Saturday, September 12, 2009

Nasty British health bureaucrats again refuse to approve an effective liver cancer drug

They prefer to spend the money on an army of clerks and "administrators". Only a third of NHS employees are doctors and nurses

Britain's healthcare cost-effectiveness watchdog has again rejected Bayer's drug Nexavar for treating liver cancer on the state health service, despite a revised charging scheme from the company.

Wednesday's decision is a setback for Bayer and its partner Onyx Pharmaceuticals, which have already seen Nexavar turned down by the National Institute of Health and Clinical Excellence (NICE) to treat kidney cancer. Nexavar received a preliminary rebuff from NICE in May but Bayer had hoped to convince the agency Nexavar was worth paying after it put forward a patient access scheme that would have reduced the cost of treatment to the National Health Service.

Bayer said the decision on its drug, known generically as sorafenib, for the treatment of hepatocellular carcinoma was a blow to patients. "We thought we had satisfied NICE's criteria for how Nexavar would be assessed -- however, the goal posts appeared to have moved," said Nicole Farmer, the company's British head of oncology. "This proposal by NICE conflicts dramatically with the government's strategy to bring UK cancer outcomes in-line with the rest of Europe, where Nexavar is already widely available in countries such as France, Germany, Spain, Italy, Romania, and Greece."

Hepatocellular carcinoma is the most common form of liver cancer, accounting for 80 to 90 percent of all primary liver tumors. Nexavar is one of Bayer's top new drug hopes, along with anti-blood clotting pill Xarelto. It has proved successful against liver and kidney cancer and Bayer is also pursuing approvals for use against lung and breast tumors.


Medicare for Dummies

Contradictions worthy of the Marx Brothers

The thing about the bully pulpit is that Presidents can make the most fantastic claims and it takes days to sort the reality from the myths. So as a public service, let's try to navigate the, er, remarkable Medicare discussion that President Obama delivered on Wednesday. It isn't easy.

Mr. Obama began by depicting a crisis in the entitlement state, noting that "our health-care system is placing an unsustainable burden on taxpayers," especially Medicare. Unless we find a way to cauterize this fiscal hemorrhage, "we will eventually be spending more on Medicare than every other government program combined. Put simply, our health-care program is our deficit problem. Nothing else even comes close."

On this score he's right. Medicare's unfunded liability—the gap between revenues and promised benefits—is currently some $37 trillion over the next 75 years. Yet the President uses this insolvency as an argument to justify the creation of another health-care entitlement, this time for most everyone under age 65. It's like a variation on the old Marx Brothers routine: "The soup is terrible and the portions are too small."

As astonishing, Mr. Obama claimed he can finance universal health care without adding "one dime to the deficit, now or in the future, period," in large part by pumping money out of Medicare. The $880 billion Senate plan he all but blessed this week would cut Medicare by as much as $500 billion, mainly by cutting what Mr. Obama called "waste and abuse." Perhaps this is related to the "waste and abuse" that Congresses of both parties have targeted dozens of times without ever cutting it.

Apparently this time Mr. Obama means it, though he said this doesn't mean seniors should listen to "demagoguery and distortion" about Medicare cuts. That's because Medicare is a "sacred trust," and the President swore to "ensure that you—America's seniors—get the benefits you've been promised."

So no cuts, for anyone—except, that is, for the 24% of senior beneficiaries who are enrolled in the Medicare Advantage program, which Democrats want to slash by $177 billion or more because it is run by private companies. Mr. Obama called that money "unwarranted subsidies in Medicare that go to insurance companies—subsidies that do everything to pad their profits but don't improve the care of seniors."

In fact, Advantage does provide better care, which is one reason that enrollment has doubled since 2003. It's true that the program could be better designed, with more competitive bidding and quality bonuses. But Advantage's private insurers today provide the kind of care that Mr. Obama said he would mandate that private insurers provide for the nonelderly—"to cover, with no extra charge, routine checkups and preventative care."

