While top members of the House and Senate are struggling to put together health care overhaul bills on Capitol Hill, elsewhere in Washington, patient advocates and other groups are trying to take apart some of the deals already cut with top health care industry groups.
Earlier this spring, President Obama and Senate Finance Committee Chairman Max Baucus announced a series of deals with many of Washington's top health care players — including groups representing doctors, drug makers, hospitals and health insurers.
In exchange for those groups agreeing to voluntarily trim spending over the next decade, Congress wouldn't make deeper cuts as part of the health care overhaul process.
Plus, the health care groups wouldn't launch multimillion-dollar lobbying and advertising campaigns against the bills. On that score, the deals have pretty much succeeded. But now patient advocates and others say lawmakers have given away too much to health care special interests.
"Our coalition has not embraced one bill at this time, and that's because of cost containment," or, more specifically, the lack thereof, said Ralph Neas, CEO of the National Coalition on Health Care.
Neas, whose group is nonprofit and nonpartisan (its honorary co-chairmen include former Presidents Jimmy Carter and George H.W. Bush) is more than a bit skeptical of the promises made by the health industry groups to cut $2 trillion over the next 10 years. "We said that's a magnificent commitment. But I come from a civil rights background. Voluntary efforts don't work. There's got to be some enforceability," Neas said.
As an example, he points to the $80 billion pledged by the brand-name pharmaceutical industry, which stands to make a lot more money from a lot more newly insured patients if a major overhaul becomes law. Said Neas, "If they're going to get these hundreds of billions of dollars, trillions of dollars over the next 10 or 20 years, they should be paying more than $80 billion."
Many patient and consumer groups are particularly unhappy about provisions now included in both House and Senate health bills that would give brand-name makers of expensive biotech drugs 12 additional years on the market before cheaper generic copies could be made and sold.
Former GOP Congressman Bill Thomas is among them. "It is outrageous to provide them 12 years — just outrageous," said Thomas, now a senior adviser to a Washington law firm and a part-time scholar at the American Enterprise Institute.
That's not what the drug industry says, of course. "Critics ignore the tremendous costs and challenges involved in researching and developing such complex and cutting-edge medicines," said Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, the brand name drug industry group.
"Development costs for innovative biologics can exceed $1.2 billion, plus another $450 million to build specialized manufacturing facilities," Johnson said.
Meanwhile, patients who need expensive biotech drugs are caught in the middle.
Anne Collins of Arlington, Va., has psoriatic arthritis, a complication of psoriasis. She claims Simponi, the new biologic drug she takes, is nothing short of a miracle. "I probably wouldn't be here today, because I probably wouldn't be able to walk, if I didn't take this drug," she said at a recent news conference.
But it costs $2,000 to fill each monthly prescription for her medicine. And while her insurance pays most of the cost for now, "I blew through all of my benefits last year, and I will do so again," because the policy that covers her only provides $40,000 annually for prescription drugs.
Yet it will be years, if ever, before there's a less expensive generic version of the medication.
Thomas said since both the House and Senate bills now have 12-year patent extensions for the biotech drugs, there's only one way to force the drug makers to bargain: Put other things in the health bills they like even less.
"You've got to move amendments that put them at risk so when you close the door and you want to talk about the 12 years, they don't thumb their nose at you, they actually see what their risk is," he added.
One possibility is language allowing people to import lower-cost drugs from other countries — an issue drug makers despise. And there's no shortage of members who'd like to offer that amendment when the health care overhaul bills reach the House and Senate floors.