Category: Health Care

Posted on

M Perez And CMR

Dear Group,

Megan Perez is leaving McMorris Rodgers’ staff, according to her LinkedIn page, Most of you have probably never heard of Ms. Perez, but I find her story most interesting. Ms. Perez has served McMorris Rodgers as her “Legislative Director” for a year and eight months and as “Policy Advisor” for the ten months prior. As Legislative Director Ms. Perez annualized salary was $94,000 (see page 1370). Her LinkedIn page is worth visiting. Ms. Perez lays claim to a pivotal roll in legislation with which we are familiar, for example, the ABLE Act and the Steve Gleason Act, as well as work to “analyze and provide guidance on legislative policy on healthcare.” It is probably fair to assume Ms. Perez contributed to the last minute insertion into the Omnibus Appropriations (Spending) Bill a nice perk for the Omeros Corporation. I wonder if she is also responsible for McMorris Rodgers, framing the Omeros perk as ensuring access to “safe, innovative, and life-changing drug[s]?” The sole purpose at least of the Omeros drug in question, Omidria, is to dilate the pupil in cataract surgery, (For more detail check out my post from March 27, 2018.)

Ms. Perez is leaving McMorris Rodgers to join the Petrizzo Group. Never heard of it? Neither had I, but through the wonders of the internet you can visit its public face with just a click. I encourage you to visit and read what they offer…and to whom they offer it.  The website mentions no partisan lean, only that they “…excel at complicated, high-stakes endeavors that blend skilled thinking, sophisticated strategy and precise execution.” Among the notable accomplishments they cite is “engaging influential policymakers on national healthcare issues.” They appear to me as the perfect example of a firm that makes its money by lobbying. Photos of the U.S. Capitol and Lincoln’s statue in the Lincoln Memorial are featured on the website. (Is Lincoln’s image borrowed as code for a Party whose major fundraising event is a “Lincoln Day” dinner?)

I pursued Ms. Perez’ imminent migration to the Patrizzo Group from McMorris Rodgers’ office while wondering if Ms. Perez were leaving what she may perceive as McMorris Rodgers’ sinking ship. Was she bailing out to the safety of a lobbyist position, part of the infamous D.C. “revolving door” between lawmaker’s offices and the lobbyists who are paid to influence them? While visiting the Petrizzo Group website, I clicked “Our Clients.” There I found eleven corporate insignia from the familiar (Starbucks), to the obscure (BSquare). But right there in the middle was Omeros, one of the companies for which McMorris Rodgers inserted a nice little perk paying out a total $26 million dollars over ten years, according to the Congressional Budget Office. Even better, some investors must have gotten advance word, since the stock price of Omeros jumped 45% over the Wednesday night before the Omnibus Spending Bill finally passed on Friday.

On Good Friday at Centerplace in Spokane Valley McMorris Rodgers was specifically asked about the newspaper reports on the Omeros perk. For an instant she appeared flustered…and immediately reverted to message, defending her insertion to the bill as necessary “to provide patients across the country access to safe, innovative, life-changing drugs.” Omidria, a $400 per dose drug for dilating the pupil, fits none of those adjectives. Either McMorris Rodgers did not do her homework to understand the drugs for which she was putting forward this exception to Medicare rules or she did understand them and assumed the voters would be mollified by her messaging. In either case she failed us and she seems unwilling to live up to that failure. Even if we believed health care in this country were really a free market (it isn’t), how can she justify legislating a specific exception to Medicare rules for the benefit of a select few drug companies?

There is a pattern here. McMorris Rodgers and her Republican colleagues want to rein in the costs of “entitlement” programs, i.e. Social Security, Medicare, Medicaid, and the Affordable Care Act. She votes for a Balanced Budget Amendment to the Constitution. It is just too expensive, too much of a strain on the federal budget to continue, she says…and then she legislates special expenditures out of those same tax coffers for a handful of drug companies.

She is either appeasing a Republican donor or she is in over her head. Either way, she is not representing my best interests or the interests of eastern Washington.

Keep to the high ground,
Jerry

P.S. The Petrizzo Group is not on K Street, the infamous location of so many lobbying firms. If proximity is any measure of wealth and influence take note: the Petrizzo Group is located at an easy ten minute walk from the U.S. Capitol. K Street is twice as far away.

