Tuesday, May 19, 2009

States, U.S. Hike Rx Prices 

Multi-state suit against Wyeth proves Government cannot stand competition

By John R. Graham

Categories: California, Delaware, Florida, Illinois, Indiana, Louisiana, Massachusetts, Medicaid, Michigan, Nevada, New Hampshire, New York, Pharmaceuticals, Tennessee, Texas, Virginia, Wisconsin

I'd bet that Avis, Hertz and other car-rental businesses pay a lot less per car than I do.  After all, they buy entire fleets and I buy only one car every few years.  Imagine if I could get a law passed that made it illegal for cars to be sold to different customers for different prices.   Would I be able to buy cars cheaper?

Probably not: Depending on how many cars were sold to corporate fleets versus how many to individuals, the price of cars to corporate fleets would rise.  Renters would pay a higher price.

So, governments generally allow different prices to prevail in markets - but not when the government competes against private customers.  For example, it is illegal for a private patient or organization to pay less than the government for prescriptions.  We've known for years of evidence that this increases prices to private buyers of medicines (which I discussed in a 2003 report, pp. 10-12, 25-26).

This has not stopped states and the federal government from acting aggressively to artificially increase Rx prices for American patients.  The latest is a multi-state and federal lawsuit against Wyeth Pharmaceuticals, in which 16 states and the U.S. are colluding on a lawsuit charging that private hospitals got lower prices for Protonix Oral and Protonix IV acid-reflux medicines than state Medicaid programs were able to negotiate.

The business case for these discounts was that the patients would be loyal to those medicines once discharged from the hospitals, and encourage their doctors to keep them on those meds as out-patients.

Horror of horrors!  Competition between Wyeth and other drug-makers who make different therapies for acid-reflux disorder (such as a certain purple pill).  And the states were little more than ineffective bystanders.  Well, we just can't have that.

The result of this lawsuit will not be lower Rx prices to state Medicaid programs: Rather, it will be higher drug prices for hospitals and out-patients, and a higher likelood of fewer patients having access to a broad choice of anti-reflux therapies.

• posted by John R. Graham
• 12:54 pm
• 0 comment

Tuesday, May 5, 2009

The "Drive Doctors Out" Bill Advances 

By John LaPlante

Categories: Medical Malpractice, Nevada

The Nevada Assembly voted to remove a cap on "pain and suffering" damages in medical malpractice claims.

The Nevada Policy Research Institute calls it the "Drive Doctors Out of Nevada" bill.

• posted by John LaPlante
• 8:12 am
• 0 comment

Tuesday, April 28, 2009

As Night Follows Day 

By John LaPlante

Categories: Nevada

As night follows day, unemployment often leads to being without insurance. So we've got another story on the subject, this time from Nevada. Federally funded health clinics are seeing an uptick in traffic. No surprise there.

But here's something else that stands out from this story, which discusses the plight of a man and his wife: "He never had to think about finding a doctor who charges on a sliding scale."

I wonder if he has ever thought of how much the doctors he has seen charge, or what he would, could, or should pay a doctor. For people with insurance, the "price" of seeing a doctor obscured with co-pays and deductibles, and then buried in the cost of an insurance policy. The cost of the insurance, in turn, is obscured by tax subsidies granted by governments to employers who select the policies.

Health care costs money, and the employed pay for it in ways they don't see. Unemployment makes those costs visible.

• posted by John LaPlante
• 7:35 am
• 0 comment

Monday, April 20, 2009

No Quarter 

Advocates of sane and humanitarian drug laws are dazed and confused if they think today's a celebration day.

By Mark Todd Engler

Categories: Alaska, Arizona, California, Colorado, Connecticut, Hawaii, Illinois, Maine, Maryland, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Washington

This 4/20 ought to have been a real heartbreaker for opponents of cannabis prohibition who've bought into the ocean of hype surrounding Obama's assurances of change.

Or perhaps there was just a communication breakdown, because despite promising a whole lotta love for states' rights regarding medical marijuana during the campaign, real reform is over the hills and far away.

Obama's DOJ said over the weekend that after considering a California federal judge's request for an explanation from the feds regarding their alleged new policy on the persecution of state-approved medical marijuana dispensaries and users, government attorneys have determined it's basically not much different than the old policy. Furthermore, the Bush administration's "investigation, prosecution, and conviction of (California medical marijuana distributer Charles Lynch) are entirely consistent with the policies of DOJ and with public statements made by the Attorney General with respect to marijuana prosecutions," according to the DOJ brief (pdf).

But even if the government's actions don't appear now to be exactly jiving with the political smoke blown by Obama and his attorney general, said Justice Department attorneys, it hardly matters. You see, the "enforcement policies of the Department of Justice, including those expressed by the United States Attorney's Office, or by Attorney General Holder on this topic, do not confer any rights or defenses on any person."

