Sometimes it’s black and white and sometimes it really isn’t. Increasingly in online journalism, there are no subtleties, just politicians who deserve sainthood and those who deserve to be pilloried in the public square. Until the day that we activists are perfect, perhaps black and white distinctions miss some critical nuances.Today’s blog highlights a case in point.
Before we dive in to Sen. Heinrich’s Canadian Pharma vote, a few important notices:
What You Can Do to Save ACA: For those worried about ACA coverage for themselves and their families, Senator Elizabeth Warren’s office said they are being flooded with calls, as are the offices of Speakers Ryan and McConnell. Senator Warren’s staff said what will help the most is to call the five Republican senators who have broken away from the GOP to demand a slow down of the repeal and thank them for their efforts. Click here for contact information, speaking points, and links to more information.
Chaco Canyon Action Today. Click here for time, location and reason you need to be there.
Women’s March, Jan 21, 11-2pm. Click here for details on the Santa Fe march and here for details on the ABQ march. In Santa Fe, we still need volunteers to mill in the crowd with sign-up sheets for Retake and to staff tables in the Rotunda. How about some men signing up so the women can be part of the march and rally? Just reply to this blog or comment below.
Clemency Deadline Fast Approaching. President Obama has moments of remarkable moral clarity. And then there is Guantanamo still open, millions of immigrants deported, and Leonard Peltier, Chelsea Manning, Marcus Garvey, Edward Snowden and Oscar Lopez Rivera. Click here for a Nation article on these five that includes specific contact information and speaking points for making your voices heard. Less than a week to go for Obama to do the right thing. Trump sure won’t.
Time Running Out to Get ID’s. Equality New Mexico (eqnm.org) is urging transgender New Mexican to update their identity documents prior to the Jan. 20 inauguration, including U.S. Passport, Driver’s License, and legal Name Change. Go to http://www.transequality.org/documents/state/new-mexico for resources and documents to begin the process online. For assistance, contact the Transgender Resource Center of New Mexico (tgrcnm.org) at 505-200-9086.
Santa Fe City Council Sanctuary City Deliberations. Click here for information on the schedule of city council meetings and what you can to to support our immigrants and our partner, Somos Un Pueblo Unido. Wed. Jan 25, 5pm. Put this in your calendar. This is our local opportunity to Retake our Democracy and to support our immigrant neighbors. Let’s show up in force.
Lastly, click here to see the schedule of Action Team Meetings coming, click here to find out about how you can play a leadership role in Retake Our Democracy. Got 5-10 hours a week to save our country, our planet, and our kids’ futures? I hope so.
Martin Heinrich: Pillory or Praise
First the obvious: Martin Heinrich voted against a bill supported by the vast majority of progressive Democrats. Okay, Cory Booker also voted against the bill. This is pretty black and white. They voted nay and if 3 of the thirteen other Democrats who also voted nay had voted aye, it would have passed. The bill would have allowed Americans to order prescription drugs from other countries, most importantly Canada, where drugs tend to be cheaper. This post examines the position asserted by Sanders and others to allow reimportation of prescription drugs without FDA regulation as well as concerns raised by the FDA, the pharmaceutical industry related to the absence of regulation and possible safety concerns. And finally, this post considers the influence of self-interested lobbyists who pour funding into the campaign coffers of those who must then vote on an issue that is not as black and white as it appears at first blush.
Pricing and Pharmaceutical Costs. First, from Bernie Sanders’ press release some information on pricing:
“EpiPen, for example, costs more than $600 in the United States compared to $290 in Canada for the exact same allergy treatment. A popular drug for high cholesterol, Crestor, costs $730 in the U.S. but $160 across the northern border. Abilify, a drug to treat depression, is more than $2,636 for a 90-day supply in the U.S. but only $436 in Canada.” . For the complete Left Gear article from which this quote is taken, click here.
The price differences cited in the Sanders press release are not insignificant. They could make a big difference for millions of Americans,. .I decided to dig a bit deeper as the sample size is pretty small. The data in the table at right comes from the International Federation of Health Plans (IFHP) 2013 Comparative Price Report,
I went deeper, recalling that in my conversation with Sen Heinrich’s aide Joe Britton, he quoted the FDA as asserting only a 1% difference in pricing. And indeed, according to an FDA report, many US generic drugs are cheaper here than they are in Canada, and of the seven generic drugs introduced between 1993-2002, six were cheaper in the US. The report states that “These studies ignore how competition in the U.S. market lowers generic drug prices so they are lower than drug prices abroad, say FDA economists.” For the full FDA report, click here.
But while pointing to the possible lower costs of generic drugs produced in the US, the FDA report was published in 2002 and US pharmaceutical costs have increased significantly since then. And as this report from the Campaign for Sustainable Rx Pricing reveals, prices have escalated very significantly since 2003:
Today, prescription drug expenditures are nearly 20 percent of health care costs.
Prescription spending is growing faster than any other part of the health care dollar.
American spending on prescription drugs increased 13.1 percent in 2014—the largest annual increase since 2003. This uptick was largely driven by an unprecedented 30.9 percent increase in spending on specialty medications. In 2015, spending rose another 12.2 percent.
Specialty drug pricing alone is far outpacing the Consumer Price Index and specialty drugs are expected to increase to 44 percent of overall drug spending by 2017.
Spending on 10 breakthrough drugs alone will cost just three government programs nearly $50 billion over a decade.
According to a recent AARP report, the annual retail cost of widely-used specialty prescription drug therapies in 2013 averaged $53,384 annually. This is more than the median US household income ($52,250) for the same time period, twice as much as the median income for Medicare beneficiaries ($23,500), and almost three and a half times higher than the average Social Security retirement benefit ($15,526).
