tv Washington Journal Dylan Scott Discusses Medicare Drug Prices CSPAN January 30, 2017 5:03pm-5:32pm EST
feature a live discussion with author and political commentator nick adams. we're taking your phone calls, e-mails and tweets during the message. >> the problems america has right now. this is still by far and away the greatest country in the history of the world. >> nick adams is the author of america, the greatest good, the american boomerang, how the world's greatest turn-around nation will do it again. and retaking america. crushing political correctness. mr. adams is also the founder and executive director of the foundation for liberty and american greatness, an organization dedicated to promoting american exceptionalism and combating anti-americanism worldwide. watch in-depth live from noon to 3:00 p.m. eastern sunday on book tv on c-span2. dylan scott joins us now to talk about how president trump
wants to lower prescription drug prices. he's with stat news. and for viewers unfamiliar with stat news, what is it? >> we're a national publication. we cover health care and medicine. we're based out of boston, owned by the boston globe, but we have reporters across the country including us here in d.c. that cover the politics. >> stat news.com is the website for viewers who want to follow along and look at some of your reporting. what did president trump claim when it came to prescription drug prices? >> he said he wants to bring down prescription drug prices. how had ewants to do that is what's unusual. he says he wants to change how the federal government pays for its prescription drugs that it buys through medicare and medicaid. he wants more direct negotiations between the federal government and the drug companies. that's usually what you hear from democratic politicians, not republicans. whether he's able to rangle his
party to do what he wants to do will be interesting to watch. >> special phone lines for our viewers, special line for medicare recipients, otherwise we split our phone lines by region, if you're in the eastern times. it might be helpful to the discussion to explain how drugs are bought, how medicare drugs are purchased by the federal government now before we understand how he's going to change the system. >> sure. the medicare prescription drug program is currently administered by private insurance programs. so those individual plans do negotiate with drug companies for the prices that they pay, and there are some built-in rebates that drug companies have to pay to the federal government that are required by federal law. however, the argument in favor of having the whole medicare program negotiate with drug
companies is that's a much bigger buying block, a lot more bargaining power. so in theory, that could help drive prices even lower. the question is whether it really would. what you would have to do is be willing to restrict some of the drugs that medicare covers. and that, you could see for obvious reasons why that could be politically risky. >> as you sat down with donald trump, not only talking about the campaign trail, but his administration talking about it in the opening days of their administration, here's sean spicer in the first press conference that was held on monday of last week, when asked about prescription drug prices. >> you've heard the president the last couple weeks talk about the price of pharmaceutical drugs. and the need to get those prices down, and bring manufacturing back in the pharmaceutical industry to benefit the country. it's an issue that he's going to continue to work on. he understands as we reform health care as we repeal and replace obamacare, getting ahold of the cost of prescription drugs, to give people more access to them, and greater
plans in health care. that's going to be a key part of it. >> sean spicer last week. dylan scott is with us of stat news. changing the way that the negotiations happen, is there any evidence that it would actually lower prices for the end user? >> that's the big question. so the congressional score keeper, the congressional budget office has looked at this policy. what they've said is the only way you're going to achieve meaningful savings is if the federal government is willing to either restrict access to certain drugs, charge higher co-pays, something like that, or flat-out not cover it. and that is where the trump policy and the policy democrats have put forward runs into
trouble. because you can imagine how the pharmaceutical industry could quickly attack it, if, you know, somebody's grandparent isn't able to get their cancer drugs because the federal government has the say, we're in negotiations, you haven't met our price point so we're not going to cover your drug. >> you mentioned the trump policy and the policy democrats have put forward. is donald trump's health and human services nominee, congressman tom price, is he onboard with these changes? what has he said? >> it was interesting. in the hearings that congressman price had before the senate committees, democrats pushed them on this point, that the policy was more in line that their thinking than republicans. congressman price was noncommittal. he said a couple of times that donald trump will be his boss, and so it will be his job to implement the policies that president trump wants. there was clearly reluctance on his part and there really hasn't been any appetite among congressional republicans who would have to pass some kind of legislation to really make this happen to institute it.
