With the Senate in a stand off over a plan for prescription drug coverage, Senator Craig Thomas (R, WY) joined the MSNBC.com to answer questions and discuss proposals for how the government should contribute to covering the cost of medicine to Americans. Senator Thomas took questions over the phone. Chat producer Will Femia moderates.
MSNBC-Will Femia: Senator, thank you very much for joining us today. I was hoping to start with an outline of the plan you support, but as both plans have been voted down, now what?
Question from Katie: What time frames are we looking at for passing any form of this bill?
Senator Craig Thomas: Well, it’s not certain, as you said. The two major amendments did not get the 60 votes which were required yesterday. So in order to get something that would pass, there has to be some changes made so some other issue can get the 60 votes. The reason you need 60 is because the cost of the proposals is more than budget from last year (we don’t have a budget for this year unfortunately) so they can raise a budget point of order.
Coming back to your question, there are two things, probably, that can happen. One is the underlying bill would shorten the drug patents is out there, I suspect it would pass. The other has been a bill that allows for reintroduction of drugs from Canada which has passed but has some restrictions on safety. Those two probably will pass.
The third thing that could happen is that there could be an accommodation between the three bills that are out there that would garner 60 votes. Whether that will happen or not, I don’t know.
Question from Molly Brown: Senator Craig Thomas, Do you truly feel qualified to speak on denying others prescriptions while you enjoy full medical coverage… paid by us?
MSNBC-Will Femia: This is kind of a cheap shot question I think, because obviously you no one set out to deny anyone coverage, but I’d like to use it to ask about why some common ground couldn’t be reached in drafting a bill. Is having nothing really better than a compromise?
Senator Craig Thomas: I suspect that is true. As is usually the case, you do have to compromise between different points of view. One of the problems here is that Senator Daschle pulled this from committee so there was not a committee bill recommended, which is the normal situation.
By the way, I don’t have any better coverage than anyone else who has a job, or anyone else who works for the federal government. So the implication that members of Congress have something special is not factual. Most people who are working do have some kind of coverage by the way. We’re talking now mostly about either people who are very, very poor or are in Medicare.
But yes, we can. The difference is how it’s done. Whether it’s part of Medicare of whether it’s done as a separate private program. How much contribution is to be made by the recipient. Should there be first dollar coverage so you always pay for something until you get to the catastrophic level. There’s lots of different ways to look at it and that’s what makes it… And then the total cost. The cost of one bill that was turned bill that was turned down was almost twice as much as the other one.
So those things have to be reconciled and quite frankly I think they probably will be.
Question from Michael Gillig: The problem I am seeing with starting a prescription drug program is, costs. Although I know a woman that can’t buy her medications due to her limited funds, the government has limited funds also, don’t we? As a kid in the candy store I want all the flavors, as a kid in a candy store with limited funds I pick only what I can afford. I question the over medication of the elderly.
Senator Craig Thomas: Well, that’s a very good question. The previous person who said some have it and some don’t and we want to give it to everyone, ought to understand that we have to pay for it also. So you’ll see the contributions either in general taxes or in Medicare payroll payments are going to have to go up, of course, to make this work.
That is part of the problem. We ought to do some selectivity. We ought to have more liberal programs for the people who are more needy than those who are more able to take care of themselves. I think that’s a difference that’s there even though Medicare is for everyone because everyone pays into it.
But there does have to be some differences. You can buy everything of every choice for everybody or else you simply can’t afford it. So we have to decide who’s going to get the greater benefits, what is going to be allowed within the benefits, and to cover the needs and at the same time do it in a program that can be supported financially because remember, all of us, as tax payers, are going to have to pay for this. It isn’t going to come from Mars somewhere.
MSNBC-Will Femia: What do you think of that last question’s last line by the way? As a nation are we too dependent on drugs?
