Political Hay

Hillary Health Care Redux

Head for the hills -- Dr. Clinton wants to operate tomorrow morning!

By 2.7.06

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Fresh from rolling her eyes at the President at the SOTU, Hillary Clinton took direct aim at CMS director Mark McClellan about what the media has now deemed "the troubled" Medicare prescription drug plan. In full campaign mode, Saint Hillary told Dr. McClellan during a hearing, "I, for one, believe we should scrap this and start over."

With what? Clinton didn't say. But she is still proud of her record so we can assume that Plan B is Hillarycare all over again. Indeed, after trashing McClellan she took the opportunity to take credit for drug prices going down when she was running the health-care show. "We weren't successful getting the legislation passed, but we were successful sending a message that people better get their prices down," she said.

Maybe. But back then the market value of biotech stocks also went down. So too did the amount of venture capital flowing into startups at the time. Indeed, the amount of money going into biotech declined more sharply when Hillary was threatening price controls than at any other time since biotech has been around. I did a survey of biotech firms at the time and found that 75 percent of them had two years of cash or less left in large part because, as the head of the biotech trade group BIO testified at the time, investors were scared by the de facto price controls in the administration's health-care plan.

And the price controls Hillary did get passed in the Vaccines for Children Program were cited by the Institute of Medicine in 2001 as one reason the vaccine industry is stagnant and unprofitable. Who wants to invest in products knowing your prices are going to be frozen for a decade?

Then there is Children's Health Care Insurance Plan Hillary loves to take credit for. This program provides federal money to set up state run low cost insurance programs for working class kids. It was supposed to insure nearly nine million children. Guess what? Under her stewardship kids were first dumped from Medicaid and then re-enrolled into SCHIP programs. And then it took four years to enroll three million children. And at the same time, private companies dumped coverage for kids and many parents simply stopped insuring their kids at all.

Not to worry. Mrs. Clinton's Plan B is universal health care made more efficient with medical information technology and paying doctors and hospitals more to do better jobs. Now, electronic patient records (EPR) will be an extremely valuable tool for improving quality of care and promoting medical progress. But Clinton's vision of health-care information looks more like a central government computer spitting out guidelines and practice patterns for everyone to follow.

She asserts that the VA outperforms the private sector in delivering chronic and preventive care. Now what could have made this "astounding success" possible? Why Hillary of course! "We started during the Clinton administration to transition the VA system to a paperless system....The VA is leading the way in reducing medical errors, improving patient safety, and delivering high quality care; now this is a lesson about what can be done when we have a plan. A plan that is evidence-based, a plan that uses what we know works, and a system that we can actually get to respond to that evidence-based planning."

Not really. The Veterans Administration was recently criticized by the General Accounting Office for not creating a culture of safety, of being behind the curve in reducing medical errors, etc. As to high quality care, studies show that when patients' characteristics are adjusted by how sick they are, VA "customers" often stay in the hospital longer, are more likely to die after receiving care for a heart attack or prostate cancer, and more likely to have been prescribed a medication that can potentially increase the risk of falling and hip fractures than people in private health plans.

Hillary also says, "The other thing the VA has done to keep costs down is negotiate for drug prices with the drug companies. Something which the Medicare system was forbidden to do when the Medicare prescription drug benefit was passed."

Here too, she fudges the facts. The VA keeps drug costs down by imposing price controls. Companies must sell their medicines to the VA at a price that is at least 24 percent below their average selling price and it goes down from there. If they don't, they can't sell to Medicare or Medicaid. Further, the VA imposes an automatic one-year hold on most new medicines while it "studies" its effects. For many important medicines such as Gleevec for stomach cancer or drugs for mental illness, patients must "fail first" on a cheaper drug before they get a breakthrough.

Most troubling, a study by Professor Frank Lichtenberg of Columbia University found that the majority of the VA National Formulary's drugs are more than eight years old -- just 19% of prescription drugs approved since 2000 and 38% of prescription drugs approved between 1990-2000 are on the VA Formulary. Professor Lichtenberg estimates that "the use of older drugs in the VA system may have reduced life expectancy by 2.04 months," and that the value of this reduction was almost $25,000 per person.

Additionally, he found that veterans' life expectancy increased significantly before the National Formulary was introduced (between 1991-1997), but did not increase and may have declined after the National Formulary was introduced (between 1997-2002). Yet, the life expectancy of all U.S. males increased both before and after 1997. But apparently Mrs. Clinton wants to inflict this approach on all of us.

Mrs. Clinton cannot be trusted to be truthful on health care. Over a decade ago, she was shrill and commandeering. Today, she shrouds and couches her intent in faux-techno-medicine chatter and cooked up citations she hopes no one will check. But tear away the fraud and you find someone still bent on expanding the government's reach into every aspect of health care and who believes that the only thing that was missing from her first attempt was a better computer. She needs to be challenged on her facts, her assertions, and her "logic" each time she opens her mouth on the health-care issue. Her objectives have not changed, only the lies and the way in which they are fabricated.

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About the Author
Robert M. Goldberg is vice president of the Center for Medicine in the Public Interest and founder of Hands Off My H ealth, a grass roots health care empowerment network. His is new book, Tabloid Medicine: How the Internet is Being Used To Hijack Medical Science For Fear and Profit, was published last month by Kaplan.