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In a 93-1 vote, the US Senate passes the Food and Drug Administration Improvement Act of 2007 (H.R.2273), which grants the FDA broad new authority to monitor the safety of drugs after they are approved. It was based in part on the recommendations of a 2001 report by the Institute of Medicine (see September 22, 2001). The institute had been asked by the FDA to examine drug safety after it was revealed that the FDA and drugmaker Merck had permitted the drug Vioxx to stay on the market despite numerous indications that it increased patients’ risk of a heart attack. But the bill that is passed is much weaker than the original version, and ignores some of the institute’s most critical recommendations. A USA Today investigation will find that industry-friendly changes made to the bill were instigated by senators “who raised millions of dollars in campaign donations from pharmaceutical interests.” For example, 49 senators successfully defeated an effort that would have allowed US consumers to import lower-cost drugs from Canada and other industrialized countries. The senators who opposed the provision “received about $5 million from industry executives and political action committees since 2001—nearly three quarters of the industry donations to current members of the Senate,” USA Today found. Another factor contributing to the amendment’s failure was that President Bush said he would veto the bill if it permitted the imports. Also excised from the bill was language that would have give the FDA the authority to ban advertising of high-risk drugs for two years. This was one of the Institute of Medicine’s key recommendations. Senator Pat Roberts (R-Kan) argued that the change would restrict free speech. Drug interests have given Roberts $18,000 so far this year, and $66,000 since 2001. Sen. Judd Gregg (R-NH) was responsible for a change that reduced the agency’s power to require post-market safety studies. He insisted on limiting this authority so that the FDA could only target drugs when there’s evidence of harm. Gregg has received $168,500 from drug industry interests since 2001. The bill’s main sponsors—senators Edward Kennedy, (D-Mass) and Mike Enzi (R-Wyo)—agreed to water down a proposal that would have required all clinical drug studies be made public after meeting with industry officials. The senators agreed to change the language so that only studies submitted to the FDA would be available. Enzi and Kennedy have received $174,000 and $78,000, respectively, from drug interests since 2001. Amendments aimed at reducing industry conflicts of interest on FDA expert advisory panels were also stripped from the bill. One of those amendments would have made it more difficult for scientists to advise the FDA on drug approval applications from a company the scientist had received money from. Another would have required that FDA panels consist of no more than one member with financial ties to the drug industry. The Senate also rejected an amendment to establish an independent FDA office to monitor the safety of drugs after they are released on the market. The office that currently has this authority is the same one that approves new drugs, an arrangement that lawmakers and at least one FDA scientist (see November 18, 2004) believe is a conflict of interest. (Zwillich 5/9/2007; US Congress 5/10/2007; Dilanian 5/14/2007)
Top “tea party” and other conservative organizers, taking part in a private conference call, discuss their primary goal for health care reform: blocking any kind of compromise entirely, and ensuring that no health care reform package of any kind is passed. An AFL-CIO organizer manages to get involved in the call, and his notes are provided to, first, the union itself, and then to the Washington Post’s Greg Sargent. The call consists of representatives of powerful lobbying and “grassroots” organizations (see April 14, 2009, April 15, 2009, May 29, 2009, July 27, 2009, August 4, 2009, August 5, 2009, Before August 6, 2009, August 6, 2009, and August 6-7, 2009) such as the American Liberty Alliance, the “Tea Party Patriots,” and RecessRally.com (see August 5, 2009). (Sargent 8/11/2009) The conference call is sponsored by the “Tea Party Patriots,” which labels itself the “official grassroots American movement.” The group is sponsored and organized by, among other organizations, FreedomWorks (see April 14, 2009). When the “Tea Party Patriots” organized a trip to Washington in July, FreedomWorks provided the members with prepared packets of information and briefed them on how a visit to Capitol Hill works. (MSNBC 8/12/2009) Sargent writes: “It’s certain to be seized on by [Democrats] to argue that organized tea party opposition to [President] Obama has no constructive intentions and is fomenting public ‘concern’ about Obama’s plan solely to prevent any reform from ever taking place. GOP officials would argue that they don’t share these goals.” The moderator on the call tells participants that bipartisan compromise on the Senate Finance Committee, where senators are holding talks, must be stopped at all costs. Organizers are told to pressure Republican senators seen as likely to compromise with Senate Democrats, including Chuck Grassley (R-IA), Mike Enzi (R-WY), and Olympia Snowe (R-ME), to stop the negotiating. “The goal is not compromise, and any bill coming out this year would be a failure for us,” the moderator says. He adds that “the Democrats will turn even a weak bill from the Senate Finance Committee into Canadian-style single-payer through underhanded implementation.” Single-payer, or a system of government-only health care, is not in any versions of the legislation in either house of Congress. Another organizer says, “The purpose of tea parties is not to find a solution to the health care crisis—it is to stop what is not the solution: Obamacare.” A spokeswoman for the American Liberty Alliance later acknowledges that comments like the ones noted by the AFL-CIO source were likely made, and that the organization’s specific goal is to prevent the current legislation in Congress from becoming law. No audio of the call exists, she claims. A “tea party” organizer later denies that his organization has any intention of “politically ‘accepting’ or denying legislation.” (Sargent 8/11/2009)
Senator Orrin Hatch (R-UT) says the Senate should not pass a health care reform bill unless it garners “bipartisan” support. Hatch goes on to say that such a bill would not be bipartisan unless it could win “somewhere between 75 and 80 votes.” Two of Hatch’s colleagues, Charles Grassley (R-IA) and Mike Enzi (R-WY), have made similar statements, with Enzi demanding “a bill that 75 or 80 senators can support.” Progressive news and advocacy Web site Think Progress notes that all three senators have made very different claims in the past:
In 2001, all three boasted that then-President Bush’s $1.35 trillion tax-cut bill was “built upon bipartisanship” after it passed the Senate with 58 votes.
