“Until 2003, Medicare covered most hospital and doctor visits for the elderly, but it did not cover the ever-growing costs of prescription medications. Former President George W. Bush changed that when he signed a law adding prescription drug coverage to Medicare.
But there was a catch.
At drug companies’ behest, the Republican-controlled Congress banned Medicare from using its market power to drive down drug prices. The prohibition was controversial at the time — Nancy Pelosi, then the House Minority Leader, called it “unconscionable.” Critics saw the prohibition as the government’s abandonment of the single most effective tool for restraining drug costs.
In the years since, the prices for brand-name prescription drugs have skyrocketed, and the prohibition on negotiation has become even more controversial. Higher prices mean larger co-payments for drugs for some seniors, many of whom live on fixed incomes. It’s also a major budgetary problem: From 2018 to 2021, Medicare spending on the 10 top-selling drugs jumped from $22 billion to $48 billion, far outpacing the program’s overall cost growth over the same period.
That’s why, in last year’s Inflation Reduction Act, President Joe Biden and congressional Democrats partly undid the prohibition. Under the law, Medicare will pay a much-reduced price for drugs that consume a disproportionate share of Medicare spending, ultimately saving an estimated $100 billion over the next ten years.”
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“Although the Inflation Reduction Act marks the most substantial change in how we pay for drugs in two decades, it doesn’t change the fact that drug companies will still be rewarded for bringing a drug to market and selling as much of it as they can — whether or not the drug works very well.
Medicare could pave the way toward smarter drug development by paying more for more effective drugs and less for drugs that are less effective. That would send the right signals about where drug companies should target their research investments. The Inflation Reduction Act isn’t that law. We’ll spend less on prescription drugs because of it, and that’s all to the good, but we won’t be spending any smarter.”
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“Some drugs are (literally) worth their weight in gold. Think of Sovaldi and Harvoni, which were approved a decade ago and can cure Hepatitis C, a deadly viral disease that once afflicted between 3 and 5 million Americans. Paying a lot for cures encourages drug companies to invest in developing drugs with curative potential.
But most drugs aren’t cures. Drug companies generally earn more, in fact, on drugs that patients take over an extended period. That helps explain why fully one quarter of all drug approvals are for cancer drugs. They’re really profitable, even though they often don’t work very well.”
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“How we pay for drugs, in short, sends the wrong signals to the market about the kind of innovation we value. The good news is we can fix that. As law professor Rachel Sachs has argued, Medicare and Medicaid (and to some extent private insurers as well) are required by law to cover all FDA-approved drugs, whatever their value to human health. That linkage can be severed. We could give CMS the authority not only to drive down the prices of the most expensive drugs, as the IRA does, but also give it the power to pay less for, or even exclude coverage for, drugs of marginal efficacy.
Connecting payment to value would be complicated, and there’s no perfect way to do it. It would also be controversial: Paying less for some novel therapies would likely restrict access to therapies that some patients desperately want. But we’d send much smarter signals to drug manufacturers about where to target their investment dollars. And the benefits of better-targeted innovation would accumulate over time, vastly improving human health in the long run.
The IRA was meant to save the taxpayers’ money, not to improve their health. That was worth doing. But the next reform to payment policy ought to aim higher.”
“People with ties to China’s law enforcement agencies conducted the largest known covert digital influence operation aimed at discrediting the West and promoting Beijing’s agenda across more than 50 social media and online platforms, according to a report published Tuesday by Meta.
On Facebook, clandestine users with ties to the authoritarian government racked up more than 550,000 followers by spouting lies about the United States’ alleged role in creating the COVID-19 pandemic and criticizing Washington’s support of Taiwan.”
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“The campaign, which lasted over a year, garnered few, if any, eyeballs from real social media users, based on Meta’s analysis. But the breadth of the international influence campaign by those associated with the Chinese government highlights how Beijing is vying for prominence alongside Moscow as the most active spreader of disinformation ahead of major elections in the European Union, U.S. and the United Kingdom next year.”
“When National Security Adviser Jake Sullivan relayed the news to Biden that former Afghan President Ashraf Ghani fled the country, he writes, Biden exploded in frustration and said, “Give me a break.”
In the excerpt, Foer depicts a scene that went viral of the withdrawal: when dozens of Afghans climbed onto the side of a jet to escape the country.
“Only after the plane had lifted into the air did the crew discover its place in history,” Foer writes. “When the pilot couldn’t fully retract the landing gear, a member of the crew went to investigate, staring out of a small porthole. Through the window, it was possible to see scattered human remains.””
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“When former ambassador to Afghanistan John Bass touched down in Afghanistan after the plane’s departure to lead the evacuation effort, he toured the gates of the airport where he was greeted “by the smell of feces and urine, by the sound of gunshots and bullhorns blaring instructions in Dari and Pashto.”