so that's what trump is up against. >> let's get to the phones. sherry is a medicare recipient in alfred, maine. good morning. >> caller: good morning. thank you for c-span. this is awesome. one of my drugs, the last time i got it, my co-pay was $7.20, and that was in 2016. now 2017, walgreens said the price was going to be -- my co-pay was going to be $1,100. so i called them and asked why. and they said, insurance is paying $500 less and the price of the drug went up $600. so i can't even get that drug now. i'm going to have to go off that medication. >> dylan scott? >> this is the big problem and the reason that prescription drugs have been in the news so much, is that people are paying high out-of-pocket costs. and the people -- the cost that
the people are feeling on their wallet is the reason it's become such a vibrant political issue, i think. something to watch whether they try to reform medicare or replaci replacing will address the overall cost of the drugs, or at least the out-of-pocket cap that people are paying, or out-of-pocket costs that people are paying themselves versus what insurance has to cover. >> one alternative affordable care act replacement plan put forward last week was senator collins of maine, and senator cassidy of louisiana last week. did they address this issue, in that replacement plan that they talked about? >> there hasn't been anything in the republican plans, including senator cassidy and collins, that has addressed prescription drugs in a head-on way. there are very smart people here in d.c. that think because republicans will ultimately need some democratic support to pass a plan that repeals and replaces the affordable care act, they
might do something, even if it's relatively minor on drug prices to win over at least a handful of democrats. what exactly that looks like and whether a token gesture on drug prices is enough to give democrats to vote to upend their signature legislative achievement of the last decade, that's kind of the open question. >> let's head to troy, michigan. steven's waiting. also a medicare recipient. good morning. >> caller: good morning, gentlemen. i've got two questions. i hear from one side that medicare is okay, then the other side says unless something is done, medicare is going to go bankrupt. which one is true? or is it in the middle? and the first lady, people forget that the insurance companies and doctors went to the white house and made deals with obamacare -- with obama. so that's why these insurance companies can jack up the prices, because obama's allowing them to do it. >> on the question of medicare, i do think in terms of whether
the program is financially solvent or not, that depends which party you ask. it's not going bankrupt anytime soon, but republicans would point out that unless you make some structural changes, over the long term, it could start to run into financial problems. i don't think that there's been any indication that republicans are actually going to address medicare in the near term. the affordable care act is going to be a big enough problem and a big enough debate for them to try to get through over the next year or so. and to your point, i do think something to watch in the debate over the aca is how industry reacts. because they did, the doctors, insurance plans, the drug industry, they were at the table when the affordable care act was passed. and a lot of people credit the industry buy-in with the law finally getting over the finish line. so how they play ball or not with the republicans in repealing and replacing the law is going to be a crucial factor. >> you talk about that industry buy-in, whether an effort to address this issue amid those
debates, and to the industry help stop that from happening? >> the drug industry? >> yes. >> so, one of the things that's going on about the aca, the drug industry got to the table very early and they agreed to do a couple of things. they said we're willing to pay a fee that helps cover the law's costs and we're willing to give bigger rebates to medicaid. we're willing to cover this hole in benefits that medicare recipients had been facing. but if we do those things, we don't want to see any more direct price controls. that was the deal that the obama administration was willing to make, because having the drug industry on your side in washington helps to get things done. >> we want to talk about the drug industry. lobbying arm's reaction since this has been talked about by the trump administration, brought up again, a new ad campaign coming out from the drug industry. here's one of the new commercials that they just put out.
in its entirety, came out last week, as the "washington post" points out in its headline, that new ad campaign missing one detail. any question about pricing? >> the drug industry wants to keep the debate that they create innovative medicines that improve people's lives. when it gets down to it, that's their argument, in the end, we have to be willing to pay a certain price in order to get those break-through treatments. so going forward, it's been in their playbook for a long time, that's kind of the fundamental argument, we're innovators, and we make medicines, as the ad made clear, is going to change the world. any effort to really crack down on prices could hinder those research and development efforts. >> mary is in tacoma, washington, this morning. mary, good morning. >> caller: good morning. i have a question. i'm not sure if my facts are correct at this point. but if memory serves me, president bush negotiated
medicare part d, where he assured that we were not allowed to -- or the government was not allowed to negotiate prices with the pharmacy -- pharmacological industry. where did that end up with the aca, and in the current decision to try to get prices down? >> you've got your history right. the medicare prescription drug benefit was passed in the 2000s under president bush. and part of that law stipulated that the federal government as a whole, the medicare program as a whole would not be allowed to negotiate drug prices directsly. that was left to the private plans that administer the medicare part d, the drug benefit program. so that's why it would require congress to act in order to change that part of the law. and that's why it becomes very difficult for president trump to implement his policy, because republicans have historically
been very reluctant to allow the federal government to get so directly involved in the drug market. >> burley is in east petersberg, pennsylvania. medicare recipient. go ahead. >> caller: good morning, gentlemen. i do not think medicare is going to go bankrupt. because we have a way of -- the problem i have with medicare is that when they introduced prescription drugs, i did not know it was mandatory you had to have it, because my prescription had so many side effects. it was making me sicker than i really was. so i decided not to use prescription. then eventually i was penalized for not using prescription. so i have every month until the day i die, i have to pay medicare $28 for not having prescription. if they can give me prescription that doesn't have that many side effects, yes. but now i am penalized because
