State of the Union or State of the Campaign?

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I sat through the State of the Union (SOTU) speech, and it raised many more questions for me than answers. I remember back when this speech was a chance for the President to offer solutions to the country’s problems and would use the platform to bring both sides together around those solutions. The SOTU has slowly morphed into a raucous, reaction-baiting contest, and this time it turned into full-out campaign speech.

Now I realize that this election season is different than any other. The questions about President Biden’s viability to serve another 4 years has been on the forefront of everyone’s mind. As one pundit pointed out, this was a true “health and wellness check” for the President. But showing his vitality wasn’t enough. He turned this into a campaign speech and the Republicans played along. I think I can safely say that this was a SOTU like no other. I had hopes that the Republican rebuttal would focus on issues but that was not to be.

Historically it has been my job to analyze the healthcare issues that the President outlines and discuss the possible impact of each of them on seniors and the chance that they will become laws, regulations, or executive orders. This was difficult this time because any talk toward substantive issues was few and far between. Even so, what was said and not said is important and deserve our attention.

First, the President touted the Inflation Reduction Act (IRA) and, surprisingly, talked quite a bit about the Affordable Care Act (ACA or Obamacare). He talked about reproductive rights since it will be a big discussion point in the election. Another surprise was what he didn’t talk about, the opioid epidemic, pandemic preparedness, mental health, or the Cancer moonshot initiative. It certainly would have been valuable to hear where these important issues fell in his priority list. He did point out that he wants to invest in America’s businesses to promote innovation. I’ll have more to say about that later. I have to admit I expected more information about the Administration’s stance on some of these issues.

Now, let’s talk about the issues he did talk about. He pointed out the $2,000 cap that the Inflation Reduction Act (IRA) put on the yearly Medicare Part D out-of-pocket costs for prescription drugs. That was no small accomplishment. This will be a great help to those Medicare beneficiaries who are taking expensive medicines. The ability to spread those costs over the plan year can also ease the impact of drug costs. One benefit of this cap that is not often discussed is the ability for those who have not yet retired to calculate their healthcare needs more accurately when they do retire. The President also recommended that this same cap be applied to commercial insurance. I’m not sure what impact this will have on commercial insurance providers or their patients but I’m always a little wary when the government seeks to expand its control into the competitive commercial marketplace. I think this approach will take a lot of discussion before it is implemented.

From my point of view, the most impactful revelation was the President’s statement that he would like to expand the ability to fix the price of prescription drugs from the initial number of ten a year to a maximum of 50 a year. While this is an astonishing expansion of a yet to be implemented process, it was, unfortunately, not unexpected. I urge you to read my earlier blog, written a year and a half ago, about the oft used tactic the government uses to expand its control of our healthcare. There has been legislation already introduced, that luckily has yet to go forward, that proposed expansion and now the President wants to double down and even raise the number of drugs that would be impacted. To me this is part of a campaign speech rather than a well thought out healthcare initiative. It may sound good on the campaign trail, but this is not a good idea.

It seems to me that the President is being disingenuous in this proposed increase. I have talked often about the negative impact to innovation that the IRA price fixing will have. That impact has already been realized in the alteration of research priorities in some drug companies. The President bragged about America’s response to the COVID pandemic, saying, “the vaccines that saved us from COVID are now being used to beat cancer.” It was the pharmaceutical drug companies that discovered and manufactured the vaccines that saved us from COVID. It is the pharmaceutical drug companies that are using the knowledge gained to discover new medicines for cancer and other diseases. He also bragged about his desire to invest in America’s businesses so they can innovate in computer chip technology and other areas. Why is he so willing to invest our government’s money in these businesses so they can be more successful but at the same time so willing to further restrict innovation that can have a huge impact on the health of our citizens? A measured course to increase competition will not cost one penny of government money. The sad part of this whole approach is that there is no guarantee these savings will ever be realized by Medicare beneficiaries at the pharmacy counter.

I don’t know about you but, I’m already tired of campaign speeches, and I’m tired of legislation via sound bites. I would like serious solutions to serious problems. If you feel that way, tell your lawmaker how you feel. It does make a difference.

Best, Thair   

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