Senator Craig Thomas: I tend to agree with that. I think when you look at the very high increase in costs of healthcare, and pharmaceuticals being one of them, it’s a combination of price and increased utilization. So I do think that because of the advertising, perhaps because of the medical practitioners, people are given and taking many more drugs than they used to. Some are needed, and some perhaps are taking more than they need to because it’s a given thing to do. So yes, I think over-utilization is one of the problems.
Question from Steve Pipenger: Why do we allow pharmaceuticals to advertise directly to consumers (this drives up the costs through marketing and forces us to pay for higher prices)? This is not a free speech issue, this is a public health issue.
Senator Craig Thomas: There’s talk about it, but what can you do? These are private businesses. I suppose some people would say, “Alright, let’s put price controls on.” And the pharmaceutical companies say, “If you do that, we will have to reduce the research we do into new and better medications.”
There’s a limit to what the government ought to do in the private sector. I think maybe people want choices and in order to have choices you have to know what the choices are. But I tend to think, personally that it’s overadvertised, but I would be reluctant to have the government describe how much of that you can do and how you do it. That’s pretty much a freedom factor.
Question from thomas nickovich: When ever the government starts providing services such as this it always seems to be rampant with corruption. The cost of goods and services goes way out of proportion. What will make this program any different? Why don’t we let the free market system take care of this its self?
MSNBC-Will Femia: I’m not sure which plan this guy is criticizing, but can you speak to the question of designing an corruption proof vs. corruption prone system and whether opening the market is a good idea?
Senator Craig Thomas: Obviously we’re sort of overtaken and overwhelmed by corruption, Enron and those kinds of thing, but the fact is that most businesses are not corrupt and I think we need to understand that.
Really that’s kind of the choice frankly between the two major proposals that were out there. One was distributed like Medicare by the government and people were paid to do it but there was no competition, it was a government program.
The other one was a contract arrangement where the private sector actually did it, and they were encouraged to try to reduce prices and save money by encouraging generics this and that. So I think you’re right.
Another factor is if the recipient has to make some kind of initial payment. Whenever you grant some service without any contribution by the recipient, then they lose interest in trying to be careful about it. So I think that’s really one of combination arguments that’s going on here is who should be the distributor in the delivery of this program. So I think we want to take a look at allowing the private sector to begin to be a partner in this distribution system.
Let me make one other thing clear: Most everyone is interested in helping those most needy people. If they can’t afford to participate in payments, fine, if they qualify. The problem is when you deal with everyone who’s eligible for Medicare, you’ve gone far beyond the needy. So there is a difference between helping those that are very needy and a general program.
MSNBC-Will Femia: Do you foresee an interim plan that just deals with the needy?
Senator Craig Thomas: We’re going to vote one one of those today. The so-called Hegel bill deals with the very needy on the bottom end, and with catastrophic spending for everyone on the top end. Frankly, I don’t believe that proposition is going to get as many votes as the others. It’s more of the discount card approach.
Question from Fred Weber: How about if the government were to buy ONLY GENERIC drugs wholesale? Pharmaceuticals don’t have a good track record proving that their latest [patented] products are any safer or more effective. Also, direct-to-consumer ad’s should be banned. Patients are [supposedly] paying their doctors for advice [about controlled substances] in the first place. It’s time to clamp down...
Senator Craig Thomas: I think you have to look at the origin of generic drugs. They are a result of somebody doing a great deal of research and having for a time a prescribed drug that then becomes generic. So you don’t have generics unless someone has done this previous investment. But I agree with the questioner that generics can be much less expensive and often do the same thing.
So if you’re buying your own, you’re likely to go more often the generic route, and that’s why choice is so important.
MSNBC-Will Femia: But you’re saying that’s not a government choice, that would be a personal choice?
Senator Craig Thomas: I think it’s a personal choice. When you get into government volume buying and so on, what you’re doing then is beginning to have government established price controls. And I think we’ve proven that in the business sector, to make good successful products, that is not a good way to do it.
MSNBC-Will Femia: Can the government do something to compensate for the loss in revenue to keep up the research incentives?