Advantage plans have excelled at filling in the gaps of the a la carte medicine of traditional Medicare, contracting with doctors and hospitals to coordinate care and improve quality and covering items such as vision, hearing and management of chronic illness. If seniors in Advantage lose this coverage because of the 14% or 15% budget cut that Mr. Obama favors, well, that's "waste and abuse."

Mr. Obama did also promise to create "an independent commission of doctors and medical experts charged with identifying more waste in the years ahead." That kind of board is precisely what has many of the elderly worried about government rationing of treatment: As ever-more health costs are financed by taxpayers, something will eventually have to give on care the way it has in every other state-run system.

But Mr. Obama told seniors not to pay attention to "those scary stories about how your benefits will be cut, especially since some of the folks who are spreading these tall tales have fought against Medicare in the past and just this year supported a budget that would essentially have turned Medicare into a privatized voucher program."

This is a partisan swipe at one of the best GOP ideas to rationalize the federal budget, despite Mr. Obama's accusations that his opponents want to do "nothing." This reform would get Medicare out of the business of spending one out of five U.S. health dollars, and instead give the money directly to seniors to buy insurance to encourage them to be more conscious of cost and value within a limited budget. Democrats would rather have seniors dance to decisions made by his unelected "commission of doctors and medical experts."

Mr. Obama also called for "civility" in debate even as he calls the arguments of his critics "lies." So in the spirit of civility, we won't accuse the President of lying about Medicare. We'll just say his claims bear little relation to anything true.


Obama's cry aimed at Dems

President Obama on Wednesday defiantly scolded opponents of his sweeping health care reform proposal, saying "the time for bickering is over, the time for games has passed. Now is the season for action." And that was aimed just at members of his own party.

In fact, nearly his entire speech was targeted directly at Democrats, who, despite massive majorities in both the House and the Senate, have been at loggerheads over just how to overhaul America's health care system.

Having misplayed the sweltering summer, when conservatives gathered force and turned town halls across the country into angry tutorials on the expansive - and expensive - reform plan, Mr. Obama has expended nearly all of his once-boundless political capital and has been reduced to begging his own party to find consensus - any consensus.

He used fear: "More families will go bankrupt ... more will die"; he used shame: "Too many Americans [are] counting on us to succeed"; he blamed politics: "Out of this blizzard of charges and countercharges, confusion has reigned."

He all but begged. "If you come to me with a serious set of proposals, I will be there to listen. My door is always open," the president said, looking out on more than 100 House Democrats who simply cannot agree on how to move forward.

According to the latest tallies, some 45 moderate Blue Dog Democrats oppose Mr. Obama's plan, and especially its cost - upward of $1.5 trillion over 10 years. Meanwhile, 60 liberal Democrats oppose the plan if the president jettisons the "public option," or government-run health care.

In between are libertarian Democrats, some of whom oppose what they see as a power grab, and purely pragmatic Democrats, unconvinced that the federal government can oversee such an enormous undertaking (especially when it could hardly handle the "cash for clunkers" program).

Mr. Obama's speech appeared to unify Democrats as to their real enemies - not members of their own party, but the Republicans across the aisle - in the joint session of Congress, held in the House chamber. Spilling onto the other side of the aisle, Democrats repeatedly leapt to their feet in standing ovations. At times, the session had the feel of the old-time call-and-response in a boisterous church.

More here

Obama Doubles Down

Counting on the sheer inertia of Democratic and health industry self-interest in Washington to drive a bill into law

Democrats have wanted President Obama to drop some of his cool and fight for their health-care agenda, and last night they weren't disappointed. The President gave away very little on the substance of what Congressional leaders are proposing, even as he offered a rhetorical bow or two to the idea of compromise. The main message of his speech to Congress is that he is doubling down on his health-care bets and counting on the sheer inertia of Democratic and health industry self-interest in Washington to drive a bill into law.