In November 2003, after the Senate passed a prescription drug plan for seniors that was heavily favored by pharmaceutical firms, Grassley praised himself as the “lead Senate architect of the bipartisan legislation.” The bill passed with 54 votes.
In 2005, Senate Republicans harshly criticized Senate Democrats for filibustering seven of President Bush’s 205 nominees to the federal judiciary. Hatch and Grassley argued strongly against those nominees needing to be confirmed by a 60-vote “supermajority.” Hatch called the filubuster “unconstitutional,” and Grassley described judicial filibusters as “an abuse of our function under the Constitution.” (van Susteren 8/20/2009; Millhiser 8/20/2009)
Senator Max Baucus (D-MT), the chairman of the Senate Finance Committee and a key player in the Democrats’ health care reform process, defends his insistence on a bipartisan process that will produce reform supported by both Democrats and Republicans. Yet Baucus admits that Senate Republicans are almost uniformly committed to killing reform outright. Baucus is a member of the Finance Committee’s “Gang of Six,” a group of three conservative Democrats and three Republicans who are working to craft a reform proposal. “I just think if it is bipartisan, it’s more sustainable, it’s more durable, long-lasting,” Baucus says. “There will be more buy-in around the country. We’re going to make some mistakes. If it’s bipartisan, it will be easier to fix the mistakes, work together to fix the mistakes. It’s just better for the country.” However, he says: “The Republican leadership in the Senate and in the House is doing its utmost to kill this bill. They are putting intense political pressure on Chuck Grassley, Olympia Snowe, and Mike Enzi [the three Republican members of the “Gang of Six”], to bow out, because they want to kill it. So I’ve got a challenge ahead of me to work out all this on policy as we go through these meetings. The other thing is the politics of it: ‘People, this is the right thing to do for America. I know you’re under intense political pressure, but do the right thing. I know it’s easy for me to say right now, because I’m getting beat up by both sides, but not nearly as much as you are by the Republican hierarchy.’” Baucus says it is important to craft a bill that can garner the 60 votes needed to defeat a filibuster, which the Republicans will almost certainly invoke to try to delay or kill any reform bill. He does not support the reconciliation process that would allow the bill to pass with a 51-vote majority. (Jilani 8/21/2009; Harrington 8/21/2009)
Opponents of health care reform lead the debate during a speech and followup session by Senator Mike Enzi (R-WY), one of the so-called “Gang of Six” who are helping to write the Senate Finance Committee’s health care reform proposal. Around 500 people attend the event, held in a high school gym in Gillette, Wyoming. Enzi lambasts Senate Democrats and the White House for not engaging in what he calls “bipartisan collaboration” on reform, and calls for “market-based” health care solutions. Enzi says he has no use for a so-called “public option,” which would mandate a government-run alternative to private health care. “A government option is a monopoly, and it’s no option,” Enzi says, earning a strong round of applause. State Representative Timothy Hallinan, a Gillette Republican, earns more applause when he urges Enzi to pull out of negotiations with Senate Democrats and oppose any reform bill. When urged to do so by an audience member who identifies himself as a Republican, Enzi claims: “If I hadn’t been involved in this process as long as I have and to the depth as I have, you would already have national health care.… Someone has to be at the table asking questions. If you’re not at the table, you’re on the menu.… It’s not where I get them to compromise, it’s what I get them to leave out.” Some pro-reform members of the audience note the large amounts of campaign contributions Enzi has taken, and argue for the public option. Enzi retorts by claiming two government-run medical programs, Medicare and Medicaid, are “going broke,” and a public option program would suffer the same fate. (Associated Press 8/25/2009)
Max Baucus (D-MT), the chairman of the Senate Finance Committee, releases his committee’s final version of health care reform, a version known as the “chairman’s mark.” None of the Republicans on the committee support the bill (known as the “America’s Healthy Future Act,” or AHFA), and some Democrats, including John D. Rockefeller (D-WV), have serious questions about it as well. Baucus says: “The $856 billion dollar package will not add to the federal deficit. The Finance Committee will meet to begin voting on the chairman’s mark next week.” An analysis by the Congressional Budget Office (CBO) shows that the bill will actually “result in a net reduction in federal budget deficits of $49 billion over the 2010-2019 period.” Senators Charles Grassley (R-IA) and Mike Enzi (D-WY) have said that they want a much smaller bill that imposes no fees on health insurance companies, prevents legal immigrants from gaining coverage for five years, and bans any federal coverage for abortions. The Baucus bill does not allow for federal monies to be used for abortions, as Republicans have insisted upon, with the exception of situations involving rape or incest. Illegal immigrants are not provided coverage through the bill; legal immigrants cannot get government subsidies and must wait five years before qualifying for Medicaid. Immigrants’ citizenship status will be verified, as Republicans have requested. Another Republican provision, “tort reform” (efforts to reduce legal claims against doctors and HMOs), is part of the bill. There is no “public option” for government-financed health care for uninsured citizens, as Republicans and conservative Democrats have demanded. The bill allows for the purchasing of insurance across state lines, for “high-deductible” policies, and for so-called “high-risk pools,” three provisions Republicans have demanded. And, beginning in 2014, federal monies will be made available “to all states to defray the costs of covering newly-eligible beneficiaries.” (111th Congress, 1st Session 9/16/2009; Volsky 9/16/2009; Volsky 9/17/2009) Even after seeing a bill with so many inclusions they have asked for, Senate Republicans continue to insist that there is nothing in the bill they can support. (Volsky 9/17/2009)
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