In other words, the song remains the same: Going to California, or any other state that's legalized medical marijuana, provides no legal protection whatsoever against an individual's rights getting trampled under foot by the federal government so long as the criminally incompetent drug war rambles on and the dogs of doom are howling "More."

• posted by Mark Todd Engler
• 7:58 pm
• 0 comment

Monday, March 30, 2009

Smoke and Drink for the Children? 

After socializing risk, state complains about the costs of socialized risk

By John LaPlante

Categories: Nevada

The Nevada Policy Research Institute notices that politicians in the state with Sin City would like people to sin a bit more.

AB277 and AB255 would more than double the current excise tax rates on cigarettes and alcohol. The cigarette tax rate would rise from 80 cents per pack of 20 to $1.80 — an increase of 125 percent. The excise tax on liquor would rise by 115 percent, while the tax on other alcoholic products such as beer would riSse by 331 percent.

The increased revenues would go to (depending on who's talking) health care or education. So light up! It's bad for your health, but the future of the children is at stake.

Government gets into this situation when it takes over health care. Speaking of the Master Settlement Agreement with tobacco companies, Geoffrey Lawrence writes:

After socializing the cost of healthcare, the states were essentially complaining that the costs were socialized. Individuals who did not have to bear the financial costs of their actions directly, it was argued, became less averse to smoking than they otherwise would have been, driving up state-run healthcare costs.

• posted by John LaPlante
• 4:15 pm
• 0 comment

Tuesday, March 24, 2009

Judge on Feds' New State-Friendly Medi-Pot Policy: Can I Get That in Writing? 

Says AG's statements of late raise more questions than answers

By Mark Todd Engler

Categories: Alaska, Arizona, California, Colorado, Connecticut, Hawaii, Illinois, Maine, Maryland, Michigan, Minnesota, Montana, Nanny State, Nevada, New Mexico, Oregon, Rhode Island, Washington

A California federal judge has requested that U.S. Attorney General Eric Holder's justice department explain, on paper and in black and white, just precisely what in blazes the administration has in mind regarding its much buzzed-about shift in medical marijuana policies.

Pot law reform advocates have been flying high on rumors that Obama's kinder, gentler Drug Enforcement Administration - in a 180-degree reversal of Bush- and Clinton-era policies - is set to turn over a new leaf and start respecting the democratic wishes of state voters regarding cannabis laws.

However, the sentencing judge in a high-profile California medical marijuana case seems a tad skeptical - or maybe just a little confused. U.S. District Judge George H. Wu wants to know if Obama's federal law enforcement braintrust has actually devised a legitimate, coherent new states' rights-respecting prosecutorial policy.

Wu on Monday postponed sentencing the owner of a Morro Bay medical marijuana dispensary convicted of five federal counts, including distributing drugs.

(Wu) said he will hold off sentencing Charles Lynch, 47, until prosecutors provide a written clarification from the Justice Department on the Obama administration's newly revised position that federal agents target marijuana distributors only if they violate state and federal law.

Judge Wu may suspect the administration is just blowing some capricious smoke into the air, hoping it'll narcotize the medical marijuana activist constituency, most of whom no doubt Voted for Change, without actually doing or indeed changing anything of substance (or in writing) at all.

But if indeed there's been a true and documentable shift in federal medical marijuana policy, then there are likely a whole lot of federal prosecutors around the country who aren't even close to being on the same page as the newly minted higher-ups on the issue. For example, Thom Mrozek, a spokesman for the U.S. attorney in Los Angeles, was quoted just Monday after Wu issued his request saying that the Lynch case "involves a violation of federal law, and that's really all that matters."

Lynch's attorney, Reuven Cohen, reminded reporters on Monday that throughout his client's trial, the federal government did all it could to keep any discussion whatsoever of medical marijuana's legality under California law entirely out of jury earshot.

"At least the statements that we have from Attorney General Holder thus far indicate that somehow state law is now relevant to these prosecutions," said Cohen. "Well, the government, as everyone here who covered the trial knows, argued for days to keep state law out of it. And the reason they did that is that Charlie was in complete compliance with state law."

• posted by Mark Todd Engler
• 3:28 pm
• 0 comment

Wednesday, February 11, 2009

Nevada Looking to Add Autism Mandate 

By Marc Kilmer

Categories: Insurance Regulation, Nevada

Nevada is preparing to join the list of states considering mandating health insurance coverage of autism treatment. The appearance of these mandates in state legislatures is becoming so commonplace that it almost isn't noteworthy. What is noteworthy, however, is the quality of the news reporting about the Nevada law.