P.P.S. Ms. Perez LinkedIn resume shows she has worked for U.S. Representatives since she graduated from the University of South Florida with a B.A. in Political Science in 2011. While still in college she served as an intern with Rep. Bill Young of south Florida, at time the longest-serving Republican member of Congress. It is probably fair to guess Ms. Perez will be amply rewarded in her new position with the Petrizzo Group. Not bad for someone apparently in her late twenties with an undergraduate degree in Political Science.

Posted on

Empowerment or Entitlement?

Dear Group,

On Good Friday I attended the last of McMorris Rodgers’ hastily assembled “Conversations with Cathy.” She arrived with a considerable security detail leading her to the front of the fifty or so people assembled. Her opening remarks made reference to a proud accomplishment, the Steve Gleason Act. She detailed eye tracking devices enabling patients suffering from advanced ALS to communicate. I had heard the story from her before. Why is this story a feature of her every appearance?

Part of the answer to that question is this. Although McMorris Rodgers often lets the words “reach across the aisle” roll off her lips, the Gleason Act is one of only a handful of efforts on her part to actually reach…and, as you will see, even this effort carries a whiff of partisan messaging.

Steve Gleason is familiar to anyone who pays attention to football. He graduated from Gonzaga Prep and WSU; his parents still live in eastern Washington. He went on from local football fame to a career with the New Orleans Saints. There he turned the tide with an outstanding play one afternoon in 2006 just as New Orleans was staggering to its feet after Hurricane Katrina. Then tragedy struck him. Steve was diagnosed with amyotrophic lateral sclerosis (ALS), a horrific disease that finally leaves its victims with little or no voluntary movement except the ability to move their eyes. Steve at the time was only thirty-three, a man recently married and trying to start a family, a football hero with considerable resources. Instead of giving in to despair, he and his family used Steve’s fame, resources, and contacts to become tireless advocates for those suffering from ALS and other neuromuscular diseases.

When Medicare balked at paying for relatively new and expensive technology that allows patients to produce robotic speech by translating their eye movements, Mr. Gleason, his family, his non-profit, and the considerable network of followers pursued a legislative mandate for covering the technology. They enlisted Senator David Vitter (R-LA) and, through Steve’s family in eastern Washington, Cathy McMorris Rodgers to file bills in the Senate and the House. They lobbied. They organized a machine-voice calling campaign to Congresspeople called Robocalls from Humans. They invested themselves, time, and money in the effort petitioning Congress to act to grant money through Medicare to cover the technology.

With all that effort, the Steve Gleason Act passed both Senate and the House in 2015 (unanimously in the House–they did their homework) and was signed by President Obama. The original 2015 Act provided two year funding. In early February this year McMorris Rodgers was able to slip the Steve Gleason Enduring Voices Act as a rider into one of the last-minute, must-pass Continuing Resolutions and secure funding for the devices through Medicare in perpetuity. It is great story of persistence and bi-partisanship benefiting a group with a horrible disease.

A few years ago I would have ended this story here. After all, it’s a story of persistence. Society and government mustered up to do what’s right by a small group of people affected by hideous diseases. We’re all in this together, right?

Then I read this quote out of the Times Picayune:

“I believe our nation has the infrastructure and funds to provide technology for people who truly have no other voice,” Gleason said. “This is not an entitlement bill, it’s an empowerment bill, for people who want to be productive citizens.” [bold is mine]

What is he trying to say? Mr. Gleason is framing his eponymous bi-partisan law for a conservative audience, an audience for whom the meaning of entitlement is money you receive from the government but do not deserve. Apparently, Mr Gleason is sensitive to the idea that payments of money from Medicare to technology companies for eye-tracking devices for ALS patients might be looked upon as an entitlement. He is anxious to reframe his bill as: “empowerment…for people who want to be productive citizens.” Is there a subtext here suggesting that recipients of Medicare Disability or other government assistance are people who don’t want to be productive?

When the Affordable Care Act was phasing in, people who had lacked health insurance kept showing up in my office at the Spokane Eye Clinic with advanced diabetic eye disease, people with chronic diabetes who before the ACA had to choose between feeding their families and seeking care for their disease. I was able to help a good number of them. As a result many could see well enough to remain employed, feed their families…to “be productive citizens.” Mr. Gleason’s tremendous efforts aside, is the average patient with ALS likely to be more “productive” than a cared-for diabetic who is empowered to remain in the workforce? Mr. Gleason’s statement carries an implied judgement that should make us squirm.

