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zoom RSS 製薬業界 医療制度改革の負担増に抵抗/米国医療事情

<<   作成日時 : 2009/12/25 20:24   >>

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画像 議会での医療制度改革論議の最終段階に入り、製薬業界は10年で800億ドル以上のコスト負担への準備を進めている。追加コストとして200億ドル以上かかる可能性を言うロビイストもいる。
 上院法案承認後、米国医師会長Cecil B. Wilsonは医師を守るためにいくつかの最終的な変更を獲得して信頼を得た。55才以上をメディケアに加入させる提案には医師への支払料金が余りにも安いことで反対するよう呼びかけた。また、メディケア支払い率削減を取り戻すために2500億ドルの法案を2月末に通すという公的な保証を得たという。しかし上院は最近、財源なしで追加の2500億円を出す法案を否決した。医師会は反発し、代わりに議会は支払い率削減を2ヶ月延期し問題を先送りした。
 医療保険産業ロビイストは、医師や製薬業界への取引について議員に不満を言っている。保険業界は外科手術を受けたが、支払いを受け取る側はほとんど逃げ出してしまっていると主張している。
 ホワイトハウスは、組合契約下で協議された契約に影響するため下院民主党が反対する“Cadillac tax”と呼ばれる高価な保険プランに対する課税に賛成している。
 下院法案は、メディケアが薬価を協議したり安価な外国製薬品を輸入したりすることを可能にすることから、製薬業界にとっては重荷となる。上院では外国製薬剤の安全性についてFDAの後ろ盾を得てかろうじて提案できた。
 こうした脅威を避けるために、メディケア薬剤の“doughnut hole”現象のギャップを埋めるための準備をしていると言う。10年間で200億ドルをカバーすると同意していた。
 オバマ政府に対して、約束を守らないなら今後交渉を拒否すると、公然と警告した。
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メディケア薬剤給付に製薬企業から今後10年で800億ドル/米国医療事情 医療制度改革
http://kurie.at.webry.info/200906/article_33.html
治療を中止するメディケア高齢者/米国医療事情
http://kurie.at.webry.info/200808/article_47.html
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Drug Industry Girds for Rise in Its Share of Overhaul
http://www.nytimes.com/2009/12/23/health/policy/23lobby.html

By DAVID D. KIRKPATRICK
Published: December 22, 2009

WASHINGTON ― Facing last-minute liberal resistance in Congress, the drug industry is bracing for an increase in its share of the cost of the proposed health care overhaul beyond the $80 billion over 10 years that it had negotiated with the White House, industry lobbyists say.

Recent developments on the struggle over health care with background, analysis, timelines and earlier events from NYTimes.com and Google.

House lawmakers and Senate liberals were furious to learn in August that to win drug makers’ political support, the White House and the Senate Finance Committee had struck the deal to cap industry costs at $80 billion. But the White House and the Senate nonetheless appeared to stick by the agreement, which drug lobbyists called “rock-solid.”

Now, after narrowly beating back some Senate proposals to extract far more and facing similar demands from House leaders, the drug makers acknowledge that they may have to renegotiate, several drug lobbyists said, speaking on the condition of anonymity because the overhaul legislation is not yet final.

As the health care bills move toward a House-Senate conference, the liberals appear poised to lose on so many other issues ― including a proposed government-run insurer, a so-called Cadillac tax on expensive health plans and an independent Medicare-cutting commission ― that the drug makers have come to accept that their deal may have to be modified, the lobbyists said.

Some industry lobbyists say the added costs could come to as much as $20 billion more.

In an interview, Ken Johnson, a spokesman for the Pharmaceutical Research and Manufacturers of America, the industry’s main trade group, acknowledged that industry lobbyists were open to renegotiation but insisted they would drive a hard bargain.

“There is still a gap that has to be closed between what the Senate is proposing and what the House passed,” he said. “I think there is a growing sense that they may need some additional help to achieve that goal, and as a result we are willing to listen.”

Underscoring the delicacy of the talks, he followed up with an e-mail message to qualify the industry’s new openness. “We’re not an A.T.M.,” he said. “There are limits to what we can do without turning our industry upside down and adversely impacting patient care in the process.”