The speech was especially notable for its use of one of Mr. Obama's favorite rhetorical devices: Noting in the first instance that his opponents have a good point, and entirely legitimate concerns, only to reject their ideas in toto when it comes to policy. Thus he endorsed the public's concern about the competence of government to manage one-sixth of the economy, only to finish with a soaring oration about the moral necessity of letting government do so.

Thus, too, Mr. Obama bowed toward the GOP concern for medical malpractice reform, even acknowledging that it is a problem. Yet his substantive offer was limited to "demonstration projects in individual states to test these ideas." His advisers surely know that many states—including California and Texas—have already improved their tort climate for medicine with caps on noneconomic damages. The problem is that the tort bar fiercely oppose such caps, and Democrats in the Senate always defeat them. Had Mr. Obama challenged Democrats to pass that kind of tort reform, he would have been serious. As it is, his offer is mainly about making it appear that he is reaching across the aisle.

Mr. Obama also deplored the "unyielding ideological camps that offer no hope of compromise"—a line meant to appeal to independents who deplore partisanship. Yet the truth is that four of the five committees writing ObamaCare largely closed off their negotiations to Republicans. The President and his party have also trashed some of the best reform ideas—advanced by the likes of Wisconsin Republican Paul Ryan, Democratic backbencher Ron Wyden and every serious health economist in the country—that would reform the tax code so that consumer health dollars are no longer laundered through third parties, inflating medical spending.

As for Mr. Obama's policy details, he offered little else that was new. His proposals closely follow the plan laid out this week by Montana Senator Max Baucus, differing from the House plan mainly in its initial ambition but not in the scope of government regulation of the private insurance market and its ultimate and enormous cost.

Instead of trillions of dollars, he put his price tag at a less politically toxic $900 billion. But that is only within the first 10-year budget window and assumes "savings" that are surely illusory.

Instead of raising individual taxes right away—as the House bill would—Messrs. Obama and Baucus say they will only tax insurers and other health-care providers. But those providers will only pass those costs through to consumers, raising the price of private insurance and thus raising the subsidies that government would have to pay to make it affordable.

Mr. Obama was especially canny as a political matter to issue a strong defense of the so-called "public option" to compete with private insurers. The rhetoric will please his left flank, even as he and they know that divisions in his own party have already doomed that idea for now. Liberals will squawk when the Senate throws the public option over the side, but they know that Mr. Baucus's plan gets them to the same destination, only over a longer period.

Perhaps Mr. Obama's most remarkable sleight-of-hand was his claim that he "will not stand by as the special interests use the same old tactics to keep things exactly the way they are." The reality is that nearly all of those "special interests" are standing with him. The doctors' lobby, the hospitals, Big Pharma, even the largest insurers have all invested enormously in government health care.

Mr. Obama's speech was less about persuading the public than it was a political pep talk to this Beltway constituency. He hopes to buy enough political breathing space with a bump in the polls—however short-lived—to steel their nerves to power ObamaCare into law. The only way to stop it now is with a giant wave of popular opposition.


Read the Union Health-Care Label

Get ready for Detroit-style labor relations in our hospitals

In the heated debates on health-care reform, not enough attention is being paid to the huge financial windfalls ObamaCare will dole out to unions—or to the provisions in the various bills in Congress that will help bring about the forced unionization of the health-care industry.

Tucked away in thousands of pages of complex new rules, regulations and mandates are special privileges and giveaways that could have devastating consequences for the health-care sector and the American economy at large.

The Senate version opens the door to implement forced unionization schemes pursued by former Govs. Rod Blagojevich of Illinois in 2005 and Gray Davis of California in 1999. Both men repaid tremendous political debts to Andy Stern and his Service Employees International Union (SEIU) by reclassifying state-reimbursed in-home health-care (and child-care) contractors as state employees—and forcing them to pay union dues.

Following this playbook, the Senate bill creates a "personal care attendants workforce advisory panel" that will likely impose union affiliation to qualify for a newly created "community living assistance services and support (class)" reimbursement plan.