The public face of my patients was not the face of a young sports icon with a family and a painfully visible wasting disease, a young sports icon prepared to frame the money spent on speech technology as empowerment. No, before the ACA my patients suffered quietly with their diabetes as it slowly robbed them of their sight and ability to work. Visual disability that degrades the ability to work is not easily depicted like the withering musculature and deteriorating voice of the young ALS patient, but what is more empowering than the restoration of sight?

Yet, in the same Good Friday “Conversation with Cathy” McMorris Rodgers apparently saw no irony in presenting the Repeal of the Individual Mandate of the Affordable Care Act as one of her proudest achievements. It is a theme she also sang in a Breitbart interview. How does she survive the cognitive dissonance of assuring the funding in perpetuity for ALS patients, while chipping away at the health insurance on which millions depend to remain productive, to remain empowered?

She seems able to focus on individual plight, like that of her son Cole or a Steve Gleason, while unable to grasp the plight of the larger citizenry. It is a failing she shares with her Party, and certainly with her President.

I want a Congresswoman with the ability to generalize, to see the bigger picture. It is time for a change.

Keep to the high ground,
Jerry

Posted on

A Nice Business Perk With Your Omnibus Spending Bill, Sir?

Dear Group,

The chart above is a screen shot taken of the stock price of Omeros, a small bio-pharmaceutical company based in Washington State. Last week overnight between Wednesday and Thursday its stock price jumped from 11.56 to 16.78 dollars per share, an increase of 45 percent. Wouldn’t you have liked to already own that stock on Wednesday (and maybe sold some of it on Thursday)?

I guess this is the way the real money is made in the stock market. Institutional investors trading overnight had gotten wind of something about Omeros. When the markets opened to the little guy on Thursday morning the price had already popped. What happened?

This is where Cathy McMorris Rodgers and Paul Ryan come in. If you’re pressed for time go to FoxBusiness for the source article, but if you want the expanded version read on. (Versions of this article  also appeared Sunday in the Spokesman and the Sandpoint Daily Bee.) First, some background:

The story of Omeros’ overnight stock bump is the story of Omidria, the company’s main cash cow drug. Omidria is a combination drug (see details in the P.S. below) used only in eye surgery, specifically cataract surgery. The surgeon injects the drug into the front of the eye to dilate the pupil and reduce inflammation and discomfort. Omidria comes in a single use vial. The company priced the drug at nearly $500 per vial. For two years, as is the custom (since Medicare is forbidden to negotiate drug prices with drug companies) Omeros was paid by Medicare as a “pass-through,” i.e. Medicare paid the cost of the drug to Omeros. Without a “pass-through” exception like this one for Omidria, Medicare ordinarily says to the surgery center: “Here, you have this amount of money to do this surgery, everything included, you pick what you use.” That’s what Medicare usually does. So for two years cataract surgeons got to try out Omidria without thinking about the cost of the drug, i.e. the cost didn’t come out of their pockets, their patients pockets or the pocket of the surgery center in which they operated. Instead it came out of our pockets, from dwindling tax revenues. (For perspective Medicare’s “allowed” global fee amount to a hospital for a cataract surgery is $1,921.09.  For an ASC, it is $978.21. That’s before geographic adjustments. It does NOT include the surgeon’s “allowed” fee. Now consider the “passed through” price of Omidria is $500. That’s half again the outpatient surgery center’s global allowable. Drugs pricing is absurd.)

The idea is supposed to be the surgeon will learn in which patient’s eyes the drug is and isn’t useful, consider the cost of the drug, and balance the two in deciding what to use. The drug company bets that enough surgeons will believe the drug offers an advantage also hopes they will incorporate the drug into every cataract surgery while the price of the drug is not an issue. Omera tries hard to insure that use of Omidria becomes the “standard of care.” Then when Medicare drops the “pass-through” payment there will be a lot of whining about not being able to afford to use this wonder drug.

We’re all supposed to forget that the company Omeros got to name the almost $500 price tag at the beginning of all this, and we’re supposed to forget that Omeros is a publicly traded company with a stock price and a lot of money spent on marketing and lobbying. (So far they haven’t offered a penny of dividends.)

After two years we are also supposed to forget older, much cheaper drugs work just fine for the vast majority of cataract surgeries for dilating the pupil and suppressing inflammation.