“Dust assaulted his eyes and nose. He felt the heat that emanated from human bodies crowded into narrow spaces,” Foer writes.
Biden would shower Bass with ideas to evacuate more people.
“The president’s instinct was to throw himself into the intricacies of troubleshooting,” Foer writes. “‘Why don’t we have them meet in parking lots? Can’t we leave the airport and pick them up?’ Bass would kick around Biden’s proposed solutions with colleagues to determine their plausibility, which was usually low. Still, he appreciated Biden applying pressure, making sure that he didn’t overlook the obvious.”
“In total, the United States had evacuated about 124,000 people, which the White House touted as the most successful airlift in history,” Foer writes. “Bass also thought about the unknown number of Afghans he had failed to get out.””
“President Joe Biden’s pick to run the National Institutes of Health has agreed to a pair of major ethics demands made by Sen. Elizabeth Warren to help jumpstart her stalled candidacy for the top medical research job.
Monica Bertagnolli, who was nominated more than three months ago, pledged to not seek employment or compensation from any of the world’s largest pharmaceutical companies for four years after she leaves government”
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“Warren has made it a practice to push Biden nominees to adopt stronger ethical standards, in a bid to address the “revolving door” between government agencies and the industries that they supervise.
Last year, she secured similar commitments from Food and Drug Administration Commissioner Robert Califf not to seek employment or compensation from pharmaceutical or medical device companies he interacts with at the agency for four years after leaving government.
Warren, who sits on the Senate Banking Committee and Armed Services Committee, has also sought to extract ethics concessions from nominees that come up in front of those panels — including top Federal Reserve officials and Secretary of Defense Lloyd Austin.
“Going above and beyond what federal law requires, as you are doing here, sends a powerful message that you are working on behalf of the American people and no one else,” she told Austin in 2021, after he committed not to become a defense contractor or lobbyist following his stint in the administration.”
“U.S. District Court Judge Tanya Chutkan has scheduled former President Donald Trump’s federal criminal trial for his deliberate and systematic attempts to overturn the will of American voters for March 4. And if current rules remain, the American people will never see it. Instead, many will hear about it second-hand through siloed media ecosystems and from sources whose fidelity to the facts are tenuous at best.
Now is the time for this to change.”
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” If ever there was a moment in American history that should prompt the federal courts to change their outdated policy, surely the prosecution of a former president for attempting to overturn the will of the voters would be it. The time has come for the federal court system to catch-up with the times — many state courts already broadcast live trial proceedings.”
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“I suspect my former colleagues at the Justice Department are hesitant to depart from existing norms that date back to 1946 because they have been largely effective in keeping decorum in federal court rooms and protecting witnesses, jurors and judges.
But these are extraordinary times, and extraordinary times demand extraordinary transparency. At the least, the Justice Department should inform the Judicial Conference that it does not oppose efforts to broadcast Trump’s trials live.
The bright light of transparency into both of Trump’s federal cases would communicate an unfiltered and unbiased accounting of trial events, and the strong evidence the government has alleged in its indictments. Equally important, it would show Americans and the world what it means to pursue justice without regard to partisan politics.”
“The North Carolina legislature has overridden the veto of Democratic Gov. Roy Cooper and passed multiple laws specifically targeting trans youth on issues including gender-affirming care, sports, and education. It’s the latest of several states with GOP-led legislatures to approve such bills, and it highlights how Republicans are continuing to make these policies central to their platform ahead of 2024.”
“President Joe Biden’s disaster declaration came within hours of the wildfires that tore through Lāhainā, Maui, last week, where the death toll is at least 111 and a thousand people may still be missing. The disaster declaration helped unlock federal aid for Maui, adding to Hawaii’s emergency stores another 50,000 meals, 10,000 blankets, and $700 cash for survivors in the immediate aftermath.
But questions around the response at every level of government continue to mount. Many of the disaster’s survivors have said the assistance was slow to arrive, wondering days later why distribution centers were so disorderly, and missing persons numbers still so high.”
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“At the same time, some decisions made locally also contributed to the chaos. “As reports have come out, the alarm systems weren’t initiated the way that community members would expect,” Ing added. “Even the evacuation process seemed unclear. Some community members were feeling that there was more deference and priority given to the hotels.””
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“If you think about disaster response, that’s like a body responding to an injury. You’ve got arteries and capillaries, and those are not the same thing; they serve very different purposes. So I think when people critique FEMA and the federal government, it’s sort of misplaced because you can’t assume that a national, huge apparatus is going to know who the right people are on the ground to reach into the community.
What we need to do is make sure those local capillaries are very strong and as well-circulating as possible. The artery function that FEMA is meant to do are the big volumes of aid coming in. If you don’t have FEMA working with those local capillaries and supplying aid in the right spaces, then you get delay and confusion. That has to be organized at the local level so that when they show up, they’re immediately directed by the state and local level to the most effective channels.”