The current House version of ObamaCare (H.R. 3200) goes much further. Section 225(A) grants Secretary of Health and Human Services Kathleen Sebelius tremendous discretionary authority to regulate health-care workers "under the public health insurance option." Monopoly bargaining and compulsory union dues may quickly become a required standard resulting in potentially hundreds of thousands of doctors and nurses across the country being forced into unions.

Ms. Sebelius will be taking her marching orders from the numerous union officials who are guaranteed seats on the various federal panels (such as the personal care panel mentioned above) charged with recommending health-care policies. Big Labor will play a central role in directing federal health-care policy affecting hundreds of thousands of doctors, surgeons and nurses.

Consider Kaiser Permanente, the giant, managed-care organization that has since 1997 proudly touted its labor-management "partnership" in scores of workplaces. Union officials play an essentially co-equal role in running many Kaiser facilities. AFL-CIO President John Sweeney called the Kaiser plan "a framework for what every health care delivery system should do" at a July 24 health-care forum outside of Washington, D.C.

The House bill has a $10 billion provision to bail out insolvent union health-care plans. It also creates a lucrative professional-development grant program for health-care workers that effectively blackballs nonunion medical facilities from participation. The training funds in this program must be administered jointly with a labor organization—a scenario not unlike the U.S. Department of Labor's grants for construction apprenticeship programs, which have turned into a cash cow for construction industry union officials on the order of hundreds of millions of dollars each year.

There's more. Senate Finance Committee Chairman Max Baucus has suggested that the federal government could pay for health-care reform by taxing American workers' existing health-care benefits—but he would exempt union-negotiated health-care plans. Under Mr. Baucus's scheme, the government could impose costs of up to $20,000 per employee on nonunion businesses already struggling to afford health care plans.

Mr. Baucus's proposal would give union officials another tool to pressure employers into turning over their employees to Big Labor. Rather than provide the lavish benefits required by Obamacare, employers could allow a union to come in and negotiate less costly benefits than would otherwise be required. Such plans could be continuously exempted.

Americans are unlikely to support granting unions more power than they already have in the health-care field. History shows union bosses could abuse their power to shut down medical facilities with sick-outs and strikes; force doctors, nurses and in-home care providers to abandon their patients; dictate terms and conditions of employment; and impose a failed, Detroit-style management model on the entire health-care field.

ObamaCare is a Trojan Horse for more forced unionization.


The convenient fantasies of President Obama

The resignation over the Labor Day weekend of White House "green jobs" czar Van Jones tells you some interesting things about the Obama administration. One of them is that a man who proclaimed himself a "communist" in the 1990s and signed 9/11 "truther" petitions suggesting Bush administration complicity in the Sept. 11 attacks was considered fit for a White House appointment. Liberal columnists have been attacking Republicans because some of their voters are "birthers," believers in the absurd charge that President Obama was not born in Hawaii and thus is not a natural-born U.S. citizen. But they have failed to identify any "birther" who occupied a position in the Republican firmament comparable to that of "truther" Van Jones in the Obama administration.

Another interesting thing about Jones is that the administration seems enamored of his "green jobs" concept. There's an understandable political reason. Legislation to restrict carbon emissions that is supported by the administration would undoubtedly kill a large number of jobs by increasing the cost of energy, and so you can see why its advocates might want to argue that there will be a compensating number of "green jobs" created -- at least if the government spends a lot of money on them.

But this sounds like fantasy. If there were money to be made in green jobs, private investors would be creating them already. In fact big corporations like General Electric are scrambling to position themselves as green companies, gaming legislation and regulations so they can make profits by doing so. Big business is ready to create green jobs -- if government subsidizes them. But the idea that green jobs will replace all the lost carbon-emitting jobs is magical thinking.

Obama's approach to health care legislation, unless he makes a major course correction in his speech to the joint session of Congress tonight, is of a piece with his hiring of Van Jones. By ceding the task of writing legislation to congressional Democratic leaders and committee chairmen, he has been following a "no enemies to the left" strategy.

