Healthcare Monday

Finally, campaigners get specific on Medicare reform: Most Republicans this campaign season have declined to offer specific solutions to the budget troubles facing the nation's entitlement programs, particularly Medicare and Medicaid. (See, for instance, the GOP's "Pledge to America"). But no one sent Rand Paul the memo. 

The Republican hopeful to replace retiring Sen. Jim Bunning in Kentucky said this weekend that he would scale back Medicare and Social Security benefits for younger Americans. 

"You don't do anything to people who are currently receiving Medicare or Social Security," Paul told Fox News Sunday. "[But] for the younger generation, there will be — have to [be] — changes in eligibility."

The discussion shouldn't be limited to eligibility, Paul said, but should also focus on pushing higher deductibles and premiums for Medicare beneficiaries. 

"All younger people — if they're honest and will admit to it and have an adult discussion and not demagogue the issue — will admit that younger people will have to have different rules," he said.

Meanwhile, Paul's opponent, Kentucky Attorney General Jack Conway, isn't shying away from the issue either: Conway told Fox News that the Democrats should never have made that deal with the pharmaceutical lobby to prohibit the government from negotiating drug prices on behalf of the nation's lowest income seniors.

"We need Medicare bulk purchasing," Conway said. "It was wrong during this health care debate to take Pharma out of it. We ought to let Medicare negotiate for lower prices the way we let Medicaid and the [Veterans Affairs Department] do that. That would save about $200 billion."

Here's what he's talking about: Prior to 2003 enactment of the Medicare prescription drug benefit, so-called dual eligibles — the roughly 9 million Americans who qualify for both Medicare and Medicaid — got their drugs through Medicaid, which is allowed to negotiate drug prices with pharmaceutical companies.  With passage of Part D, however, drug purchasing for duals shifted to Medicare, which is explicitly prohibited from negotiating prices with those companies. As a result, the government currently pays about 30 percent more for dual eligibles’ drugs under Medicare than it would under Medicaid, according to a 2008 study from the House Oversight and Government Reform Committee. 

To get the drug lobby behind the health reform law, Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, cut an early deal with the Pharmaceutical Research and Manufacturers of America (PhRMA), vowing not to switch those drug purchases back into the hands of Medicaid negotiators. http://bit.ly/aUdMB

But many Democrats are vowing not to give up that fight — and now you can add Conway to the list. http://bit.ly/5MtjMg

"That needs to be implemented," he said.

Insurance companies pumping money into GOP: The health insurance lobby is pouring money into Republican campaign coffers in hopes of scaling back the new consumer protections contained in the health reform law, the Chicago Tribune reports.

"Since January, the nation's five largest insurers and the industry's Washington-based lobbying arm have given three times more money to Republican lawmakers and political action committees than to Democrats," the Tribune writes. "That is a marked change from 2009, when the industry largely split its political donations between the two parties, according to federal election filings." http://bit.ly/ckTcLo

Orszag calls on docs to change their ways: Peter Orszag, former White House budget director and head of the Congressional Budget Office, is urging the nation's doctors to make some routine changes. 

"Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones," Orszag writes in a New York Times op-ed. 

He's highlighting a program at New York University's Langone Medical Center that's providing certain patient services — like MRIs and elective cardiac surgery — seven days a week, while also keeping detailed outcomes data. 

"If it succeeds, it will help point the way to the health care system of the future," Orszag says. http://nyti.ms/bVJlfb 

Republicans still eying "repeal and replace" strategy: GOP leaders concede that they most likely won't be able to repeal the new health reform law in the near term, so instead they're eying a more far-reaching strategy that hinges around their taking over the House, The Washington Post reports. 

"Republicans hope to hold oversight hearings aimed at laying the groundwork for a broad-based public repudiation of the law," the Post writes. "That could give them the political momentum to overturn it if they can retake the presidency in 2012." 

"If we can do it in one fell swoop, great. But if it needs to be a multi-step process, that's how we'll do it," Rep. Dave Camp (Mich.), senior Republican on the House Ways and Means Committee, told the Post. http://wapo.st/bxWSm6

Who's funding that group anyway?: That's the question The New York Times' Mike McIntire is asking about the "Coalition to Protect Seniors," which has spent hundreds of thousands of dollars this year supporting anti-health reform candidates and slamming the new law for cutting Medicare Advantage (MA) subsidies. 

"Who are the members of the coalition? Where do they get their money? And why are they spending hundreds of thousands of dollars attacking candidates for Congress around the country?" McIntire asks. "Obvious questions, and yet they are difficult to answer, given the increased use of tax-exempt organizations as vehicles for campaign spending.

"Nonprofits can raise unlimited amounts, and spend a good percentage of that on political activities. But they are generally not required to publicly disclose their donors, making them appealing to moneyed interests who prefer to stay in the shadows."

After some digging, McIntire never locates the funders. The group, he concludes, "is about as transparent as a dirty diaper." http://nyti.ms/a7fHpe