of my choice. i thought it was my responsibility to choose for myself and my health and my well-being. but now i'm penalized for it. >> thanks for sharing your story. >> this goes back to kind of two fundamental things. one is that medicare is a popular program that it will be very difficult to change. because so many seniors are affected by it. the second single biggest insurer in the country. at the same time it's not a perfect program and people still face out-of-pocket costs and have to pay some money out of their own pocket. that's where i do think you could see some minor changes to the program. because there are ways that could maybe help address a situation like yours. but at the same time, the overarching program is so popular, it affects so many people, it's hard to imagine the bigger republican plans for overhauling it ever getting through. >> blue springs, missouri, is next, allen is a medicare recipient. good morning. >> caller: good morning, gentlemen. i have a quick comment and then
a quick question. during the election process, i had conversations with several of my friends about the advantages of obamacare with -- as related to medicare. and they all said, oh, you know, obamacare is driving up medicare costs and blah, blah, blah. when i would point out the fact that their doughnut hole would disappear if obamacare was repealed, they said, oh, that hasn't made any difference anyway. i can say for myself it's made a huge difference. has there been any discussion on that aspect of medicare under the obamacare repeal process? >> so, to your point, there was this glitch before the aca, where once medicare recipients hit a certain threshold of spending for their prescription
drugs, their benefits stopped and they had to pay the whole cost of the drug holes until they hit the coverage. the aca made sure that people were covered all the way through on their prescription drug spending. i haven't seen a ton of specific conversations yet about that piece of the aca, because in the grand scheme, it is a small piece. but it is important. and i do think that most of the people i've talked to, lobbyists and folks on the hill, they don't think that's the kind of thing that republicans would want to roll back. there's a lot of discussion how there's good things in the aca, there are popular revisions that the republicans would want to keep in closing the doughnut hole would be one of them. >> steve in florida is calling in. steve, good morning. >> caller: good morning. thank you very much for taking the call. the biggest problem i see in health care is that the whole discussion between the democrats and republicans is really about insurance. and the business of insurance and business of health care, or health care itself, are two totally different.
so the focus is the quality of care. there's in discretion of value. what do we pay when we pay for an insurance premium and what are we getting back for that money? the thing is, insurance and health care is the same thing. for instance, there are 20 million americans now who have health insurance who never had it before. however, we don't know what health care they're getting and what they're using, because we haven't measured the quality of care they're getting by the performance of the patients in terms of complying to the guidelines from either the cdc or heart association and so on and so forth. that data has been available for 20 or 30 years, insurance carriers, to be able to organize. at this point in time, we don't have a measure to tell what is the value of either programs, any programs that we have. and that's what's really wrecking the system. choosing your own doctor is
something that was promised in obamacare. and it should really be not an issue. because if the doctor is complying with proper guidelines, and providing the patients with good care in terms of preventive care and long-term chronic care, then the cost of care will drop dramatically. the cost of care isn't necessarily related to how much you spend for a particular unit of service. it really depends on what the sum of the services are over time. and so it's not an issue of whether a doctor is perceived to be a good doctor, or whether the waiting time in his room is okay, it is, what is the value of care that he is receiving. >> thanks for the call from florida. to that point, dylan scott, measurements on quality of care. how do we go about doing it now? >> well, that's the interesting thing that the aca -- one of the interesting things the aca did, it created these pilot programs that would allow doctors and health systems to be paid on a
more value based system than just fee for service. there's a couple of different ways we measured that. there are patient outcomes, of course. there are patients satisfaction. those pieces of the law, those programs are probably something that could be continued going forward. the law also created this innovation center inside the department of health and human services. and at his hearing last week, congressman price indicated that that's something he would be interested in keeping under the law, especially now that it will be under his authority. and so those kind of tests, those kind of experiments to allow us to pay more for value as opposed to just buy quantity, that's a conversation that started and it's going oh continue and there's really no sign it's going to stop. >> let's go to ocala, florida. how are you this morning? >> caller: good. i have a question. most people don't realize when people look at their paycheck, it says fica.
it doesn't say social security, or anything else. fica has a 1.445% out of every paycheck. if you work for 40 years, let's say you make $50,000 a year for 40 years, that basically means they're taking out roughly $750 a year out of your check for 40 years. when you retire they take an additional $105 additional out of your social security check. they laughingly say it's an entitlement system that needs to be addressed. but when you look at it over 40 years, it's a sizeable amount of money and you're still paying for it after you retire. >> that goes back to the point we made before which is medicare is a popular program. so any serious effort to dramatically overhaul it is going to run into a lot of political problems. there was a lot of talk shortly after president trump was elected and republicans had seized full control of congress that this is their opportunity.
