Health Care on the Hill — Democrats Set the Agenda (NewEngJourMed)

http://content.nejm.org/cgi/content/full/356/1/1?query=TOC

Volume 356:1-4 January 4, 2007 Number 1

Health Care on the Hill — Democrats Set the Agenda
John K. Iglehart

Democratic legislators, energized by their new (if slim) majorities in the 110th Congress, now face the daunting challenge of enacting an ambitious policy agenda while fulfilling their pledge to restore "pay-as-you-go" rules to new legislation. Since 2002, when the Republican-controlled Congress let these rules expire, GOP-approved measures have been fueling large annual budget deficits — the three largest in U.S. history in 2003 ($378 billion), 2004 ($413 billion), and 2005 ($318 billion). Restoration of the rules, which House Speaker Nancy Pelosi (D-CA) said she planned to accomplish in the first 100 hours of the new session, will mean that any legislation that increases federal spending or reduces taxes must be offset by equivalent revenue.

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Democrats aim to pursue a legislative agenda that reflects the interests of middle-class and working-class Americans. Although health care issues are an important component, many other matters deemed more pressing will largely consume Congress in 2007. Nevertheless, Democratic leaders included two health issues in their "Six for '06" agenda, which they planned to address quickly in the new Congress: empowering Medicare to negotiate prices of prescription drugs directly with manufacturers rather than through private health plans and expanding federal support for embryonic stem-cell research. Authorizing greater federal support for such research will remain difficult, since its advocates may be unable to muster enough votes to override another presidential veto. The other four Democratic priorities are increasing the minimum wage; overhauling U.S. policy in the war against terrorism, including a phased withdrawal from Iraq; making college tuition tax deductible; and eliminating tax policies that benefit large oil companies and encourage the shifting of jobs overseas.

The call for the direct negotiation of drug prices served Democrats well as a proposal appealing to elderly voters, but fashioning it into Medicare policy will be difficult, for various reasons. Several recent surveys (conducted by J.D. Power and Associates and the Henry J. Kaiser Family Foundation) have found the drug benefit to be very popular among seniors, although another recent Kaiser survey reported that 85% of beneficiaries favored direct government negotiations to establish drug prices.1 The program cost about $30 billion in 2006, as compared with a projected $43 billion, which will reduce the willingness of some legislators to reopen the law. In addition, the administration strongly opposes direct negotiations, suggesting that President Bush may veto any such legislation. The idea, Health and Human Services Secretary Michael O. Leavitt said in November, "really isn't about the government negotiating drug prices. It's a surrogate for a much larger issue, which is really government-run health care."2 The legislators who chair committees with jurisdiction over Medicare, particularly Senator Max Baucus (D-MT) and Representative Charles Rangel (D-NY), are also cool to the idea, largely because they have higher priorities over which they would prefer to do battle with the administration. In short, Democrats may have enough votes to remove the "no negotiation" clause from the law, but they have little leverage to compel the administration to deal directly with drug manufacturers on prices.

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Congress in committee is Congress at work, so the priorities of legislators who chair the relevant panels will largely form the new health agenda. One tool that Republicans used sparingly was Congress's authority to investigate the policies and performance of executive-branch agencies. Democrats will certainly increase oversight of executive agencies, including the Food and Drug Administration (FDA), which has lacked a permanent commissioner for most of George W. Bush's presidency and has been embroiled in controversy over its delay of over-the-counter status for emergency contraceptives and its handling of drug-safety issues. In a last-minute surprise on December 7, the Senate voted 80 to 11 to confirm Andrew C. von Eschenbach as FDA commissioner, after his nomination had been placed on hold for months by senators protesting various aspects of the agency's performance. Von Eschenbach will be spending many hours in front of at least three congressional committees, chaired by Senator Edward M. Kennedy (D-MA) and Representatives John Dingell (D-MI) and Henry A. Waxman (D-CA), who plan to convene hearings on the FDA, addressing such matters as drug and food safety and the politicization of science. Kennedy, the new chair of the Senate Health, Education, Labor and Pensions Committee, and his predecessor, Senator Michael B. Enzi (R-WY), are cosponsors of a drug-safety bill that Waxman has characterized as "a good starting point" for deliberations in the new session.

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Source Information

Mr. Iglehart is a national correspondent for the Journal.

An interview with Representative Jim Cooper (D-TN) can be heard at www.nejm.org.


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