Take note there is no free market for this drug. The original price is established by the company. Medicare is forbidden to negotiate the price. No patient gets to shop around even if they were knowledgable enough to do so effectively, and until the “pass-through” goes away, neither the surgeon nor the surgery center sees the cost or feels the pinch of the cost. Essentially, the system allows drug companies like Omeros to offer a “free” trial period in which to hook their surgeon customers, all on the taxpayers dime.

Omeros’ “pass-through” payment expired the end of 2017. Its stock price slumped from $20 to near $10 over a couple months where we find it in the above graph last Wednesday evening. What’s a CEO to do? Apparently, he or she goes to their “pro-business” Congresspeople to get a “rider” on a “must pass” bill like the Appropriations bill Trump signed last Friday. If a Congressperson is clever it is pretty easy to tuck away a provision to help out a campaign contributor in one page of text in a 2,232 page bill. Surely no one will notice. Hell, nobody will even bother to read all those pages, will they?

Actually, they will read it. FoxBusiness published an article entitled “Benefits of lobbying evident for small drugmaker” on March 24 from the Associated Press. Particularly considering the conservative source, it is well worth your time to read. McMorris Rodgers portrait is found at the top of the article.

According to the article McMorris Rodgers and Paul Ryan slipped this into the “must pass” bill at the last minute. You can read the pertinent section of the law here. It’s on page 1949 and it’s entitled “TITLE XIII—REVISIONS TO PASS THROUGH PERIOD AND PAYMENT RULES.” To be fair, both Parties have a history of slipping little zingers into “must pass” bills, zingers that couldn’t possibly get enough of attention of Congressional leadership to bring up, discuss, and actually have a separate vote.

  • Omeros spent just over $1 million on lobbying in 2017, up from $645,000 a year earlier as the company brought aboard two new firms to make its case to Congress and the Trump administration, according to lobbying disclosure records filed with the House and Senate.
  • The political money website Open Secrets shows that Omeros CEO Demopulos donated $39,600 in the 2018 election cycle to the National Republican Congressional Committee, the campaign arm of House Republicans. [some of which money will no doubt flow back to our district to defend CMR and smear Lisa Brown]
  • Federal Election Commission records show that Demopulos also donated $5,400 directly to Speaker Ryan’s campaign on Aug. 31, 2017. [That’s the maximum legal direct-to-the-candidate donation.] Demopulos gave $5,000 to Ryan’s political action committee, Prosperity Action Inc., on the same day.

McMorris Rodgers defense from the FoxBusiness article:

  • Nate Hodson, a spokesman for McMorris Rodgers, said she pushed the measure ‘to provide patients across the country access to safe, innovative, life-changing drugs.’ 

Perhaps her heart IS is the right place on this, but even if it is, this rider of hers and Ryan’s doesn’t smell right considering the circumstances. There is NOTHING about the lauded “free market” in this rider. It IS “pro-business,” though, a specific few businesses graced with $26 million of our tax money over ten years.

From another source, The Northwest Arkansas Democrat Gazette. (Rated “Center Right” by mediabiasfactcheck.com) [Bold is mine.]:

  • This provision is the correct policy, was approved by both Republicans and Democrats involved in writing the bill, and was included at the request of members of our conference,” said Ryan spokesman AshLee Strong. “To suggest any other reason is not only false but absurd and insulting.

Sorry, Mr. Paul Ryan, it may be insulting, and properly so, but it is NOT absurd.

This in a time when the public is fed up with drug prices… You choose for Ryan and McMorris Rodgers. Are they hapless victims of their own good intentions or are they trying to pull a fast one to satisfy a campaign contributor? I don’t see another option and I like neither of the alternatives.

Keep to the high ground,

Jerry

P.S. Omidria is a combination of two drugs, phenylephrine 1% and ketorolac 0.3% . Phenylephrine has been around many, many decades, ketorolac more than a decade. To be sure, injecting these drugs into the eye is a new use. Getting that approved by the FDA no doubt required expensive testing to prove safety and efficacy, but these are NOT new drugs.

Posted on

The Myth of the Free Market in Health Care

Dear Group,

Nationally we stagger, punch-drunk from issue to issue, taxes, DACA, tariffs, MeToo. The list goes on. We need to come back to this: Cathy McMorris Rodgers and “movement conservative” ideology is plain wrong and out of touch on many things, but nowhere are they more wrong than in the application of their ideology to health care in this country. On February 21 I sent out the email I’ve copied below.  I present it again today to remind us how unpopular McMorris Rodgers’ efforts to repeal the Affordable Care Act were and still should be. This issue should be front and center on our way to November.