they've been wanting to overhaul medicare for some time. now they'll have their chance. but you'll notice that that talk very quickly dissipated, especially when they also have the more immediate issue of the affordable care act to deal with. medicare is the third rail of politics, that's kind of the cliche. republicans i think very quickly realized that if we want to get through repealing and replacing the aca which is going to be a difficult debate in and of itself, we really can't afford to try to then go and touch and overhaul medicare, which is an bigger and more popular program. >> there were some late-night votes on this issue, especially drug pricing, taken up in the senate along with a series of other votes. remind us of what happened there, and the signal that that sent to drug companies. >> there were two votes. one was to allow medicare to negotiate drug prices. that one failed on a party line vote.
so democrats voted for it, republicans voted against it. it's not something the party has historically wanted to do. the other one would have allowed prescription drugs in canada that are sold more cheaply there to be reimported to the united states. that one is a little more interesting, because it did attract -- it was mostly democrats who voted for it, but about a dozen republicans did as well. on the other side, about a dozen democrats voted against it as well as a bulk of republicans. it ultimately failed. but it suggests there could be some bipartisan interest in doing something about drug prices. maybe the -- allowing drugs to be reimported from canada is one place republicans might be willing to go. i think it was at least an indication to drug makers that this isn't a purely party line issue. and there is some willingness to work across the aisle to do something about it. >> it also gave them guidance on where they need to go to in their lobbying efforts. >> you know which lawmakers are
willing to talk or willing to look at some unconventional proposal proposals. >> ida, good morning. >> caller: good morning. thank you for taking my call. someone recently, just now, called and said about the bush, when they first discussed this discussion of medicine being -- was being paid for and not negotiated at that time. in other words, the insurance company agreed to the whole thing. because they were not going to -- they're not going to be involved with the government in pricing the prescription drugs through medicare. now, as i understand it -- and your guest responded to that, and said, yes, that's true.
that that was part of the agreement, part of the beginning of medicare's discussion of it. and then he said that the -- they didn't want to involve the -- congress didn't want to involve negotiating with the insurance company regarding medicine -- regarding prescription costs. but the veterans administration, of course, does just that. and they charge, as i understand it, less than is paid for under medicare. in other words, for veterans administration, the insurance company allows the government to negotiate with them about the price. if that's the case, why couldn't that happen in medicare? what's this business about congress not wanting to
negotiate the price? >> thanks for the question. let's let dylan scott answer. >> to your point, yes, the veterans affairs department does -- has more leeway to negotiate drug prices under current federal law. the reason why that is has a long kind of complicated history. but i think one of the things that's important to remember is oftentimes veterans can get private insurance, even if they can't get a benefit or drug through the va. so when i've talked to people about it, they pointed out the distinction. the democrats make the point you did, we did this in one program, why couldn't we do it in another. the other thing to keep in mind, i guess, is that the drug companies, and i think largely congressional republicans, would argue that the private market works. and we should just allow private plans and private drug companies to negotiate between -- amongst themselves and we don't need to get the federal government involved. >> let's see if we can get in suzanne calling from florida.
medicare re sipiest. good morning. >> caller: good morning. how are you? >> doing well. go ahead. >> caller: the reason why i'm calling is, i am almost 50, and i have chronic pain issues. i have nerve damage and also fibromyalgia, and i can't work. i just went to my doctor's office just this past week, and i saw that apparently there's some law coming into effect that they are forcing the drug companies to reduce hydrocodone by 75%. and other opioids by at least 25%. i'm really concerned, because i can barely take care of my son, who's 13, and if there are new drugs out, you know, i don't
know if that's going to be covered by medicare. i mean, what is -- i'm really very concerned. >> well, i don't know the specific law that you're referring to. i do know obviously the opioid epidemic is a huge problem that our country is trying to grapple with. lawmakers and policy makers and doctors and the whole health care system is trying to figure out how do we balance the fact that there are folks like yourself who have real pain problems and need medication in order to function. on the other hand, just acknowledging and being cognizant of the fact that these drugs are being abused. so that's not an easy balance to strike and it will be a debate we keep seeing going forward. i don't know how that gets resolved. but given the scale of the problem, 30,000 people -- excuse me, 330,000 people dying from opioid overdoses a year, and a lot of people having real pain problems, it's going to be a tough line to walk for policy makers going forward. >> if you want toea