Spokesmen for the White House, Senate leaders and the House speaker declined to comment on Tuesday. Lobbyists for all the health care industries are still working frantically to monitor and adjust the final form of the legislation, often at odds with one another.

After endorsing the Senate legislation at a news conference on Monday with the Democratic leader, Harry Reid of Nevada, Dr. Cecil B. Wilson, the president-elect of the American Medical Association, took credit for securing several last-minute changes in the bill to protect doctors from various payment cuts or fees. Among other things, Dr. Wilson said, the A.M.A. had enlisted its network of physicians around the country to protest the short-lived proposal to let people over 55 buy into Medicare, which pays fees the A.M.A. considers too low.

What’s more, Dr. Wilson said, he had received public “assurances” from Senate leaders that by the end of February, the chamber would pass a $250 billion bill to undo currently mandated cuts in Medicare payment rates. Congress has regularly passed short-term changes to put off the pay cuts, and the medical association has pushed for a permanent fix as a tacit condition of its support for the health care overhaul.

The Senate recently defeated a measure to do just that, with many Democrats balking at adding $250 billion with no plans to pay for it. But Dr. Wilson says the A.M.A. is still holding out for such a permanent fix; at the organization’s request, Mr. Reid removed another temporary deferral from the health care bill. Instead, House and Senate leaders inserted a two-month extension of current pay rates into a military spending bill headed for the president’s desk, giving Congress two months to somehow resolve the matter.

“Something has to be done between January and March 1 or else the cuts will go through, so that is the window of opportunity for the House and the Senate and the White House,” Dr. Wilson said.

“We have had assurances in public from Reid and Baucus,” he added, referring to Senator Max Baucus, Democrat of Montana, chairman of the Senate Finance Committee, “and the White House is also indicating it is important to them.”

Lobbyists for the health insurance industry, meanwhile, are complaining to lawmakers that the administration’s deals for the political support of the doctors, drug makers and other care providers have precluded meaningful cost cuts. As a result, they argue, health insurers have come under the regulatory knife while the providers they pay have largely escaped.

“They pretty much left the rest of the system, which is responsible for pricing medical services, alone,” argued Karen M. Ignagni, the chief executive of America’s Health Insurance Plans, “and therein lies a major problem down the road in terms of whether health care will be affordable.”

The insurers are focused on stripping out measures that would cap the amount of revenue insurers could spend on their administrative costs and profits ― 20 percent in the Senate bill and 15 percent in the House bill. Ms. Ignagni argued the caps were “unprecedented regulation” that would limit insurers’ ability to coordinate care.

On the two other issues of biggest concern to health care lobbyists, the White House has already spoken in favor of the more cost-conscious Senate bill and against the preferences of most House liberals. The White House has said it favors the proposed “Cadillac tax” on expensive insurance plans, which many House Democrats opposed because it could affect some health plans negotiated under union contracts (and the insurance industry opposes for its own obvious reasons.)

And the White House has also said it supports the Senate bill’s creation of an independent Medicare commission that could impose cuts on the program. Many health care providers oppose the commission as a threat to their fees, and many House Democrats oppose it as an intrusion on their power

The House bill would also impose several burdens on the drug makers that are anathema to the industry, including allowing Medicare to negotiate drug prices and allowing cheaper drug imports from abroad. Senate leaders narrowly beat back similar proposals, partly with the help of a Food and Drug Administration letter raising safety concerns about imported drugs.

To avoid those threats, industry lobbyists said, drug makers were preparing to absorb more of the costs of closing the “doughnut hole”― a gap in Medicare drug coverage that can mean beneficiaries pay thousands of dollars for drugs each year. The industry had previously agreed to provide discounted drugs to help fill the gap but may now cover as much as $20 billion more over 10 years, the lobbyists said.

It is a stark shift from August when Billy Tauzin, the former Republican congressman from Louisiana who leads the industry’s trade group, insisted the $80 billion cap was inviolable, a “rock-solid deal.”

Back then, he publicly warned the Obama administration, “Who is ever going to go into a deal with the White House again if they don’t keep their word?”

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製薬業界 医療制度改革の負担増に抵抗/米国医療事情 ・・医師の一分さん
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2009/12/26 16:17

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