TrollMcWingnut | February 15, 2011 9:56 PM | Report abuse

Of course you can't take all risk out of life.

If we could count on Pharma doing a solid job on efficacy, we wouldn't need the FDA working on it too. As it is, we can't necessarily count on either one of them. The question is why and is there something that can be done about it? More emphasis on science maybe. More large trials and more statistical analysis of the information we already have. More innovative thinking.

I don't know, but something.

Posted by: AllButCertain | February 15, 2011 10:14 PM | Report abuse

"If we could count on Pharma doing a solid job on efficacy, we wouldn't need the FDA working on it too. As it is, we can't necessarily count on either one of them. The question is why and is there something that can be done about it? More emphasis on science maybe. More large trials and more statistical analysis of the information we already have. More innovative thinking."

But I just proposed that the FDA get out of the efficacy business and focus on the safety business. That's innovative, no? And maybe we need to be more discerning consumers. But where's the incentive for that, when so many people are lulled into, what I think, is a very naive notion that "the government makes sure it's ok." As regards to more innovative thinking, I think the current safety and efficacy requirements are huge barriers to entry for people who think creatively and those wanting to back them. If it takes hundreds of millions of dollars to get FDA approval, that's a lot of risk. If it was only ten million, I bet there'd be a whole lot o' creativity going on. That's a whole lot less risky. It's almost like Big Pharma and the FDA are involved in some sort of racket. :-)

Posted by: TrollMcWingnut | February 15, 2011 11:08 PM | Report abuse

Not really innovative but a variant of get gov't out of things where, from my view on the other side of the philosophical fence, it does have a necessary role to play. Finding the balance is always the issue.

Also, when it comes to medicine, lay consumers rely on professionals because there's such a discrepancy in knowledge. It's hard to be truly discerning in areas where you're at such a disadvantage.

Posted by: AllButCertain | February 15, 2011 11:28 PM | Report abuse


I am very thankful for our health insurance, and even more thankful that we found an affordable one through wise health insurance online. It has been 6 years that they have not increased my premiums. Having health insurance gives us a peace of mind

Posted by: kinglaura16 | February 16, 2011 1:19 AM | Report abuse

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