As President Obama begins to road to securing the cooperation of major corporate players in his ambitious healthcare reform package, on the legislative side of things, the Senate is laying out its proposals for the president — namely the introduction of a government-run system (the infamous “option”) to compete with the private healthcare sector.

The bipartisanship on this legislation is unprecedented, as senate Republicans are gladly working with the Dems to ensure, at least on the surface, a kinder market-driven approach to the “skin-in-the-game” strategy that may be palatable to both sides. Says Republican Sen. Charles Grassley,

“Congress has an obligation to make insurance more available and more affordable and still give people the option to keep what they have if they like it,” Grassley, of Iowa, said in the joint statement.

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Two-thousand nine is being dubbed “the year of the generic”. Two senators are trying to keep it that way, citing the potential for Pharma (and its branded, patent-extending reformulations) to simply pay off the manufacturers of generics in an effort to halt their production. It is the aim of the Preserve Access to Affordable Generics Act to abolish the so-called “pay-to-delay” actions of drug manufacturers in which massive financial buyouts are given to generic drugmakers while they wait to market their product, guaranteeing patent extensions. But is this legislation really necessary? Not according to some critics who say that it is in the best  interest of Pharma to invest in next-generation research and development, as such buyouts targeted by the legislature in this case are “last-ditch” efforts by some manufacturers to stifle generic competition. | LINK

Freshly laid off and unemployed? Have no fear. It will become cheaper for most people to keep health insurance after losing a job if the government’s stimulus plan becomes law. The purpose of the American Recovery and Reinvestment Act is to stimulate the economy by preserving and creating jobs, helping the unemployed and uninsured, and assisting states with budget relief measures. The U.S. House of Representatives has just approved measures to expand access to affordable health care coverage for workers who become jobless because of the recession. It is estimated that this package will help 8.2 million people keep their healthcare coverage. Briefly, this legislation would:

• Give a 65 percent subsidy for COBRA premiums for up to one year for workers who have lost their jobs between September 1, 2008 and December 1, 2009;
• Make funding available to states that agree to provide Medicaid coverage to these unemployed and uninsured workers and their families; and
• Extend the COBRA benefits for older and long-term employees until they are able to find new health insurance coverage through future employment or they become eligible for Medicare.

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To go along with all of the planning in deciding just how to cover a balooning Boomer population, healthcare policy wonks and legislators now have to consider the future costs of cancer drugs into the mix. 

Medicare has quietly expanded its coverage for cancer drugs to include some treatments that haven’t gotten the Food and Drug Administration’s full seal of approval.

The change was announced last summer with little fanfare and took effect in the fall. It means that doctors and patients seeking Medicare reimbursement for certain novel treatments won’t have to negotiate with the billing department for payment. But it’s also certain to increase Medicare spending, since cancer medications often cost thousands of dollars a month.

Cancer and other high-profile illnesses of aging constantly receive press similar to this item. Isn’t it time for legislators and third parties to sit down and discuss coverage of aging HIV+ patients? Although sheer numbers may argue otherwise, one cannot deny the unforseen consequences patients in the latter population will have on the financing of chronic care. | LINK

• Apparently not much is being done to to force fiduciary relationships between pharma companies and the physicians who study and test devices on their patients as subjects. A report [PDF] commissioned by the HHS Dept. confirms the findings.
• FT Editorial: Time for a stronger FDA.
• A parting gift of sorts for Pharma from the outgoing Bush administration? Congressional Democrats decry the FDA guidelines which will allow pharma companies to advise physicians on off-label uses of medications described in the medical literature. Since these guidelines do not represent FDA-approved indications for the drugs, Democrats are calling foul, implying a carte blanche atmosphere for ultimate sanctioned widespread utilization of treatments not appropriately studied and vetted normally.
• Citing “computer failures”, Indiana-based Wellpoint (the nation’s largest insurer via revenue) tries to explain why it has cut off prescription drug access to its elderly beneficiaries.
• The FDA has asked pharma company Merck for additional information before approving the HPV vaccine for use in older women.

In 2007, there was a slowdown in the rate of medical spending, according to recent federal data. It’s the first such slowdown in over 45 years. A big part of that rate of decline was in the major decrease in spending for pharmaceuticals and related expenses.  But at over 16% of the GDP, many healthcare economists worry about healthcare spending’s sustainability, and that has the new Congress ready to concerned and ready to act this year. One way that may help would be to reexamine SCHIP, the bill authorizing individual states’ help for families in states in which Medicaid does not cover all basic healthcare expenses to children who need it. Its present incarnation expires in March, and a reorganization is in order; Obama has hinted at this.

Barack Obama hasn’t officially taken office yet, and the “shift of power” in the U.S. senate is still to be decided — but that doesn’t mean we aren’t privvy to the possibilities for the methods in which the legislative branch will approach the skyrocketing costs of healthcare in this country.

The NYT sees it this way: Congress should curb the tremendous growth of Medicare Advantage alignments.  If CMS cannot effectively monitor its own out-of-control administrative costs, then how can it even begin to rein in the expenses incurred by its association with private fee-for-service plans with respect to the beneficiary?

Back in the 1980s, private plans — known as health maintenance organizations — were seen as a savior for Medicare. They could provide the same or better services as traditional fee-for-service Medicare, but because of managed care they could do it at a lower cost. Over the years Congress brought other, less managed private plans into Medicare, and in 2003 the Republican-dominated Congress substantially increased government payments to private plans.

Medicare currently pays the private plans — now called the Medicare Advantage program — 13 percent more on average than the same services would cost in the traditional fee-for-service program. Some of the added payments are used to provide extra benefits for enrollees, like reduced cost-sharing or reduced premiums for such extra benefits as vision and dental care.

Barack Obama is on board with eliminating taxpayer subsidies to pay for these plans.  Hopefully, this represents change (at least in the publicly-financed healthcare sector) he believes in and will implement.