CMR’s Ideology and the Myth of Free Market Health Care

Here in these United States we spend more than $10,000 per year on health care on average for every man, woman and child. Canada and the United Kingdom each spend per capita less than half that per person. In spite of spending less than half as much per person than we do, health outcomes in Canada and the United Kingdom are better than ours. Yes, in Canada you might have to wait, but in Canada people with diabetes have access to treatment. They don’t have to make a choice between getting treatment and feeding their families. They don’t have to neglect their disease for fear of bankruptcy, go blind, and wind up on the Canadian equivalent of Social Security Disability.

While Cathy McMorris Rodgers remains in office this WILL NOT CHANGE. Why is that? It is because McMorris Rodgers has drunk the Republican/Libertarian Kool-Aid. Contained in that Kool-Aid is the absolute conviction that the free market solves all problems and that all government social programs are inefficient and foster dependence.

Facts that don’t fit her mind frame of Libertarian ideology bounce off–if they reach her at all. At a “Coffee With Cathy” in April of 2017 I brought up the Canadian experience. Her response was pure Republican/Libertarian framing: She asserted that Canadians come down to the United States in droves to get procedures done in the United States on account of endless waits and rationing.

Spokane is a major medical center close to the Canadian border. I told Ms. McMorris Rodgers I practiced for 28 years doing ocular surgery, quite a lot of it urgent and emergent. I told her that in those 28 years I operated on just one Canadian patient. I told her that I have many Canadian friends, and that all of them speak well of the Canadian health system. There was a brief blank stare in response, a tiny gap before she pivoted to another angle. Was that the moment my reality bounced off her frame? I’ll never know. 

Did McMorris Rodgers carry this inconvenient fact with her as a result of our meeting? No. On May 4, 2017, she enthusiastically voted for and cheerled the American Health Care Act, the AHCA, aka Trumpcare. There was nothing in that bill that was aimed at reducing the per capita cost of health care or even a glimmer of recognition that other countries have great health care systems that cost half of what we spend. Instead, the AHCA would have moved us further away from national systems.

The Republican House AHCA…proposed major reforms relative to current law (ACA) that would substantially reduce the number of persons covered, moderately lower the budget deficit over a decade, reverse the tax increases on the top 5% (mainly the top 1%), dramatically cut Medicaid payments (25-35%) that benefit lower-income persons, and expand choice by allowing lower quality insurance to be purchased at lower prices for the young and middle-aged.  Wikipedia

Notice the earmarks of Libertarian ideology. McMorris Rodger’s AHCA cut taxes on the rich (a basic tenet of her faith), lowered total government expenditures over a decade (which she later enthusiastically gave to corporations and the already wealthy by voting for and cheerleading the Tax Scam Law), and cut money out of a social program, Medicaid (another of her fundamental tenets of faith). Would it lower the per capita cost of health care? NO! It pretended to lower cost by expanding “choice” (a fundamental talking point), in this case, the “choice” was to buy inadequate insurance and expose oneself to medical bankruptcy. 

Oh, yes, there is one McMorris Rodgers talking point about lowering the actual cost of care. What is it? “Encouraging competition by increasing transparency.” Really? The patient is going to lower the per capita cost of health care in the system by shopping around for the cheapest lab test or MRI? That isn’t just unrealistic, it is absurd. A very few patients equipped to critically evaluate quality and willing to spend the time might bargain for the best deal in this market, but that is a tiny minority. You won’t find Trump or Charles Koch bargaining for a cut rate MRI. They’ll hire the best physician they can find to get the best MRI…and damn the cost. The folks with the least time (working two minimum wage jobs) and in the most dire circumstances (presenting with a neglected and now acute problem) certainly are NOT going to “shop around”. What make-believe planet do these free market true believers live on?

McMorris Rodgers’ slavish devotion to free market ideology blinds her to reality. The unfettered, unregulated free market is the bedrock tenet of the “Republican cause,” the cause for which she hones the sales pitch. Health care in this country is ridiculously expensive because it is not and never will be a “free” market. No amount of pontification by Paul Ryan, McMorris Rodgers and the Freedom Caucus will make it so. Pretending that free market principles will lower cost in a for-profit environment is a delusion from which McMorris Rodgers is incapable of recovering. 

Our country’s problem with health care cost will not be solved while McMorris Rodgers is in office. Her ideological frame prevents her from understanding. Send her home.

Keep to the high ground,

Jerry