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Those aren't quite the same. Medicare part D plans are actually private insurance plans whose costs are subsidized by the government. It's not the same as the g

by entee 10y ago

Those aren't quite the same. Medicare part D plans are actually private insurance plans whose costs are subsidized by the government. It's not the same as the government itself negotiating for drugs, which is essentially what the NHS in England and many other systems in the developed world do.

maxerickson 10y ago
Right. Part D is what people are talking about when they talk about Medicare not being able to negotiate prices. edit: That's one of the advantages of the privatized system, companies take the heat for having a formulary.
- entee 10y ago
  Yes and no, a detailed article covering the terms of the debate is here: http://healthaffairs.org/blog/2016/09/19/the-politics-of-medicare-and-drug-price-negotiation/ http://healthaffairs.org/blog/2016/09/19/the-politics-of-med... Most relevant quote: "One bargaining chip to attract market-oriented Republican votes was the so-called “noninterference clause”—a provision drug manufacturers had a major role in writing and getting through Congress—which banned negotiations between Medicare and pharmaceutical companies on drug prices and prevented the government from developing its own formulary or pricing structure. Instead of CMS negotiating on Part D plans’ behalf, prescription drug plans compete for enrollees and negotiate directly with manufacturers." Part D (and presumably Part C plans that offer prescription coverage) negotiate with the drug companies individually. CMS cannot negotiate en-bloc for all the Part D plans. Therefore Part D plans have the same leverage as traditional insurers, which is to say some, but not nearly as much as All-Of-Medicare has. The VA and Medicaid do regulate/negotiate drug prices, but those are much smaller populations. I think something like the VA system might work, but you'd have to have politicians willing to take some political risk or find a way of isolating drug price negotiations from political pressure. I think in this political climate, that's a really tall order. Remember when "If you want to talk to your doc about end of life plans we'll reimburse you for the visit" turned into Death Panels? I suspect we'd see something similar... EDIT: and yes, private companies with a formulary are a great way to isolate yourself from the political heat, but you then lose the negotiating power government has ;)

by entee 10y ago

maxerickson 10y ago

Right. Part D is what people are talking about when they talk about Medicare not being able to negotiate prices. edit: That's one of the advantages of the privatized system, companies take the heat for having a formulary.

entee 10y ago
Yes and no, a detailed article covering the terms of the debate is here: http://healthaffairs.org/blog/2016/09/19/the-politics-of-medicare-and-drug-price-negotiation/ http://healthaffairs.org/blog/2016/09/19/the-politics-of-med... Most relevant quote: "One bargaining chip to attract market-oriented Republican votes was the so-called “noninterference clause”—a provision drug manufacturers had a major role in writing and getting through Congress—which banned negotiations between Medicare and pharmaceutical companies on drug prices and prevented the government from developing its own formulary or pricing structure. Instead of CMS negotiating on Part D plans’ behalf, prescription drug plans compete for enrollees and negotiate directly with manufacturers." Part D (and presumably Part C plans that offer prescription coverage) negotiate with the drug companies individually. CMS cannot negotiate en-bloc for all the Part D plans. Therefore Part D plans have the same leverage as traditional insurers, which is to say some, but not nearly as much as All-Of-Medicare has. The VA and Medicaid do regulate/negotiate drug prices, but those are much smaller populations. I think something like the VA system might work, but you'd have to have politicians willing to take some political risk or find a way of isolating drug price negotiations from political pressure. I think in this political climate, that's a really tall order. Remember when "If you want to talk to your doc about end of life plans we'll reimburse you for the visit" turned into Death Panels? I suspect we'd see something similar... EDIT: and yes, private companies with a formulary are a great way to isolate yourself from the political heat, but you then lose the negotiating power government has ;)