In a post a year ago . . . (“The Dow just hit another all-time high.  The American Ebola death toll remains zero. Gas prices are down. Unemployment claims are down to a level not seen in 14 years” — Obama’s wrecking the country) . . . I incuded this:

OBAMACARE IS WORKING

Health care inflation hasn’t been so low in ages, even as the percentage of Americans who lack coverage has dropped dramatically.  Want to learn more?  Check out Zeke Emanuel’s just-published Reinventing American Health Care: How the Affordable Care Act will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System.

One big-picture way of looking at Obamacare is that it shifts tens of billions a dollars a year from wealthy people to make health care affordable for low income people.  That’s TERRIBLE if you are wealthy, short-sighted, and selfish.  But pretty great if you’re near the bottom of the economic ladder – or if someone you care about might someday develop a preexisting condition. (Which is to say: everyone.)

There’s a lot more to like in the Act than just that — read Emanuel’s book — but for me, at least, that explains a lot.  It’s not some dubious “free lunch.”  It’s tens of billions of dollars raised largely from a 3.8% surtax on investment income above $250,000 going to improve the lives and health and security of every American and helping American manufacturers compete.

Republicans have voted more than 50 times to repeal it . . . and have spent $418 million to run 880,000 TV spots to persuade voters it’s a terrible thing.  (Akin to slavery, says Republican front-runner Ben Carson.)

In fact, it is a good thing — with room for improvement.

In particular need of improvement: our crazy and outrageous drug prices.  The Senate has actually launched a bi-partisan investigation into some of this — mirabile dictu! — led by Susan Collins and Claire McCaskill.

And the same Zeke Emanuel just penned this thoughtful piece on the connection between crazy drug prices and your tax bill and insurance bill, even if the only pill you ever take is a 2-cent ibuprofen.

YOU may not know it, but you could be on the hook to pay at least $124 this year for a drug you probably don’t take. . . .

The drug is a new class of cholesterol-lowering agents called PCSK9 inhibitors. Its cost and how we are paying for it illustrate why we all need to care about not only our own health care bills but also those of our neighbors. . . .

. . . [O]ne preliminary study found that taking the drug lowered the overall chances that a patient would experience a heart attack or stroke, or hospitalization or death from heart disease, to 1.7 percent from 3.3 percent. . . .

. . . The problem is that the companies producing these drugs — Amgen, Sanofi and Regeneron — announced that the retail price for a prescription would be more than $14,000 per patient per year. . . .

. . . [E]ven if the price came down to about $11,000 per patient per year, and only 1.1 million of the roughly 23 million middle-age Americans with high cholesterol actually took these drugs, the bill would be so high that for a typical insurance plan, “annual insurance premiums would increase by $124 for every person” [and] “taxpayers will have the additional burden of paying for similar increases in” the costs for Medicare . . . Medicaid and the Veterans Affairs department.

. . . [A]s these PCSK9 inhibitors make clear, it is not just patients’ perspectives we need to take into account. . . . Because we all pay, all Americans have to have a voice in determining value.

. . . The controversy centers on how much we should pay for each additional [quality-adjusted] year of life [QALY*]. Is it $50,000? $100,000? More? In England they have a flexible target, wherein above $45,000 per QALY drugs require an increasingly stronger case for coverage. But even if we use a much higher target in the United States — say, $150,000 — it turns out these PCSK9 inhibitors still fail the value test. The drugs would cost patients as much as $300,000 for every quality-adjusted life year they add. . . .

In the United States, government regulation is usually a solution of last resort when industry self-regulation fails. But if insurance premiums keep going up $124 per person because of a single drug, Americans may find it more appealing. . . .

Instead of eight hearings on Benghazi, maybe we can focus on finding sensible ways to negotiate drug prices . . . setting them high enough to encourage research and development, yet low enough to free up funds for stress-reducing things (most Americans are under a lot of financial stress) that could lower our heart-attack risk by even more . . . laughter — along with walking and eating smarter — being perhaps the best medicine of all.

*From Wikipedia: “The quality-adjusted life year or quality-adjusted life-year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived.[1][2] It is used in assessing the value for money of a medical intervention. One QALY equates to one year in perfect health. If an individual’s health is below this maximum, QALYs are accrued at a rate of less than 1 per year. To be dead is associated with 0 QALYs, and in some circumstances it is possible to accrue negative QALYs to reflect health states deemed ‘worse than dead’.”

 

 

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