Senator Craig Thomas: Actually, the government now provides a substantial amount of research money. But still, the initiative to successfully produce a product is based on the opportunity for profit. And when you get it the other way around, just having the government have somebody do the research, then you’re back in the government run, outside the initiative type program.
Question from Pete Goulah: Did you get the sense during debate that the Democrats are really just sandbagging so that this issue is still around for them to campaign on in November (and maybe forever)?
Senator Craig Thomas: I must confess that I think there is some politics here, some consideration of the upcoming election. But that’s not the main drive. The main drive is people are interested in providing a needed service, with disagreements as to how to best do that.
But it is true that some of these things are used for political gain, no question.
Question from Lincoln Christensen: It is illusion to think that the Senior Benefit costs taxpayers for the benefits of the seniors. The money is only funneled through the seniors but gets picked at by pharmacies, taxing governments, distributors, pharmacy salespeople, insurance companies, and finally the drug company. All the senior gets is the drugs. Lets send the money directly to the drug companies, it will save time and money to support their search and advertising directly from the public coffers rather than making the poor seniors the scapegoats.
MSNBC-Will Femia: Can cost be reduced by eliminating middlemen like that?
Senator Craig Thomas: There have been efforts like that. They’ve tried to do it by putting together groups that are large enough to be able to negotiate lower prices. That is possible, and frankly I’ve been a little surprised that more senior groups haven’t put something together.
Now, what they do is the limit their choices then, of course. They also are likely to make it unavailable at the local drug store, and some of those downsides. But there’s not question that if you can put together a large group, you can negotiate with a particular producer and get a lower price, and that can be done.
Question from gberet: Why not commission the AARP to form a buyers cartel?
MSNBC-Will Femia: That’s what you’re talking about right?
Senator Craig Thomas: Basically yes. And there have been some of those group purchasing plans developed. That’s what the card approach is about.
Question from John Eubanks: Drug costs have *tripled* in recent years as I understand it. Meanwhile, Medicare rates for *actual medical services* are being cut 5.4% this year alone. Why are prescription drugs the **only** part of medical care that does
MSNBC-Will Femia: Is that true?
Senator Craig Thomas: I don’t think that’s quite true. The prices for medical services are not set by the government. The reimbursement for Medicare is set by the government but if the price is higher, either someone else pays the additional amount, or perhaps the provider won’t serve Medicare people, that’s happened.
So the 5.4 reduction was a long term part of Medicare and was based on a formula tied to GDP.
Question from jonsey: How effective are the card programs though...if you can’t afford a 100$ script, you probably can’t afford a $70 script with a 30% off card.
Senator Craig Thomas: Again, there are people who can’t afford even reduced price and those are the ones who require assistance. There is a program called Medicade. If people qualify, they get their drugs, and some seniors do qualify.
So yes, there are people who, regardless of how much you reduced it, would still be needy and there needs to be programs for them. They represent a relatively small percentage of the total however.
Question from Name: the whole focus in healthcare is backwards if Americans drove their cars 90 mph and never changed the oil or checked the brakes would anyone wonder why repair costs were so high? be brave and focus on the real issue preventative health
Senator Craig Thomas: That’s a good point, and in fact, as you know, the President has been focusing on more exercise and better health care and so on, and I think that’s an excellent idea. Obviously that is not going to fix everyone’s problems, particularly as people get much older, but there’s no question that all of us in this country need to give more thought to taking care of ourselves, getting exercise, eating properly, all those things.
Pills are never going to fix everything.
MSNBC-Will Femia: Thank you very much for joining us today Senator, can you give us some closing comments before we have to let you go?
Senator Craig Thomas: I appreciate the opportunity to respond to some of your questions. Making healthcare available for everyone, particularly the needy, is something we all want to do. I hope we can do it with a combination of assistance and doing it for ourselves and the private sector.
MSNBC-Will Femia: Thanks very much Senator for chatting.
Senator Craig Thomas: You bet, I appreciate the opportunity. See ya later.