Spending on specialty medicines (drugs that require special handling, administration, or monitoring) increased by $54 billion over the past five years, accounting for 73 percent of all medicine spending growth.
Prices are rising on some common drugs, too. Four of the top 10 prescription drugs in the United States have increased in price by more than 100 percent since 2011.
Safety Issues. The FDA report above also cites concerns about safety and integrity of drugs purchased on the internet. “While some foreign drug manufacturers submit their products to FDA for approval, the imported drugs arriving through the mail, through private express couriers, or by passengers arriving at ports of entry are often unapproved drugs that may not be subject to any reliable regulatory oversight. FDA cannot assure the safety of drugs purchased from such sources.” This was a point that Heinrich’s aides made repeatedly in our conversation, asserting that for the FDA to expand regularity oversight to cover newly imported prescription drugs, the cost would be approximately $2 billion. A second and reasonably balanced FDA report outlines the benefits and the risks involved in importing drugs from Canada, from other countries and through the internet. The report includes reference to a group of seniors in Maine who in one trip to Canada to purchase prescription drugs, the group saved over $19,000 on drugs that were essentially the same as those available in the US. But the report also identifies the risks from importing prescription drugs and risks vary according to source with internet sales being almost entirely unregulated as companies professing to be ‘Canadian’ can have no connection with Canada whatsoever. But Canadian regulated drugs sold in Canadian pharmacies appear to be as safe as drugs approved by the FDA. Quoting from the FDA report: “Manufacturing facilities that make drugs for Canadians have been approved and registered by Health Canada’s Health Products and Food Branch, the federal agency responsible for regulating drugs sold in Canada. This agency is responsible for approving the product labeling, which must be made available in Canada’s two official languages, English and French.Given the rigor of obtaining prescription drugs from Canada appears to be as safe as doing so in the US,”
The Influence of Self-Interested Lobbying Groups. So it seems clear that Americans stand to save a significant amount of money if they were able to fill their prescriptions in Canada and with little safety risk. However, it also appears that other forms or reimportation can pose risks in terms of the integrity and safety of the drugs imported, especially when obtaining drugs through the internet. Wouldn’t it be nice, if we absolutely knew that votes on this bill were cast on the relative merits of the case. It is possible to find a plausible argument for opposing this amendment on safety concerns, as asserted by Heinrich and Booker. But how much of the safety argument is genuine, after all the safety argument has been adopted by the pharmaceutical industry’s lobbying arm, The Pharmaceutical Research and Manufacturers of America, which has claimed that “foreign governments will not ensure that prescription drugs entering the U.S. from abroad are safe and effective,” as The Intercept reported Thursday. But the pharmaceutical lobby is hardly unbiased in this issue and it is hard to take seriously their safety concerns when these are raised by representatives of an industry making huge profits as a result of their virtual monopoly on the US market.
The Influence of Campaign Contributions. Heinrich and Booker voted against this. Why? Well, a slew of Internet sources point in one direction (the influence of money) and the chart at right tends to substantiate those claims. As you can see, Democrats voting “no” on the amendment received over double the level of donations from pharma that those voting yes received. The differences are even more stark when examining GOP Senators. It seems black and white: a bad vote on the part of Booker, Heinrich, and eleven other Democrats.
The Larger Picture. But the LeftGear article cited above was headlined: Pharma 13. Never Forget Who They Are. So I decided to go a bit deeper and examine Booker and Heinrich’s overall rating by progressive organizations who create ‘report cards’ on members of Congress based upon voting records. What I found was quite interesting:
- On Progressive Tilt, Booker scored a lifetime rating of 97.99 and an A, while Heinrich scored an 85.21 and a B.
- On the Gov.Trac score, Booker received a .22 rating and Heinrich a .24 rating, both being ranked more liberal than MN Amy Klobuchar, the co-sponsor of the amendment that Booker and Heinrich voted against; and
- The most comprehensive rating system I could find, The Voter’s Self-Defense System, Heinrich scored: 100% on abortion, 88-100% on animal rights, 92-100% on civil liberties, 83-100% on environment, and 85-100% on health, with perfect 100s from the American Public Health Association, American Nurses Association, and SEIU for insurance coverage positions. Booker’s scores were this high or better. These are not the ratings of Senators who have not been on our side a vast majority of the time. Click here for the full Voters Self-Defense System report on Heinrich.
In conclusion..So where does that leave us: Heinrich (and Booker) accepted significant donations from pharma, Booker over $400,000, Heinrich about $150,000, and then both voted against something that leaves you and I scratching our heads. While there are arguments about safety and lack of regulation, I am not sure these concerns should outweigh the very real health and financial benefits possible from allowing reimportation from Canada. But the bill did not just approve reimportation from just Canada and I do have concerns about opening the flood door to reimportation from other sources. My conclusion is three-fold. This example reinforces the critical need to get money out of politics entirely, good members of Congress can vote badly on individual issues and some issues are portrayed in the media as very black and while, when in reality they be a murky shade of grey..
We can’t climb into Senator Heinrich’s head and know if that $150,000 influenced his vote at all. It doesn’t look good. But at the end of the day, Martin Heinrich has sided with us far more often than not. And while I am not entirely sure I buy the safety argument, I also feel very comfortable with Martin Heinrich being my representative in the US Senate, and feel we need to be more balanced in assessing the integrity of our representatives. One vote does not a career make. It is a dirty scene in DC and the only way to really ‘drain that swamp’ is to eliminate all money in politics and significantly curb the influence of lobbyists.
Paul & Roxanne