By refusing to rule out the government option -- which its architects see as the road to a single-payer government insurance system -- Obama has prevented the emergence of a set of policies that have a chance of passing the Senate. The Senate Republicans in the "gang of six" who have been negotiating with Senate Finance Chairman Max Baucus are not going to agree on a bill without assurance from the White House that they won't get rolled by hard-left House Democrats in conference committee.

Yesterday Baucus came out with his own plan, which includes a tax on high-value health insurance policies. But this is likely to be rejected by the Left, by labor unions that have negotiated such benefits from employers, and by members of Congress from states like New York, where, because of state policies, almost all health insurance costs that much.

There is an element of convenient fantasy as well in Obama's health care statements to date. We are going to save money by spending money. We are going to solve our fiscal problems with a program that will increase the national debt by $1,000,000,000,000 over a decade. We are going to guarantee you can keep your current insurance with a bill that encourages your employer to stop offering it.

The list goes on. We are going to improve health care for seniors by cutting $500,000,000,000 from Medicare. We aren't going to insure illegal aliens, except that we won't have any verification provisions to see that they can't apply and get benefits.

Most politicians like to promise voters all good things at once. Democrats got in the habit of doing this over the past 14 years when they could not pass legislation by themselves. Van Jones' moment in the White House is over. Exposure of his record in conservative media made him politically unacceptable, even though mainstream outlets like the New York Times ignored the issue entirely.

The Democrats' health insurance bills remain under consideration, and with large majorities in both houses, passage of some bill cannot be ruled out. But August town hall meetings and national polls have put the Democrats on the defensive. No-enemies-to-the-left and convenient fantasies may work in Chicago. They don't work so well when your constituency is the whole United States.


Does Obama think Americans are so gullible?

President Obama’s address to Congress and the nation Wednesday evening was yet another illustration of his seemingly endless ability to soar to genuinely impressive rhetorical heights without ever landing back on truthful ground. Nothing better illustrates this than Obama’s medical malpractice “demonstration project” gambit. Here’s the essential fact about federal demonstration projects – they are nothing more than a dodge, a deceitful way for Washington politicians to appear as if they are doing something concrete when in reality they’re tucking the idea at hand safely out of sight over in a corner. Obama might as well have said Wednesday night that he will appoint a presidential commission or have challenged Congress to create an emergency national task force on medical malpractice. The Democratic majority sitting in the House chamber would have stomped and clapped and yelled with equal delight, knowing the chief executive had just consigned medical malpractice caps to irrelevance, along with any GOP senator or representative gullible enough to think Obama was thus doing anything other than playing them for suckers.

So it was throughout this 47- minute nationally televised monument to presidential flimflam. Sometimes the prevarications were so obvious that even the president’s most ardent supporters – like the news staff of The New York Times - had to concede that he was playing fast and loose with the facts. For instance, the Times quoted Obama’s repeating of his familiar claim that “if you are among the hundreds of millions of Americans who already have health insurance, nothing in our plan requires you to change what you have.”

"That is technically true,” the Times carefully admitted, “but there is a real possibility that existing policies could change as a result of the legislation. The government, for instance, would set new standards, and employers that already offer insurance would have to bring their plans into compliance.” In other words, when, as is inevitable, the cost of providing health insurance is more than the federal fine Obama seeks for not providing it, companies will drop their employee plans, forcing millions of people into the government-run health care system against their will.

Similarly, Obama claimed “most of this plan can be paid for by finding savings within the existing health care system, a system that is currently full of waste and abuse.” If $675 billion equals “most” of the $900 billion Obama says his proposal would cost, why wait to get those savings? Finally, there is abortion and illegal immigrants. Obama said “no federal dollars” will fund abortions under his proposal and “the reforms I am proposing would not apply to those who are here illegally.” If Obama truly believes that, then he will have no objection when Democrats in Congress reverse their previous votes barring such provisions from the legislation when they were proposed by Republicans. In short, did the president sleep through August?


No comments: