Healthcare Roundup

No one is happy about what is being done in Washington. That is the upshot of my reading. I say something is better than nothing.

Missing in Action on Healthcare?

Most of these elements are controversial. Former single-payer advocates, for instance, are banking on a public plan to open the door to a single-payer system. Insurers know that and are working overtime to make sure that doesn't happen. Aside from saying he supports a public plan, the president hasn't gotten his hands dirty in the political muck. Is he pursuing a conscious strategy to be above the fray or waiting to see what Congress does before jumping in? Is the president being strategically vague or abdicating to Congress because he, too, is feeling the heat from the special interests that contributed millions to his campaign?

Campaign rhetoric led the electorate to believe that a new president was ready to overhaul the healthcare system and bring health coverage to everyone. A poll released by the Kaiser Family Foundation indicates that there is strong support for health reform but that the public can be swayed on the details. "There is still a tremendous opportunity for leadership," says Kaiser CEO Drew Altman. But the special interests can still move the debate in one direction or another.

***

Money directed at health information technology in the stimulus package is not likely to bring down the cost of medical care; nor will preventive care, the much-touted disease-management programs or research into what medical interventions work. Earlier this year an article in the Annals of Internal Medicine by three respected healthcare experts, Theodore Marmor, Jonathan Oberlander and Joseph White, concluded that such reforms "sound like benign devices to moderate medical spending" and may be desirable for other reasons. But they are "ineffective as cost control measures." Serious cost containment--global budgeting, for instance, which sets a cap on what can be spent on healthcare by various sectors--is as far off of the table as single-payer.

"We do not know how to control health spending significantly," Princeton health economist Uwe Reinhardt told health journalists at their annual conference a few weeks ago. "The Obama administration must have the guts to force physicians to defend their high cost of spending. We could save 30 percent without hurting patients if they practiced medicine right." But the administration seems to be moving more in the direction of stopping the Medicare fee cuts already scheduled for doctors. The AMA was gleeful when the administration released its budget. President Nancy Nielsen said that the budget proposal "takes a huge step forward to ensure that physicians can care for seniors by rejecting planned Medicare physician payment cuts of 40 percent over the next decade."

***

If Obama wants to give more than lip service to a public plan, he should offer guidance on how it will work. Right now the term is loosely tossed around and means different things to different interest groups. But most ordinary people, if they understand it at all, believe it will enable them to chuck the coverage they have and choose cheaper and better coverage. If Massachusetts healthcare is a model, though, that's not likely. There, if residents have employer coverage and decline it because it's too expensive, they are barred from subsidized insurance. In other words, they don't have much of a choice. The reason: to keep people from "crowding out" private insurance; that is, taking away business from the private carriers. On May 4, New York Senator Charles Schumer stepped into the void and proposed " principles" that seem to answer some objections from insurers.

Right now it looks like the insurance industry has the upper hand in negotiations over a public plan. It will take a lot more voices and political muscle to nudge health reform to a point where it serves the needs of millions of Americans who are either shut out of the current system or have become its victims.

The Machinery Behind Health-Care Reform - washingtonpost.com

The inclusion of as much as $36.5 billion in spending to create a nationwide network of electronic health records fulfilled one of Obama's key campaign promises -- to launch the reform of America's costly health-care system.

But it was more than a political victory for the new administration. It also represented a triumph for an influential trade group whose members now stand to gain billions in taxpayer dollars.

A Washington Post review found that the trade group, the Healthcare Information and Management Systems Society, had worked closely with technology vendors, researchers and other allies in a sophisticated, decade-long campaign to shape public opinion and win over Washington's political machinery.

***

Such an approach would rely on unprecedented data-mining into medical records and the practices of doctors, a kind of surveillance that also would enable insurers to cut costs by controlling more precisely the care that patients receive.

"Finally, we're going to have access to millions and millions of patient records online," said Blackford Middleton, a physician, Harvard professor and chairman of the Center for Information Technology Leadership, whose studies have concluded the health-care system could save $77.8 billion each year through the universal use of information technology networks. "This is the biggest step for health-care information technology in this country's history."

But others said the case was far from being so clear. Some observers said the projected savings are overly optimistic and that launching such vast computer networks under tight deadlines is risky, a lesson learned by the Bush administration when it botched a variety of homeland security systems rushed into place after the Sept. 11 terrorist attacks.

***

The CBO, then led by Orszag, examined the industry-funded study behind the $77.8 billion assertion, among other things, and concluded that it relied on "overly optimistic" assumptions and said much is unknown about the potential impact of health information technology.

A CBO analysis of the stimulus bill this year projected that spending on electronic health records could yield perhaps $17 billion in savings over a decade.

GE Launches $6 Billion Plan to Develop Health Care Innovations

With the pace of health care reform quickening in Congress, General Electric came to Washington on Thursday, May 7, to launch a multibillion-dollar initiative it says will provide better health care at lower costs to more people—goals shared by many lawmakers.

The company also hopes the $6 billion program, dubbed “healthymagination,” will substantially boost its bottom line by fostering the growth of GE Healthcare.

During the next six years, GE plans to invest $3 billion in research and development to create at least 100 technologies and innovations it says will reduce the cost of medical procedures by 15 percent, increase access to health services by 15 percent and improve quality and efficiency by 15 percent. Another $3 billion will be allocated to improving coverage in rural and poor communities around the world.

Where Are the Democrats Going With Healthcare?

Health-Care Dialogue Alarms Obama's Allies:

"Disputes over whether to create a new government-sponsored insurance program to compete with private companies shine a light on the intraparty fissures that may prove more problematic than any partisan brawl.

More than 70 House Democrats recently warned party leaders that they will not support a broad health reform bill that does not offer consumers a government-sponsored policy, and two unions withdrew from a high-profile health coalition because it would not endorse a public plan.
ad_icon

'It's way too early' to abandon what it considers a central plank in health reform, said Andy Stern, president of the Service Employees International Union. He said the organization pulled out of the bipartisan Health Reform Dialogue because it feared its friends in the coalition were sacrificing core principles too soon. 'You don't make compromises with your allies.'"

***


Douglass disputed suggestions of a rift in the party. "The Democrats are extraordinarily unified this time around," she said.

Yet even administration allies acknowledged tensions over the public plan option.

"This issue has become so vituperative, a serious conversation about how to structure a public plan has gotten secondary attention," Pollack said.

Nichols, who has proposed creating a semi-public option that would have publicly appointed managers but no rate-setting authority, said the disagreement signals a new phase in the overall debate. As he put it: "We've gotten past the kumbaya phase."

Innovating Health Care

An interview with Clay Christensen on Disrupting Health Care — HBS Working Knowledge:

"An acclaimed author and expert on the development and commercialization of technological and business innovation, HBS professor Clayton Christensen has written a new book aimed at changing our national conversation about health care. In The Innovator's Prescription: A Disruptive Solution for Health Care (read an excerpt), Christensen and his coauthors, the late Jerome Grossman and Jason Hwang (MBA '06), focus not on how the United States will pay for health care in the coming decades, but rather on targeting innovations that will make health care both more affordable and more effective in the future."

National Healthcare - A Prophecy and Why We Need It

First, the prophecy courtesy of E. J. Dionne:

Getting there won't be pretty. But for the first time since the passage of Medicare in the 1960s, the forces favoring action on health-care reform are stronger than the forces of cynicism and obstruction.

Feel free to be skeptical. Since Bill and Hillary Clinton's reform efforts foundered in 1994, predicting the death of any comparable venture has been the safest bet in Washington.

But this conclusion misses almost everything that has been happening. It's not just that the public (including business) is frustrated with the status quo. And it has little to do with the details that policy wonks are necessarily hashing over.

What matters is that members of Congress have quietly been preparing the ground for reform since the Democrats took over two years ago. And the competing interest groups seem more inclined to get what they can out of reform than to stop the enterprise altogether.

And why we need it from The New York Times, Finding a Doctor Who Accepts Medicare Isn’t Easy:

"Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.

When shopping for a doctor, ask if he or she is enrolled with Medicare. If the answer is no, that doctor has opted out of the system. Those who are enrolled fall into two categories, participating and nonparticipating. The latter receive a lower reimbursement from Medicare, and the patient has to pick up more of the bill."

***

How do you find a doctor who accepts Medicare? The Web site www.medicare.gov provides a list of enrolled doctors. Other sources are state medical societies and local hospitals, most of which have online directories of doctors. But that’s no guarantee they will see new patients.

Other options are also available. Roughly 18,000 walk-in, stand-alone urgent care centers in the United States are staffed with doctors who set simple fractures, take X-rays, do minor surgery, diagnose ailments and write prescriptions. By far the majority of these centers take Medicare.

Employers Planning to Cut Health Benefits

Just what we need right now (and, yes, that is sarcasm). I hard grousing on MSNBC this morning about Obama pushing health care reform while also trying to get the credit unfrozen. As if health insurance/benefits were a key part of the economy. What will the AMA do when medical insurance no longer exists or the payments decline? Welcome to the free market, Doctors.

Take a look at Survey Finds Nearly 20 Percent of Employers Plan to Drop Health Benefits from workforce.com:

Nineteen percent of employers responding to a new Hewitt Associates survey are planning to stop offering health benefits over the next three to five years, nearly five times as many as the 4 percent that said they were planning an exit strategy last year.

***

• When employers were asked to what extent health care reform proposals outlined by the Barack Obama administration would affect their current health care strategies, 51 percent said they would have some impact, while 44 percent said it would have no impact.
• While one-third of executives think the Obama administration and Congress should address health reform in the president’s first year in office,
63 percent believe it will take place in Obama’s first term.
• Moreover, 60 percent of executive said the federal government should take the lead, while 33 percent said the federal government and the states should share responsibility.

Want to Know About the Government's Health Care Proposals?

Take a look at ResourceShelf's RAND Launches Unique Tool to Evaluate Health Reform Proposals:

"Like our health-care system itself, the subject of health-care reform is complex. Every policy prescription to solve one problem will ripple through the system in ways not easily seen or understood. RAND Health created COMPARE in recognition of these complexities and the need for an unbiased source to aid policymakers with the reform efforts ahead.

Direct to COMPARE"

Mid-sized Business is Good Business

So sayeth the Indiana Chamber of Commerce by way of the Indianapolis Business Journal:

Mid-sized companies are a lot like middle children in a family, a new Indiana Chamber of Commerce study has found. They tend to achieve a lot, but don't get the attention they deserve.

The businesses amount to only 3 percent of all businesses in the state, yet generate 30 percent of the jobs and more than 40 percent of the sales, the study found. Indiana has 3,789 companies fitting the mid-size description of $5 million to $100 million in annual sales.

Frankly, this ought not be a great surprise to many. The Indiana Democratic Party talked about it this past Saturday at the convention. Yet these same businesses may lack the ability to provide the benefits of our vanishing auto industry. Which makes another reason to support national health care.

Hospitals, Health Care, and Indiana's Economy

Interesting bit of reporting in the Indianapolis Business Journal's Small Towns, Big Business, although I am not sure how Kokomo became a rural community:

The hospital is planning to expand to meet rising demand, which means it will add to its 170-person staff. That’s good news for Williamsport as the nation settles into another economic downturn.

But it’s a mixed blessing for businesses in the area. They expect to see higher hospital prices, which would hike the costs of their employee health benefits. That makes it harder for employers to keep and add jobs.

***

“People get jobs. But in the long term, who pays for this?” said Les Zwirn, a former executive at Methodist Hospital in Indianapolis who now is helping to organize a reform group called Hoosiers for Better Healthcare. “Well, we know who pays for this. Families pay for it through increased premiums and loss of coverage. And employers pay for it in terms of depressing wages and trying to slim down and scale down coverage.”

Even hospital leaders agree with those claims—to a point.

“We’re a source of costs for the businesses,” acknowledged Doug Leonard, president of the Indiana Hospital Association. “But on the other side of the coin, we provide a lot of benefits for the community.”

Paul Krugman on Health Economics

Voodoo Health Economics:

"As I’ve mentioned in past columns, the Veterans Health Administration is one of the few clear American success stories in the struggle to contain health care costs. Since it was reformed during the Clinton years, the V.A. has used the fact that it’s an integrated system — a system that takes long-term responsibility for its clients’ health — to deliver an impressive combination of high-quality care and low costs. It has also taken the lead in the use of information technology, which has both saved money and reduced medical errors."

Sure enough, Mr. McCain wants to privatize and, in effect, dismantle the V.A. Naturally, this destructive agenda comes wrapped in the flag: “America’s veterans have fought for our freedom,” says the McCain Web site. “We should give them freedom to choose to carry their V.A. dollars to a provider that gives them the timely care at high quality and in the best location.”

That’s a recipe for having healthy veterans drop out of the system, undermining its integrated nature and draining away resources.

Mr. McCain, then, is offering a completely wrongheaded approach to health care. But the way the campaign for the Democratic nomination has unfolded raises questions about how effective his eventual opponent will be in making that point.
***
Worse yet, Mr. Obama attacked his Democratic rivals’ health plans using conservative talking points about choice and the evil of having the government tell you what to do. That’s going to make it hard — if he is the nominee — to refute Mr. McCain when he makes similar arguments on behalf of such things as privatizing veterans’ care.

Still, health care ought to be a major issue in this campaign. I wonder if we’ll have time to discuss it after we deal with more important subjects, like bowling and basketball.

Heads up for Single Payer health insurance

I go this from Blue Indiana and it deserves to get attention from all of us:

My State Senator, Vi Simpson (D-Ellettsville), has introduced a bill to create a Study Commission for Single Payer Health Coverage (SB 218). Now, we just need to get a hearing for this bill.

Hoosiers for a Commonsense Health Plan (HCHP) is asking everyone to contact Senator Patricia Miller (R-Indianapolis), the Chair of the Health and Provider Services committee, to schedule a hearing for this bill.

Healthcare - Anyone Interested in What Ohio is Doing?

I had no idea that Ohio was working on a health care program. Sorry, between the attempted coup against Ockomon and trying to make a living, Ohio has not been on the radar. Then I ran across The Ohio Employer's Law Blog. This blog has an employer's slant but describes the proposed Ohio law under Deconstructing the Ohio Healthy Families Act:

Essentially, the OHFA will grant all employees working for companies with 25 or more employees 7 paid days off per year for (1) their own physical or mental illness, injury or medical condition, (2) their own professional medical diagnosis or care, or preventive medical care, and (3) the same for an employee's child, parent, or spouse. Employees who work less than 30 hours per week or 1,560 total hours per year will receive a pro rated amount of paid time off. Sick leave will begin to accumulate immediately, but employees will not be able to use it until they have been employed for 90 days. The paid sick leave must accrue at least monthly, and except for the initial 90 days of employment, employees will be able to use it as it is accrued. Employers will not be able to prohibit employees from carrying over up to 7 days of unused paid time off per year.

We might want to compare that with Mitch's plan and what the presidential candidates are proposing.

Our healthcare system has take a centerpiece in the upcoming election. Our economic well-being is tied closely to our own health.

Take a look at Kaisernetwork.org for some general, unbiased information.

"With health care emerging as a top domestic issue in the 2008 presidential election, Kaiser presents health08.org, a website providing analysis of health policy issues, regular public opinion surveys, and news and video coverage from the campaign trail."

The go take a look atBusinesses Discuss Universal Healthcare : WFMZ-TV 69News:

"It's a hot topic among the presidential candidates. Thursday morning, universal health care was the buzz among local business owners. They discussed the pros and cons over breakfast in Bethlehem.WFMZ's Eve Tannery takes us there. I think it's not an important program...it's a critical program."

The topic? How universal health care would affect businesses ... and their pockets. Lobbyist Vince Phillips, from the Pennsylvania Association of Health Underwriters, led the discussion for members of the Greater Lehigh Valley Chamber of Commerce at a breakfast meeting.

Our businesses can no longer carry health insurance for the population. Time for the business and the non-business side of the national healthcare debate to join forces. Time for us to question why the United States is the only first world country not to provide national healthcare. Time for us to question the politicians lamenting "socialized" medicine and who they are they truly working for.

Rahm Emanuel and Bruce Reed on Reitrement Health Benefits

They wrote Before We're 64 which appeared in The Washington Post on November 5. Surely this is of interest for many in this area where so many were and still some are employed by companies providing health care benefits.

We can't afford to let American workers and companies wither on the vine. We can ease the cost crunch for both by giving employers and unions a new option: buying Medicare coverage for retirees ages 55 to 64. Retirees would get quality care from a program they can trust. Employers would get to buy affordable insurance and take spiraling health costs off their books.

***

A Medicare buy-in for retirees ages 55 to 64 won't cost taxpayers. Companies could pick up most of the cost; instead of GM contributing $30 billion to a VEBA, that money would go to Medicare. Retirees would have to pay higher premiums than traditional Medicare beneficiaries do to receive health care.

Taxpayers would also benefit, because the more we can do to make Americans healthier from 55 to 64, the less Medicare will have to spend on chronic conditions later.

For many companies, buying into Medicare would be the most affordable option. It could make the difference in whether companies are able to compete -- and whether companies are able to provide retiree health coverage.

A round up of some health care news

From the Washington Post:

More Health-Care Politicking :

"Unfortunately, House Democratic leaders chose to muscle the program through the chamber last week in such a way as to fail to win over any wavering Republicans and to annoy enough others that the prospects for a compromise may be worse than ever. 'They will have ticked so many people off . . . that I don't know how they can get anyone' to change positions, Rep. Ray LaHood (R-Ill.) said of Democrats -- and he's been trying to help them round up support."

***

If the Democrats' goal is to win approval of a measure that would cover more poor children and not to simply score extra political points by keeping the issue alive, it's hard to see how their tactics made sense. If Mr. Bush and his Republican allies really are committed to getting children the health coverage they need and not just to preventing Democrats from racking up a legislative achievement, it's hard to explain their continuing intransigence.

Geez, do we really need this kind of politicking right now?

There there is this from The New York Times:

Health Sector Puts Its Money on Democrats

"People in the health care industry say the giving reflects a growing sense that the Democrats are in a strong position to win the White House next year. It also underscores the industry’s frantic effort to influence the candidates, as Democrats push their proposals to address what many polls show is a top concern among voters."

“Everybody in the industry knows that health care reform is on its way, and you have only two decisions: sit on the sidelines or get on the field,” said Kenneth E. Raske, president of the Greater New York Hospital Association.

So we can expect some sort of national health care? Or will the politicians use it for fundraising with no intention of getting the job done?

And then we have today's comments from the President, Bush Says Congress Is Wasting Time:

The president again criticized Democrats over the S-CHIP bill, saying the Senate had taken up a second version of the legislation passed by the House “despite knowing it does not have a chance of becoming law.”

While the president vetoed the first version, saying it spent too much money and covered not just the poor children it is intended to help but some middle-class children and adults, he said this version would spend even more.

“After going alone and going nowhere, Congress should instead work with the administration on a bill that puts poor children first,” he said. “We want to sit down in good faith and come up with a bill that is responsible.”

Meanwhile, The Indianapolis Star has Company brings health care to workplace.

The idea to bring a free health-care clinic into the plant sprouted in August 2006, when human resource manager David Milbee attended a Society of Human Resource Management seminar.

"We put the idea on the table and talked about what we could do to reduce health costs and make our employees healthier," said Brian Myers, Biddle president.

In the spring, Myers and Milbee visited a factory that has a free clinic in Knoxville, Tenn. They both thought it was too good to be true, and not long after, Biddle contracted with Novia. Biddle already had space for the clinic, so little construction was needed, and the clinic opened July 31.

Myers said Biddle provides its own health insurance for its nearly 180 employees, not working through another provider. He said their premium rates are low, with coverage for one person costing $12.50 per week and coverage for a family $35 per week. But the real cost to the company comes, Myers said, when an employee sees a doctor, pays a small co-pay for the visit, and Biddle has to pay the difference.

Additionally, the company loses productivity when an employee is out for several hours to see the doctor. Using the clinic, employees are away from the job site about 20 minutes.

Better diet less violent behavior?

The Sunday Herald:

Healthier menus for Scots prisons

"The move comes at a time when there is an increasing focus on the role of nutrition in preventing anti-social behaviour. One leading researcher, who is carrying out a global research project for the World Health Organisation, told the Sunday Herald that early results suggest poor diet could be a factor in nearly 40% of violent behaviour."

More on SCHIP

From Blue Indiana, Reminder: Indiana Republicans protect the President over kids:

"With the announcement yesterday that Rep. Baron Hill will vote to override the President's despicable veto of the SCHIP expansion, we can concentrate our energies within the state to pressuring the four Republicans who all voted against the bill to begin with and show no signs of abandoning their wholesale defense of the President. The indicted are, in no particular order:

Rep. Mark Souder (IN-3)
Rep. Steve Buyer (IN-4)
Rep. Dan Burton (IN-5)
Rep. Mike Pence (IN-6)

These four have made it clear: They would rather protect the President than the hundreds of thousands of children across the country without adequate health care coverage. Shame on them.

Does it make sense for Indiana citizens not to support SCHIP? Then why are the Republicans voting against it?

Jim Schellinger on health care

Follow this link. Schellinger has a video on his healthcare proposals.

If it were not for bad luck...

That was how I felt after reading the Indianapolis Business Journal's daily update today. First, Health care premiums rise 6.1 percent, and then Weaker economic growth is predicted. This does not look good.

About the rising insurance premiums, the IBJ had this to say:

The companies reported that premiums for families increased 6.1 percent, on average. That's the lowest growth rate since 1999, when premiums rose 5.3 percent and cost an average of $5,791 for families. Health care premiums rose 7.7 percent last year, when families paid $11,480.

This year's slowdown doesn't mean much because the cost increase still outpaced wages, which rose an average of 3.7 percent, said Drew Altman, the foundation's president and CEO.

The chief economic worry for next year is a recession:

Strained by an ailing housing market and credit woes, the economy in 2007 is expected to log its worst growth in five years and should be somewhat sluggish next year.

The No. 1 risk, though, is that the economy will lose its footing altogether and fall into a recession, forecasters say.

A forecast released today by the National Association for Business Economics puts the growth of gross domestic product at 2 percent for this year. The pace was 2.2 percent in the group's previous survey, in May.

So what happens if the economy tanks and those premiums cannot be paid? Tell me, again, why national health insurance is a bad thing.

Healthcare reform - Obama has a proposal

I have said before that national health care will come when Big Business can no longer afford to provide us with national health care. Looks like that process is starting. From today's Washington Post:

Sen. Barack Obama (D-Ill.) yesterday proposed federal assistance to help U.S. automakers cover the cost of their retired workers' health benefits if the companies invest in technology to improve their vehicles' fuel efficiency.

***

Obama proposed that the government pay for 10 percent of domestic automakers' health-care costs for retired workers through 2017 if the firms plow half the savings into equipment for making more efficient cars and trucks. Obama's campaign estimates that this would cost taxpayers roughly $7 billion over the next 10 years.

In addition, Obama proposed tax incentives for retooling auto assembly plants and the extension of tax credits for hybrid vehicles beyond the current 60,000-cars-per-manufacturer limit. His campaign put the 10-year cost of his plan at $20 billion and said it would be covered by auctioning greenhouse gas permits under a cap-and-trade program that Obama also supports.

Indianapolis Star on federal drug policy

Maybe I am as dim as I seem. I certainly do not understand this editorial:

The notion of allowing the federal government to "negotiate'' prescription drug prices with manufacturers appears appealing, at least on the surface.

But U.S. senators, who are expected to take up legislation on that topic this week, should keep in mind that the Congressional Budget Office found that the measure would have a "negligible effect'' on spending. They also should note that federal researchers in February found that the new Medicare drug benefit is succeeding in lowering drug costs for senior citizens.

Why has that occurred? Because the system already is set up to enhance competition. Private companies that manage the drug benefit must compete among themselves to attract clients. Providers also negotiate with drug makers to hold down prices on medications.

"We have lower drug prices for beneficiaries, lower program costs for the government, and prescription drug choices,'' Iowa Sen. Chuck Grassley told Reuters last week. "Competition is working.''

That's a message that needs to be heard more often on Capitol Hill, where for some lawmakers political pandering is a full-time job.

Executives at Indianapolis-based Eli Lilly and Co., as well as other drug makers, worry that there is no such thing as negotiation when it comes to dealing with an entity as powerful as the federal government. When bureaucrats set the terms, haggling over costs can easily cross over into price-fixing.

Granted, it's not senators' primary job to worry about drug companies' bottom line. They should, however, be concerned over Medicare recipients' access to new medications. By attempting to control the market, Congress could end up prompting drug makers to withhold newer or more costly medications from the Medicare plan. That scenario already is playing out with Veterans Affairs benefits.

It's not a case of evil drug companies taking meds away from grandma and grandpa. It has everything to do with free markets and the need for public companies to keep their shareholders' best interests in mind.

The bottom-line question: Is this legislation really necessary? The evidence -- lower drug costs, healthy competition, lower than expected costs for the government -- indicates that it isn't.

I jsut do not buy that there is the competition between companies for Medicaid patients. I just do not buy that it is a good idea that the government is forbidden from negotiating prices for Medicaid. I do buy the idea that Lilly does not like the idea.