Unlike other reporters, J. Patrick Coolican of the Las Vegas Sun spends some time looking into the issue and provides a fairly even-handed story. He gets close to the heart of the story in this paragraph:

For their proponents, these laws offer a win-win: They gather support from an energized and well-organized constituency, and they force the insurance industry to pay for treatment that might otherwise fall to the state or school districts, and, in the case of the Silver State, Nevada Early Intervention Services.

To put it more bluntly, legislators who support these mandate laws get a lot of recognition from people who care passionately about the issue. They do so without having to spend money (or force local school districts to spend money) but instead "force the insurance industry to pay for treatment." In short, legislators get praise for doing something that causes them no pain. This is the first story I've read on the autism mandate that mentions this.

I also found this comment from a state legislator interesting:

Assemblyman James Ohrenschall, D-Las Vegas, said the insurance industry, which he called a “regulated monopoly,” is often guided by “perverse incentives” not to cover various conditions. He said it is time for government intervention.

If one looks at the health insurance industry, it's pretty clear that much of the blame for "perverse incentives" lay at the feet of government regulations. There is already too much government intervention in the health insurance market. It's unfortunate that legislators like Mr. Ohrenschall think the way to fix problems caused by government intervention is to have the government intervene even more.

• posted by Marc Kilmer
• 2:44 pm
• 0 comment

Wednesday, February 11, 2009

Raid Numbers Don't Lie; Does the President? 

O on track to surpass W's medi-pot bust total

By Mark Todd Engler

Categories: Alaska, Arizona, California, Colorado, Hawaii, Maine, Maryland, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Washington

The Obama administration's declaration last week that it might someday start thinking about calling the federal drug-war dogs off state-approved medical marijuana dispensaries was certainly welcome news.

White House flack Nick Shapiro assured Americans the changer-in-chief "believes that federal resources should not be used to circumvent state laws, and as he continues to appoint senior leadership to fill out the ranks of the federal government, he expects them to review their policies with that in mind."

Again, good for him. Because as it stands now, just 23 days into the Obama years (I know, I know - it seems like so much longer), the Drug Enforcement Administration under the former Illinois Senator is on an early but unmistakable trajectory to surpass George W. Bush's two-term raid total, and do it in just two years.

DEA agents have committed at least five medical-marijuana facility burglaries since Inauguration Day. In the entirety of Bush's eight years in office (I know, I know - it seemed like so much longer), the DEA conducted 148 raids, said a spokesman from Americans for Safe Access.

By contrast, President Clinton's DEA looted voter-endorsed pot dispensaries on fewer than 20 occasions, according to the spokesman. (A bit misleading, that lower number by no means indicates some higher appreciation for individual rights or grassroots democracy on Clinton's part: States didn't even start legalizing medical marijuana until his second term. And, of course, it'd be difficult to conceive of a more fanatical living opponent of patient freedom and physician autonomy than Clinton's odious drug czar, Barry McCaffrey.)

• posted by Mark Todd Engler
• 12:17 pm
• 0 comment

Friday, January 30, 2009

Health Care is Not "Access to a Waiting List" 

By John LaPlante

Categories: Medicaid, Nevada

Here's another entry in the chapter that might be labeled "access to a waiting list is not health care." A man in Nevada has two minor children, both of whom need surgery. He's on Medicaid. So, isn't that great, he's "insured."

But what does that mean? Not much. The state has been trying to run Medicaid on the cheap (perhaps driven by the "get everyone insured" mantra, though I'm not familiar with the eligibility requirements of the program). The father can't find doctors willing to operate on his children, given the low rates of payment offered by the state.

Nevada officials are looking into the case, and are considering sending the girls to another state. Sounds a bit like Canadian-style "health care refugees," though if it works out, the family probably won't have to pay out-of-pocket for the care.

Still, the case is an illustration of the limits of "cover all kids" and other nostrums. Health care reform won't provide for human needs if it simply means expanding government programs.

• posted by John LaPlante
• 2:21 pm
• 0 comment

Friday, November 7, 2008

Nevada State Workers to Pay More 

By John LaPlante

Categories: Nevada

Currently, 95 to 100% of the cost of premiums for Nevada state employees are hidden, paid for by the state even before employees get their paychecks. That's going to change.

The state will now ask employees to chip in through payroll deduction.

Another point that stand out in the Las Vegas Sun article is this: "The base subsidy for an active employee is $502 a month for the high deductible plan. And for the low deductible plan, the state pays 95 percent or $532 with the worker chipping in $28."

The article implies that the total cost of the high-deductible plan is $502 a month, since it mentions no employee contribution. For the low-deductible plan, add $532 and $28 for a sum of $560. Run the numbers a little more and the difference between a high and low-deductible plan is only $696 per year.

The article doesn't say how "high" or "low" those deductible are, whether they have different coinsurance rates, cover different conditions, etc. But the low difference in costs makes me wonder what's going on here.

• posted by John LaPlante
• 11:25 am
• 0 comment